Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status

The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.

Impact of haemodialysis in the development of atrial fibrillation: a retrospective cross-sectional study

Background

Chronic kidney disease (CKD) is a very common co-morbidity in patients with cardiovascular disease, particularly in those with atrial fibrillation (AF). There is an increasing number of patients on haemodialysis who have AF and its impact is not fully understood.

Purpose

To assess the prevalence of AF in patients on haemodialysis, trying to identify predictors of AF development.

Methods

Unicentric, retrospective study including all patients admitted to the Nephrology ward from October 2020 to December 2020 who had CKD. Cardiovascular risk factors, known cardiac disease, time on haemodialysis, type of vascular access and demographic data were analysed. The control group was comprised of hospitalized CKD patients who were not on renal replacement therapies.

Results

A total of 126 patients were included, 57 on dialysis. Mean age for the renal replacement therapy group was 71.07±15.68 years and for the control group was 72.59±14.74 years old (p=0.575). There was an increased proportion of patients with type 2 diabetes mellitus in the control group (39 vs 20, p=0.021). No statistically significant differences were found regarding hypertension, heart failure, coronary disease or sleep apnoea between groups.

The prevalence of AF was similar in both the haemodialysis and the control group (26.3% vs 24.6%, p=0.829). Age, heart failure and coronary disease were significant risk factors for AF, irrespective of the studied group (p<0.05). There was also a significant correlation between time on dialysis and a greater likelihood of presenting AF (p<0.05). There was no correlation with type of vascular access.

Using the Youden index, an age of 80.5 years was determined as the cut-off for an increased prevalence of AF, irrespective of the study group (sensitivity of 66.7%; Specificity of 78.8%). Using ROC curves, an area under the curve (AUC) of 0.74 was obtained for age and the likelihood of AF (figure 1). Regarding time on dialysis, a cut-off point of 4.5 years was obtained with an AUC of 0.67 (sensitivity of 73% and specificity of 68.7%) (figure 2).

Conclusion

AF is very common in patients with end-stage renal disease, with a prevalence estimated to be 4 times greater than the general population. Our results suggested that, while haemodialysis may not be a risk factor for AF by itself, a longer time on haemodialysis may contribute to its onset. Age was also a contributing factor. Further prospective studies with more homogeneous groups are needed to clarify its role as an independent risk factor for AF.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Age as predictor of AFFigure 2. Time on dyalisis as predictor of AF