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HIV Medicine Oct 2013The objective of this article is to set the scene for this supplement by presenting and discussing the overall outcomes of the HIV in Europe Copenhagen 2012 Conference... (Review)
Review
The objective of this article is to set the scene for this supplement by presenting and discussing the overall outcomes of the HIV in Europe Copenhagen 2012 Conference and how the HIV in Europe initiative intends to further address challenges and themes raised during the conference.
Topics: Congresses as Topic; Delayed Diagnosis; Denmark; Europe; HIV; HIV Seropositivity; Hepatitis; Humans; Mass Screening
PubMed: 24033894
DOI: 10.1111/hiv.12062 -
The Cochrane Database of Systematic... Nov 2018Resistance to antiretroviral therapy (ART) among people living with human immunodeficiency virus (HIV) compromises treatment effectiveness, often leading to virological...
BACKGROUND
Resistance to antiretroviral therapy (ART) among people living with human immunodeficiency virus (HIV) compromises treatment effectiveness, often leading to virological failure and mortality. Antiretroviral drug resistance tests may be used at the time of initiation of therapy, or when treatment failure occurs, to inform the choice of ART regimen. Resistance tests (genotypic or phenotypic) are widely used in high-income countries, but not in resource-limited settings. This systematic review summarizes the relative merits of resistance testing in treatment-naive and treatment-exposed people living with HIV.
OBJECTIVES
To evaluate the effectiveness of antiretroviral resistance testing (genotypic or phenotypic) in reducing mortality and morbidity in HIV-positive people.
SEARCH METHODS
We attempted to identify all relevant studies, regardless of language or publication status, through searches of electronic databases and conference proceedings up to 26 January 2018. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov to 26 January 2018. We searched Latin American and Caribbean Health Sciences Literature (LILACS) and the Web of Science for publications from 1996 to 26 January 2018.
SELECTION CRITERIA
We included all randomized controlled trials (RCTs) and observational studies that compared resistance testing to no resistance testing in people with HIV irrespective of their exposure to ART.Primary outcomes of interest were mortality and virological failure. Secondary outcomes were change in mean CD4-T-lymphocyte count, clinical progression to AIDS, development of a second or new opportunistic infection, change in viral load, and quality of life.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed each reference for prespecified inclusion criteria. Two review authors then independently extracted data from each included study using a standardized data extraction form. We analysed data on an intention-to-treat basis using a random-effects model. We performed subgroup analyses for the type of resistance test used (phenotypic or genotypic), use of expert advice to interpret resistance tests, and age (children and adolescents versus adults). We followed standard Cochrane methodological procedures.
MAIN RESULTS
Eleven RCTs (published between 1999 and 2006), which included 2531 participants, met our inclusion criteria. All of these trials exclusively enrolled patients who had previous exposure to ART. We found no observational studies. Length of follow-up time, study settings, and types of resistance testing varied greatly. Follow-up ranged from 12 to 150 weeks. All studies were conducted in Europe, USA, or South America. Seven studies used genotypic testing, two used phenotypic testing, and two used both phenotypic and genotypic testing. Only one study was funded by a manufacturer of resistance tests.Resistance testing made little or no difference in mortality (odds ratio (OR) 0.89, 95% confidence interval (CI) 0.36 to 2.22; 5 trials, 1140 participants; moderate-certainty evidence), and may have slightly reduced the number of people with virological failure (OR 0.70, 95% CI 0.56 to 0.87; 10 trials, 1728 participants; low-certainty evidence); and probably made little or no difference in change in CD4 cell count (mean difference (MD) -1.00 cells/mm³, 95% CI -12.49 to 10.50; 7 trials, 1349 participants; moderate-certainty evidence) or progression to AIDS (OR 0.64, 95% CI 0.31 to 1.29; 3 trials, 809 participants; moderate-certainty evidence). Resistance testing made little or no difference in adverse events (OR 0.89, 95% CI 0.51 to 1.55; 4 trials, 808 participants; low-certainty evidence) and probably reduced viral load (MD -0.23, 95% CI -0.35 to -0.11; 10 trials, 1837 participants; moderate-certainty evidence). No studies reported on development of new opportunistic infections or quality of life. We found no statistically significant heterogeneity for any outcomes, and the I² statistic value ranged from 0 to 25%. We found no subgroup effects for types of resistance testing (genotypic versus phenotypic), the addition of expert advice to interpretation of resistance tests, or age. Results for mortality were consistent when we compared studies at high or unclear risk of bias versus studies at low risk of bias.
AUTHORS' CONCLUSIONS
Resistance testing probably improved virological outcomes in people who have had virological failure in trials conducted 12 or more years ago. We found no evidence in treatment-naive people. Resistance testing did not demonstrate important patient benefits in terms of risk of death or progression to AIDS. The trials included very few participants from low- and middle-income countries.
Topics: Antirheumatic Agents; CD4 Lymphocyte Count; Disease Progression; Drug Resistance, Viral; HIV Seropositivity; Humans; Randomized Controlled Trials as Topic
PubMed: 30411789
DOI: 10.1002/14651858.CD006495.pub5 -
PloS One 2013The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART)... (Review)
Review
BACKGROUND
The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART.
METHODS AND FINDINGS
We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use.
CONCLUSIONS
Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.
Topics: Anti-HIV Agents; Female; HIV Seropositivity; Heterosexuality; Humans; Male; Risk; Sexual Partners; Viral Load
PubMed: 23418455
DOI: 10.1371/journal.pone.0055747 -
Prevention Science : the Official... Jun 2014In sub-Saharan Africa, the prevalence of depressive symptoms among people living with HIV (PLHIV) is considerably greater than that among members of the general... (Randomized Controlled Trial)
Randomized Controlled Trial
In sub-Saharan Africa, the prevalence of depressive symptoms among people living with HIV (PLHIV) is considerably greater than that among members of the general population. It is particularly important to treat depressive symptoms among PLHIV because they have been associated with poorer HIV care-related outcomes. This study describes overall psychosocial functioning and factors associated with depressive symptoms among PLHIV attending HIV care and treatment clinics in Kenya, Namibia, and Tanzania. Eighteen HIV care and treatment clinics (six per country) enrolled approximately 200 HIV-positive patients (for a total of 3,538 participants) and collected data on patients' physical and mental well-being, medical/health status, and psychosocial functioning. Although the majority of participants did not report clinically significant depressive symptoms (72 %), 28 % reported mild to severe depressive symptoms, with 12 % reporting severe depressive symptoms. Regression models indicated that greater levels of depressive symptoms were associated with: (1) being female, (2) younger age, (3) not being completely adherent to HIV medications, (4) likely dependence on alcohol, (5) disclosure to three or more people (versus one person), (6) experiences of recent violence, (7) less social support, and (8) poorer physical functioning. Participants from Kenya and Namibia reported greater depressive symptoms than those from Tanzania. Approximately 28 % of PLHIV reported clinically significant depressive symptoms. The scale-up of care and treatment services in sub-Saharan Africa provides an opportunity to address psychosocial and mental health needs for PLHIV as part of comprehensive care.
Topics: Adult; Alcohol Drinking; Depression; Female; HIV Seropositivity; Health Status Indicators; Humans; Kenya; Longitudinal Studies; Male; Namibia; Prevalence; Risk Factors; Social Support; Surveys and Questionnaires; Tanzania; Violence
PubMed: 23868419
DOI: 10.1007/s11121-013-0420-8 -
Infectious Diseases in Obstetrics and... 2012Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman's overall health. Hormonal... (Review)
Review
BACKGROUND
Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman's overall health. Hormonal contraceptives are safe and effective means to avoid unintended pregnancy, but there is concern that coadministration of antiretroviral drugs may alter contraceptive efficacy.
MATERIALS AND METHODS
We performed a literature search of PubMed and Ovid databases of articles published between January 1980 and February 2012 to identify English-language reports of drug-drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the FDA prescribing information of contraceptive hormone preparations and antiretrovirals for additional data and recommendations.
RESULTS
Twenty peer-reviewed publications and 42 pharmaceutical package labels were reviewed. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when coadministered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring, and implant were lacking.
CONCLUSIONS
HIV-positive women should be offered a full range of hormonal contraceptive options, with conscientious counseling about possible reduced efficacy of COCs and the contraceptive implant when taken with ARVs. DMPA and the LNG-IUS maintain their contraceptive efficacy when taken with ARVs.
Topics: Anti-Retroviral Agents; Contraception; Contraceptives, Oral, Hormonal; Drug Interactions; Female; HIV Seropositivity; Humans; Infectious Disease Transmission, Vertical; Pregnancy
PubMed: 22927715
DOI: 10.1155/2012/890160 -
Medical Science Monitor : International... Feb 2011Bacteria and yeasts isolated from respiratory tracts of 39 Cambodian and 28 Kenyan HIV-positive children were tested for the presence of HIV-1 sequences.
BACKGROUND
Bacteria and yeasts isolated from respiratory tracts of 39 Cambodian and 28 Kenyan HIV-positive children were tested for the presence of HIV-1 sequences.
MATERIAL/METHODS
Bacteria and yeasts from the respiratory tract (nose, pharyngeal swabs) were isolated from 39 Cambodian and 28 Kenyan HIV-positive children. Bacterial chromosomal DNA was prepared by standard protocol and by Qiagen kit. The PCR specific for HIV sequences was carried out using HIV-1-specific primers.The analysis was performed by colony and dot-blot hybridization using HIV-1-specific primers which represent gag, pol and env genes of the virus. The sequencing of some PCR products was performed on the ABI 373 DNA Sequencer.
RESULTS
The majority of microbes were characterized as Staphylococcus aureus, Klebsiella pneumoniae, and resp. Candida albicans. In some cases E. coli, Streptococcus pyogenes, Proteus mirabilis and Candida tropicalis were identified. Bacteria of 16 Cambodian (41%) and 8 Kenyan (31%) children were found to be positive in colony and dot-blot DNA hybridization. By the sequencing of PCR products synthesized on the template of patients' bacterial DNA using primers 68;69 for env HIV-1 gene, homology of greater than 90% with HIV-1 isolate HXB2 (HIVHXB2CG) was revealed.
CONCLUSIONS
Bacteria and yeasts from the respiratory tract of 41% of Cambodian and 31% of Kenyan HIV-positive children bear HIV-like sequences. The role of bacteria in the HIV disease process is discussed.
Topics: Bacteria; Base Sequence; Cambodia; Child; DNA, Viral; HIV; HIV Seropositivity; Humans; Kenya; Molecular Sequence Data; Nucleic Acid Hybridization; Polymerase Chain Reaction; Reproducibility of Results; Respiratory System; Sequence Analysis, DNA
PubMed: 21358602
DOI: 10.12659/msm.881449 -
AIDS Care 2015Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from...
Despite evidence globally of the heavy HIV burden among sex workers (SWs) as well as other poor health outcomes, including violence, SWs are often excluded from accessing voluntary, confidential and non-coercive health services, including HIV prevention, treatment, care and support. This study therefore assessed the prevalence and association with regular HIV testing among street- and off-street SWs in Vancouver, Canada. Cross-sectional baseline data were used from a longitudinal cohort known as "An Evaluation of Sex Worker's Health Access" (AESHA; January 2010-July 2012). This cohort included youth and adult SWs (aged 14+ years). We used multivariable logistic regression to assess the relationship between explanatory variables and having a recent HIV test (in the last year). Of the 435 seronegative SWs included, 67.1% reported having a recent HIV test. In multivariable logistic regression analysis, having a recent HIV test remained significantly independently associated with elevated odds of inconsistent condom use with clients [adjusted (multivariable) odds ratios, AOR: 2.59, 95% confidence intervals [95% CIs]: 1.17-5.78], injecting drugs (AOR: 2.33, 95% CIs: 1.17-4.18) and contact with a mobile HIV prevention programme (AOR: 1.76, 95% CIs: 1.09-2.84) within the last six months. Reduced odds of having a recent HIV test was also significantly associated with being a migrant/new immigrant to Canada (AOR: 0.33, 95% CIs: 0.19-0.56) and having a language barrier to health care access (AOR: 0.26, 95% CIs: 0.09-0.73). Our results highlight successes of reaching SWs at high risk of HIV through drug and sexual pathways. To maximize the effectiveness of including HIV testing as part of comprehensive HIV prevention and care to SWs, increased mobile outreach and safer-environment interventions that facilitate access to voluntary, confidential and non-coercive HIV testing remain a critical priority, in addition to culturally safe services with language support.
Topics: Adult; Canada; Condoms; Cross-Sectional Studies; Female; HIV Seropositivity; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Male; Reagent Kits, Diagnostic; Risk Factors; Sex Work; Sex Workers; Sexual Behavior; Social Environment; Transients and Migrants; Violence
PubMed: 25428563
DOI: 10.1080/09540121.2014.978730 -
AIDS (London, England) Jan 2019To identify the ways in which HIV seroconversion impacts subsequent health behaviors in the context of evolving HIV treatment technologies.
OBJECTIVES
To identify the ways in which HIV seroconversion impacts subsequent health behaviors in the context of evolving HIV treatment technologies.
DESIGN
Prospective cohort study.
METHODS
We assessed changes in health and HIV risk behaviors following HIV seroconversion both before and after HIV treatment access (i.e. HAART) in the United States by drawing from the Multicenter AIDS Cohort Study, which collected data from men who have sex with men (MSM) (n = 4616) in four US cities from 1984 to 2008. Longitudinal regression analyses with individual fixed effects accounted for time-invariant, unobservable determinants of risk behaviors. Further analyses assessed the sensitivity of our results to controlling for indicators of physical and mental health (e.g. CD4 cell count, depression) and differential attrition by higher risk individuals.
RESULTS
Among those who seroconverted during observation (n = 558), HIV seroconversion was associated with reduced odds of subsequent engagement in sex with at least two partners [adjusted odds ratio [adjusted odds ratio (aOR): 0.371; confidence interval (CI): 0.263-0.523], insertive anal sex with at least two partners (aOR: 0.360; CI: 0.219-0.591), and heavy drinking (aOR: 0.704; CI: 0.508-0.977). Seroconversion after HAART availability and treatment initiation was associated with further reduced odds of engaging in these behaviors. CD4 cell count, depression, and attrition did not change these results.
CONCLUSION
Specific health and HIV risk behaviors declined following seroconversion, especially with treatment availability and utilization. These positive behavior changes following HIV seroconversion provide evidence for continued investment in the HIV care continuum, including support for HIV testing and engagement in clinical care and treatment.
Topics: Adolescent; Adult; Anti-Retroviral Agents; HIV Seropositivity; Health Risk Behaviors; Health Services Accessibility; Humans; Male; Middle Aged; Prospective Studies; Sexual Behavior; United States; Young Adult
PubMed: 30325770
DOI: 10.1097/QAD.0000000000002048 -
PloS One 2019Cryptococcus causes 15% of AIDS-related deaths and in South Africa, with its high HIV burden, is the dominant cause of adult meningitis. Cryptococcal meningitis (CM)...
INTRODUCTION
Cryptococcus causes 15% of AIDS-related deaths and in South Africa, with its high HIV burden, is the dominant cause of adult meningitis. Cryptococcal meningitis (CM) mortality is high, partly because patients enter care with advanced HIV disease and because of failure of integrated care following CM diagnosis. We evaluated pathways to hospital care, missed opportunities for HIV testing and initiation of care.
METHODS
We performed a cross-sectional study at five public-sector urban hospitals. We enrolled adults admitted with a first or recurrent episode of cryptococcal meningitis. Study nurses conducted interviews, supplemented by a prospective review of medical charts and laboratory records.
RESULTS
From May to October 2015, 102 participants were enrolled; median age was 40 years (interquartile range [IQR] 33.9-46.7) and 56 (55%) were male. In the six weeks prior to admission, 2/102 participants were asymptomatic, 72/100 participants sought care at a public-sector facility, 16/100 paid for private health care. The median time from seeking care to admission was 4 days (IQR, 0-27 days). Of 94 HIV-seropositive participants, only 62 (66%) knew their status and 41/62 (66%) had ever taken antiretroviral treatment. Among 13 participants with a known previous CM episode, none were taking fluconazole maintenance therapy. In-hospital management was mostly amphotericin B; in-hospital mortality was high (28/92, 30%). Sixty-four participants were discharged, 92% (59/64) on maintenance fluconazole, 4% (3/64) not on fluconazole and 3% (2/64) unknown. Twelve weeks post-discharge, 31/64 (48%) participants were lost to follow up. By 12 weeks post discharge 7/33 (21%) had died. Interviewed patients were asked if they were still on fluconazole, 11% (2/18) were not.
CONCLUSIONS
Among hospitalised participants with CM, there were many missed opportunities for HIV care and linkage to ART prior to admission. Universal reflex CrAg screening may prompt earlier diagnosis of cryptococcal meningitis but there is a wider problem of timely linkage to care for HIV-seropositive people.
Topics: Adult; Antiretroviral Therapy, Highly Active; Clinical Audit; Critical Pathways; Cryptococcosis; Female; Follow-Up Studies; HIV Seropositivity; Health Facilities; Hospitalization; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Patient Acceptance of Health Care; Patient Care; Patient Discharge; South Africa; Treatment Outcome
PubMed: 31830060
DOI: 10.1371/journal.pone.0225742 -
American Journal of Public Health Jul 1989For the near term, control of the AIDS epidemic depends entirely upon altering the human behavior which results in HIV transmission. How best to achieve the required... (Review)
Review
For the near term, control of the AIDS epidemic depends entirely upon altering the human behavior which results in HIV transmission. How best to achieve the required changes has been controversial with approaches ranging from education/information only, to a vast array of largely unproven voluntary behavior modification techniques, to mandatory testing and restrictive measures. Given the complexity of human behavior and the reality of a still uncontrolled epidemic, at least among poor urban drug using minorities, there is a legitimate role for most approaches and any promising behavior modification strategy deserves evaluation. However, because voluntarism will not work for some individuals, society still must choose between effective public health law--including restrictive measures--now, and a much larger reservoir of HIV infection and more deaths from AIDS for many generations to come.
Topics: Acquired Immunodeficiency Syndrome; Adult; Behavior Control; Colorado; Confidentiality; Contraception; Female; HIV Seropositivity; Homosexuality; Humans; Legislation, Medical; Male; Mandatory Programs; Methadone; Sexual Behavior; Sexually Transmitted Diseases; United States; Voluntary Programs
PubMed: 2660605
DOI: 10.2105/ajph.79.7.878