【國外Guideline更新】Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

What's New in the Guidelines

Last Updated: November 14, 2017; Last Reviewed: November 14, 2017

The Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States (Perinatal Guidelines) are published in an electronic format that can be updated as relevant changes in prevention and treatment recommendations occur. The Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission (the Panel) is committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information.

Major revisions within the last 12 months are as follows:

【新知】CDC Officially Admits People With HIV Who Are Undetectable Can't Transmit HIV

After hundreds of other experts and HIV organizations have already signed on to a pledge that recognizes that people living with HIV whose treatment has brought their viral load to an undetectable level — which is nearly half of all HIV-positive people in the U.S. — do not transmit HIV to any other person, the Centers for Disease Control and Prevention has come out with the definitive statement on the subject.

In recognition of National Gay Men’s HIV/AIDS Awareness Day, the CDC memo stated, "On this day, we join together in taking actions to prevent HIV among gay and bisexual men and ensure that all gay and bisexual men living with HIV get the care they need to stay healthy." Gay and bisexual men, the CDC noted, continue to be disproportionately affected by HIV, with, "more than 26,000 gay and bisexual men received an HIV diagnosis in 2015, representing two-thirds of all new diagnoses in the United States, and diagnoses increased among Hispanic/Latino gay and bisexual men from 2010 to 2014."

【國外Guildeline更新】Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

What's New in the Guidelines

Updates to the Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

The Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV Infected Adults and Adolescents document was published in an electronic format that could be easily updated as relevant changes in prevention and treatment recommendations occur.

The editors and subject matter experts are committed to timely changes in this document because so many health care providers, patients, and policy experts rely on this source for vital clinical information.

All changes are developed by the subject matter groups listed in the document (changes in group composition are also promptly posted). These changes are reviewed by the editors and by relevant outside reviewers before the document is altered. Major revisions within the last 6 months are as follows:

【論文分享】Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis

Dr Rebecca F Baggaley, PhD'Correspondence information about the author Dr Rebecca F BaggaleyEmail the author Dr Rebecca F Baggaley, Michael A Irvine, PhD*, Werner Leber, PhD*, Valentina Cambiano, PhD, Jose Figueroa, MFPH, Heather McMullen, PhD, Prof Jane Anderson, FRCP, Andreia C Santos, PhD, Fern Terris-Prestholt, PhD, Alec Miners, PhD, Prof T Déirdre Hollingsworth, PhD†, Prof Chris J Griffiths, DPhil†

*Contributed equally
†Contributed equally

Published: 30 July 2017

【新知轉載】HIV and Diabetes

Last Reviewed: October 6, 2017

Key Points

• Diabetes is a disease in which levels of blood glucose (also called blood sugar) are too high. Glucose comes from the breakdown of the foods we eat and is our main source of energy. There are two main types of diabetes: type 1 diabetes and type 2 diabetes.
• Use of some HIV medicines may increase blood glucose levels and lead to type 2 diabetes. Other risk factors for type 2 diabetes include a family history of diabetes, being overweight, and lack of physical activity.
• People with HIV should have their blood glucose levels checked before they start taking HIV medicines. People with higher-than-normal glucose levels may need to avoid taking some HIV medicines and use other HIV medicines instead.
• Blood glucose testing is also important after starting HIV medicines. If testing shows high glucose levels, a change in HIV medicines may be necessary.
• Type 2 diabetes can often be controlled with a healthy diet and regular exercise. A healthy diet includes vegetables, fruits, beans, whole grains, and lean meats and is low in processed foods high in sugar and salt. Regular exercise means being active for 30 minutes on most days of the week. Sometimes, in addition to a healthy diet and regular physical activity, some people may need to take medicines to control type 2 diabetes.

【新知轉載】愛滋病的每日藥物，可能被一年6次的針劑取代

2017-08-03

疾病的治療方式其實也容易對病患的生活造成影響，特別是需要每日服用的藥物，患者可能因忘記或忙碌而忽略，進而影響到治療的效果。《The Lancet》日前刊登美國製藥公司的最新發表，研究團隊表示，在未來對抗愛滋病毒(human immunodeficiency virus, HIV)的方式──除了透過每日服用口服藥物，還有機會透過久久一次的注射方式，讓患者的生活更便利。研究中作者招募309位愛滋病患者作為受試者進行試驗。實驗結果顯示，每一個月以及每兩個月注射一次藥物針劑的受試族群，其所產生的治療效果，包括抑制病毒、避免病毒摧毀患者的免疫系統、停止愛滋病的進程發展等，與每日服用抗反轉錄病毒藥物療法(antiretroviral medication)的藥錠之族群相當。

新聞出處：Injections ‘next revolution’ in HIV - study《BBC》
http://www.bbc.com/news/health-40703336
研究刊登在《The Lancet》的網頁
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31917-7/fulltext

原文網址：全球醫藥新知網站-愛滋病的每日藥物，可能被一年6次的針劑取代

【轉知】抗人類免疫缺乏病毒藥品處方使用規範106.09.01

【新知】Is PrEP making a difference? Top HIV researchers provide answers

July 23, 2017, by Emily Newman

BETA is attending and reporting from the 2017 International AIDS Society conference on HIV Science this week in Paris, France from July 23 to 26—bringing you the latest news, updates, and research on HIV treatment and prevention.

As countries, cities and agencies worldwide ramp up their investment in pre-exposure prophylaxis (PrEP) services for people at risk for HIV, many are wondering: Is this strategy working in the “real world”—outside the safe parameters of clinical trials?

At the International AIDS Society conference this week, three researchers offered evidence to this point. Here’s what we learned about how the scale-up of PrEP health services (along with other PrEP awareness and educational campaigns) is helping to reduce the number of new HIV infections in communities and countries around the world.

【會議】AIDS 2018 ( 22nd International AIDS Conference )

會議詳情網址：AIDS 2018

AIDS 2018 Conference Objectives

Convene the world’s experts to advance knowledge about HIV, present new research findings, and promote and enhance global scientific and community collaborations in synergy with other health and development sectors.

Promote human rights based and evidence-informed HIV responses that are tailored to the needs of particularly vulnerable communities, including people living with HIV, displaced populations, men who have sex with men, people in closed settings, people who use drugs, sex workers, transgender people, women and girls and young people.

Activate and galvanize political commitment and accountability among governments, donors, private sector and civil society for an inclusive, sustainable and adequately financed, multi-sectoral, integrated response to HIV and associated coinfections and comorbidities.

Address gaps in and highlight the critical role of HIV prevention, in particular among young people in all their diversity and its integration in a range of health care settings.

Spotlight the state of the epidemic and the HIV response in Eastern Europe and Central Asia with a focus on investments, structural determinants and services.

【UPDATE】 Leading scientists celebrate progress towards 90-90-90 targets

原文網址：Leading scientists celebrate progress towards 90-90-90 targets

25 JULY 2017

Hundreds of the world’s leading HIV researchers, programme planners and implementers and civil society advocates gathered prior to the 2017 IAS Conference on HIV Science to assess progress towards the 90-90-90 targets. The workshop, sponsored by the International Association of Providers of AIDS Care (IAPAC) and UNAIDS, in partnership with the Global Network of People Living with HIV, focused on the latest data on progress and on new opportunities to continue to speed gains towards the 90-90-90 milestones.

The targets were launched by UNAIDS in 2014 to accelerate progress so that, by 2020, 90% of all people living with HIV know their HIV status, 90% of all people with diagnosed HIV are accessing sustained antiretroviral therapy and 90% of all people accessing antiretroviral therapy are virally suppressed. In 2016, for the first time, more than two-thirds of people living with HIV knew their HIV status and more than half of all people living with HIV had access to antiretroviral therapy.

【UNAIDS UPDATE】 9th AIDS conference on science opens in Paris

原文網址：9th AIDS conference on science opens in Paris

24 JULY 2017

More than 6 000 HIV professionals from around the world have gathered in Paris for the 9th IAS Conference on HIV Science. The four-day conference is one of the largest open scientific meetings on HIV, organized by the International AIDS Society (IAS) in partnership with the French National Agency for Research on AIDS and Viral Hepatitis (ANRS).

This year’s conference will prioritize basic science, a prerequisite step to ending the HIV epidemic and feature studies that shine a light on the specific needs of key populations, including young people, transgender people, men who have sex with men, sex workers and people who inject drugs.

The conference was officially opened on Sunday evening by French Health Minister Agnes Buzyn, UNAIDS Executive Director Michel Sidibé, French economist Esther Duflo, Giovanna Rincon, President of the ACCEPTESS-T association and officiated by Linda-Gail Bekker, President of IAS and International Scientific Chair of IAS 2017 as well as IAS 2017 Local Scientific Chair and former director of ANRS.

Global HIV funding has many preoccupied at the Paris conference. Funding cuts would devastate HIV research and treatment programmes, stalling or undoing recent progress highlighted in the latest UNAIDS report released 20 July. IAS reiterated that their shared objective was to ensure that science remains the backbone of the global AIDS response saying funding was critical to end the HIV epidemic.

The conference runs from 23 July to the 26th.

臺灣暴露前口服預防性投藥使用指引

指引下載網站：台灣愛滋病學會

【NEWS】FDA Approves Generic Truvada for HIV Treatment and PrEP

However, Gilead Sciences, the brand-name manufacturer of Truvada, insists a generic version “will not be immediately available.”

June 9, 2017 • By Benjamin Ryan

In a move that has taken HIV advocates by surprise and stewed considerable confusion, the U.S. Food and Drug Administration (FDA) has approved a generic formulation of Gilead Sciences’ blockbuster antiretroviral (ARV) Truvada (tenofovir disoproxil fumarate/emtricitabine). This decision could have major implications for the future cost of Truvada, to insurers and consumers alike.

However, Gilead insisted in a statement, “A generic version of Truvada will not be immediately available. It’s important to note that there are a number of factors involved in commercialization that are not tied directly to FDA approval.”

【會議】ICC 2017(The 30th International Congress of Chemotherapy and Infection 2017)

【會議】CROI 2017: Seattle

會議網址：CROI 2017: Seattle

The annual Conference on Retroviruses and Opportunistic Infections (CROI) brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. CROI is a global model of collaborative science and the premier international venue for bridging basic and clinical investigation to clinical practice in the field of HIV and related viruses.

CROI 2017 was held from February 13 to February 16, 2017, in Seattle, Washington, at the Washington State Convention Center. Webcasts, abstracts, electronic posters, and other electronic resources from CROI 2017 are now available online.

The CROI Foundation partners with the International Antiviral Society–USA (IAS–USA) for organization of the conference.

【健保署轉知】C肝全口服新藥第二階段給付條件放寬，提早於5月15日實施

　　為讓更多C型肝炎病患接受全口服抗病毒新藥的治療，全民健保藥物給付項目及支付標準共同擬訂會議前於4月20日通過修訂C肝藥品給付規定，今健保署考量給付條件放寬後，肝纖維化程度F3及F4患者將不用先經過干擾素及雷巴威林治療失敗即可使用，受惠人數更多，且這類患者病況較為嚴重，易衍生為肝硬化或肝癌，故公布於106年5月15日實施第二階段給付條件放寬，讓患者能及早接受治療。

原規劃第二階段給付條件放寬於6月1日實施，但在健保署署長及同仁共同研議可行性之下，將努力加速處理登錄系統修正等相關行政作業，決定提早至5月15日實施，這項決定也得到衛生福利部部長的支持及認肯。

健保署強調，今年度健保總額分配之全口服新藥專款預算為20億元，為達分配公平，採取由醫師代病患預先登錄，並取得號碼，才能得到藥品給付的措施，請醫療院所要確實依照C肝新藥給付執行計畫申報登錄作業！

發布日期：106-05-03

原文網址：衛生福利部中央健康保險署

【健保署新聞】藥物共擬會議通過，放寬C肝全口服新藥第二階段給付條件

　　為讓更多C型肝炎病患接受全口服抗病毒新藥的治療，全民健保藥物給付項目及支付標準共同擬訂會議(以下簡稱「藥物共擬會議」)今(20)日通過修訂C肝藥品給付規定，不再限定病患需曾接受「干擾素」合併「雷巴威林」治療且失敗，而放寬為僅需符合F3(含)以上之肝纖維化程度的門檻，經消化系內科專科醫師完成登錄及取號程序後，即可使用健保給付的C肝新藥。

健保署表示，根據衛生福利部C肝辦公室的估計，符合第二階段放寬用藥條件的病人數約9,100名。另為配合給付條件放寬，該署須同時修正個案登錄系統，預計6月1日可開放第二階段給付條件之申請。

C肝全口服新藥自今(106)年1月24日開始納入健保給付，但由於預算有限，第一階段開放條件是參採消化系醫學會之建議，以感染病毒基因型第一型的慢性C型肝炎病人，且曾使用「干擾素」合併「雷巴威林」治療失敗且無肝功能代償不全，而且肝纖維化程度為F3(含)以上者，作為優先給藥之對象。
健保署表示，今年度健保總額分配之全口服新藥專款預算為20億元，可供8,000名C肝病人治療。為達平均分配，該署根據過去加入「健保加強慢性B型及C型炎治療計畫」的C肝病人數，按醫院、診所及六個分區予以比例分配。

不過，根據統計，截至4月20日止，全台已登錄用藥的病人數為2,482人。為使更多C肝患者盡快接受治療，健保署今天提請藥物共擬會議討論，決定放寛第二階段的給付條件，同意患者只要符合F3(含)以上之肝纖維化程度，且無肝功能代償不全，不論過去有無使用「干擾素」或「雷巴威林」的治療經驗，均可納入給付。

此外，健保署分析發現，目前接受全口服C肝新藥治療的病人，以在醫院領藥約占分配額度的3成5；但在診所領藥治療的病人，平均僅占診所分配額度的6%，例如在中區(台中市、彰化縣、南投縣)原分配有200個名額，但迄今只有3人在診所治療，顯然多數病人不清楚可在胃腸肝膽科診所就近治療。

健保署表示，自1月下旬 C肝新藥納入健保給付上路，係仿照器官捐贈及登錄制度，採取由醫師代病患預先登錄，並取得號碼，是為了維護申請藥物給付的公平性、減少爭議。不過，該署發現部分醫院診所怕麻煩，並未確實依照C肝新藥給付執行計畫申報登錄作業，就先提供藥品給病人，或要求患者先自費，這些都不符規定。

健保署重申，一旦醫事服務機構因行政疏失造成藥費不予支付，則不應再向病患收取自費。相關常見的申報錯誤態樣，詳見新聞稿附件。

民眾想知道C肝全口服新藥詳細之執行計畫內容，或對計畫內容有相關問題，可到健保署官網(www.nhi.gov.tw)查詢，其路徑如下：中央健康保險署網站／藥材專區／藥品／「C型肝炎全口服新藥專區」，或直接點選以下連結：「https://goo.gl/WlOS8i」。

發布日期：106-04-20

原文網址：衛生福利部中央健康保險署

【會議】IAS ( International AIDS Society ) 2017

會議詳情及轉載原文：International AIDS Society (IAS)




Dear IAS Members and Partners

As 2017 begins, our community is anxious and concerned. Political and societal changes continue to upend our expectations and generate uncertainty about what is ahead of us. We worry about human rights, the plight of refugees and migrants, progress towards gender equality, and the strength of our commitment to each other as human beings.
Deeply wrapped up in all of this is our fight against HIV – a disease that has shown itself adept at exploiting the very changes that seem to be dominating our world.

As corners of the planet shift towards nationalism and xenophobia, we wonder where the future of our global cause lies. Is the progress we have made against the greatest pandemic of our time slipping through our hands?
No, it’s not – at least not yet.

In the midst of this anxiety and uncertainty, we’ve seen action and defiance against rolling back hard-won gains. The millions of people who participated in Women’s Marches around the world in January are proof that apathy doesn’t rule, that a collective determination is there to resist a new world order that demonizes and isolates those in need.
Our movement has shown that we know how to make history, not merely observe or survive it. That is our strength. We are not history’s passengers. We are its conductors.

【CDC訊息轉知】疾管署自3月1日起再新增公費A型肝炎疫苗實施對象，請醫界朋友鼓勵民眾及早接種(疾病管制署致醫界通函第320號)

原文網址：致醫界通函

全國醫界朋友，您好：

為有效降低A型肝炎疫情，疾管署自今（2017）年3月1日起至今年12月31日止，再新增針對所有A型肝炎IgG抗體陰性之HIV感染者，公費提供1劑A型肝炎疫苗(之前僅提供1977年1月1日以後出生之對象)。
依疾管署監測資料顯示，去(2016)年急性病毒性A型肝炎累積確定病例數計1,133例，為歷年來最高病例，確定病例中有1,047例 (92%)為男性，537例 (47%)合併感染HIV。今年A型肝炎病例數截至2月21日止，累積確定病例數計98例(較去年同期64例增加1.5倍)，其中有27例 (28%)合併感染HIV，顯示A型肝炎疫情持續升高。
疾管署自去年10月1日起實施「擴大A型肝炎公費疫苗接種試辦計畫」，針對1977年1月1日(含)以後出生確診HIV感染或新確診梅毒、淋病者，提供1劑公費A肝疫苗。鑒於國內A型肝炎疫情仍持續，且考量HIV感染者免疫力較梅毒或淋病患者為低，暴露後感染發病風險較高，爰自今年3月1日起，擴大將「所有A型肝炎IgG抗體陰性之HIV感染者」納入計畫。請醫師診治時，針對符合本計畫公費A肝疫苗接種對象(如附件1)，鼓勵儘早接種A型肝炎疫苗，以降低疾病發生之風險。
除了前述計畫，疾管署今年亦續辦「急性病毒性A型肝炎確定病例接觸者A型肝炎疫苗免費接種計畫」(如附件2)，籲請醫師於診治患者時，除依法進行通報、適時提供衛教及鼓勵篩檢HIV或其他性病外，並請患者配合衛生單位確實提供接觸者名單（家庭成員或同住者、性伴侶），以利儘快安排接觸者接種1劑公費A型肝炎疫苗。
接種疫苗為預防A型肝炎最有效的措施，接種1劑A型肝炎疫苗後，約有95%以上的個體可產生保護抗體，而按期完成兩次疫苗接種，產生的免疫力可維持20年以上。請臨床醫師除協助前述符合公費A肝疫苗實施對象接種疫苗外，亦請提醒並鼓勵患有慢性肝病、曾移植肝臟的病人、男男間性行為者、藥物成癮者及往來於A型肝炎流行地區等高風險族群自費接種A型肝炎疫苗，並請其於第1劑接種後6至12個月內接種第2劑，以獲得長期免疫力。


檢視更新日期：2017-02-22
維護單位：公關室

【健保署轉知】C肝全口服新藥1/24起有條件納入健保給付

　　治療C型肝炎的全口服新藥納入健保給付，是蔡英文總統重要的醫療公衛政策之一，在衛生福利部全民健康保險會105年12月通過有條件納入健保後，今(18)日由中央健保署正式公告，即日起開放各醫療院所消化系內科專科醫師篩選符合治療條件的病人，透過VPN系統完成登錄後，本月24日起可開始給藥，讓第一批符合給付條件病患可在農曆年前拿到這個健康大禮。

健保署指出，106年健保總額預算分配，C型肝炎用藥之健保預算共計31.01億元(醫院26.55億元、西醫基層診所4.46億元)，屬專款專用，其中20億元將用於全口服新藥(醫院17.12億元、西醫基層診所2.88 億元)，其餘10.01億元仍保留給未能符合優先使用條件及其他仍需傳統干擾素療法的病人使用。