June 27, 2012Volume 7 - Issue 25

DynaMed Weekly Update

For the week ending June 15, 2012

Last week 716 articles were evaluated via DynaMed's Systematic Literature Surveillance and 335 were added to DynaMed content.  

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Zidovudine plus Nevirapine May Reduce HIV Transmission to Infants Born to Mothers with HIV Infection and No Previous Antiretroviral Therapy

 

Zidovudine monotherapy has been commonly used for postexposure HIV prophylaxis in formula-fed infants whose mothers did not receive antenatal antiretroviral therapy, but the use of combination antiretroviral therapy has increased in recent years (AIDS Patient Care STDS 2011 Jan;25(1):1, HIV Med 2011 Aug;12(7):422). The optimal approach in this population remains unknown. A new unblinded randomized trial compared 3 antiretroviral regimens in infants born to mothers with HIV infection who had not received previous antiretroviral therapy.

 

A total of 1,745 formula-fed infants (gestational age ≥ 32 weeks, birth weight ≥ 1.5 kg) were randomized within 48 hours of birth to single vs. double. vs. triple oral antiretroviral regimens. The single antiretroviral group received zidovudine twice daily for 6 weeks. The double therapy group received the same zidovudine regimen plus 3 doses of nevirapine, the first within 48 of birth, the second 48 hours later, and the third 96 hours after the second. The triple therapy group received zidovudine for 6 weeks plus 2 weeks of lamivudine and nelfinavir twice daily. Maternal HIV was diagnosed during labor and delivery in 73%, and none of the mothers had received previous antiretroviral therapy. Women who had any antiretroviral drug other than zidovudine during labor were excluded.

 

The efficacy analysis included 1,684 infants (61 infants who did not receive study drug or whose mothers were HIV-negative on confirmatory testing were excluded). At 3 months the overall HIV infection rates in infants were 11.1% for zidovudine alone, 7.1% for double therapy (p = 0.03 vs. zidovudine alone, NNT 25), and 7.4% for triple therapy (p = 0.03 vs. zidovudine alone, NNT 27) (level 2 [mid-level] evidence). The intrapartum transmission rates were 4.8%for zidovudine alone, 2.2% for double therapy (p = 0.046, NNT 37), and 2.4% for triple therapy (p = 0.046, NNT 42). There were no significant differences in in utero infection rates. Triple therapy was associated with significantly higher incidence of neutropenia compared to double therapy (27.5% vs. 14.9%, p < 0.001, NNH 7) (N Engl J Med 2012 Jun 21;366(25):2368). These data are the basis for recent updates to perinatal guidelines which now recommend double therapy with zidovudine plus nevirapine over triple therapy for at risk infants (AIDSinfo.nih.gov/guidelines).

 

For more information, see the Prevention of maternal-child HIV transmission topic in DynaMed.

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DynaMed Extra 

DynaMed Extra: Lorcaserin (Belviq) FDA Approved for Chronic Weight Management in Adults

 

Lorcaserin (Belviq) was FDA approved today to be used in addition to diet and exercise for chronic weight management in adults who are obese (body mass index [BMI] ≥ 30 kg/m2), or overweight (BMI ≥ 27 kg/m2) with a weight-related condition (such as hypertension, diabetes, or dyslipidemia) (FDA Press Release 2012 Jun 27). Randomized trial evidence (limited by losses to follow-up of about 50%) suggests that lorcaserin 10 mg twice daily for 52 weeks increases the likelihood of losing at least 5% body weight from 20%-25% with placebo to 47.5% (NNT 4-5) (level 2 [mid-level] evidence). Lorcaserin was not associated with a significant increase in heart valve problems on echocardiography (a reason other weight loss medications were withdrawn from the market), but was associated with a potential risk for serotonin syndrome, especially if combined with other serotonergic drugs.

 

For more information, see the Weight loss medications for obesity in adults topic in DynaMed.

New Topics added to DynaMed this Week
Call for Peer Reviewers

We are currently seeking reviewers for:  

Prevention of maternal-child HIV transmission

Neonatal Herpes 

Learn more about the DynaMed Contribution Opportunities:

 

DynaMed Peer Review 

Editorial Policies for Reviewers 

 

 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information
 
CREDITS
Physicians: 0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: June 27, 2012

Expiration Date: June 27, 2013
Estimated Completion Time:

15 minutes

There is no fee for this activity.

 

To Receive Credit 

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

 

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Learning Objectives 

Upon successful completion of this educational program, the reader should be able to: 

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

 

Faculty Information

 

Alan Ehrlich, MD- Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

 

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company
  


Disclosures 

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

 

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AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

  

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