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Billioux VG, Chang LW, Reynolds SJ, Nakigozi G, Ssekasanvu J, Grabowski MK, Ssekubugu R, Nalugoda F, Kigozi G, Kagaayi J, Serwadda D, Gray RH, Wawer MJ. Human immunodeficiency virus care cascade among sub-populations in Rakai, Uganda: an observational study. J Int AIDS Soc 2017; 20:21590. [PMID: 28605171 PMCID: PMC5515027 DOI: 10.7448/ias.20.1.21590] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/18/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION To assess progress towards the UNAIDS 90-90-90 initiative targets, we examined the HIV care cascade in the population-based Rakai Community Cohort Study (RCCS) in rural Uganda and examined differences between sub-groups. METHODS Self-reports and clinical records were used to assess the proportion achieving each stage in the cascade. Statistical inference based on a χ2 test for categorical variables and modified Poisson regression were used to estimate prevalence risk ratios (PRRs) and 95% confidence intervals (CI) for enrolment into care and initiating antiretroviral therapy (ART). RESULTS From September 2013 through December 2015, 3,666 HIV-positive participants were identified in the RCCS. As of December 2015, 98% had received HIV Counseling and Testing (HCT), 74% were enrolled in HIV care, and 63% had initiated ART of whom 92% were virally suppressed after 12 months on ART. Engagement in care was lower among men than women (enrolment in care: adjPRR 0.84, 95% CI 0.77-0.91; ART initiation: adjPRR 0.75, 95% CI 0.69-0.82), persons aged 15-24 compared to those aged 30-39 (enrolment: adjPRR 0.72, 95% CI 0.63-0.82; ART: adjPRR 0.69, 95%CI 0.60-0.80), unmarried persons (enrolment: adjPRR 0.84, 95% CI 0.71-0.99; ART adjPRR 0.80, 95% CI 0.66-0.95), and new in-migrants (enrolment: adjPRR 0.75, 95% CI 0.67-0.83; ART: adjPRR 0.76, 95% CI 0.67-0.85). This cohort achieved 98-65-92 towards the UNAIDS "90-90-90" targets with an estimated 58% of the entire HIV-positive RCCS population virally suppressed. CONCLUSIONS This cohort achieved over 90% in both HCT and viral suppression among ART users, but only 65% in initiating ART, likely due to both an ART eligibility criterion of <500 CD4 cells/mL and suboptimal entry into care among men, younger individuals, and in-migrants. Interventions are needed to promote enrolment in HIV care, particular for hard-to-reach sub-populations.
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Affiliation(s)
- Veena G. Billioux
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Larry W. Chang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven J. Reynolds
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gertrude Nakigozi
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Joseph Ssekasanvu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Mary K. Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Robert Ssekubugu
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Fred Nalugoda
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Godfrey Kigozi
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Joseph Kagaayi
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - David Serwadda
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
- Department of Disease Control & Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Ronald H. Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Maria J. Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Rakai Community Cohort Study, Rakai Health Sciences Program, Kalisizo, Uganda
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Efficacy of a Social Self-Value Empowerment Intervention to Improve Quality of Life of HIV Infected People Receiving Antiretroviral Treatment in Nepal: A Randomized Controlled Trial. AIDS Behav 2017; 21:1620-1631. [PMID: 27613646 PMCID: PMC5422450 DOI: 10.1007/s10461-016-1546-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We developed a comprehensive and culturally applicable empowerment intervention social self-value package with an aim to assess its efficacy in order to improve the quality of life (QoL) of HIV infected people receiving antiretroviral treatment. Participants were randomly allocated to receive either six weekly intervention sessions or standard care. Nonlinear mixed-effects models were performed to compare changes in empowerment scores over time. Between September and November 2014, 1447 individuals were screened, of whom 132 were randomly assigned to either the intervention or control group. The mean scores of empowerment, social support and quality of life increased and stigma scores were reduced in the intervention group at 3- and 6-months. An intervention effect on social support, stigma and QoL was significantly increased by time and group with low and high empowerment. No adverse events were reported. The empowerment intervention was efficacious in improving QoL of HIV infected people.
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Martins R, Silva GL, Andreozzi V. Joint analysis of longitudinal and survival AIDS data with a spatial fraction of long-term survivors: A Bayesian approach. Biom J 2017; 59:1166-1183. [PMID: 28464317 DOI: 10.1002/bimj.201600159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/05/2022]
Abstract
A typical survival analysis with time-dependent covariates usually does not take into account the possible random fluctuations or the contamination by measurement errors of the variables. Ignoring these sources of randomness may cause bias in the estimates of the model parameters. One possible way for overcoming that limitation is to consider a longitudinal model for the time-varying covariates jointly with a survival model for the time to the event of interest, thereby taking advantage of the complementary information flowing between these two-model outcomes. We employ here a Bayesian hierarchical approach to jointly model spatial-clustered survival data with a fraction of long-term survivors along with the repeated measurements of CD4+ T lymphocyte counts for a random sample of 500 HIV/AIDS individuals collected in all the 27 states of Brazil during the period 2002-2006. The proposed Bayesian joint model comprises two parts: on the one hand, a flexible model using Penalized Splines to better capture the nonlinear behavior of the different CD4 profiles over time; on the other hand, a spatial cure model to cope with the set of long-term survivor individuals. Our findings show that joint models considering this set of patients were the ones with the best performance comparatively to the more traditional survival approach. Moreover, the use of spatial frailties allowed us to map the heterogeneity in the disease risk among the Brazilian states.
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Affiliation(s)
- Rui Martins
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Escola Superior de Saúde Egas Moniz, Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Giovani L Silva
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Bloco C6 - Piso 4, Campo Grande, 1749-016, Lisboa, Portugal.,Departamento de Matemática-Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, 1049-001, Lisboa, Portugal
| | - Valeska Andreozzi
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Bloco C6 - Piso 4, Campo Grande, 1749-016, Lisboa, Portugal.,Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, 130, 1169-056, Lisboa, Portugal
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Matza LS, Chung KC, Kim KJ, Paulus TM, Davies EW, Stewart KD, McComsey GA, Fordyce MW. Risks associated with antiretroviral treatment for human immunodeficiency virus (HIV): qualitative analysis of social media data and health state utility valuation. Qual Life Res 2017; 26:1785-1798. [PMID: 28341926 PMCID: PMC5486893 DOI: 10.1007/s11136-017-1519-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 01/03/2023]
Abstract
Purpose Despite benefits of antiretroviral therapies (ART), people with HIV infection have increased risk of cardiovascular disease, kidney disease, and low bone mineral density. Some ARTs increase risk of these events. The purpose of this study was to examine patients’ perspectives of these risks and estimate health state utilities associated with these risks for use in cost-utility models. Methods Qualitative thematic analysis was conducted to examine messages posted to the POZ/AIDSmeds Internet community forums, focusing on bone, kidney, and cardiovascular side effects and risks of HIV/AIDS medications. Then, health state vignettes were drafted based on this qualitative analysis, literature review, and clinician interviews. The health states (representing HIV, plus treatment-related risks) were valued in time trade-off interviews with general population participants in the UK. Results Qualitative analysis of the Internet forums documented patient concerns about ART risks, as well as treatment decisions made because of these risks. A total of 208 participants completed utility interviews (51.4% female; mean age 44.6 years). The mean utility of the HIV health state (virologically suppressed, treated with ART) was 0.86. Adding a description of risk resulted in statistically significant disutility (i.e., utility decreases): renal risk (disutility = −0.02), bone risk (−0.03), and myocardial infarction risk (−0.05). Conclusions Patient concerns and treatment decisions were documented via qualitative analysis of Internet forum discussions, and the impact of these concerns was quantified in terms of health state utilities. The resulting disutilities may be useful for differentiating among ARTs in economic modeling of treatment for patients with HIV.
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Affiliation(s)
- Louis S Matza
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | | | | | | | | | - Katie D Stewart
- Outcomes Research, Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
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de Bruin M, Oberjé EJM, Viechtbauer W, Nobel HE, Hiligsmann M, van Nieuwkoop C, Veenstra J, Pijnappel FJ, Kroon FP, van Zonneveld L, Groeneveld PHP, van Broekhuizen M, Evers SMAA, Prins JM. Effectiveness and cost-effectiveness of a nurse-delivered intervention to improve adherence to treatment for HIV: a pragmatic, multicentre, open-label, randomised clinical trial. THE LANCET. INFECTIOUS DISEASES 2017; 17:595-604. [PMID: 28262598 DOI: 10.1016/s1473-3099(16)30534-5] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 11/14/2016] [Accepted: 11/24/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND No high-quality trials have provided evidence of effectiveness and cost-effectiveness of HIV treatment adherence intervention strategies. We therefore examined the effectiveness and cost-effectiveness of the Adherence Improving self-Management Strategy (AIMS) compared with treatment as usual. METHODS We did a pragmatic, multicentre, open-label, randomised controlled trial in seven HIV clinics at academic and non-academic hospitals in the Netherlands. Eligible participants were patients with HIV who were either treatment experienced (ie, with ≥9 months on combination antiretroviral therapy [ART] and at risk of viral rebound) or treatment-naive patients initiating their first combination ART regimen. We randomly assigned participants (1:1) to either AIMS or treatment as usual (ie, containing a range of common adherence intervention strategies) using a computer-generated randomisation table. Randomisation was stratified by treatment experience (experienced vs naive) and included block randomisation at nurse level with randomly ordered blocks of size four, six, and eight. 21 HIV nurses from the participating clinics received three training sessions of 6 h each (18 h in total) on AIMS and a 1·5 h booster training session at the clinic (two to three nurses per session) after each nurse had seen two to three patients. AIMS was delivered by nurses during routine clinic visits. We did mixed-effects, intent-to-treat analyses to examine treatment effects on the primary outcome of log10 viral load collected at months 5, 10, and 15. The viral load results were exponentiated (with base 10) for easier interpretation. Using cohort data from 7347 Dutch patients with HIV to calculate the natural course of illness, we developed a lifetime Markov model to estimate the primary economic outcome of lifetime societal costs per quality-adjusted life-years (QALYs) gained. This trial is registered at ClinicalTrials.gov (number NCT01429142). FINDINGS We recruited participants between Sept 1, 2011, and April 2, 2013; the last patient completed the study on June 16, 2014. The intent-to-treat sample comprised 221 patients; 109 assigned to AIMS and 112 to treatment as usual. Across the three timepoints (months 5, 10, and 15), log viral load was 1·26 times higher (95% CI 1·04-1·52) in the treatment-as-usual group (estimated marginal mean 44·5 copies per mL [95% CI 35·5-55·9]) than in the AIMS group (estimated marginal mean 35·4 copies per mL [29·9-42·0]). Additionally, AIMS was cost-effective (ie, dominant: cheaper and more effective) since it reduced lifetime societal costs by €592 per patient and increased QALYs by 0·034 per patient. INTERPRETATION Findings from preparatory studies have shown that AIMS is acceptable, feasible to deliver in routine care, and has reproducible effects on medication adherence. In this study, AIMS reduced viral load, increased QALYs, and saved resources. Implementation of AIMS in routine clinical HIV care is therefore recommended. FUNDING Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Marijn de Bruin
- University of Aberdeen, Institute of Applied Health Sciences, Aberdeen, UK; Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands.
| | - Edwin J M Oberjé
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Hans-Erik Nobel
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI School for Public Health & Primary Care, Maastricht University, Maastricht, Netherlands
| | | | - Jan Veenstra
- Sint Lucas Andreas Hospital, Amsterdam, Netherlands
| | - Frank J Pijnappel
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
| | - Frank P Kroon
- Leiden University Medical Centre, Leiden, Netherlands
| | | | | | | | - Silvia M A A Evers
- Department of Health Services Research, CAPHRI School for Public Health & Primary Care, Maastricht University, Maastricht, Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Center of Economic Evaluations, Utrecht, Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
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Abstract
INTRODUCTION Tenofovir alafenamide is a new oral prodrug of tenofovir resulting in relatively low plasma levels and rapid uptake into peripheral blood mononuclear cells in its active form. The United States Food and Drug Administration has now approved this drug coformulated with elvitegravir/cobicistat/emtricitabine, rilpivirine/emtricitabine and emtricitabine. United States guidelines now list this formulation as one of the preferred components of a variety of antiretroviral regimens, and is included as an alternative in other international guidelines, with the notable exception of the World Health Organization, mostly due to limited availability. Areas covered: This review covers pre-clinical and clinical data searched through PubMed up to August 2016. Expert opinion: Tenofovir alafenamide is effective as part of an antiretroviral regimen. There is also compelling data that it has less adverse effects on bone mineral density and possibly kidneys than tenofovir disoproxil fumarate. Although approved for use in those with estimated glomerular filtration rates as low as 30 mL/min, data is somewhat limited in this group. While there are few reasons to not use tenofovir alafenamide as a substitute for tenofovir disoproxil fumarate, the former should not be used with rifamycins, is not yet recommended in pregnancy and needs to be studied further before it can be considered as part of a pre-exposure prophylaxis regimen.
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Affiliation(s)
- Katya C Corado
- a Division of HIV Medicine, Department of Internal Medicine , Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance CA , USA
| | - Eric S Daar
- a Division of HIV Medicine, Department of Internal Medicine , Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance CA , USA
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Ji Y, Wang Z, Shen J, Chen J, Yang J, Qi T, Song W, Tang Y, Liu L, Shen Y, Zhang R, Lu H. Trends and characteristics of all-cause mortality among HIV-infected inpatients during the HAART era (2006-2015) in Shanghai, China. Biosci Trends 2017; 11:62-68. [PMID: 28132999 DOI: 10.5582/bst.2016.01195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Globally, the overall mortality rate among HIV-infected patients has significantly declined during the HAART era. Deaths among HIV-infected inpatients need to be characterized in order to formulate intervention strategies to further improve medical care for this population and their prognosis. In the current study, deaths among HIV-infected inpatients from 2006 to 2015 at a medical center for HIV infection and AIDS patient care in Shanghai, China were retrospectively analyzed. Trends in mortality rates and the proportion of deaths caused by AIDS or non-AIDS-related illnesses were evaluated. A bivariate analysis was performed to identify the demographic and clinical factors associated with AIDS or non-AIDS-related deaths among HIV-infected inpatients. Among 6,473 HIV-infected patients who were discharged from 2006 to 2015, 326 deaths (5.04%) were identified. The yearly mortality rate declined significantly over time (χ2 = 34.41, p < 0.001). Results revealed that most deaths were attributed to AIDS-related illnesses (76.9 %, 233/303), and the proportion of causes of death did not change significantly over time (χ2 = 13.847, p = 0.127). Bivariate analysis identified characteristic factors associated with AIDS-related mortality. Compared to patients who died of non-AIDS illnesses, patients who died of AIDS-related illnesses had a CD4+ T cell count lower than 50 cells/μL (OR 4.587, 2.377-8.850) and fewer liver (OR 0.391, 0.177-0.866) or renal comorbidities (OR 0.188, 0.067-0.523) on admission. Results indicated that the overall in-hospital mortality rate among HIV-infected patients has declined over the past decade. However, AIDS-related illnesses were still the major causes of deaths among HIV-infected inpatients, suggesting that further efforts are needed to improve AIDS care in China.
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Affiliation(s)
- Yongjia Ji
- Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University
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An epidemiological modelling study to estimate the composition of HIV-positive populations including migrants from endemic settings. AIDS 2017; 31:417-425. [PMID: 27831947 DOI: 10.1097/qad.0000000000001329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Migrants account for a significant number of people living with HIV in Europe, and it is important to fully consider this population in national estimates. Using a novel approach with the UK as an example, we present key public health measures of the HIV epidemic, taking into account both in-country infections and infections likely to have been acquired abroad. DESIGN Mathematical model calibrated to extensive data sources. METHODS An individual-based stochastic simulation model is used to calibrate to routinely collected surveillance data in the UK. Data on number of new HIV diagnoses, number of deaths, CD4 cell count at diagnosis, as well as time of arrival into the UK for migrants and the annual number of people receiving care were used. RESULTS An estimated 106 400 (90% plausibility range: 88 700-124 600) people were living with HIV in the UK in 2013. Twenty-three percent of these people, 24 600 (15 000-36 200) were estimated to be undiagnosed; this number has remained stable over the last decade. An estimated 32% of the total undiagnosed population had CD4 cell count less than 350 cells/μl in 2013. Twenty-five and 23% of black African men and women heterosexuals living with HIV were undiagnosed respectively. CONCLUSION We have shown a working example to characterize the HIV population in a European context which incorporates migrants from countries with generalized epidemics. Despite all aspects of HIV care being free and widely available to anyone in need in the UK, there is still a substantial number of people who are not yet diagnosed and thus not in care.
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160
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Senard O, Burdet C, Visseaux B, Charpentier C, Le Gac S, Julia Z, Lariven S, Descamps D, Yazdanpanah Y, Yeni P, Joly V. Epidemiological Profile of Newly Diagnosed HIV-Infected Patients in Northern Paris: A Retrospective Study. AIDS Res Hum Retroviruses 2017; 33:11-16. [PMID: 27476681 DOI: 10.1089/aid.2016.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In attempt to identify the factors associated with delayed diagnosis during HIV infection, we studied retrospectively the epidemiological profile of HIV-infected patients diagnosed between January 1, 2012 and December 31, 2013 and followed in our clinical center in Paris. Data were compared to those obtained at the same site during the year 2003. One hundred eighty-six patients fulfilled the inclusion criteria: 49 (26%) had a CD4 count <200/mm3 at diagnosis. Compared to subjects with CD4 count ≥200/mm3, advanced patients were older, had a higher plasma viral load, had more often an AIDS-defining event at the time of HIV diagnosis (45% vs. 3%), had been infected more often through heterosexual contact (69% vs. 44%), had less frequently past HIV testing (23% vs. 63%), and tended to live in less favorable conditions. A higher proportion of these patients initiated antiretroviral therapy in the 3 months following diagnosis (93.9% vs. 48.1%). Compared to data obtained in 161 patients in 2003, the proportions of advanced patients were similar between the two periods (26% vs. 22%). There was a significant increase from year 2003 to the 2012-2013 period in the proportion of men who have sex with men (MSM) (50% vs. 27%) and in the percentage of patients infected with HIV-1 subtype B (48% vs. 27%) and with positive syphilis serology (22% vs. 8%). Our data show that (1) HIV screening should be extended to populations with the following characteristics: older age, heterosexuality, and low socioeconomic level, and (2) HIV transmission continues to progress in MSM, arguing for the value of preexposure prophylaxis.
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Affiliation(s)
- Olivia Senard
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Charles Burdet
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Biostatistique, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Benoit Visseaux
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Sylvie Le Gac
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Zélie Julia
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Sylvie Lariven
- Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Patrick Yeni
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
| | - Véronique Joly
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat, AP-HP, Paris, France
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Hernandez-Romieu AC, Garg S, Rosenberg ES, Thompson-Paul AM, Skarbinski J. Is diabetes prevalence higher among HIV-infected individuals compared with the general population? Evidence from MMP and NHANES 2009-2010. BMJ Open Diabetes Res Care 2017; 5:e000304. [PMID: 28191320 PMCID: PMC5293823 DOI: 10.1136/bmjdrc-2016-000304] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/18/2016] [Accepted: 11/23/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Nationally representative estimates of diabetes mellitus (DM) prevalence among HIV-infected adults in the USA are lacking, and whether HIV-infected adults are at increased risk of DM compared with the general adult population remains controversial. METHODS We used nationally representative survey (2009-2010) data from the Medical Monitoring Project (n=8610 HIV-infected adults) and the National Health and Nutrition Examination Survey (n=5604 general population adults) and fit logistic regression models to determine and compare weighted prevalences of DM between the two populations, and examine factors associated with DM among HIV-infected adults. RESULTS DM prevalence among HIV-infected adults was 10.3% (95% CI 9.2% to 11.5%). DM prevalence was 3.8% (CI 1.8% to 5.8%) higher in HIV-infected adults compared with general population adults. HIV-infected subgroups, including women (prevalence difference 5.0%, CI 2.3% to 7.7%), individuals aged 20-44 (4.1%, CI 2.7% to 5.5%), and non-obese individuals (3.5%, CI 1.4% to 5.6%), had increased DM prevalence compared with general population adults. Factors associated with DM among HIV-infected adults included age, duration of HIV infection, geometric mean CD4 cell count, and obesity. CONCLUSIONS 1 in 10 HIV-infected adults receiving medical care had DM. Although obesity contributes to DM risk among HIV-infected adults, comparisons to the general adult population suggest that DM among HIV-infected persons may develop at earlier ages and in the absence of obesity.
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Affiliation(s)
| | - Shikha Garg
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eli S Rosenberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Angela M Thompson-Paul
- Division of Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Phillips AN, Cambiano V, Nakagawa F, Bansi-Matharu L, Sow PS, Ehrenkranz P, Ford D, Mugurungi O, Apollo T, Murungu J, Bangsberg DR, Revill P. Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. PLoS One 2016; 11:e0167654. [PMID: 27977702 PMCID: PMC5157976 DOI: 10.1371/journal.pone.0167654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/17/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. METHODS An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. FINDINGS In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. CONCLUSION The cost thresholds identified suggest that there is clear scope for adherence monitoring-based interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.
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Affiliation(s)
- Andrew N Phillips
- Research Department of Infection & Population Health, UCL, London, United Kingdom
| | - Valentina Cambiano
- Research Department of Infection & Population Health, UCL, London, United Kingdom
| | - Fumiyo Nakagawa
- Research Department of Infection & Population Health, UCL, London, United Kingdom
| | | | - Papa Salif Sow
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Peter Ehrenkranz
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Deborah Ford
- Institute for Clinical Trials and Methodology, UCL, London, United Kingdom
| | | | | | | | - David R. Bangsberg
- Oregon Health Sciences University-Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Paul Revill
- Centre for Health Economics, University of York, York, United Kingdom
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163
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Serious Non-AIDS Events: Therapeutic Targets of Immune Activation and Chronic Inflammation in HIV Infection. Drugs 2016; 76:533-49. [PMID: 26915027 DOI: 10.1007/s40265-016-0546-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the antiretroviral therapy (ART) era, serious non-AIDS events (SNAEs) have become the major causes of morbidity and mortality in HIV-infected persons. Early ART initiation has the strongest evidence for reducing SNAEs and mortality. Biomarkers of immune activation, inflammation and coagulopathy do not fully normalize despite virologic suppression and persistent immune activation is an important contributor to SNAEs. A number of strategies aimed to reduce persistent immune activation including ART intensification to reduce residual viremia; treatment of co-infections to reduce chronic antigen stimulation; the use of anti-inflammatory agents, reducing microbial translocation as well as interventions to improve immune recovery through cytokine administration and reducing lymphoid tissue fibrosis, have been investigated. To date, there is little conclusive evidence on which strategies beyond treatment of hepatitis B and C co-infections and reducing cardiovascular risk factors will result in clinical benefits in patients already on ART with viral suppression. The use of statins seems to show early promise and larger clinical trials are underway to confirm their efficacy. At this stage, clinical care of HIV-infected patients should therefore focus on early diagnosis and prompt ART initiation, treatment of active co-infections and the aggressive management of co-morbidities until further data are available.
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Mendes-Bastos P, Brasileiro A, Matos-Pires E, Rodrigues I, Marques C, Coelho-Macias V, Fernandes C. De novo HIV infection diagnoses in a Department of Dermatology and Venereology in Lisbon, Portugal. Int J STD AIDS 2016; 28:887-892. [PMID: 27815548 DOI: 10.1177/0956462416679279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Portugal has the highest prevalence rate of HIV infection in Western Europe. The proportion of patients with a late diagnosis, carried out in full-blown AIDS stage, remains high. Skin and mucous membrane manifestations are not rare in these patients. Objective A demographic, clinical, and laboratorial characterization of patients with de novo HIV infection diagnosis made in the Department of Dermatology and Venereology of a central hospital in Lisbon, Portugal. Methods Retrospective review of medical records of adult patients newly diagnosed with HIV infection (reactive immunoassay for antibodies to HIV-1/HIV-2 or HIV p24 antigen) in the Dermatology and Venereology Department of a Portuguese central hospital in the period between January 2005 and December 2013. Results During the study period, 97 new cases were diagnosed, 70 men and 27 women. The median age at diagnosis was 36 years. Of the total, 50 cases were diagnosed with a concomitant sexually transmitted infection (STI), more frequently syphilis and ano-genital HPV infection. The remaining 47 patients were diagnosed with other dermatological conditions such as prurigo nodularis, psoriasis, and Kaposi's sarcoma. The duration of complaints that lead to medical attention ranged from <1 week to 8 years, being significantly lower in patients diagnosed with a concomitant STI ( p < 0.01). Basal viral load was also lower in this group of patients ( p < 0.05). Of all the new diagnosed cases, 80% of patients are currently retained in care. Conclusion This study grants a descriptive overview of de novo HIV infection diagnoses performed by dermatovenereologists in a central hospital in Lisbon, Portugal. As in the past, the importance of Dermato-Venereology for HIV infection diagnosis remains present in daily clinical practice.
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Affiliation(s)
- Pedro Mendes-Bastos
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ana Brasileiro
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Eugénia Matos-Pires
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Isaura Rodrigues
- 2 Department of Laboratory Medicine/Clinical Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Cristina Marques
- 2 Department of Laboratory Medicine/Clinical Pathology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Vasco Coelho-Macias
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Cândida Fernandes
- 1 Department of Dermatology and Venereology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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166
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Kowalska JD, Shepherd L, Ankiersztejn-Bartczak M, Cybula A, Czeszko-Paprocka H, Firląg-Burkacka E, Mocroft A, Horban A. Poor Linkage to Care Despite Significant Improvement in Access to Early cART in Central Poland - Data from Test and Keep in Care (TAK) Project. PLoS One 2016; 11:e0162739. [PMID: 27711159 PMCID: PMC5053409 DOI: 10.1371/journal.pone.0162739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The main objective of the TAK project is investigating barriers in accessing HIV care after HIV-diagnosis at the CBVCTs of central Poland. Here we describe factors associated with and changes over time in linkage to care and access to cART. METHOD Data collected in 2010-2013 in CBVCTs were linked with HIV clinics records using unique identifiers. Individuals were followed from the day of CBVCTs visit until first clinical visit or 4/06/2014. Cox-proportional hazard models were used to identify factors associated with being linked to care and starting cART. RESULTS In total 232 persons were diagnosed HIV-positive and 144 (62.1% 95%CI: 55.5-68.3) persons were linked to care. There was no change over time in linkage to care (p = 0.48), while time to starting cART decreased (p = 0.02). Multivariate factors associated with a lower rate of linkage to care were hetero/bisexual sexual orientation, lower education, not having an HIV-positive partner and not using condoms in a stable relationship. Multivariate factors associated with starting cART were lower education, recent year of linked to care, and first HIV RNA and CD4 cell count. CONCLUSIONS Benefits of linkage to care, measured by access to early treatment, steadily improved in recent years. However at least 1 in 3 persons aware of their HIV status in central Poland remained outside professional healthcare. Persons at higher risk of remaining outside care, thus target population for future interventions, are bi/heterosexuals and those with lower levels of education.
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Affiliation(s)
- Justyna D. Kowalska
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- * E-mail:
| | - Leah Shepherd
- Department of Infection and Population Health, University College London, London, United Kingdom
| | | | - Aneta Cybula
- Medical University of Warsaw, Department of Infectious and Tropical Diseases and Hepatology, Warsaw, Poland
| | | | | | - Amanda Mocroft
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Andrzej Horban
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
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167
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Gurski KF, Hoffman KA. Influence of concurrency, partner choice, and viral suppression on racial disparity in the prevalence of HIV infected women. Math Biosci 2016; 282:91-108. [PMID: 27712990 DOI: 10.1016/j.mbs.2016.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/28/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
In 1992, Watts and May introduced a simple dynamical systems model of the spread of HIV based on disease transmission per partnership including the length of partnership duration. This model allowed for the treatment of concurrent partnerships, although it was hampered by the assumption of an important latent phase which generated a non-autonomous system. Subsequent models including concurrency have been based on networks, Monte Carlo, and stochastic simulations which lose a qualitative understanding of the effects of concurrency. We present a new autonomous deterministic model of the effect of concurrent sexual partnerships that allows for an analytical study of disease transmission. We incorporate the effect of concurrency through the newly derived force of infection term in a mathematical model of the transmission of HIV through sexual contact in a population stratified by sexual behavior and race/ethnicity. The model also includes variations in population mixing (partner choice) and non-uniform Highly Active Anti-Retroviral Treatment (HAART) leading to viral suppression. We use this mathematical model to understand the non-uniform spread of HIV in women who were infected through heterosexual contact. In addition, an analytical study shows the importance of continued condom use in virally suppressed MSM. Numerical simulations of the reproduction number as a function of concurrency, viral suppression level, and mixing show a reservoir of disease present in both heterosexual and MSM populations. Statistical analysis of parameter values show that viral suppression level, mixing and progression to AIDS without viral suppression have a strong correlation (either positive or negative) with the number of HIV positive women. Concurrency and assortative mixing are shown to be essential to reproduce infection levels in women, as reported by 2010 data from the Center for Disease Control (CDC).
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Affiliation(s)
- K F Gurski
- Department of Mathematics, Howard University, Washington, DC 20059, United States.
| | - K A Hoffman
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD, United States
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Maulsby C, Valdiserri RO, Kim JJ, Mahon N, Flynn A, Eriksson E, Jain KM, Enobun B, Holtgrave DR. The Global Engagement in Care Convening: Recommended Actions to Improve Health Outcomes for People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:405-416. [PMID: 27710081 DOI: 10.1521/aeap.2016.28.5.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The National HIV AIDS Strategy (NHAS) calls for a more coordinated response to the HIV epidemic. The Global Engagement in Care Convening created a forum for domestic and international experts to identify best practices in HIV care. This manuscript summarizes the meeting discussions and recommendations from meeting notes and an audio recording of the meeting. Recommendations include: further standardization of performance goals and performance measures; additional research; a more robust system to support competing needs of clients receiving services; electronic information exchanges for HIV-related data; an expansion of the role of other health professionals to extend the capacity of physicians and other members of the care team; and revisions to current financing systems to increase reimbursement for and access to services that promote linkage to and retention in HIV care. The recommendations provide a unique example of "reverse technical assistance" and will inform U.S. program development, research, and policy.
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Affiliation(s)
- C Maulsby
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - R O Valdiserri
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - J J Kim
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - N Mahon
- M·A·C AIDS Fund and Global Philanthropy and Corporate Citizenship, The Estée Lauder Companies, Inc
| | - A Flynn
- M·A·C AIDS Fund, New York, New York
| | | | - K M Jain
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - Blessing Enobun
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
| | - D R Holtgrave
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Health, Baltimore, Maryland
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169
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Swartz JA. A Multi-Group Latent Class Analysis of Chronic Medical Conditions Among Men Who Have Sex with Men. AIDS Behav 2016; 20:2418-2432. [PMID: 27037547 DOI: 10.1007/s10461-016-1381-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Until recently, research on the health of gay and other men who have sex with men (MSM) has focused on risk for and the health consequences of HIV and other sexually transmitted infections. A multigroup latent class analysis examined a range of lifetime chronic medical conditions (CMCs) among MSM. Covariates included sociodemographics, substance use, psychological distress, and HIV serostatus. A two-class model best fit the medical condition data: a low probabilities class for most CMCs and a moderate to high probabilities (MHP) class. HIV serostatus was associated with increased within-class probabilities for some CMCs, particularly gastrointestinal and skin disorders. Only increasing age and use of erectile dysfunction drugs were directly associated with increased odds of being in the MHP class whereas methamphetamine use, identifying as gay, and lower alcohol use were indirectly associated. Implications of the findings for future research and the health care needs of MSM are discussed.
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Affiliation(s)
- James A Swartz
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 W. Harrison Street, (M/C 309), Chicago, IL, 60607, USA.
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170
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Nichols BE, Boucher CAB, van der Valk M, Rijnders BJA, van de Vijver DAMC. Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study. THE LANCET. INFECTIOUS DISEASES 2016; 16:1423-1429. [PMID: 27665989 DOI: 10.1016/s1473-3099(16)30311-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 08/01/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with tenofovir and emtricitabine prevents HIV infections among men who have sex with men (MSM). PrEP can be given on a daily or intermittent basis. Unfortunately, PrEP is not reimbursed in most European countries. Cost-effectiveness analyses of PrEP among MSM in Europe are absent but are key for decision makers to decide upon PrEP implementation. METHODS We developed a deterministic mathematical model, calibrated to the well defined Dutch HIV epidemic among MSM, to predict the effect and cost-effectiveness of PrEP. PrEP was targeted to 10% of highly sexually active Dutch MSM over the coming 40 years. Cost-effectiveness ratios were calculated to predict the cost-effectiveness of daily and on-demand PrEP. Cost-effectiveness ratios below €20 000 were considered to be cost-effective in this analysis. FINDINGS Within the context of a stable HIV epidemic, at 80% effectiveness and current PrEP pricing, PrEP can cost as much as €11 000 (IQR 9400-14 100) per quality-adjusted life-year (QALY) gained when used daily, or as little as €2000 (IQR 1300-3000) per QALY gained when used on demand. At 80% effectiveness, daily PrEP can be considered cost-saving if the price of PrEP is reduced by 70%, and on-demand PrEP can be considered cost-saving if the price is reduced by 30-40%. INTERPRETATION PrEP for HIV prevention among MSM in the Netherlands is cost-effective. The use of PrEP is most cost-effective when the price of PrEP is reduced through on-demand use or through availability of generic PrEP, and can quickly be considered cost-saving. FUNDING None.
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Affiliation(s)
- Brooke E Nichols
- Department of Viroscience, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | - Bart J A Rijnders
- Department of Internal Medicine, Section Infectious Diseases, Erasmus Medical Center, Rotterdam, Netherlands
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171
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Omland LH, Legarth R, Ahlström MG, Sørensen HT, Obel N. Five-year risk of HIV diagnosis subsequent to 147 hospital-based indicator diseases: a Danish nationwide population-based cohort study. Clin Epidemiol 2016; 8:333-40. [PMID: 27660491 PMCID: PMC5019186 DOI: 10.2147/clep.s101288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It has been suggested that targeted human immunodeficiency virus (HIV) testing programs are cost-effective in populations with an HIV prevalence >0.1%. Several indicator diseases are known to be associated with increased risk of HIV infection, but estimates of HIV frequency in persons with relevant indicator diseases are nonexistent. Methods In a nationwide population-based cohort study encompassing all Danish residents aged 20–60 years during 1994–2013, we estimated the 5-year risk of an HIV diagnosis (FYRHD) after a first-time diagnosis of 147 prespecified potential indicator diseases. To estimate the risk of HIV diagnosis in the general population without any indicator diseases, we calculated the FYRHD starting at age 25, 35, 45, and 55 years. Results The risk in the male general population was substantially higher than the female general population, and the risk was lower in the older age categories. Individuals of African origin had a higher FYRHD than individuals of Danish origin. A number of diseases were identified with a FYRHD >0.1%, with infectious diseases, such as syphilis, hepatitis, and endocarditis, associated with a particularly high FYRHD. Other potential indicator diseases, such as most urologic, nephrologic, rheumatologic, and endocrine disorders were generally associated with a low FYRHD. Conclusion Our study identified a large number of indicator diseases associated with a FYRHD >0.1%. These data can be used as a tool for planning targeted HIV screening programs.
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Rebecca Legarth
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen
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172
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Abstract
Patients diagnosed late in the course of HIV infection are at an increased risk of negative health outcomes and are more likely to transmit HIV to others. Using the CDC's definition for AIDS, we analyzed case report data from persons diagnosed with AIDS within 12 months of an HIV diagnosis ("late-to-test") in Riverside County, CA, between 2009 and 2014. Of 1385 HIV cases, 422 (30.5%) were late-to-test. Factors associated with late-to-test were: having no insurance (P = 0.005), being Hispanic (P = 0.002) and being between 45 and 64 years of age (P < 0.001). Females (P = 0.013) and those in the eastern region of Riverside County (P = 0.002) were less likely to be late-to-test. In the absence of universal HIV testing, interventions to decrease late testing are needed.
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Affiliation(s)
- Aaron T. Gardner
- Epidemiology & Program Evaluation Branch, Riverside University Health System Public Health
- Correspondence: Aaron T. Gardner, Epidemiology & Program Evaluation Branch, Riverside University Health System-Public Health, Riverside, CA (e-mail: )
| | - Rachaline Napier
- Epidemiology & Program Evaluation Branch, Riverside University Health System Public Health
| | - Brandon Brown
- University of California, Riverside, School of Medicine, Center for Healthy Communities, Riverside, CA
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Vera-Villarroel P, Valtierra A, Contreras D. Affectivity as mediator of the relation between optimism and quality of life in men who have sex with men with HIV. Int J Clin Health Psychol 2016; 16:256-265. [PMID: 30487869 PMCID: PMC6225089 DOI: 10.1016/j.ijchp.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/18/2016] [Indexed: 11/24/2022] Open
Abstract
Background/Objective: Increased life expectancy has made quality of life the primary objective in the care of chronic patients and people living with HIV. It found evidence of the link between optimism, quality of life and well-being. This article aimed to determine whether affectivity in its two dimensions (positive and negative) played a mediating role in the association between optimism and quality of life in men living with HIV. Method: 116 men living with HIV (the average age was 36.8 years (SD=9.06), and the average time from the diagnosis was 8.2 years) responded to three instruments: Life Orientation Test revised version (LOT-R), the Positive and Negative Affect Schedule (PANAS) and the World Health Organization Quality of Life-Bref (WHOQoL-Bref). Results: The results showed that positive affect had no mediating effect, whereas negative affect mediated the relation of optimism with two quality-of-life dimensions (overall quality of life and environment). Conclusion: In conclusion, negative affect was found to participate only partially, acting as a mediating variable.
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Affiliation(s)
- Pablo Vera-Villarroel
- Universidad de Santiago de Chile (USACH) and Centro de Innovación en Tecnologías de la Información para Aplicaciones Sociales (CITIAPS), Chile
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Millard T, Agius PA, McDonald K, Slavin S, Girdler S, Elliott JH. The Positive Outlook Study: A Randomised Controlled Trial Evaluating Online Self-Management for HIV Positive Gay Men. AIDS Behav 2016; 20:1907-18. [PMID: 26896121 DOI: 10.1007/s10461-016-1301-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper was to evaluate the effectiveness of an online self-management program in improving health outcomes and well-being for gay men living with HIV in Australia. The online Positive Outlook Program was based on self-efficacy theory and used a self-management approach to enhance HIV-positive gay men's skills, confidence and abilities to manage the psychosocial issues associated with HIV in daily life. The 7-week program was delivered in closed groups and comprised information modules, action-planning activities, moderated discussion boards, and weekly peer-facilitated 'live chats'. A randomised controlled trial was conducted to establish the effectiveness of the Positive Outlook program compared to a 'usual care' control. Participants were HIV-positive gay men 18 years or older living in Australia. Primary outcomes were evaluated at three time-points (baseline, post-intervention and 12-week's post-intervention follow-up) and included HIV-related quality of life (PROQOL-HIV), outcomes of health education (HeiQ) and HIV specific self-efficacy (Positive Outlook Self-Efficacy Scale). A total of 132 gay men with HIV in Australia were randomly allocated to the intervention (n = 68) or usual care control (n = 64) groups. Maximum likelihood marginal-linear modelling indicated significant improvement in the intervention group on the PROQOL-HIV subscales of body change (p = 0.036), social relationships (p = 0.035) and emotional distress (p = 0.031); the HeiQ subscales of health-directed activity (p = 0.048); constructive attitudes and approaches (p = 0.015); skill and technique acquisition (p = 0.046) and health service navigation (p = 0.008); and the Positive Outlook Self-Efficacy Scale on the subscales of relationships (p = 0.019); social participation (p = 0.006); and emotions (p = 0.041). Online delivery of self-management programs is feasible and has the potential to improve quality of life, self-management skills and domain specific self-efficacy for gay men with HIV.
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Affiliation(s)
- Tanya Millard
- Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia.
| | - Paul A Agius
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Karalyn McDonald
- Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Jean Hailes Research Unit, Monash University, Melbourne, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Sean Slavin
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
| | - Julian H Elliott
- Department of Infectious Diseases, Monash University, Level 2 Burnet Tower, 85 Commercial Road, Melbourne, 3004, Australia
- Centre for Population Health, Burnet Institute, Melbourne, Australia
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
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175
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Miners AH, Llewellyn CD, Cooper VL, Youssef E, Pollard AJ, Lagarde M, Sabin C, Nixon E, Sachikonye M, Perry N, Fisher M. A discrete choice experiment to assess people living with HIV's (PLWHIV's) preferences for GP or HIV clinic appointments. Sex Transm Infect 2016; 93:105-111. [PMID: 27535762 PMCID: PMC5339551 DOI: 10.1136/sextrans-2016-052643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/30/2016] [Accepted: 07/17/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To understand which aspects of general practitioner (GP) and HIV clinic appointments people living with HIV (PLWHIV) most value when seeking advice for new health problems. METHODS A discrete choice experiment using a convenience sample of people diagnosed with HIV. Participants were recruited from 14 general HIV clinics in the South East of England between December 2014 and April 2015. ORs were calculated using conditional logit (CLOGIT) and latent class models (LCMs). RESULTS A total of 1106 questionnaires were returned. Most participants were male (85%), white (74%) and were men who have sex with men (69%). The CLOGIT analysis showed people particularly valued shorter appointment waiting times (ORs between 1.52 and 3.62, p<0.001 in all instances). The LCM analysis showed there were two distinct classes, with 59% and 41% of respondents likely to be in each. The first class generally preferred GP to HIV clinic appointments and particularly valued 'being seen quickly'. For example, they had strong preferences for shorter appointment waiting times and longer GP opening hours. People in the second class also valued shorter waiting times, but they had a strong general preference for HIV clinic rather than GP appointments. CONCLUSIONS PLWHIV value many aspects of care for new health problems, particularly short appointment waiting times. However, they appear split in their general willingness to engage with GPs.
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Affiliation(s)
- A H Miners
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - C D Llewellyn
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - V L Cooper
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - E Youssef
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - A J Pollard
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
| | - M Lagarde
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - C Sabin
- HIV Epidemiology & Biostatistics Group, University College London, London, UK
| | - E Nixon
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - M Sachikonye
- UK Community Advisory Board Country (UKCAB), London, UK
| | - N Perry
- Brighton and Sussex Clinical Trials Unit, Brighton and Sussex Medical Schools, Brighton, UK
| | - M Fisher
- Department of Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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176
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Flowers P, Riddell J, Park C, Ahmed B, Young I, Frankis J, Davis M, Gilbert M, Estcourt C, Wallace L, McDaid LM. Preparedness for use of the rapid result HIV self-test by gay men and other men who have sex with men (MSM): a mixed methods exploratory study among MSM and those involved in HIV prevention and care. HIV Med 2016; 18:245-255. [PMID: 27492141 PMCID: PMC5347967 DOI: 10.1111/hiv.12420] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
Abstract
Objectives The aim of the study was to explore preparedness for the HIV self‐test among men who have sex with men (MSM) and those involved in HIV prevention and care. Methods A mixed methods exploratory research design was employed, detailing awareness and willingness to use the self‐test and the perceived barriers and facilitators to implementation. Quantitative and qualitative data collection and analysis were completed in parallel. Descriptive and inferential analysis of cross‐sectional bar‐based survey data collected from MSM through a self‐completed questionnaire and oral fluid specimen collection (n = 999) was combined with qualitative, thematic, analysis of data collected through 12 expert focus groups (n = 55) consisting of gay men, National Health Service (NHS) staff, community organizations, entrepreneurs and activists. Findings were subsequently combined and assessed for synergies. Results Among MSM, self‐test awareness was moderate (55%). Greater awareness was associated with increased educational attainment [adjusted odds ratio 1.51; 95% confidence interval (CI) 1.00–2.30; P = 0.05] and previous history of sexually transmitted infection (STI) testing (adjusted odds ratio 1.63; 95% CI 1.11–2.39; P = 0.01). Willingness to use the test was high (89%) and associated with meeting sexual partners online (unadjusted odds ratio 1.96; 95% CI 1.31–2.94; P < 0.001). Experts highlighted the overall acceptability of self‐testing; it was understood as convenient, discreet, accessible, and with a low burden to services. However, some ambivalence towards self‐testing was reported; it could reduce opportunities to engage with wider services, wider health issues and the determinants of risk. Conclusions Self‐testing represents an opportunity to reduce barriers to HIV testing and enhance prevention and access to care. Levels of awareness are moderate but willingness to use is high. Self‐testing may amplify health inequalities.
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Affiliation(s)
- P Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - J Riddell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - C Park
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - B Ahmed
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - I Young
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - J Frankis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - M Davis
- School of Social Sciences, Monash University, Melbourne, Vic., Australia
| | - M Gilbert
- Applied Epidemiology Unit, Ontario HIV Treatment Network, Toronto, ON, Canada
| | - C Estcourt
- Barts and the London School of Medicine and Dentistry, Barts Sexual Health Centre, Blizard Institute, London, UK
| | - L Wallace
- Health Protection Scotland, Glasgow, UK
| | - L M McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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177
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Stonbraker S, Befus M, Nadal LL, Halpern M, Larson E. Evaluating the utility of provider-recorded clinical status in the medical records of HIV-positive adults in a limited-resource setting. Int J STD AIDS 2016; 28:685-692. [PMID: 27495146 DOI: 10.1177/0956462416663990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Provider-reported summaries of clinical status may assist with clinical management of HIV in resource poor settings if they reflect underlying biological processes associated with HIV disease progression. However, their ability to do so is rarely evaluated. Therefore, we aimed to assess the relationship between a provider-recorded summary of clinical status and indicators of HIV progression. Data were abstracted from 201 randomly selected medical records at a large HIV clinic in the Dominican Republic. Multivariable logistic regressions were used to examine the relationship between provider-assigned clinical status and demographic (gender, age, nationality, education) and clinical factors (reported medication adherence, CD4 cell count, viral load). The mean age of patients was 41.2 (SD = ±10.9) years and most were female (n = 115, 57%). None of the examined characteristics were significantly associated with provider-recorded clinical status. Higher CD4 cell counts were more likely for females (OR = 2.2 CI: 1.12-4.31) and less likely for those with higher viral loads (OR = 0.33 CI: 0.15-0.72). Poorer adherence and lower CD4 cell counts were significantly associated with higher viral loads (OR = 4.46 CI: 1.11-20.29 and 6.84 CI: 1.47-37.23, respectively). Clinics using provider-reported summaries of clinical status should evaluate the performance of these assessments to ensure they are associated with biologic indicators of disease progression.
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Affiliation(s)
| | - Montina Befus
- 2 Department of Epidemiology, Mailman School of Public Health, NY, USA
| | | | - Mina Halpern
- 3 Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Elaine Larson
- 1 Columbia University School of Nursing, NY, USA.,2 Department of Epidemiology, Mailman School of Public Health, NY, USA
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178
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Hile SJ, Feldman MB, Alexy ER, Irvine MK. Recent Tobacco Smoking is Associated with Poor HIV Medical Outcomes Among HIV-Infected Individuals in New York. AIDS Behav 2016; 20:1722-9. [PMID: 26837623 PMCID: PMC4942487 DOI: 10.1007/s10461-015-1273-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tobacco smoking is associated with adverse health effects among people living with HIV (PLWH), including a higher risk of cancer and cardiovascular problems. Further, there is evidence that PLWH are two to three times more likely to smoke than the general population. The aim of this study was to examine the association between tobacco smoking and biomarkers of HIV disease progression, including unsuppressed viral load (viral load >200 copies/mL) and low CD4 cell count (<200 cells/mm(3)). Recent tobacco smoking was reported by 40 % (n = 5942) of 14,713 PLWH enrolled in Ryan White Part A programs in the New York City metropolitan area. In multivariate analyses controlling for sociodemographic and clinical characteristics, recent tobacco smoking was independently associated with unsuppressed viral load (AOR = 1.38, CI 1.26-1.50) and low CD4 cell count (AOR = 1.12, CI 1.01-1.24). Findings suggest the importance of routine assessments of tobacco use in clinical care settings for PLWH.
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179
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Bello KJ, Mesner O, O'Bryan TA, Won SH, Lalani T, Ganesan A, Agan BK, Okulicz JF. Factors associated with 10 years of continuous viral load suppression on HAART. BMC Infect Dis 2016; 16:351. [PMID: 27449671 PMCID: PMC4957300 DOI: 10.1186/s12879-016-1677-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 06/09/2016] [Indexed: 12/03/2022] Open
Abstract
Background The principal goal of HAART is sustained viral load (VL) suppression resulting in immune reconstitution and improved HIV outcomes. We studied the factors associated with 10 years of continuous VL suppression on HAART in the US Military HIV Natural History Study. Methods Participants with continuous VL suppression (CS, n = 149) were compared to those who did not have continuous viral load suppression (NCS, n = 127) for ≥10 years on HAART. Factors associated with >10 years of VL suppression were evaluated by multivariate logistic regression. Additionally, association between CS and CD4 reconstitution was analyzed with a mixed effects model. Results Compared to NCS participants, a lower proportion of CS participants started HAART in the early HAART era (66 vs 90 %, for years 1996–1999; p < 0.001) and had less antiretroviral use prior to HAART (37 vs 83 %; p < 0.001). At initial HAART, the median CD4 cell count was higher and VL was lower for CS compared to NCS participants (375 cells/uL [256, 499] vs 261 cells/uL [146, 400]; p < 0.001 and 4.4 log10 copies/mL [3.5, 4.9] vs 4.5 log10 copies/mL [3.8, 5.0]; p = 0.048, respectively). New AIDS events were lower during HAART (5 vs 13 %; p = 0.032) and post-HAART CD4 trajectories were greater for the CS compared to NCS group. Factors negatively associated with ≥10 years of VL suppression included log10 VL at first HAART (OR 0.61, 95 % CI 0.4, 0.92; p = 0.020) and antiretroviral use prior to HAART (OR 0.16, 95 % CI 0.06, 0.38; p < .001). Conclusions Sustained VL suppression is a key to long-term health in HIV-infected patients, as demonstrated by the lower proportion of AIDS events observed 10 years after HAART initiation. The current use of more potent and well-tolerated regimens may mitigate the negative factors of pre-HAART VL and prior ARV use encountered by treatment initiated in the early HAART era.
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Affiliation(s)
- Kathryn J Bello
- Internal Medicine Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA
| | - Octavio Mesner
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Thomas A O'Bryan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Naval Medical Center, 620 John Paul Jones Circle, Portsmouth, 23708, VA, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, 20889, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive #100, Bethesda, 20817, MD, USA
| | - Jason F Okulicz
- Internal Medicine Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA. .,Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, 20814, MD, USA. .,Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, 78234, TX, USA.
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180
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Lindboe JB, Langkilde A, Eugen-Olsen J, Hansen BR, Haupt TH, Petersen J, Andersen O. Low-dose growth hormone therapy reduces inflammation in HIV-infected patients: a randomized placebo-controlled study. Infect Dis (Lond) 2016; 48:829-37. [PMID: 27417288 DOI: 10.1080/23744235.2016.1201722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) has drastically increased the life expectancy of HIV-infected patients. However, HIV-infected patients exhibit increased inflammation and 33-58% exhibit a characteristic fat re-distribution termed HIV-associated lipodystrophy syndrome (HALS). Recombinant human growth hormone (rhGH) has been tested as treatment of HALS. Low-dose rhGH therapy improves thymopoiesis and fat distribution in HIV-infected patients and appears to be well tolerated. However, since high-dose rhGH is associated with adverse events related to inflammation, we wanted to investigate the impact of low-dose rhGH therapy on inflammation in HIV-infected patients. METHODS Forty-six cART-treated HIV-infected men were included in the HIV-GH low-dose (HIGH/Low) study: a randomized, placebo-controlled, double-blinded trial. Subjects were randomized 3:2 to 0.7 mg/day rhGH, or placebo for 40 weeks. rhGH was self-administered between 1 pm and 3 pm. The primary outcome of this substudy was changes in inflammation measured by plasma C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor (suPAR). RESULTS Both CRP (-66%, p = 0.002) and suPAR (-9.7%, p = 0.06) decreased in the rhGH group compared to placebo; however, only CRP decreased significantly. The effect of rhGH on inflammation was not mediated through rhGH-induced changes in insulin-like growth factor 1, body composition, or immune parameters. CONCLUSION Daily 0.7 mg rhGH treatment for 40 weeks, administered at nadir endogenous GH secretion, significantly reduced CRP. The effect does not appear to be mediated by other factors. Our findings suggest that low-dose rhGH treatment may minimize long-term risks associated with high-dose rhGH therapy.
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Affiliation(s)
- Johanne Bjerre Lindboe
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Anne Langkilde
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Jesper Eugen-Olsen
- b Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Birgitte R Hansen
- b Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,c Department of Infectious Diseases , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Thomas H Haupt
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
| | - Janne Petersen
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,d Department of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Ove Andersen
- a Optimed, Clinical Research Centre 056, Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;,c Department of Infectious Diseases , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark
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181
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Brennan A, Horgan M, Jackson A, Browne JP, Bergin CJ. Utilisation patterns and cost of hospital care for people living with HIV in Ireland in 2012: a single-centre study. Int J STD AIDS 2016; 28:229-237. [PMID: 27000297 DOI: 10.1177/0956462416640167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data on the pattern and cost of health service use by HIV patients are required for evaluations of the cost-effectiveness of new drugs and technologies as well as being essential for service planning. The aim of this study was to identify the utilisation patterns and cost of hospital care for HIV patients in a single centre in Ireland in 2012. Data on the frequency and non-drug costs of all hospital resources used by HIV patients were extracted from a hospital activity-based costing system. Cost data were analysed using a generalised linear model. A total of 328 patients, 3672 patient months, were included in this study. Patients had a mean of 4.4 scheduled infectious disease outpatient appointments per patient year; 37% of patients also used another outpatient service, 15% in-patient services, 4% day-case service and 18% emergency department services in 2012. Patients with very advanced HIV disease continue to incur a disproportionate amount of the total cost of providing care. This study provides baseline utilisation and cost data for use of both infectious-disease and non-infectious disease hospital services and will be useful for service planning in light of the likely increases in resource demands.
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Affiliation(s)
- Aline Brennan
- 1 Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Mary Horgan
- 2 School of Medicine, University College Cork, Cork, Ireland.,3 Cork University Hospital, Cork, Ireland
| | | | - John P Browne
- 1 Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Colm J Bergin
- 4 St James's Hospital, Dublin, Ireland.,5 School of Medicine, Trinity College, Dublin, Ireland
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182
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Hull M, Shafran S, Wong A, Tseng A, Giguère P, Barrett L, Haider S, Conway B, Klein M, Cooper C. CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 Updated Canadian HIV/Hepatitis C Adult Guidelines for Management and Treatment. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2016; 2016:4385643. [PMID: 27471521 PMCID: PMC4947683 DOI: 10.1155/2016/4385643] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2015] [Indexed: 12/13/2022]
Abstract
Background. Hepatitis C virus (HCV) coinfection occurs in 20-30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Purpose. To update national standards for management of HCV-HIV coinfected adults in the Canadian context with evolving evidence for and accessibility of effective and tolerable DAA therapies. The document addresses patient workup and treatment preparation, antiviral recommendations overall and in specific populations, and drug-drug interactions. Methods. A standing working group with HIV-HCV expertise was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published HCV antiviral data and update Canadian HIV-HCV Coinfection Guidelines. Results. The gap in sustained virologic response between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All coinfected individuals should be assessed for interferon-free, Direct Acting Antiviral HCV therapy. Regimens vary in content, duration, and success based largely on genotype. Reimbursement restrictions forcing the use of pegylated interferon is not acceptable if optimal patient care is to be provided. Discussion. Recommendations may not supersede individual clinical judgement. Treatment advances published since December 2015 are not considered in this document.
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Affiliation(s)
- Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada V6T 1Z4
| | | | - Alex Wong
- Regina Qu'Appelle Health Region, Regina, SK, Canada S4P 1E2
| | - Alice Tseng
- Toronto General Hospital, Toronto, ON, Canada M5G 2C4
| | | | - Lisa Barrett
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC, Canada V6Z 2C7
| | | | - Curtis Cooper
- The Ottawa Hospital, General Campus, G12, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
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183
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Marrone G, Mellgren Å, Eriksson LE, Svedhem V. High Concordance between Self-Reported Adherence, Treatment Outcome and Satisfaction with Care Using a Nine-Item Health Questionnaire in InfCareHIV. PLoS One 2016; 11:e0156916. [PMID: 27310201 PMCID: PMC4911158 DOI: 10.1371/journal.pone.0156916] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 12/29/2022] Open
Abstract
Background In this cross-sectional study we present an integrated analysis of a self-reported Health Questionnaire and socio-demographic and treatment outcome data from the national Swedish HIV cohort, InfCareHIV. Objectives To evaluate the Health Questionnaire and identify the main determinants of adherence. Methods A total of 2,846 patients answered a nine-item disease-specific Health Questionnaire between 2012 and 2014, corresponding to 44% of all active patients in the national InfCareHIV cohort. The questionnaire assessed patient related outcome measures (PROMs) regarding health and antiretroviral treatment (ART) and patient related experience measures (PREMs) regarding involvement in care and satisfaction with the care provider. Result We found the Health Questionnaire to be valid and reliable when used in ordinary clinical practice. There was a high concordance between self-reported adherence to ART in the past seven days and treatment outcome, with 94% of patients who reported optimal adherence having a viral load <50 copies/ml. The main determinants of optimal adherence were heterosexual transmission path, being born in Sweden, being male, not reporting experience of ART side effects and being fully satisfied with care. Conclusion The nine-item Health Questionnaire can identify patients at risk of treatment failure, those in need of clinical assessment of adverse events and those with impaired physical health.
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Affiliation(s)
- Gaetano Marrone
- Department of Infectious Diseases and Clinical Virology, Karolinska University Hospital, Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - Åsa Mellgren
- Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden
| | - Lars E. Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- School of Health Sciences, City University London, London, United Kingdom
| | - Veronica Svedhem
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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184
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Pool ERM, Dogar O, Lindsay RP, Weatherburn P, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database Syst Rev 2016; 2016:CD011120. [PMID: 27292836 PMCID: PMC8604206 DOI: 10.1002/14651858.cd011120.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
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Affiliation(s)
- Erica RM Pool
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Omara Dogar
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingHeslingtonYorkUKYO10 5DD
| | - Ryan P Lindsay
- Idaho State UniversityDepartment of Community and Public HealthMeridianIdahoUSA
| | - Peter Weatherburn
- London School of Hygiene and Tropical MedicineSigma Research, Department of Social & Environmental Health ResearchLondonUK
| | - Kamran Siddiqi
- York UniversityDepartment of Health Sciences/Hull York Medical SchoolYorkUKYO10 5DD
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Evolution of Neuroadaptation in the Periphery and Purifying Selection in the Brain Contribute to Compartmentalization of Simian Immunodeficiency Virus (SIV) in the Brains of Rhesus Macaques with SIV-Associated Encephalitis. J Virol 2016; 90:6112-6126. [PMID: 27122578 DOI: 10.1128/jvi.00137-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/16/2016] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED The emergence of a distinct subpopulation of human or simian immunodeficiency virus (HIV/SIV) sequences within the brain (compartmentalization) during infection is hypothesized to be linked to AIDS-related central nervous system (CNS) neuropathology. However, the exact evolutionary mechanism responsible for HIV/SIV brain compartmentalization has not been thoroughly investigated. Using extensive viral sampling from several different peripheral tissues and cell types and from three distinct regions within the brain from two well-characterized rhesus macaque models of the neurological complications of HIV infection (neuroAIDS), we have been able to perform in-depth evolutionary analyses that have been unattainable in HIV-infected subjects. The results indicate that, despite multiple introductions of virus into the brain over the course of infection, brain sequence compartmentalization in macaques with SIV-associated CNS neuropathology likely results from late viral entry of virus that has acquired through evolution in the periphery sufficient adaptation for the distinct microenvironment of the CNS. IMPORTANCE HIV-associated neurocognitive disorders remain prevalent among HIV type 1-infected individuals, whereas our understanding of the critical components of disease pathogenesis, such as virus evolution and adaptation, remains limited. Building upon earlier findings of specific viral subpopulations in the brain, we present novel yet fundamental results concerning the evolutionary patterns driving this phenomenon in two well-characterized animal models of neuroAIDS and provide insight into the timing of entry of virus into the brain and selective pressure associated with viral adaptation to this particular microenvironment. Such knowledge is invaluable for therapeutic strategies designed to slow or even prevent neurocognitive impairment associated with AIDS.
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Siddiqi AEA, Irene Hall H, Hu X, Song R. Population-Based Estimates of Life Expectancy After HIV Diagnosis: United States 2008-2011. J Acquir Immune Defic Syndr 2016; 72:230-6. [PMID: 26890283 PMCID: PMC4876430 DOI: 10.1097/qai.0000000000000960] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Using National HIV surveillance system data, we estimated life expectancy and average years of life lost (AYLL) among persons diagnosed with HIV infection during 2008-2011. METHODS Population-based surveillance data, restricted to persons with diagnosed HIV infection aged 13 years or older, from all 50 states and Washington, D.C. were used to estimate life expectancy after HIV diagnosis using the life table method. Generated estimates were compared with life expectancy in the general population in the same calendar year to calculate AYLL. Life expectancy and AYLL were also estimated for subgroups by age, sex, and race/ethnicity. RESULTS The overall life expectancy after HIV diagnosis in the United States increased by 3.43 years from 25.43 (95% CI: 25.37 to 25.49) in 2008 to 28.86 (95% CI: 28.80 to 28.92) in 2011. Improvements were observed irrespective of sex, race/ethnicity, transmission category, and stage of disease at diagnosis, though the extent of improvement varied by different characteristics. Based on the life expectancy in the general population, in 2010, the AYLL were 12.8 years for males and 16.5 years for females. By race/ethnicity, on average, blacks (13.3 years) and whites (13.4 years) had fewer AYLL than Hispanics/Latinos (14.7). CONCLUSIONS Despite improvements in life expectancy among people diagnosed with an HIV infection during 2008-2011, disparities by sex and by race/ethnicity persist. Targeted efforts should continue to further reduce disparities and improve life expectancy after HIV diagnosis.
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Affiliation(s)
- Azfar-e-Alam Siddiqi
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - H. Irene Hall
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Xiaohong Hu
- HIV Incidence and Case Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
| | - Ruiguang Song
- Quantitative Sciences and Data Management Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
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187
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Simmons R, Kall M, Collins S, Cairns G, Taylor S, Nelson M, Fidler S, Porter K, Fox J. A global survey of HIV-positive people's attitudes towards cure research. HIV Med 2016; 18:73-79. [PMID: 27167600 DOI: 10.1111/hiv.12391] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Involvement of people living with HIV (PLHIV) in the design of HIV cure studies is important, given the potential risks to participants. We present results of an international survey of PLHIV to define these issues and inform cure research. METHODS PLHIV were recruited in June-November 2014 through HIV websites, advocacy forums, social media and 12 UK HIV clinics. The survey included questions concerning demographics, HIV disease history, the desirability of types of cure and the patient's willingness to accept potential toxicity and treatment interruption (TI). We examined factors associated with TI and willingness to accept substantial risks. RESULTS A total of 982 PLHIV completed the survey; 87% were male, 79% white and 81% men who have sex with men (MSM). Fifty-one per cent were aged 25-44 years and 69% were UK residents. The median time since diagnosis was 7 years [interquartile range (IQR) 2-17 years]. Eighty-eight per cent were receiving antiretrovirals (91% reported undetectable viral load). Health/wellbeing improvements (96%) and an inability to transmit HIV (90%) were more desirable cure characteristics than testing HIV-negative (69%). Ninety-five per cent were interested in participating in cure studies, and 59% were willing to accept substantial risks. PLHIV with a low CD4 count [201-350 cells/μL vs. ≥ 350 cells/μL; odds ratio (OR) 2.11; 95% confidence interval (CI) 1.11-4.00] were more likely to accept risks, whereas those with limited knowledge of HIV treatments vs. excellent/good knowledge and those aged ≥ 65 years vs. 45-64 years were less likely to accept risks [OR 0.58 (95% CI 0.37-0.90) and OR 0.18 (95% CI 0.07-0.45), respectively]. TI was acceptable for 62% of participants, with the main concerns being becoming unwell (82%), becoming infectious (76%) and HIV spreading through the body (76%). CONCLUSIONS Cure research was highly acceptable to the PLHIV surveyed. Most individuals would accept risks, including TI, even in the absence of personal benefit. An optimal cure would improve health and minimize onward transmission risk.
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Affiliation(s)
- R Simmons
- MRC, Clinical Trials Unit University College, London, UK
| | - M Kall
- Public Health England, London, UK
| | | | | | - S Taylor
- Birmingham Heartlands Hospital, Birmingham, UK
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | | | - K Porter
- MRC, Clinical Trials Unit University College, London, UK
| | - J Fox
- Guy's and St Thomas' Hospital, London, UK
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188
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Siddiqi K, Mdege N. Smoking: A Major Roadblock in the Fight Against AIDS. Nicotine Tob Res 2016; 18:2175-2176. [PMID: 27146640 PMCID: PMC5103933 DOI: 10.1093/ntr/ntw130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences University of York York, United Kingdom
| | - Noreen Mdege
- Department of Health Sciences University of York York, United Kingdom
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189
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Pett SL, Amin J, Horban A, Andrade-Villanueva J, Losso M, Porteiro N, Sierra Madero J, Belloso W, Tu E, Silk D, Kelleher A, Harrigan R, Clark A, Sugiura W, Wolff M, Gill J, Gatell J, Fisher M, Clarke A, Ruxrungtham K, Prazuck T, Kaiser R, Woolley I, Arnaiz JA, Cooper D, Rockstroh JK, Mallon P, Emery S. Maraviroc, as a Switch Option, in HIV-1-infected Individuals With Stable, Well-controlled HIV Replication and R5-tropic Virus on Their First Nucleoside/Nucleotide Reverse Transcriptase Inhibitor Plus Ritonavir-boosted Protease Inhibitor Regimen: Week 48 Results of the Randomized, Multicenter MARCH Study. Clin Infect Dis 2016; 63:122-32. [PMID: 27048747 DOI: 10.1093/cid/ciw207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/23/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alternative combination antiretroviral therapies in virologically suppressed human immunodeficiency virus (HIV)-infected patients experiencing side effects and/or at ongoing risk of important comorbidities from current therapy are needed. Maraviroc (MVC), a chemokine receptor 5 antagonist, is a potential alternative component of therapy in those with R5-tropic virus. METHODS The Maraviroc Switch Study is a randomized, multicenter, 96-week, open-label switch study in HIV type 1-infected adults with R5-tropic virus, virologically suppressed on a ritonavir-boosted protease inhibitor (PI/r) plus double nucleoside/nucleotide reverse transcriptase inhibitor (2 N(t)RTI) backbone. Participants were randomized 1:2:2 to current combination antiretroviral therapy (control), or replacing the protease inhibitor (MVC + 2 N(t)RTI arm) or the nucleoside reverse transcriptase inhibitor backbone (MVC + PI/r arm) with twice-daily MVC. The primary endpoint was the difference (switch minus control) in proportion with plasma viral load (VL) <200 copies/mL at 48 weeks. The switch arms were judged noninferior if the lower limit of the 95% confidence interval (CI) for the difference in the primary endpoint was < -12% in the intention-to-treat (ITT) population. RESULTS The ITT population comprised 395 participants (control, n = 82; MVC + 2 N(t)RTI, n = 156; MVC + PI/r, n = 157). Baseline characteristics were well matched. At week 48, noninferior rates of virological suppression were observed in those switching away from a PI/r (93.6% [95% CI, -9.0% to 2.2%] and 91.7% [95% CI, -9.6% to 3.8%] with VL <200 and <50 copies/mL, respectively) compared to the control arm (97.6% and 95.1% with VL <200 and <50 copies/mL, respectively). In contrast, MVC + PI/r did not meet noninferiority bounds and was significantly inferior (84.1% [95% CI, -19.8% to -5.8%] and 77.7% [95% CI, -24.9% to -8.4%] with VL <200 and <50 copies/mL, respectively) to the control arm in the ITT analysis. CONCLUSIONS These data support MVC as a switch option for ritonavir-boosted PIs when partnered with a 2-N(t)RTI backbone, but not as part of N(t)RTI-sparing regimens comprising MVC with PI/r. CLINICAL TRIALS REGISTRATION NCT01384682.
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Affiliation(s)
- Sarah Lilian Pett
- The Kirby Institute, University of New South Wales, Sydney, Australia Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology Clinical Research Group, Infection and Population Health, University College London, United Kingdom
| | - Janaki Amin
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrejz Horban
- Wojewodzki Szpital Zakazny Centrum Diagnostyki i Terapii AIDS, Warsaw, Poland
| | | | - Marcelo Losso
- Hospital General de Agudos J M Ramos Mejia Fundación IBIS Coordinacion de Investigacion Clinica Academica en Latinoamerica
| | - Norma Porteiro
- Fundación Infectologia de Atencion Ambulatoria, Buenos Aires, Argentina
| | - Juan Sierra Madero
- Instituto Nacional de Ciencias Medicas y Nutriciòn Salvador Zubiran, Tlalpan, Mexico
| | - Waldo Belloso
- Fundación IBIS Coordinacion de Investigacion Clinica Academica en Latinoamerica Hospital Italiano de Buenos Aires, Argentina
| | - Elise Tu
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Silk
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Anthony Kelleher
- The Kirby Institute, University of New South Wales, Sydney, Australia St Vincent's Hospital, Sydney, Australia
| | - Richard Harrigan
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | | | | | - John Gill
- Southern Alberta Clinic, Calgary, Canada
| | | | - Martin Fisher
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | - Amanda Clarke
- Brighton and Sussex University Hospitals National Health Service Trust, Brighton, United Kingdom
| | - Kiat Ruxrungtham
- HIV Netherlands, Australia, Thailand Research Collaboration, Bangkok
| | - Thierry Prazuck
- Orleans Hospital (Centre Hospitalier Regional D'Orleans Orleans La Source), France
| | | | | | | | - David Cooper
- The Kirby Institute, University of New South Wales, Sydney, Australia St Vincent's Hospital, Sydney, Australia
| | | | - Patrick Mallon
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Emery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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190
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Zah V, Toumi M. Economic and health implications from earlier detection of HIV infection in the United Kingdom. HIV AIDS (Auckl) 2016; 8:67-74. [PMID: 27073328 PMCID: PMC4806762 DOI: 10.2147/hiv.s96713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population. PATIENTS AND METHODS A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M). RESULTS In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years). CONCLUSION The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.
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Affiliation(s)
- Vladimir Zah
- Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France
- ZRx Outcomes Research Inc., Mississauga, Canada
| | - Mondher Toumi
- Ecole Doctoral Interdisciplinaire Sciences-Santé (EDISS), University of Lyon, Lyon, France
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191
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Ntusi NAB, Ntsekhe M. Human immunodeficiency virus-associated heart failure in sub-Saharan Africa: evolution in the epidemiology, pathophysiology, and clinical manifestations in the antiretroviral era. ESC Heart Fail 2016; 3:158-167. [PMID: 28834662 PMCID: PMC5657330 DOI: 10.1002/ehf2.12087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 01/12/2023] Open
Abstract
The survival of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) who have access to highly active antiretroviral therapy (ART) has dramatically increased in recent times. This review focuses on HIV‐associated heart failure in sub‐Saharan Africa (SSA). In HIV infected persons, heart failure may be related to pathology of the pericardium, the myocardium, the valves, the conduction system, or the coronary and pulmonary vasculature. HIV‐associated heart failure can be because of direct consequences of HIV infection, autoimmune reactions, pro‐inflammatory cytokines, opportunistic infections (OIs) or neoplasms, use of ART or therapy for OIs and presence of traditional cardiovascular risk factors. Myocardial involvement includes diastolic dysfunction, asymptomatic left ventricular dysfunction, cardiomyopathy, myocarditis, fibrosis, and steatosis. Pericardial diseases include pericarditis, pericardial effusions (rarely causing tamponade), pericardial constriction, and effusive‐constrictive syndromes. Coronary artery disease is commonly reported in industrial nations, although its prevalence is thought to be low in HIV‐infected persons from SSA.
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Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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192
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Nakagawa F, van Sighem A, Thiebaut R, Smith C, Ratmann O, Cambiano V, Albert J, Amato-Gauci A, Bezemer D, Campbell C, Commenges D, Donoghoe M, Ford D, Kouyos R, Lodwick R, Lundgren J, Pantazis N, Pharris A, Quinten C, Thorne C, Touloumi G, Delpech V, Phillips A. A Method to Estimate the Size and Characteristics of HIV-positive Populations Using an Individual-based Stochastic Simulation Model. Epidemiology 2016; 27:247-56. [PMID: 26605814 PMCID: PMC4733816 DOI: 10.1097/ede.0000000000000423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 11/23/2015] [Indexed: 12/24/2022]
Abstract
It is important not only to collect epidemiologic data on HIV but to also fully utilize such information to understand the epidemic over time and to help inform and monitor the impact of policies and interventions. We describe and apply a novel method to estimate the size and characteristics of HIV-positive populations. The method was applied to data on men who have sex with men living in the UK and to a pseudo dataset to assess performance for different data availability. The individual-based simulation model was calibrated using an approximate Bayesian computation-based approach. In 2013, 48,310 (90% plausibility range: 39,900-45,560) men who have sex with men were estimated to be living with HIV in the UK, of whom 10,400 (6,160-17,350) were undiagnosed. There were an estimated 3,210 (1,730-5,350) infections per year on average between 2010 and 2013. Sixty-two percent of the total HIV-positive population are thought to have viral load <500 copies/ml. In the pseudo-epidemic example, HIV estimates have narrower plausibility ranges and are closer to the true number, the greater the data availability to calibrate the model. We demonstrate that our method can be applied to settings with less data, however plausibility ranges for estimates will be wider to reflect greater uncertainty of the data used to fit the model.
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Affiliation(s)
- Fumiyo Nakagawa
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Ard van Sighem
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Rodolphe Thiebaut
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Colette Smith
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Oliver Ratmann
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Valentina Cambiano
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Jan Albert
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Andrew Amato-Gauci
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Daniela Bezemer
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Colin Campbell
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Daniel Commenges
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Martin Donoghoe
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Deborah Ford
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Roger Kouyos
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Rebecca Lodwick
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Jens Lundgren
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Nikos Pantazis
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Anastasia Pharris
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Chantal Quinten
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Claire Thorne
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Giota Touloumi
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Valerie Delpech
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
| | - Andrew Phillips
- From the Research Department of Infection and Population Health, UCL, London, United Kingdom; Stichting HIV Monitoring, Amsterdam, The Netherlands; INSERM, Centre INSERM U897, Bordeaux, France; Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; CEEISCAT, Generalitat de Catalunya, Barcelona, Spain; WHO Regional Office for Europe, Copenhagen, Denmark; Institute of Clinical Trials and Methodology, UCL, London, United Kingdom; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Research Department of Primary Care and Population Health, UCL, London, United Kingdom; CHIP @ Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; UCL Institute of Child Health, UCL, London, United Kingdom; and Public Health England, London, United Kingdom
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Bonora S, Calcagno A, Trentalange A, Di Perri G. Elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide for the treatment of HIV in adults. Expert Opin Pharmacother 2016; 17:409-19. [DOI: 10.1517/14656566.2016.1129401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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194
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Shepherd L, Borges ÁH, Ravn L, Harvey R, Bower M, Grulich A, Silverberg M, Kronborg G, Galli M, Kirk O, Lundgren J, Mocroft A. Predictive value of prostate specific antigen in a European HIV-positive cohort: does one size fit all? Antivir Ther 2016; 21:529-534. [PMID: 26823399 DOI: 10.3851/imp3026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is common practice to use prostate specific antigen (PSA) ≥4.0 ng/ml as a clinical indicator for men at risk of prostate cancer (PCa), however, this is unverified in HIV+ men. We aimed to describe kinetics and predictive value of PSA for PCa in HIV+ men. METHODS A nested case control study of 21 men with PCa and 40 matched-controls within EuroSIDA was conducted. Prospectively stored plasma samples before PCa (or matched date in controls) were measured for the following markers: total PSA (tPSA), free PSA (fPSA), testosterone and sex hormone binding globulin (SHBG). Conditional logistic regression models investigated associations between markers and PCa. Mixed models were used to describe kinetics. Sensitivity and specificity of using tPSA >4 ng/ml to predict PCa was calculated. Receiver operating characteristic curves were used to identify optimal cutoffs in HIV+ men for total PSA. RESULTS 61 HIV+ men were included with a median 6 (IQR 2-9) years follow-up. Levels of tPSA increased by 13.7% per year (95% CI 10.3, 17.3) in cases, but was stable in controls (-0.4%; 95% CI -2.5, 1.7). Elevated PSA was associated with higher odds of PCa at first (OR for twofold higher 4.7; 95% CI 1.7, 12.9; P<0.01) and last sample (8.1; 95% CI 1.1, 58.9; P=0.04). A similar relationship was seen between fPSA and PCa. Testosterone and SHBG level were not associated with PCa. tPSA level >4 ng/ml had 99% specificity and 38% sensitivity. The optimal PSA cutoff was 1.5 ng/ml overall (specificity =84%, sensitivity =81%). CONCLUSIONS PSA was highly predictive of PCa in HIV+ men; however, the commonly used PSA>4 ng/ml to indicate high PCa risk was not sensitive in our population and use of the lower cutoff of PSA>1.5 ng/ml warrants consideration.
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Affiliation(s)
- Leah Shepherd
- Research Department of Infection and Population Health, University College London, London, UK
| | - Álvaro H Borges
- Centre for Health & Infectious Disease Research (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ravn
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Richard Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College Healthcare National Health Service Trust, London, UK
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Andrew Grulich
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | | | - Gitte Kronborg
- Institut for Klinisk Medicin, Hvidovre Hospital, Hvidovre, Denmark
| | - Massimo Galli
- Clinic of Infectious Disease, Luigi Sacco Hospital, Milan, Italy
| | - Ole Kirk
- Centre for Health & Infectious Disease Research (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Lundgren
- Centre for Health & Infectious Disease Research (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Mocroft
- Research Department of Infection and Population Health, University College London, London, UK
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195
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Mohammadnezhad M, Fetuu FP, Mangum T, Alakalia JQ, Lucas JJ. A Systematic Review Study on Prevalence, Determinants, and Risk Factors of HIV/AIDS among Pacific Countries. WORLD JOURNAL OF AIDS 2016. [DOI: 10.4236/wja.2016.64024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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196
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Kubicka J, Gizińska J, Kowalska J, Siwak E, Swiecki P, Pulik P, Szulborska B, Burkacka-Firlag E, Horban A. Efavirenz as component of initial combination antiretroviral therapy – Data from the Polish Observational Cohort of HIV/AIDS Patients (POLCA) Study Group. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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197
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Ray AS, Fordyce MW, Hitchcock MJ. Tenofovir alafenamide: A novel prodrug of tenofovir for the treatment of Human Immunodeficiency Virus. Antiviral Res 2016; 125:63-70. [DOI: 10.1016/j.antiviral.2015.11.009] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
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Sashindran V, Chauhan R. Antiretroviral therapy: Shifting sands. Med J Armed Forces India 2016; 72:54-60. [PMID: 26900224 PMCID: PMC4723694 DOI: 10.1016/j.mjafi.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022] Open
Abstract
HIV/AIDS has been an extremely difficult pandemic to control. However, with the advent of antiretroviral therapy (ART), HIV has now been transformed into a chronic illness in patients who have continued treatment access and excellent long-term adherence. Existing indications for ART initiation in asymptomatic patients were based on CD4 levels; however, recent evidence has broken the shackles of CD4 levels. Early initiation of ART in HIV patients irrespective of CD4 counts can have profound positive impact on morbidity and mortality. Early initiation of ART has been found not only beneficial for patients but also to community as it reduces the risk of transmission. There have been few financial concerns about providing ART to all HIV-positive people but various studies have proven that early initiation of ART not only proves to be cost-effective but also contributes to economic and social growth of community. A novel multidisciplinary approach with early initiation and availability of ART at its heart can turn the tide in our favor in future. Effective preexposure prophylaxis and postexposure prophylaxis can also lower transmission risk of HIV in community. New understanding of HIV pathogenesis is opening new vistas to cure and prevention. Various promising candidate vaccines and drugs are undergoing aggressive clinical trials, raising optimism for an ever-elusive cure for HIV. This review describes various facets of tectonic shift in management of HIV.
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Affiliation(s)
- V.K. Sashindran
- Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - Rajeev Chauhan
- Graded Specialist (Medicine), Air Force Hospital Amla, M.P., India
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199
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Furuoka F, Hoque MZ. Determinants of antiretroviral therapy coverage in Sub-Saharan Africa. PeerJ 2015; 3:e1496. [PMID: 26664812 PMCID: PMC4675103 DOI: 10.7717/peerj.1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022] Open
Abstract
Among 35 million people living with the human immunodeficiency virus (HIV) in 2013, only 37% had access to antiretroviral therapy (ART). Despite global concerted efforts to provide the universal access to the ART treatment, the ART coverage varies among countries and regions. At present, there is a lack of systematic empirical analyses on factors that determine the ART coverage. Therefore, the current study aimed to identify the determinants of the ART coverage in 41 countries in Sub-Saharan Africa. It employed statistical analyses for this purpose. Four elements, namely, the HIV prevalence, the level of national income, the level of medical expenditure and the number of nurses, were hypothesised to determine the ART coverage. The findings revealed that among the four proposed determinants only the HIV prevalence had a statistically significant impact on the ART coverage. In other words, the HIV prevalence was the sole determinant of the ART coverage in Sub-Saharan Africa.
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Affiliation(s)
- Fumitaka Furuoka
- Asia-Europe Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammad Zahirul Hoque
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Grossman CI, Ross AL, Auerbach JD, Ananworanich J, Dubé K, Tucker JD, Noseda V, Possas C, Rausch DM. Towards Multidisciplinary HIV-Cure Research: Integrating Social Science with Biomedical Research. Trends Microbiol 2015; 24:5-11. [PMID: 26642901 DOI: 10.1016/j.tim.2015.10.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 11/30/2022]
Abstract
The quest for a cure for HIV remains a timely and key challenge for the HIV research community. Despite significant scientific advances, current HIV therapy regimens do not completely eliminate the negative impact of HIV on the immune system; and the economic impact of treating all people infected with HIV globally, for the duration of their lifetimes, presents significant challenges. This article discusses, from a multidisciplinary approach, critical social, behavioral, ethical, and economic issues permeating the HIV-cure research agenda. As part of a search for an HIV cure, both the perspective of patients/participants and clinical researchers should be taken into account. In addition, continued efforts should be made to involve and educate the broader community.
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Affiliation(s)
- Cynthia I Grossman
- 5601 Fishers Lane Room 9G19, MSC 9831, National Institutes of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
| | | | - Judith D Auerbach
- Center for AIDS Prevention Studies, Department of Medicine, School of Medicine, University of California, Mailcode 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Jintanat Ananworanich
- 6720A Rockledge Drive, Suite 400, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, USA
| | - Karine Dubé
- 120 Mason Farm Road, #2047 Genetic Medicine Building, Institute of Global Health and Infectious Diseases (IGHID), Collaboratory of AIDS Researchers for Eradication (CARE), Chapel Hill, NC 27516, USA
| | - Joseph D Tucker
- UNC Project-China, 2 Lujing Road, Guangzhou, China, 510095; and University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Veronica Noseda
- Sidaction, 228 rue Faubourg Saint-Martin, 75010 Paris, France
| | - Cristina Possas
- Oswaldo Cruz Foundation, Evandro Chagas National Institute of Infectious Diseases and Bio-Manguinhos, Avenida Brazil 4365 Manguinhos, CEP 21040-360, Rio de Janeiro, Brazil
| | - Dianne M Rausch
- 5601 Fishers Lane Room 9G19, MSC 9831, National Institutes of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD 20892, USA
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