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Preexposure Prophylaxis (PrEP) for HIV

Author/s: 
Matthew A Spinelli, Kenneth Ngure, Monica Gandhi

Preexposure prophylaxis (PrEP) involves use of antiviral medication for HIV prevention in HIV-negative adults or adolescents at risk for HIV through sex or injection drug use. The United Nations Programme on HIV/AIDS (UNAIDS) recently set a goal for 95% of people at risk of HIV (approximately 10 million people worldwide) to have access to and use PrEP in 2025, although only 3.5 million individuals at risk of HIV were receiving PrEP as of 2023. The UNAIDS 2024 global AIDS update reported no decrease in HIV incidence since 2021, with an estimated 1.3 million new infections reported globally in 2023.

Keywords 
prophylaxis Anti-HIV Agents HIV

Acupuncture for Recurrent Urinary Tract Infection in Women: A Systematic Review and Meta-Analysis

Author/s: 
Qin, X., Corle, M.E., Yang, L., Liang, J., Wang, K., Guo, X., Zhang, A.L., Mao, L., Lu, C., Xue, C.C., Liu, X.

Abstract

Background: Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI).

Objectives: To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women.

Search strategy: Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019.

Selection criteria: Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included.

Data collection and analysis: Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI).

Main results: Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I2 = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I2= 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92).

Conclusions: Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture.

Tweetable abstract: This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.

Keywords: Acupuncture; prophylaxis; recurrent urinary tract infection; systematic review; treatment.

Keywords 
treatment Acupuncture prophylaxis systematic review recurrent urinary tract infection
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