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  • September 12, 2018 9:20 AM | Anonymous

    Women's Health Update 2018 
    Presented by Essential Access Health & Contraceptive Technology   

    October 24-25, 2018, Los Angeles, CA 

    REGISTER TODAY to attend Women's Health Update 2018, including hands-on clinical training sessions on the latest methods and techniques for contraceptive care. The clinical trainings will be provided by nationally recognized experts in the field. Learn more.


  • September 07, 2018 8:27 AM | Anonymous

    Offered via the Association of Reproductive Health Professionals (ARHP)  

    Description: 

    According to the CDC, in 2015, there were an estimated 38,500 new HIV infections, down from 41,800 in 2010. While great progress has been made in preventing and treating HIV, there is still much work to be done. This two-webinar series examines clinical providers’ vital role in HIV prevention.  

    Webinar 1:

    HIV Prevention: Frontline Providers' Role in

    "Getting to Zero"

    September 25th at 4pm EDT

    After this webinar, you will be able to:

    • Summarize current epidemiology of HIV in the U.S.
    • Describe three national frameworks for preventing new HIV infections
    • Summarize current guidelines for HIV screening
    • Explain the current guidelines for initiation of antiretroviral treatment for people living with HIV
    • Apply guidelines and patient-centered communication techniques to a case study 

    Webinar 2:

    HIV Prevention in the Clinical Setting

    November 1st at 2pm EDT

    After this webinar, you will be able to:

    • Summarize current epidemiology of HIV in the U.S.
    • Explain current guidelines for HIV screening
    • Describe current guidelines for initiation of treatment for people who test positive
    • Describe the role of pre-exposure prophylaxis (PrEP) in HIV prevention
    • Apply guidelines and patient-centered communication techniques to a case study 



  • September 04, 2018 9:50 AM | Anonymous
    September 4, 2018, Medscape 


    The US Food and Drug Administration (FDA) has approved two new oral treatments for adults with HIV-1 infection, Pifeltro and Delstrigo, both from Merck & Co, according to a company news release.

    Pifeltro contains doravirine (100 mg), a new non-nucleoside reverse transcriptase inhibitor to be given in combination with other antiretroviral medicines.  Delstrigo is a once-daily fixed-dose combination of doravirine (100 mg), lamivudine (3TC; 300 mg), and tenofovir disoproxil fumarate (TDF; 300 mg).

    Both drugs are indicated for the treatment of HIV-1 infection in adults with no prior antiretroviral treatment history and are taken once daily with or without food.

    The FDA approved doravirine on the basis of the phase 3 DRIVE-FORWARD clinical trial, in which 766 patients with no antiretroviral treatment history were randomly assigned to once-daily treatment with doravirine or darunavir 800 mg plus ritonavir 100 mg (DRV+r), each in combination with emtricitabine (FTC)/TDF or abacavir (ABC)/3TC.

    Treatment with doravirine led to sustained viral suppression through 48 weeks, meeting its primary endpoint of noninferiority compared with DRV+r, each in combination with FTC/TDF or ABC/3TC.

    At week 48, 84% of the doravirine group and 80% of the DRV+r group had plasma HIV-1 RNA of less than 50 copies/mL.

    Of the 20% of study participants with a high viral load at baseline (HIV-1 RNA > 100,000 copies/mL), 77% in the doravirine group and 74% in the DRV+r group achieved HIV-1 RNA of less than 50 copies/mL at week 48.

    The rate of therapy discontinuation due to adverse events was low in both groups (2% in the doravirine group and 3% in the DRV+r group). Clinical adverse reactions of all grades occurring in at least 5% of participants in the doravirine group included nausea (7%), headache (6%), fatigue (6%), diarrhea (5%), and abdominal pain (5%). No adverse reactions of grade 2 or higher occurred in 2% or more of participants treated with doravirine.

    The doravirine/3TC/TDF combination pill was approved on the basis of data from the phase 3 DRIVE-AHEAD trial, in which 728 patients naive to antiretroviral therapy were randomly assigned to once-daily treatment with doravirine/3TC/TDF or efavirenz (EFV)/emtricitabine/tenofovir disoproxil fumarate (EFV 600 mg/FTC 200 mg/TDF 300 mg).

    The doravirine/3TC/TDF combination provided sustained viral suppression through 48 weeks, meeting its primary endpoint of noninferiority compared with EFV/FTC/TDF.

    At week 48, 84% of the doravirine/3TC/TDF group had plasma HIV-1 RNA of less than 50 copies/mL, as did 81% of the EFV/FTC/TDF group.

    Of the 21% of patients with a high viral load at baseline (HIV-1 RNA > 100,000 copies/mL), 77% in the doravirine/3TC/TDF group and 72% in the EFV/FTC/TDF group achieved HIV-1 RNA of less than 50 copies/mL at week 48.

    A statistically significantly lower proportion of doravirine-treated patients reported neuropsychiatric adverse events in the three prespecified categories of dizziness (9% vs 37%), sleep disorders and disturbances (12% vs 26%), and altered sensorium (4% vs. 8%).

    The rate of discontinuation of treatment due to adverse events was lower with doravirine/3TC/TDF than with EFV/FTC/TDF (3% vs 6%). Clinical adverse reactions of all grades occurring in at least 5% of patients in the doravirine group included dizziness (7%), nausea (5%), and abnormal dreams (5%). No adverse reactions of grade 2 or higher occurred in 2% or more of patients treated with doravirine.

    Both of the new drugs "are contraindicated when co-administered with drugs that are strong cytochrome P450 (CYP)3A enzyme inducers as significant decreases in doravirine plasma concentrations may occur, which may decrease the effectiveness of Delstrigo and Pifeltro. Delstrigo is contraindicated in patients with a previous hypersensitivity reaction to 3TC," the company said in its news release.

    "As a result of the remarkable strides made in the fight against HIV, clinicians and their patients have the opportunity to work together to identify treatment regimens that may be best for each individual, taking into account other aspects of that person's health, including other medicines they may be taking," David Wohl, MD, from the AIDS Clinical Trials Unit at the University of North Carolina at Chapel Hill, said in the release. "Today's approvals of Delstrigo and Pifeltro provide two new options for the treatment of HIV-1 in appropriate treatment-naive adult patients."

    Merck said it anticipates that both drugs will be stocked through wholesalers within 1 month.


     
  • August 30, 2018 2:07 PM | Anonymous

    August 30, 2018, MedPage Today 

    Sexually transmitted disease (STD) diagnoses have increased every year since 2013, with the number of new STD diagnoses the highest ever in 2017, CDC researchers found.

    There were 2.3 million cases of chlamydia, gonorrhea, and syphilis diagnosed in 2017, with syphilis diagnoses up by 76% and gonorrhea diagnoses up by 67% since 2013, according to preliminary data released by the CDC at the National STD Prevention Conference in Washington.

    At a press briefing, Gail Bolan, MD, director of the CDC division of STD prevention, characterized this as a "continuation of a persistent and troubling trend," particularly noting that rates of diagnosis for gonorrhea "nearly doubled" among men and increased one-fifth among women, "something we haven't seen in a long time," she added.

    The CDC reported that chlamydia remained the most common condition reported to the CDC, with more than 1.7 million cases diagnosed in 2017, with a little under half among women ages 15 to 24.

    Bolan cited another troubling statistic about the looming threat of antibiotic resistance regarding gonorrhea treatment. The CDC currently recommends a two-dose therapy for gonorrhea consisting of an intramuscular dose of ceftriaxone -- the only "highly effective" antibiotic used to treat gonorrhea in the U.S. -- and oral azithromycin.

    But Bolan reported that a "small, but growing fraction" of lab specimens of gonorrhea are showing "signs of antibiotic resistance." While she added that there has never been a "confirmed treatment failure" when using this recommended treatment, the worry is there may eventually be a strain of gonorrhea that does not respond to ceftriaxone.

    "Our nation urgently needs new treatment options for gonorrhea," Bolan said. "But CDC alone cannot turn the tide on rising STDs. It requires new commitment from the healthcare sector, scientists, industry, state and local health departments."

    "Commitment" usually means "money," and state and local health officials spoke candidly about the country's "eroding public health infrastructure" that they felt contributed to the tremendous increase in STDs. Specifically, officials cited years of cutbacks in funding for STD prevention, with state and local health departments who rely on federal funding to support their STD programs, working with budgets that are half of what they were 15 years ago.

    "We maintain our bridges and roads, and we see them on TV when they crumble. You don't always see a crumbling public health infrastructure," said Michael Fraser, PhD, executive director, Association of State and Territorial Health Officials (ASTHO). "We know what works with STD prevention. We just don't want to pay for all of it."

    David C. Harvey, MSW, executive director, National Coalition of STD Directors, called for an additional $70 million in funding to "immediately arm state and local health programs to combat this crisis." He said that treatment for STDs costs more than $16 billion a year.

    "It is time that President Trump and Secretary Azar declare STDs in America a public health crisis," adding that emergency access to funding is also needed to bring these rates down.

    In addition to cutbacks in federal and state funding, Harvey cited other factors for the rise of STDs in America, namely the "extreme lack of awareness and education about STDs and sexual health." But he also said providers and patients played a significant role as "doctors are not screening and testing for STDs and patients don't know they need to ask for screening and treatment."

    Bolan added that screening needs to be "routine care" and that providers and patients need to be having that conversation about testing.

    Harvey added a plea to Congress for more funding for provider training, through the CDC STD Prevention Training Centers, where funding has also been cut over the last 20 years.

    But Fraser pointed out that the solution to the rising STD problem is not going to be "treating our way out of it," and that a solid public health infrastructure is also needed. He specifically noted that cuts in funding have affected programs that support "disease investigators," who meet with individuals, talk about their sexual behavior, do contact tracing, and try to prevent future infections.

    "Expecting a physician in an already hurried day-to-day practice to do a slew of [recommended STD testing] is probably not realistic, given the way physicians practice," he said. "Public health can take some of the pressure off the clinical system. You don't need a medical degree to prevent an STD -- you need to talk with people about using condoms."

    Bolan said that the full 2017 STD surveillance report is expected to be released in late September.


  • August 29, 2018 9:00 AM | Anonymous

    APAOG members may view recorded webinars at anytime. Please check out our latest addition, "When Sex Hurts: Identifying and Treating the Causes of Sexual Pain: presented by Alyse Kelly-Jones, MD.

    Click here to view the webinar library. *Must be logged in to view webinar library. 


  • August 28, 2018 9:30 AM | Anonymous
    August 28, 2018, JAAPA 


    Evaluating patients for infertility is common in the primary care setting and can involve multiple differentials and treatment options. This case report describes a 34-year-old woman whose infertility evaluation led to the diagnosis of a pituitary adenoma. 

    Read the full article here.

  • August 23, 2018 9:13 AM | Anonymous

    August 23, 2018, MedPage Today 

    Routine screening for cervical cancer substantially reduces disease incidence and mortality for average-risk women ages 21 to 65, and the benefits outweigh the harms, the U.S. Preventive Services Task Force (USPSTF) concluded in a final guidance statement on the issue.

    The recommendations encompassed multiple screening strategies. The task force concluded "with high certainty" that the benefits of screening women ages 21 to 29 every 3 years with cytology alone (Pap test) "substantially outweigh the harms." The USPSTF panel also concluded that screening every 3 years with a Pap test alone, every 5 years with high-risk human papillomavirus (hrHPV) DNA testing alone, or every 5 years with both tests (cotesting) provides benefits that outweigh the harms for women ages 30 to 65.

    The final recommendations differed from the draft guidance, published in September 2017, by recognizing cotesting as an acceptable screening option. However, cotesting every 5 years for women 30 to 65 is identified as an "alternative" to the "preferred" strategies of cervical cytology or hrHPV testing alone.

    "Women should choose which strategy is right for them after a discussion with their clinician," according to a statement from the USPSTF.

    The task force's review of evidence showed that women younger than 21 or older than 65 do not benefit from screening, provided that women at the upper end of the age range were adequately screened in the past.

    The recommendations, published in JAMA, apply to women with an intact cervix, irrespective of sexual history, but do not apply to women with a history of cervical cancer or precancerous cervical lesions.

    "Screening for cervical cancer saves lives and identifies the condition early when it is treatable," said task force member Carol Mangione, MD, of UCLA. "There are several effective screening strategies available, so women should talk to their doctor about which one is right for them."

    Added panelist Melissa Simon, MD, of Northwestern University's Feinberg School of Medicine in Chicago: "Most cases of cervical cancer occur in women who have not been regularly screened or appropriately treated. That's why it's important for women to be screened regularly throughout their lifetime and receive follow-up and treatment when needed."

    The authors of an accompanying editorial lauded the USPSTF for including cotesting as an option for cervical cancer screening.

    "The USPSTF has shown a high degree of responsiveness to the concerns of clinicians and patients about cotesting," wrote Lee Learman, MD, PhD, of Florida Atlantic University in Boca Raton, and Francisco Garcia, MD, of the University of Arizona in Tucson.

    "The current USPSTF recommendation statement preserves the greatest range of choices for practitioners and patients; in that sense, both will benefit," the editorial added.

    The recommendations have the effect of achieving "an unprecedented degree of concordance across recommendations from a variety of professional organizations," Learman and Garcia continued. The USPSTF, American College of Obstetricians and Gynecologists (ACOG), American Cancer Society/American Society for Colposcopy and Cervical Pathology (ASCCP)/American Society for Clinical Pathology, and (to a lesser extent) the Women's Preventive Services Task Force of the Institute of Medicine "all arrived at very similar recommendations."

    The author of a second editorial appearing in JAMA Internal Medicine noted that the USPSTF did not include cost-effectiveness in the review that led to the recommendations. "Although the USPSTF sets the standard for evidence-based recommendations and acknowledges the critical value of high-quality evidence in making recommendations, it might reasonably be asked, where is the evidence of value in cervical cancer screening?" wrote George Sawaya, MD, of the University of California San Francisco.

    Sawaya pointed out that he is leading an ongoing evaluation of cost-effectiveness analyses "to determine the range of reasonable options for cervical cancer screening. Such analyses may inform future screening recommendations."

    He also noted that the USPSTF recommendations differ in two ways from the Society of Gynecologic Oncology (SGO) guidance on the issue: (1) Starting hrHPV testing at age 30, rather than 25, as supported by SGO; and (2) testing at 5-year intervals and not more frequently.

    ACOG, ASCCP, and SGO issued a joint statement, thanking the USPSTF for including multiple screening options in the recommendations and describing the task force guidance as "largely in line" with their own recommendations.

    One or more members of the task force disclosed relationships with Healthwise, the National Area Health Education Center Organization, and the Merck Foundation.

    Sawaya reporting having no relevant relationships with industry.

  • August 21, 2018 11:41 AM | Anonymous

    August 21, 2018, Medscape 

    The standard of care for human papillomavirus (HPV)-positive oropharyngeal cancer remains radiation therapy and cisplatin, say experts, after interim results from a large phase 3 trial comparing another regimen showed worse outcomes. Patients who were treated with radiation and cetuximab had worse overall and progression-free survival, but overall rates of serious (grade 3 to 5) adverse events were similar for both study groups. These top-line results from RTOG 1016 were outlined in a press release issued by the National Cancer Institute (NCI), which funded the trial. 

  • August 15, 2018 9:38 AM | Anonymous

    August 15,2018, Healio 

    Women in labor receiving IV remifentanil patient-controlled analgesia were half as likely to need a subsequent epidural than those receiving intramuscular pethidine injection, which is the current standard of care, according to data published in The Lancet.

    “Previous studies have shown that at least one in three women given pethidine to manage pain during labor require a subsequent epidural as the drug is not always effective. It also has unwanted side effects such as sedation and nausea for the mother, and it may pass into the baby’s bloodstream through the placenta,” Matthew J.A. Wilson, MD, from the School of Health and Related Research at the University of Sheffield, England, said in a press release.

    Remifentanil may be an alternative to pethidine but is not widely used or researched, according to Wilson and colleagues. Therefore, the researchers conducted a trial to investigate whether IV remifentanil patient-controlled analgesia during labor reduces the need for epidural analgesia and subsequent adverse maternal or neonatal events compared with intramuscular pethidine injection.

    A total of 400 women aged 16 years or older, beyond 37 weeks’ gestation were randomly assigned to receive either remifentanil (n = 201) or pethidine (n = 199) during labor if they requested opioid pain relief. Patients in the remifentanil group controlled their own IV drip and could receive a 40-g bolus of remifentanil on demand every 2 minutes. Patients in the pethidine group were injected with 100 mg of pethidine every 4 hours for up to 400 mg in a 24-hour period.

    All participants were able to request an epidural at any time. If patients received an epidural, the other form of pain relief was discontinued.

    The allocated drug was received by 93% of participants in the remifentanil group and 77% of participants in the pethidine group.

    The researchers found that 19% of patients in the remifentanil group and 41% of those in the pethidine group had an epidural (RR = 0.48; 95% CI, 0.34–0.66).

    Women in the remifentanil group reported that their pain was less severe than those in the pethidine group. The need for forceps and vacuum during labor was less common among women receiving remifentanil than those receiving pethidine (15% vs. 26%).

    The incidence of low oxygen levels was twice as likely among women in the remifentanil group than the pethidine group (14% vs. 5%). Additionally, supplementary oxygen was given to more patients in the remifentanil group.

    No serious adverse events or drug reactions were observed in either group.

    “Our findings challenge the routine use of pethidine for pain relief during labor,” Wilson said in the release. “Remifentanil reduced the need for an epidural by half and there were no lasting problems for the mothers and babies in our trial, although the effect of remifentanil on maternal oxygen levels needs to be clarified in further studies.” – by Alaina Tedesco

    Disclosure: The authors report no relevant financial disclosures.


  • August 08, 2018 10:13 AM | Anonymous

    August 8, 2018, JAAPA 

    Adverse reactions to hormonal contraceptives are a common patient concern. Alopecia, an adverse reaction to androgen activity caused by the progestin component of hormonal contraceptives, can cause considerable psychosocial distress for women. This article discusses how to identify the level of androgen activity in certain progestins, how increased androgen activity can lead to hair loss, and alternatives for patients experiencing androgenic alopecia due to high androgen index contraceptives.

    Read more.

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