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Myanmar's democracy and health on life support
The Lancet
doi : 10.1016/S0140-6736(21)00656-5
EDITORIAL| VOLUME 397, ISSUE 10279, P1035, MARCH 20, 2021
COVID-19, community trials, and inclusion
Paramjit S Gill,Shoba Poduval,Jarnail S Thakur,Romaina Iqbal
doi : 10.1016/S0140-6736(21)00661-9
COMMENT| VOLUME 397, ISSUE 10279, P1036-1037, MARCH 20, 2021
Sustained neutralising antibodies in the Wuhan population suggest durable protection against SARS-CoV-2
Richard Strugnell,Nancy Wang
doi : 10.1016/S0140-6736(21)00434-7
COMMENT| VOLUME 397, ISSUE 10279, P1037-1039, MARCH 20, 2021
The risk of no risk in STEMI
Mai Tone L?nnebakken
doi : 10.1016/S0140-6736(21)00375-5
COMMENT| VOLUME 397, ISSUE 10279, P1039-1040, MARCH 20, 2021
Same script, different viruses: HIV and COVID-19 in US Black communities
Errol L Fields,Raniyah Copeland,Ernest Hopkins
doi : 10.1016/S0140-6736(20)32522-8
COMMENT| VOLUME 397, ISSUE 10279, P1040-1042, MARCH 20, 2021
Ending the HIV epidemic in US Latinx sexual and gender minorities
Carlos E Rodriguez-Diaz,Omar Martinez,Sean Bland,Jeffrey S Crowley
doi : 10.1016/S0140-6736(20)32521-6
COMMENT| VOLUME 397, ISSUE 10279, P1043-1045, MARCH 20, 2021
Roll-out of the Global Burden of Animal Diseases programme
J Rushton,B Huntington,W Gilbert,M Herrero,P R Torgerson,A P M Shaw,M Bruce,T L Marsh,D L Pendell,T M Bernardo,D Stacey,D Grace,K Watkins,M Bondad-Reantaso,B Devleesschauwer,D M Pigott,M Stone,S Mesenhowski
doi : 10.1016/S0140-6736(21)00189-6
COMMENT| VOLUME 397, ISSUE 10279, P1045-1046, MARCH 20, 2021
Biden's first legislative victory: $1·9 trillion for COVID-19
Susan Jaffe
doi : 10.1016/S0140-6736(21)00657-7
WORLD REPORT| VOLUME 397, ISSUE 10279, P1047-1048, MARCH 20, 2021
Aid agencies turn attention to diabetes
Sharmila Devi
doi : 10.1016/S0140-6736(21)00658-9
WORLD REPORT| VOLUME 397, ISSUE 10279, P1049-1050, MARCH 20, 2021
Chris Butler: primary care research supremo
Richard Lane
doi : 10.1016/S0140-6736(21)00583-3
PERSPECTIVES|PROFILE| VOLUME 397, ISSUE 10279, P1051, MARCH 20, 2021
Documenting the struggle for reproductive justice and rights
Lisa Hallgarten
doi : 10.1016/S0140-6736(21)00584-5
PERSPECTIVES|FILM| VOLUME 397, ISSUE 10279, P1052-1053, MARCH 20, 2021
Human flourishing in a health-creating society
Nigel Crisp
doi : 10.1016/S0140-6736(21)00585-7
PERSPECTIVES|THE ART OF MEDICINE| VOLUME 397, ISSUE 10279, P1054-1055, MARCH 20, 2021
Dame Fiona Caldicott
Geoff Watts
doi : 10.1016/S0140-6736(21)00586-9
OBITUARY| VOLUME 397, ISSUE 10279, P1056, MARCH 20, 2021
Antibody response to first BNT162b2 dose in previously SARS-CoV-2-infected individuals
Charlotte Manisty,Ashley D Otter,Thomas A Treibel,?ine McKnight,Daniel M Altmann,Timothy Brooks,Mahdad Noursadeghi,Rosemary J Boyton,Amanda Semper,James C Moon
doi : 10.1016/S0140-6736(21)00501-8
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1057-1058, MARCH 20, 2021
Undoing supremacy in global health will require more than decolonisation
Keerti Gedela
doi : 10.1016/S0140-6736(21)00383-4
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1058, MARCH 20, 2021
Undoing supremacy in global health will require more than decolonisation
Pascale Allotey,Daniel D Reidpath
doi : 10.1016/S0140-6736(21)00379-2
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1058, MARCH 20, 2021
Undoing supremacy in global health will require more than decolonisation – Authors' reply
Seye Abimbola,Madhukar Pai
doi : 10.1016/S0140-6736(21)00373-1
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1058-1059, MARCH 20, 2021
Osteoarthritis in 2020 and beyond
Manon Pigeolet,Anusha Jayaram,Kee B Park,John G Meara
doi : 10.1016/S0140-6736(21)00208-7
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1059-1060, MARCH 20, 2021
Osteoarthritis in 2020 and beyond – Authors' reply
David J Hunter,Lyn March,Mabel Chewon behalf of the commissioners for the Lancet Commission on osteoarthritis
doi : 10.1016/S0140-6736(21)00205-1
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1060, MARCH 20, 2021
Satiation or satiety? More than mere semantics
Tim Klaassen,Daniel Keszthelyi
doi : 10.1016/S0140-6736(21)00245-2
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1060-1061, MARCH 20, 2021
Satiation or satiety? More than mere semantics – Authors' reply
M Florencia Carbone,Sanjiv Mahadeva,Brian E Lacy,Nicholas J Talley,Alexander C Ford
doi : 10.1016/S0140-6736(21)00239-7
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1061, MARCH 20, 2021
Control vaccine formulation
Peter Doshi,Kyungwan Hong,Tom Jefferson,Mark Jones,Anisa Rowhani-Farid
doi : 10.1016/S0140-6736(21)00382-2
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1061-1062, MARCH 20, 2021
Control vaccine formulation – Authors' reply
Alfred J Saah,Nubia Mu?oz
doi : 10.1016/S0140-6736(21)00437-2
CORRESPONDENCE| VOLUME 397, ISSUE 10279, P1062, MARCH 20, 2021
Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial
PRINCIPLE Trial Collaborative Group
doi : 10.1016/S0140-6736(21)00461-X
ARTICLES| VOLUME 397, ISSUE 10279, P1063-1074, MARCH 20, 2021
Azithromycin, an antibiotic with potential antiviral and anti-inflammatory properties, has been used to treat COVID-19, but evidence from community randomised trials is lacking. We aimed to assess the effectiveness of azithromycin to treat suspected COVID-19 among people in the community who had an increased risk of complications.
Seroprevalence and humoral immune durability of anti-SARS-CoV-2 antibodies in Wuhan, China: a longitudinal, population-level, cross-sectional study
Zhenyu He,Lili Ren,Juntao Yang,Li Guo,Luzhao Feng,Chao Ma,Xia Wang,Zhiwei Leng,Xunliang Tong,Wang Zhou,Geng Wang,Ting Zhang,Yan Guo,Chao Wu,Qing Wang,Manqing Liu,Conghui Wang,Mengmeng Jia,Xuejiao Hu,Ying Wang,Xingxing Zhang,Rong Hu,Jingchuan Zhong,Jin Yang,Juan Dai,Lan Chen,Xiaoqi Zhou,Jianwei Wang,Weizhong Yang,Chen Wang
doi : 10.1016/S0140-6736(21)00238-5
ARTICLES| VOLUME 397, ISSUE 10279, P1075-1084, MARCH 20, 2021
Wuhan was the epicentre of the COVID-19 outbreak in China. We aimed to determine the seroprevalence and kinetics of anti-SARS-CoV-2 antibodies at population level in Wuhan to inform the development of vaccination strategies.
Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data
Gemma A Figtree,Stephen T Vernon,Nermin Hadziosmanovic,Johan Sundstr?m,Joakim Alfredsson,Clare Arnott,Vincent Delatour,Margrét Le?sd?ttir,Emil Hagstr?m
doi : 10.1016/S0140-6736(21)00272-5
ARTICLES| VOLUME 397, ISSUE 10279, P1085-1094, MARCH 20, 2021
In cardiovascular disease, prevention strategies targeting standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, hypercholesterolaemia, and smoking) are crucial; however, myocardial infarction in the absence of SMuRFs is not infrequent. The outcomes of individuals without SMuRFs are not well known.
18F-fluorodeoxyglucose PET/CT findings in a systemic inflammatory response syndrome after COVID-19 vaccine
Julie Steinberg,Alex Thomas,Amir Iravani
doi : 10.1016/S0140-6736(21)00464-5
CLINICAL PICTURE| VOLUME 397, ISSUE 10279, E9, MARCH 20, 2021
Epidemiology of HIV in the USA: epidemic burden, inequities, contexts, and responses
Patrick S Sullivan,Anna Satcher Johnson,Elizabeth S Pembleton,Rob Stephenson,Amy C Justice,Keri N Althoff,Heather Bradley,Amanda D Castel,Alexandra M Oster,Eli S Rosenberg,Kenneth H Mayer,Chris Beyrer
doi : 10.1016/S0140-6736(21)00395-0
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1095-1106, MARCH 20, 2021
The HIV epidemic in the USA began as a bicoastal epidemic focused in large cities but, over nearly four decades, the epidemiology of HIV has changed. Public health surveillance data can inform an understanding of the evolution of the HIV epidemic in terms of the populations and geographical areas most affected. We analysed publicly available HIV surveillance data and census data to describe: current HIV prevalence and new HIV diagnoses by region, race or ethnicity, and age; trends in HIV diagnoses over time by HIV acquisition risk and age; and the distribution of HIV prevalence by geographical area. We reviewed published literature to explore the reasons for the current distribution of HIV cases and important disparities in HIV prevalence. We identified opportunities to improve public health surveillance systems and uses of data for planning and monitoring public health responses. The current US HIV epidemic is marked by geographical concentration in the US South and profound disparities between regions and by race or ethnicity. Rural areas vary in HIV prevalence; rural areas in the South are more likely to have a high HIV prevalence than rural areas in other US Census regions. Ongoing disparities in HIV in the South are probably driven by the restricted expansion of Medicaid, health-care provider shortages, low health literacy, and HIV stigma. HIV diagnoses overall declined in 2009–18, but HIV diagnoses among individuals aged 25–34 years increased during the same period. HIV diagnoses decreased for all risk groups in 2009–18; among men who have sex with men (MSM), new diagnoses decreased overall and for White MSM, remained stable for Black MSM, and increased for Hispanic or Latino MSM. Surveillance data indicate profound and ongoing disparities in HIV cases, with disproportionate impact among people in the South, racial or ethnic minorities, and MSM.
HIV and women in the USA: what we know and where to go from here
Adaora A Adimora,Catalina Ramirez,Tonia Poteat,Nancie M Archin,Dawn Averitt,Judith D Auerbach,Allison L Agwu,Judith Currier,Monica Gandhi
doi : 10.1016/S0140-6736(21)00396-2
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1107-1115, MARCH 20, 2021
New diagnoses of HIV infection have decreased among women in the USA overall, but marked racial and geographical disparities persist. The federal government has announced an initiative that aims to decrease the number of new infections in the nation by 90% within the next 10 years. With this in mind, we highlight important recent developments concerning HIV epidemiology, comorbidities, treatment, and prevention among women in the USA. We conclude that, to end the US HIV epidemic, substantially greater inclusion of US women in clinical research will be required, as will better prevention and treatment efforts, with universal access to health care and other supportive services that enable women to exercise agency in their own HIV prevention and care. Ending the epidemic will also require eliminating the race, class, and gender inequities, as well as the discrimination and structural violence, that have promoted and maintained the distribution of HIV in the USA, and that will, if unchecked, continue to fuel the epidemic in the future.
The persistent and evolving HIV epidemic in American men who have sex with men
Kenneth H Mayer,LaRon Nelson,Lisa Hightow-Weidman,Matthew J Mimiaga,Leandro Mena,Sari Reisner,Demetre Daskalakis,Steven A Safren,Chris Beyrer,Patrick S Sullivan
doi : 10.1016/S0140-6736(21)00321-4
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1116-1126, MARCH 20, 2021
Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.
Insurance coverage and financing landscape for HIV treatment and prevention in the USA
Jennifer Kates,Lindsey Dawson,Tim H Horn,Amy Killelea,Nicole C McCann,Jeffrey S Crowley,Rochelle P Walensky
doi : 10.1016/S0140-6736(21)00397-4
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1127-1138, MARCH 20, 2021
In 2010, the US health insurance system underwent one of its most substantial transformations with the passage of the Affordable Care Act, which increased coverage for millions of people in the USA, including those with and at risk of HIV. Even so, the system of HIV care and prevention services in the USA is a complex patchwork of payers, providers, and financing mechanisms. People with HIV are primarily covered by Medicaid, Medicare, private insurance, or a combination of these; many get care through other programmes, particularly the Ryan White HIV/AIDS Program, which serves as the nation's safety net for people with HIV who remain uninsured or underinsured but offers modest to no support for prevention services. While uninsurance has drastically declined over the past decade, the USA trails other high-income countries in key HIV-specific metrics, including rates of viral suppression. In this paper in the Series, we provide an overview of the coverage and financing landscape for HIV treatment and prevention in the USA, discuss how the Affordable Care Act has changed the domestic health-care system, examine the major programmes that provide coverage and services, and identify remaining challenges.
The opioid crisis and HIV in the USA: deadly synergies
Sally L Hodder,Judith Feinberg,Steffanie A Strathdee,Steven Shoptaw,Frederick L Altice,Louis Ortenzio,Chris Beyrer
doi : 10.1016/S0140-6736(21)00391-3
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1139-1150, MARCH 20, 2021
The opioid epidemic is one of the greatest public health problems that the USA faces. Opioid overdose death rates have increased steadily for more than a decade and doubled in 2013–17, as the highly potent synthetic opioid fentanyl entered the drug supply. Demographics of new HIV diagnoses among people who inject drugs are also changing, with more new HIV diagnoses occurring among White people, young people (aged 13–34 years), and people who reside outside large central metropolitan areas. Racial differences also exist in syringe sharing, which decreased among Black people and Hispanic people but remained unchanged among White people in 2005–15. Recent HIV outbreaks have occurred in rural areas of the USA, as well as among marginalised people in urban areas with robust HIV prevention and treatment services (eg, Seattle, WA). Multiple evidence-based interventions can effectively treat opioid use disorder and prevent HIV acquisition. However, considerable barriers exist precluding delivery of these solutions to many people who inject drugs. If the USA is serious about HIV prevention among this group, stigma must be eliminated, discriminatory policies must change, and comprehensive health care must be accessible to all. Finally, root causes of the opioid epidemic such as hopelessness need to be identified and addressed.
Call to action: how can the US Ending the HIV Epidemic initiative succeed?
Chris Beyrer,Adaora A Adimora,Sally L Hodder,Ernest Hopkins,Greg Millett,Sandra Hsu Hnin Mon,Patrick S Sullivan,Rochelle P Walensky,Anton Pozniak,Mitchell Warren,Bruce Richman,Raniyah Copeland,Kenneth H Mayer
doi : 10.1016/S0140-6736(21)00390-1
SERIES|HIV IN THE USA| VOLUME 397, ISSUE 10279, P1151-1156, MARCH 20, 2021
With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care—advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.
