The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Kenneth H Mayer - One of the best experts on this subject based on the ideXlab platform.
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Antiretrovirals for Primary HIV Prevention: the Current Status of Pre- and Post-Exposure Prophylaxis
Current HIV AIDS Reports, 2015Co-Authors: Douglas S. Krakower, Sachin Jain, Kenneth H MayerAbstract:In light of the 2 million HIV infections that occur globally each year, there is a need to optimize strategies that integrate biomedical and behavioral approaches to HIV prevention. Post-Exposure Prophylaxis (PEP) immediately after acute high-risk Exposures and pre-Exposure Prophylaxis (PrEP) for those who engage in recurrent high-risk behaviors are promising bio-behavioral approaches to decreasing HIV transmission. Guidelines have recommended PEP for occupational and non-occupational Exposures for over 15 years, but uptake of PEP has been limited, partly as a result of insufficient awareness of this intervention among persons at highest risk for acquiring HIV. However, since the publication of large randomized clinical trials demonstrating the efficacy of PrEP, and the dissemination of guidelines endorsing its use, there is a renewed focus on bio-behavioral prevention. Numerous studies have recently assessed the acceptability of bio-behavioral prevention programs among diverse populations or described experiences implementing these programs in “real-world” settings. As research and clinical data informing optimal utilization of PEP and PrEP are rapidly accumulating, this review provides a timely summary of recent progress in bio-behavioral prevention. By contextualizing the most noteworthy recent findings regarding PEP and PrEP, this review seeks to inform the successful implementation of these promising prevention approaches.
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subsequent hiv infection among men who have sex with men who used non occupational Post Exposure Prophylaxis at a boston community health center 1997 2013
Aids Patient Care and Stds, 2015Co-Authors: Sachin Jain, Catherine E Oldenburg, Matthew J Mimiaga, Kenneth H MayerAbstract:Abstract Non-occupational Post-Exposure Prophylaxis (NPEP) has been recommended to prevent HIV acquisition for nearly 20 years. However, limited behavioral and clinical outcome data exist after men who have sex with men (MSM) present for NPEP. We reviewed the electronic medical records of HIV-uninfected adults who presented for NPEP at a large community health center in Boston between July, 1997 and August, 2013. Data from 894 patients were analyzed, 88.1% of whom were MSM. Consensual unprotected sex was the most common reason for NPEP visits among MSM (64.2%), followed by condom failure (30.6%). The HIV serostatus of the partner was unknown for 64.4% of the MSM, positive with unknown treatment status for 18.1%, positive and not on treatment for 4.1%, and positive and on treatment for 13.4%. Thirty-nine patients subsequently became HIV-infected (4.4%), all of whom were MSM. The MSM-specific HIV incidence after NPEP use was 2.2 cases per 100 person-years. Incident HIV infection was associated with younger ...
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Post Exposure Prophylaxis use and recurrent Exposure to hiv among men who have sex with men who use crystal methamphetamine
Drug and Alcohol Dependence, 2015Co-Authors: Catherine E Oldenburg, Sachin Jain, Kenneth H Mayer, Matthew J MimiagaAbstract:Background Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-Exposure Prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk Exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users.
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adherence to Post Exposure Prophylaxis for non forcible sexual Exposure to hiv a systematic review and meta analysis
Aids and Behavior, 2014Co-Authors: Catherine E Oldenburg, Kenneth H Mayer, Matthew J Mimiaga, Till Barnighausen, Guy HarlingAbstract:To characterize adherence to Post-Exposure Prophylaxis after non-forcible sexual Exposure to HIV, we conducted a review of the literature and meta-analysis. Articles were considered if they contained primary adherence data following non-forcible sexual Exposure. Random-effects meta-analysis was used to create pooled point estimates for adherence. Of 1,257 abstracts identified through our search algorithm, 17 were eligible for inclusion in this review, representing 3,634 patients enrolled in 3 randomized controlled trials (RCTs), 9 prospective and 5 retrospective observational studies. Pooled adherence, primarily assessed by self-report, was 77 % [95 % confidence interval (CI) 68–87] in prospective observational studies, 81 % (95 % CI 65–96) in retrospective studies, 78 % (95 % CI 65–91) in RCTs, and 78 % (95 % CI 72–85) overall. Overall adherence was moderately high, with high variability between studies. Assessment of adherence could be enhanced by the use of objective measurements.
Charles E. Rupprecht - One of the best experts on this subject based on the ideXlab platform.
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SYN023, a novel humanized monoclonal antibody cocktail, for Post-Exposure Prophylaxis of rabies.
Public Library of Science (PLoS), 2017Co-Authors: Tzu-yuan Chao, Charles E. Rupprecht, Shiqi Ren, Enyun Shen, Susan Moore, Shou-feng Zhang, Li Chen, Eric TsaoAbstract:Rabies is a neglected zoonotic disease that is preventable in humans by appropriate Post-Exposure Prophylaxis (PEP). However, current PEP relies on polyclonal immune globulin products purified from pooled human (HRIG) or equine (ERIG) plasma that are either in chronic shortage or in association with safety concerns. Here, we present the development of an antibody cocktail, SYN023, made of two novel monoclonal antibodies (MAb) CTB011 and CTB012 that could serve as safer and more cost-effective alternatives to the current RIG products. Both CTB011 and CTB012 are humanized MAbs that bind to non-overlapping epitopes on the rabies virus (RABV) glycoprotein (G) with sub-nanomolar affinities. Sequence analysis revealed that many of the critical residues in binding are highly conserved across different species of lyssaviruses. When combined at a 1:1 ratio, CTB011/CTB012 exhibited neutralization capabilities equivalent or superior to HRIG against 10 North American street RABV isolates in vitro and 15 prevalent Chinese RABV strains in animal models. Finally, SYN023, at a dosage of 0.03 mg/kg, was able to offer the same degree of protection as standard HRIG administration (20 IU/kg) in Syrian hamsters challenged with a highly virulent bat (Tadarida brasiliensis) RABV variant. Taken together, the high-potency and broad-spectrum neutralization demonstrated by SYN023 make it an effective candidate for human rabies PEP consideration
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evidence for a 4 dose vaccine schedule for human rabies Post Exposure Prophylaxis in previously non vaccinated individuals
Vaccine, 2009Co-Authors: Charles E. Rupprecht, Deborah J Briggs, Martin I. Meltzer, Catherine M Brown, Richard Franka, Samuel L Katz, Harry D Kerr, Susan M Lett, Robin Levis, William SchaffnerAbstract:After Exposure, human rabies is preventable by prompt application of Post-Exposure Prophylaxis. Historically, the total number of rabies vaccine doses administered during human Prophylaxis has decreased, as modern biologics have improved and scientific knowledge has grown. A review of the literature on rabies virus pathogenesis, experimental animal studies, clinical trials, epidemiological surveillance, and economic analyses was conducted to determine the potential utility of reducing the current 5-dose intramuscular series of human rabies vaccine administered in the United States. Based upon the available evidence, a reduced schedule of cell-culture rabies vaccine, administered on days 0, 3, 7, and 14, given in conjunction with rabies immune globulin, was supported and recommended by the United States Advisory Committee on Immunization Practices.
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epidemiology of rabies Post Exposure Prophylaxis united states of america 2006 2008
Vaccine, 2009Co-Authors: Kira A Christian, Jesse D Blanton, Michael Auslander, Charles E. RupprechtAbstract:Abstract Background The United States of America (USA) does not have a national reporting system for rabies Post-Exposure Prophylaxis (PEP). We describe the epidemiology of PEP in the USA so recommendations can be made during a PEP shortage. Methods A two-part questionnaire designed to evaluate PEP distribution practices and estimate PEP use was administered to state health department representatives. Results Seventy-five percent of participants responded that no public health guidance was needed to make a recommendation for PEP. The annual national average PEP use is 23,415 courses of PEP (range: 10,645–35,845). Conclusion PEP is loosely monitored and a precise estimate of PEP use is unknown. Improved national surveillance for PEP is needed.
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experimental utility of rabies virus neutralizing human monoclonal antibodies in Post Exposure Prophylaxis
Vaccine, 2001Co-Authors: Cathleen A. Hanlon, C A Demattos, D C Hooper, Abner Louis Notkins, Hilary Koprowski, Michael Niezgoda, Charles E. RupprechtAbstract:Rabies immune globulin (RIG) is essential for Post-Exposure Prophylaxis but is expensive and not widely available. Rabies virus-neutralizing human monoclonal antibodies (Mabs) were evaluated in vitro and in a Syrian hamster model as a potential future alternative. Seven Mabs neutralized representative rabies virus variants. However, a European bat lyssavirus was not neutralized by either Mabs or RIG. Moreover, Duvenhage virus was neutralized by RIG, but not by Mabs, and Lagos bat and Mokola viruses were neutralized by one Mab but not by RIG. In hamsters, one Mab resulted in protection that was comparable to human RIG. These results suggest that Mabs may provide a promising alternative to RIG.
Martin I. Meltzer - One of the best experts on this subject based on the ideXlab platform.
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evidence for a 4 dose vaccine schedule for human rabies Post Exposure Prophylaxis in previously non vaccinated individuals
Vaccine, 2009Co-Authors: Charles E. Rupprecht, Deborah J Briggs, Martin I. Meltzer, Catherine M Brown, Richard Franka, Samuel L Katz, Harry D Kerr, Susan M Lett, Robin Levis, William SchaffnerAbstract:After Exposure, human rabies is preventable by prompt application of Post-Exposure Prophylaxis. Historically, the total number of rabies vaccine doses administered during human Prophylaxis has decreased, as modern biologics have improved and scientific knowledge has grown. A review of the literature on rabies virus pathogenesis, experimental animal studies, clinical trials, epidemiological surveillance, and economic analyses was conducted to determine the potential utility of reducing the current 5-dose intramuscular series of human rabies vaccine administered in the United States. Based upon the available evidence, a reduced schedule of cell-culture rabies vaccine, administered on days 0, 3, 7, and 14, given in conjunction with rabies immune globulin, was supported and recommended by the United States Advisory Committee on Immunization Practices.
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Cost effectiveness of rabies Post Exposure Prophylaxis in the United States.
Vaccine, 2008Co-Authors: Praveen Dhankhar, Sagar A. Vaidya, Daniel B. Fishbien, Martin I. MeltzerAbstract:There is growing concern in the United States about the excessive use of rabies Post Exposure Prophylaxis (PEP) treatment. In this paper we have estimated the cost effectiveness of rabies PEP treatment under various scenarios of rabies transmission. When the risk of a patient getting rabies is deemed greater than 0.7%, then giving PEP will be cost saving (societal perspective). For lower risks of transmission, cost effectiveness estimates ranged from approximately $500,000 per life saved to $billions. The uncertainty caused by the wide range of cost effectiveness can only be resolved through analysis of data describing rabies transmission risk in a variety of scenarios.
Martin W Bratschi - One of the best experts on this subject based on the ideXlab platform.
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leprosy Post Exposure Prophylaxis lpep programme study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin
BMJ Open, 2016Co-Authors: Jan Hendrik Richardus, Anuj Tiwari, Tanja Barthjaeggi, L. Mieras, Peter Steinmann, Wim H Van Brakel, Martin W BratschiAbstract:Introduction The reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as Post-Exposure Prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50–60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy Post-Exposure Prophylaxis (LPEP) programme was designed to obtain those data. Methods and analysis The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented. Ethics and dissemination Ethical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies.
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negligible risk of inducing resistance in mycobacterium tuberculosis with single dose rifampicin as Post Exposure Prophylaxis for leprosy
Infectious Diseases of Poverty, 2016Co-Authors: L. Mieras, Martin W Bratschi, Richard M Anthony, Wim H Van Brakel, Jacques Van Den Broek, Emmanuelle Cambau, Arielle Cavaliero, Christa Kasang, Geethal Perera, Lee B ReichmanAbstract:Post-Exposure Prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2-3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosis strains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR Prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis.
Matthew J Mimiaga - One of the best experts on this subject based on the ideXlab platform.
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subsequent hiv infection among men who have sex with men who used non occupational Post Exposure Prophylaxis at a boston community health center 1997 2013
Aids Patient Care and Stds, 2015Co-Authors: Sachin Jain, Catherine E Oldenburg, Matthew J Mimiaga, Kenneth H MayerAbstract:Abstract Non-occupational Post-Exposure Prophylaxis (NPEP) has been recommended to prevent HIV acquisition for nearly 20 years. However, limited behavioral and clinical outcome data exist after men who have sex with men (MSM) present for NPEP. We reviewed the electronic medical records of HIV-uninfected adults who presented for NPEP at a large community health center in Boston between July, 1997 and August, 2013. Data from 894 patients were analyzed, 88.1% of whom were MSM. Consensual unprotected sex was the most common reason for NPEP visits among MSM (64.2%), followed by condom failure (30.6%). The HIV serostatus of the partner was unknown for 64.4% of the MSM, positive with unknown treatment status for 18.1%, positive and not on treatment for 4.1%, and positive and on treatment for 13.4%. Thirty-nine patients subsequently became HIV-infected (4.4%), all of whom were MSM. The MSM-specific HIV incidence after NPEP use was 2.2 cases per 100 person-years. Incident HIV infection was associated with younger ...
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Post Exposure Prophylaxis use and recurrent Exposure to hiv among men who have sex with men who use crystal methamphetamine
Drug and Alcohol Dependence, 2015Co-Authors: Catherine E Oldenburg, Sachin Jain, Kenneth H Mayer, Matthew J MimiagaAbstract:Background Men who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-Exposure Prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk Exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users.
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adherence to Post Exposure Prophylaxis for non forcible sexual Exposure to hiv a systematic review and meta analysis
Aids and Behavior, 2014Co-Authors: Catherine E Oldenburg, Kenneth H Mayer, Matthew J Mimiaga, Till Barnighausen, Guy HarlingAbstract:To characterize adherence to Post-Exposure Prophylaxis after non-forcible sexual Exposure to HIV, we conducted a review of the literature and meta-analysis. Articles were considered if they contained primary adherence data following non-forcible sexual Exposure. Random-effects meta-analysis was used to create pooled point estimates for adherence. Of 1,257 abstracts identified through our search algorithm, 17 were eligible for inclusion in this review, representing 3,634 patients enrolled in 3 randomized controlled trials (RCTs), 9 prospective and 5 retrospective observational studies. Pooled adherence, primarily assessed by self-report, was 77 % [95 % confidence interval (CI) 68–87] in prospective observational studies, 81 % (95 % CI 65–96) in retrospective studies, 78 % (95 % CI 65–91) in RCTs, and 78 % (95 % CI 72–85) overall. Overall adherence was moderately high, with high variability between studies. Assessment of adherence could be enhanced by the use of objective measurements.