Is AIDS chronic or terminal? The perceptions of persons living with AIDS and their informal support partners

Viral Attachment Blocking Chimera Composed of DNA Origami and Nanobody Inhibits Pseudorabies Virus Infection In Vitro

Antivirals are indispensable tools that can be targeted at viral domains directly or at cellular domains indirectly to obstruct viral infections and reduce pathogenicity. Despite their transformative use in healthcare, antivirals have been clinically approved to treat only 10 of the more than 200 known pathogenic human viruses. Additionally, many virus functions are intimately coupled with host cellular processes, which presents challenges in antiviral development due to the limited number of clear targets per virus, necessitating extensive insight into these molecular processes. Compounding this challenge, many viral pathogens have evolved to evade effective antivirals. We hypothesize that a viral attachment blocking chimera (VirABloC) composed of a viral binder and a bulky scaffold that sterically blocks interactions between a viral particle and a host cell may be suitable for the development of antivirals that are agnostic to the extravirion epitope that is being bound. We test this hypothesis by modifying a nanobody that specifically recognizes a nonessential epitope presented on the extravirion surface of pseudorabies virus strain 486 with a 3-dimensional wireframe DNA origami structure ∼100 nm in diameter. The nanobody switches from having no inhibitory properties to 4.2 ± 0.9 nM IC50 when conjugated with the DNA origami scaffold. Mechanistic studies support that inhibition is mediated by the noncovalent attachment of the DNA origami scaffold to the virus particle, which obstructs the attachment of the viruses onto host cells. These results support the potential of VirABloC as a generalizable approach to developing antivirals.

A Multi-Site Study of Social Cognitive Factors Related to Adherence Among Youth Living With HIV in the New Era of Antiretroviral Medication

Objective

The goal of the current study was to determine how a set of social cognitive factors predict antiretroviral therapy (ART) medication adherence in youth living with HIV in an era of newer highly active ART medications using a conceptual model.

Methods

Behaviorally infected youth living with HIV ages 13-24 (N = 822) from 14 sites within the Adolescent Medicine Trials Unit (AMTU) were included in the study. Structural equation modeling was used to explore predictors of ART medication adherence.

Results

Results found that motivational readiness for ART was related to higher ART medication adherence, which was associated with lower viral load. Higher social support and higher self-efficacy had an indirect relationship with higher adherence through increased motivational readiness. Fewer psychological symptoms were associated with higher social support and higher self-efficacy. Lower substance use was directly associated with lower adherence.

Conclusions

The results provide insight into factors that may be related to adherence in youth living with HIV. Findings suggest focusing on motivational readiness to increase adherence. Improving the patients' ART self-efficacy and strengthening their social support networks during treatment can increase motivational readiness for ART treatment. Furthermore, programs maybe more effective with the inclusion of risk reduction components especially those related to substance use.

Adaptation of the HIV/AIDS Self-Management Education Program for Men Who Have Sex With Men in Thailand: An Application of the ADAPT-ITT Framework

This formative research aimed to describe the use of the ADAPT-ITT framework to modify the HASMEP for use with HIV-positive Thai men who have sex with men (MSM). We selected, adapted, and tested the acceptability and feasibility of the HASMEP intervention for delivery in an HIV clinic in Thailand. We chose to base our adaptation on the HASMEP that was initially developed in South Africa. The ADAPT-ITT framework was used to guide the study. Our adaptation was informed by qualitative data collected during focus groups from 48 participants (40 HIV-positive Thai MSM and 8 health care providers) and online surveys of Thai MSM. Findings of focus groups indicate that the HASMEP is feasible and acceptable when administered to the participants. The result of this work is an adapted HASMEP intervention and training materials. This study provides a strong foundation for further research on HIV/AIDS self-management in HIV-positive MSM.

Incidence and Predictors of Antiretroviral Treatment Modification in HIV-Infected Adults: A Brazilian Historical Cohort from 2001 to 2010

This study estimated the incidence of and time to first antiretroviral therapy (ART) modification. This longitudinal analysis comprised a sample of 236 patients from three HIV/AIDS referral centers in Belo Horizonte, Brazil—part of a major historical cohort. Inclusion criteria were as follows: having been treatment-naive patient ≥18 years old who initiated ART between 2001 and 2005 in these three referral centers. The main endpoint was time to first ART modification. Patients were followed up for five years, covering the period 2001–2010, during which time Pearson's chi-square test was performed to compare ART modification between groups. Kaplan-Meier inverse survival curves were employed to describe the probability of ART modification and Cox proportional hazard regression was used to estimate the adjusted hazard ratio (aHR) of ART modification. Among 247 patients from the major cohort, 236 were eligible. Median follow-up time was 37.2 months and the contribution in person-months was 7,615.4 months. A total of 108 (45.8%) patients had their ART regimen modified at least once (incidence rate: 1.42 per 100 person-months). Adverse drug reactions were the main reason for ART modification. Women (aHR = 1.62; p = 0.022) and patients on protease inhibitor- (PI-) based regimens (aHR = 2.70; p < 0.001) were at higher risk of ART modification.

Shared Illness and Social Support Within Two HIV-Affected African American Communities

A key source of resiliency within HIV-affected African American communities is informal social support. Data from dyadic conversations and focus groups were used to address the following research question: What are HIV-positive African Americans' social support experiences within their informal social networks in response to HIV-related problems? Circumstances that exacerbated HIV-related problems included others' fear of contagion, reticence to be involved, judgment and rejection, and disregard for privacy Support from HIV-negative others buffered the impact of problems when others communicate interest, take the initiative to help, or make a long-term investment in their success. Support from other HIV-positive persons was helpful given the shared connection because of HIV, the opportunity to commiserate about what is mutually understood, and the fight for mutual survival Based on these findings, we offer suggestions for future research and social network interventions aimed at bolstering connections between HIV-positive peers, reducing stigma, and improving family support.

The work of negotiating HIV as a chronic condition: a qualitative analysis

Living with human immunodeficiency virus (HIV) in the industrialised world has for over a decade been conceptualised as living with a chronic illness. People living with HIV now are amongst the first to live and age with the virus. Drawing on a qualitative longitudinal study in a low-incidence area in a low-incidence country, this paper investigates the nuanced ways that people negotiate this condition. While it has been argued that HIV is a condition like any other chronic disease, our thematic analysis reveals some similarities and particularities around living with the condition. In comparing themselves to others with the condition, high levels of diversity of experience were identified that extended well beyond length of time from diagnosis. In comparing their illness with other illnesses, the location, for example, of their specialist service within a clinic for those with acute sexually transmitted diseases was identified as problematic. The work involved in maintaining a coherent sense of self in the face of existing and shifting challenges as a result of their infection was a second strong theme. The final theme involved flux and flex work in the ways people sought to gain and maintain control over various aspects of their lives. All of these experiences are mediated by place; that is the experience is not the same as that of those who live where there is a much higher incidence of infection. The work involved in negotiating this condition in low-incidence environments deserves more attention, but aspects of these findings are significant in higher incidence contexts as well; in particular, passivity in face of infection as one ages and the potential for medication refusal as a means of maintaining control over life and death.

The Influence of the Common Cold on Self-Rated Health: A Population-Based Study

Objective

Studies on the association between self-rated health and acute conditions are sparse. The aim of this study was to examine whether individuals respond to acute conditions (such as the common cold) in health ratings as well as the effect of chronic conditions (using the Charlson comorbidity score) on self-rated health.

Methods

The national representative survey data was linked with the claims data from the Taiwan National Health Insurance for 13,723 adults ≥ 18 years. Ordered logistic regressions with fractional polynomials were estimated to determine the relationship between the frequency of common cold episodes and the Charlson comorbidity score on self-rated health. The interactions between these two variables and the baseline age were tested.

Results

Self-rated health worsens with the increased frequency of both common cold episodes and the Charlson comorbidity score. Both variables have a non-linear relationship with self-rated health. Younger individuals put heavier weight on acute health conditions than their older counterparts.

Conclusion

Individuals respond to questions regarding their self-rated health based on their acute health condition along with chronic condition. Thus the information on self-rated health depends on the timing the information is collected, and whether at that time the individual experienced acute health conditions or not.

Achieving peace and harmony in life: Thai Buddhists living with HIV/AIDS

This study aimed to reveal the process of achieving peace and harmony in life by Thai Buddhists living with HIV/AIDS in Southern Thailand. Data were gathered from 28 Thai Buddhist participants aged 18 years or older, who had lived with HIV/AIDS for 5 years or more. Purposive, snowball and theoretical sampling techniques were used to recruit the participants. Data collection, using in-depth interviews, was carried out over a 7 month period between 2011 and 2012. Grounded theory was used to guide the process of data analysis. Two categories emerged to describe the core category 'Achieving Peace and Harmony in life': (i) understanding and accepting that nothing is permanent and (ii) living life with contentment. Findings are valuable for health professionals in enhancing peace and harmony for their patients.

Stress and coping in women living with HIV: a meta-analytic review

To examine effects between stressors and coping mechanisms on behavioral health outcomes a meta-analysis was conducted using forty empirical articles which sampled 7,602 adult women living with HIV/AIDS in the U.S. (M = 36.3 years). Three independent reviewers conducted searches in abstract databases from 1997 to present day. Articles reporting effect sizes amongst psychosocial stressors and coping mechanisms with indices of behavioral/mental health were selected. The meta-analyses revealed that in a time frame characterized by the widespread availability of anti-retroviral medication, poor mental health outcomes were predicted, in a similar manner, by psychosocial stress and HIV/AIDS symptomology. Significant effects were also observed with functional impairment, though to a lesser degree. Coping by avoidance and social isolation predicted more severe mental health outcomes. Spirituality and positive reappraisal predicted greater psychological adaptation than did social support seeking. Despite advancements in anti-retroviral treatment for women, HIV/AIDS symptoms and acute and/or chronic psychosocial stress pose the same threat to behavioral and mental health. In the face of these stressors, positive reframing appears to promote psychological adaptation in a way which may lead to positive health outcomes in women living with HIV/AIDS.

Enhancing labour force participation for people living with HIV: a multi-perspective summary of the research evidence

Labour force participation has been identified as a critical social and health issue facing people living with HIV/AIDS (PHAs). We conducted a scoping study (a form of literature synthesis that summarizes research findings, research activity, and identifies literature strengths and gaps) on labour force participation for PHAs, guided by a community advisory committee. We summarized information from 243 peer-reviewed articles and 42 reports from the grey literature, and synthesized the evidence into a preliminary conceptual framework with five components: (1) the meaning of work, (2) key factors (barriers and facilitators) influencing labour force participation, (3) factors affecting vulnerable populations, (4) strategies and supports for returning to or sustaining work, and (5) outcomes (benefits and risks) of labour force participation for individuals and employers. The framework supports the development of labour force initiatives requiring collaborative efforts in multiple domains (health, employment, community) by PHAs, rehabilitation professionals, employers, insurers, and policy makers.

Addressing HIV knowledge, risk reduction, social support, and patient involvement using SMS: results of a proof-of-concept study

Men who have sex with men continue to be severely and disproportionately affected by the HIV/AIDS epidemic in the United States. Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of short message service suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. The purpose of this proof-of-concept study was to develop, implement, and test a tailored short message service-based intervention for HIV-positive men who have sex with men. The messages focused on reducing risk-taking behaviors and enhancing HIV knowledge, social support, and patient involvement. Participants reported strong receptivity to the messages and the intervention. The authors detected a statistically significant increase in HIV knowledge and social support from baseline to follow-up. Among participants who received sexual risk reduction messages, the authors also detected a statistically significant reduction in reported risk behaviors from baseline to follow-up. Results confirm the feasibility of a tailored, short message service-based intervention designed to provide ongoing behavioral reinforcement for HIV-positive men who have sex with men. Future research should include a larger sample, a control group, multiple sites, younger participants, and longer term follow-up.

Beyond reminders: a conceptual framework for using short message service to promote prevention and improve healthcare quality and clinical outcomes for people living with HIV

The availability of effective antiretroviral therapy has altered HIV from being an acute disease to being a chronic, manageable condition for many people living with HIV (PLWH). Because of their ubiquity and flexibility, mobile phones with short message service (SMS) offer a unique opportunity to enhance treatment and prevention for people managing HIV. To date, very few US studies using SMS for HIV self-management have been published. In this article, we review the published SMS-based intervention research that aimed to improve healthcare quality and outcomes for PLWH and other chronic health conditions, and propose a conceptual model that integrates the communication functionality of SMS with important psychosocial factors that could mediate the impact of SMS on health outcomes. We posit that an SMS-based intervention that incorporates the elements of interactivity, frequency, timing, and tailoring of messages could be implemented to encourage greater medication adherence as well as impact other mutually reinforcing behaviors and factors (e.g., increasing patient involvement and social support, reducing risk behaviors, and promoting general health and well-being) to support better healthcare quality and clinical outcomes for PLWH. We recommend that future studies explore the potential linkages between variations in SMS characteristics and these mediating factors to determine if and how they influence the larger outcomes.

Efficacy of a web-based intervention to reduce sexual risk in men who have sex with men

To the extent that men who have sex with men (MSM) use the Internet, it serves as a promising medium for behavioral intervention. The present study sought to investigate the efficacy of a web-based skills training and motivational intervention in a randomized trial (N = 112) conducted completely online. After a detailed assessment, MSM were randomly assigned to an online intervention or a control website. The experimental intervention consisted of risk assessment and feedback, motivational exercises, skills training, and education while the control intervention focused on relaxation skills. Follow-up data were collected 3 months later and analyzed with repeated-measures MANOVA. Although both groups evidenced across-the-board reductions in unprotected sex, perhaps due to the detailed assessment, the experimental group showed greater reductions with the riskiest partners, those of positive or unknown serostatus. Thus, this study gives preliminary evidence that a brief web-based intervention offering cognitive behavioral skills training and motivational enhancement can effectively reduce sexual risk in MSM.

Expanding the lens of HIV services provision in Canada: results of a national survey of HIV health professionals

Those living with HIV may experience a range of disabilities, including body impairments, activity limitations, and social participation restrictions. The aim of this study was to examine HIV services provision in Canada by exploring practices, referrals, and service delivery challenges from the perspective of HIV health professionals (including nurses, physicians, social workers, pharmacists, psychologists, and dieticians), and to explore differences in referrals and perceived service delivery challenges by professional group, jurisdiction, community size, and practice in a Northern region. We conducted a nationwide mail survey with the population of selected HIV health professionals in Canada using the Dillman tailored design survey method. Of the 731 deliverable mailings, we received 462 (63%) responses, with 36% of eligible respondents completing the survey (n=214). The large majority (90%) of HIV professionals were located in metropolitan or urban communities and worked predominantly in hospital in-patient (42%), out-patient (50%), and HIV specialty clinic (46%) settings in one of the three provinces (Ontario, Quebec, and British Columbia) with the highest HIV prevalence. HIV health professionals referred primarily, and at relatively high levels, to AIDS service organizations (79%) and social workers (84%) to address participation restrictions and social issues; a lower percentage referred to rehabilitation professionals and other service providers to address impairments, activity limitations, or participation restrictions. Of respondents, 74% perceived barriers to care specific to HIV. Our results suggest that there is little difference in referral patterns by profession, jurisdiction, community size, or northern region of practice. There is a need for increased information and education of HIV health professionals that may refer to rehabilitation and other health services. In addition, new approaches are needed to coordinate multisectoral care and enhance the access and delivery of HIV rehabilitation health services to better meet the disablement needs of people living with HIV in Canada.

A relationship-oriented model of HIV-related stigma derived from a review of the HIV-affected couples literature

Previous research has focused on the influence of HIV-related stigma for the psychological adjustment and physical health of persons with HIV/AIDS. Few studies, however, have examined the impact of HIV-related stigma on close relationships where one or both couple members have HIV/AIDS. The current review will integrate previous research findings to substantiate a relationship-oriented theoretical model of HIV-related stigma that delineates interpersonal variables important for understanding the influence of types of HIV-related stigma on couple-level as well as relevant individual-level outcomes. In doing so, supportive evidence is presented from the extant quantitative and qualitative literature that has assessed or examined HIV-affected couple members' experiences with HIV-related stigma. Implications from this review are presented for researchers who examine issues related to HIV-related stigma.