scholarly journals Estimating antiretroviral treatment coverage rates and viral suppression rates for homosexual men in Australia

Sexual Health ◽  
2015 ◽  
Vol 12 (5) ◽  
pp. 453 ◽  
Author(s):  
Nicole L. De La Mata ◽  
Limin Mao ◽  
John De Wit ◽  
Don Smith ◽  
Martin Holt ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Treatment ◽  
Viral Suppression ◽  
Undetectable Viral Load ◽  
Hiv Positive ◽  
Community Based ◽  
Study Objective ◽  
Hiv Epidemic ◽  
Sex With Men ◽  
Coverage Rates

Gay and other men who have sex with men (GMSM) are disproportionally affected by the HIV epidemic in Australia. The study objective is to combine a clinical-based cohort with a community-based surveillance system to present a broader representation of the GMSM community to determine estimates of proportions receiving antiretroviral therapy (ART) and/or with an undetectable viral load. Between 2010 and 2012, small increases were shown in ART uptake (to 70.2%) and proportions with undetectable viral load (to 62.4%). The study findings highlight the potential for significantly increasing ART uptake among HIV-positive GMSM to reduce the HIV epidemic in Australia.

scholarly journals Trends in antiretroviral treatment use and treatment response in three Australian states in the first decade of combination antiretroviral treatment

Sexual Health ◽  
2008 ◽  
Vol 5 (2) ◽  
pp. 141 ◽  
Author(s):  
Kathleen Falster ◽  
Linda Gelgor ◽  
Ansari Shaik ◽  
Iryna Zablotska ◽  
Garrett Prestage ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Treatment ◽  
Undetectable Viral Load ◽  
Lower Proportion ◽  
The Other ◽  
Early Disease ◽  
Community Based ◽  
Disease Research ◽  
Sex With Men ◽  
Living With Hiv

Objectives: To determine if there were any differences in antiretroviral treatment (ART) use across the three eastern states of Australia, New South Wales (NSW), Victoria and Queensland, during the period 1997 to 2006. Methods: We used data from a clinic-based cohort, the Australian HIV Observational Database (AHOD), to determine the proportion of HIV-infected patients on ART in selected clinics in each state and the proportion of treated patients with an undetectable viral load. Data from the national Highly Specialised Drugs program and AHOD were used to estimate total numbers of individuals on ART and the proportion of individuals living with HIV on ART nationally and by state. Data from the HIV Futures Survey and the Gay Community Periodic Survey were used to determine the proportion of community-based men who have sex with men on ART. The proportion of patients with primary HIV infection (PHI) who commenced ART within 1 year of diagnosis was obtained from the Acute Infection and Early Disease Research Program (AIEDRP) CORE01 protocol and Primary HIV and Early Disease Research: Australian Cohort (PHAEDRA) cohorts. Results: We estimated that the numbers of individuals on ART increased from 3181 to 4553 in NSW, 1309 to 1926 in Victoria and 809 to 1615 in Queensland between 2000 and 2006. However, these numbers may reflect a lower proportion of individuals living with HIV on ART in NSW compared with the other states (37% compared with 49 and 55% in 2000). We found similar proportions of HIV-positive men who have sex with men participants were on ART in all three states over the study period in the clinic-based AHOD cohort (81–92%) and two large, community-based surveys in Australia (69–85% and 49–83%). Similar proportions of treated patients had an undetectable viral load across the three states, with a consistently increasing trend over time observed in all states. We found that more PHI patients commenced treatment in the first year following HIV diagnosis in NSW compared with Victoria; however, the sample size was very small. Conclusions: For the most part, patterns of ART use were similar across NSW, Victoria and Queensland using a range of available data from cohort studies, community surveys and national prescription databases in Australia. However, there may be a lower proportion of individuals living with HIV on ART in NSW compared with the other states, and there is some indication of a more aggressive treatment approach with PHI patients in NSW compared with Victoria.

scholarly journals A spatial approach for Ending the HIV Epidemic for the United States – A DC Model

2020 ◽  
Author(s):  
Suparna Das ◽  
Adam Allston ◽  
Jenevieve Opoku ◽  
Michael Kharfen
Keyword(s):  
United States ◽  
At Risk ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Positive ◽  
Population At Risk ◽  
Hiv Epidemic ◽  
Spatial Approach ◽  
Mode Of Transmission ◽  
Sex With Men

Abstract Background Mode of transmission based hotspots is a smart approach to HIV mitigation yet remains poorly evaluated and implemented in the United States. The primary aim of the analysis is identifying mode of transmission based hotspots and population at risk of lower viral suppression to assist in targeted planning and implementation of programs. Methods We implemented spatial statistics to identify global-local hotspots and regression to find population at risk of lower viral suppression within the hotspots. Data was obtained from DC’s active surveillance system which were geocoded based on address of current residence. Results The analysis identified 6001 HIV positive men-who-have-sex with men (MSMs) and 6077 HIV positives non-MSMs (n=12078) living in DC, end of 2018. The hotspots for MSMs were central DC and non-MSM in south DC. Trends of viral suppression within MSM hotspots shows plateauing and among non-MSMs showed decline. The regression analysis showed MSM aged 21 – 25 (RR: 3.199, 95% CI: 1.832, 5.586) and not linked to care (8.592; 2.907, 25.398) were at higher risk of being virally unsuppressed within the hotspots. For non-MSMs we found that aged 12 – 18 (9.025; 3.314, 2.581) and unknown linkages (6.087; 3.346, 13.848) were at higher risk of being virally unsuppressed within the hotspots. Conclusion Our analysis provides a model that may be used by other jurisdictions to identify areas of priorities and plan treatment adherence programs using surveillance data. Attaining viral suppression is crucial in reducing new diagnoses and spatial approach can be an important tool Ending the HIV Epidemic.

Evaluation of rates of virologic suppression in HIV-positive patients with varying numbers of comorbidities

2021 ◽  
Author(s):  
Briann Fischetti ◽  
Maria Sorbera ◽  
Rebecca Michael, ◽  
Noor Njeim
Keyword(s):  
Viral Load ◽  
Psychiatric Disorders ◽  
Viral Suppression ◽  
Undetectable Viral Load ◽  
Secondary Outcome ◽  
Hiv Positive ◽  
Virologic Suppression ◽  
Care Clinic ◽  
Viral Loads ◽  
The Impact

Abstract Purpose To evaluate the impact of the number of comorbidities on virologic suppression in HIV-positive patients. Methods This study included patients 18 years or older who were on antiretroviral therapy (ART) with at least 2 visits to an HIV primary care clinic in the past year. The primary outcome was the percentage of patients with an undetectable viral load (a blood HIV RNA level of <20 copies/mL) among groups of patients with 0, 1 or 2, 3 or 4, and 5 comorbidities, respectively. The secondary outcome was the percentage of patients with undetectable viral loads per each comorbidity, as listed above. The study was reviewed by an institutional review board and approved as exempt from full review. Results Among the 1,144 patients (median age of 52 years, 43% female, 74% Black) included in the study, 80% had an undetectable viral load, and the mean CD4 count was 638 cells/mm3. The majority of patients (48%) had 1 or 2 comorbidities, with only 2 patients having 5 comorbidities. For patients with 0, 1 or 2, 3 or 4, and 5 comorbidities, the percentages of patients with undetectable HIV viral loads were 76%, 81.7%, 87.9%, and 100%, respectively (P = 0.0009 in χ 2 test for trend). When looking at individual comorbidities, corresponding viral suppression rates were as follows: chronic kidney disease, 88.6%; hypertension, 85.8%; type 2 diabetes, 85.7%; clinical atherosclerotic cardiovascular disease, 83.1%; substance abuse, 76%; and psychiatric disorders, 75.2%. Conclusion Improved viral suppression was seen among HIV-positive patients with an increased number of comorbidities. Patients with psychiatric disorders had the lowest viral suppression rates amongst all of the comorbidity subgroups.

scholarly journals Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage in Kenya

2019 ◽  
Author(s):  
Peter W. Young ◽  
Emily Zielinski-Gutierrez ◽  
Joyce Wamicwe ◽  
Irene Mukui ◽  
Andrea A. Kim ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Treatment ◽  
Household Survey ◽  
Undetectable Viral Load ◽  
Dried Blood Spots ◽  
Self Report ◽  
Alternative Methods ◽  
Hiv Positive ◽  
Treatment Coverage ◽  
Survey Estimates

AbstractObjectiveTo compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood.DesignPost hoc analysis of nationally-representative household survey to compare alternative biomarker-based adjustments to population HIV indicators.MethodsWe reclassified HIV-positive participants aged 15–64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) that were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/mL) on dried blood spots. We compared self-report to adjustments for ARVs measurement, UVL, or both.ResultsTreatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4–47.8] based on ARV detection alone, to 42.8% (95% CI 37.9–47.8) when ARV-adjusted, 46.2% (95% CI 41.3–51.1) when UVL-adjusted and 48.8% (95% CI 43.9–53.8) when adjusted for either ARV or UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7– 61.6) when ARV-adjusted, 57.5% (95% CI 51.9–63.0) when UVL-adjusted, and 59.8% (95% CI 54.2–65.1) when adjusted for either ARV or UVL.ConclusionsUndetectable viral load, which is routinely measured in surveys, may be a useful adjunct or alternative to ARV detection for adjusting survey estimates of knowledge of HIV status and antiretroviral treatment coverage.

Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

2020 ◽  
Author(s):  
Pierre-Julien Coulaud ◽  
Camélia Protopopescu ◽  
Khadim Ndiaye ◽  
Maël Baudoin ◽  
Gwenaëlle Maradan ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Cox Model ◽  
Task Shifting ◽  
Hiv Positive ◽  
Treatment Access ◽  
Community Based ◽  
Related Factors ◽  
Hiv Services ◽  
Community Based Organizations ◽  
Art Initiation

Abstract Increasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5–4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09–1.45), P = 0.002], those with disease symptoms [1.21 (1.04–1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15–4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65–0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72–1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access.

Short Communication: Elevated Labile Iron Levels in CD4 and CD8 T Cells from HIV-Positive Individuals with Undetectable Viral Load

2020 ◽  
Vol 36 (7) ◽  
pp. 597-600
Author(s):  
Radoslava Emilova ◽  
Victor Manolov ◽  
Yana Todorova ◽  
Nina Yancheva ◽  
Ivailo Alexiev ◽  
...  
Keyword(s):  
T Cells ◽  
Viral Load ◽  
Cd8 T Cells ◽  
Short Communication ◽  
Undetectable Viral Load ◽  
Hiv Positive ◽  
Labile Iron

scholarly journals Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage

AIDS ◽  
2020 ◽  
Vol 34 (4) ◽  
pp. 631-636
Author(s):  
Peter W. Young ◽  
Emily Zielinski-Gutierrez ◽  
Joyce Wamicwe ◽  
Irene Mukui ◽  
Andrea A. Kim ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Treatment ◽  
Hiv Positive ◽  
Treatment Coverage ◽  
Survey Estimates

scholarly journals Efavirenz-metabolizing polymorphisms, viral suppression, and depression in HIV-infected individuals initiating antiretroviral therapy in southwestern Uganda

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S430-S431
Author(s):  
Jonathan Chang ◽  
Sulggi Lee ◽  
Peter Hunt ◽  
Deanna Kroetz ◽  
Mark Siedner
Keyword(s):  
Viral Load ◽  
Viral Suppression ◽  
Undetectable Viral Load ◽  
Nucleotide Polymorphisms ◽  
Logistic Regression Models ◽  
Hopkins Symptom Checklist ◽  
Art Initiation ◽  
Demographic Covariates ◽  
Future Work ◽  
Southwestern Uganda

Abstract Background Single-nucleotide polymorphisms (SNPs) in CYP2B6 have previously been associated with a 10-fold range in trough plasma efavirenz concentrations, but associations between these SNPs and efavirenz (EFV)-mediated viral suppression and tolerability remain unclear. Methods We evaluated three SNPs in CYP2B6 (rs3745274, rs28399499, and rs4803419, Illumina OmniExpress) among HIV-infected Ugandans observed in a cohort study every 3–4 months from 2005–2015. Genotypes from these SNPs were used to group participants into previously described pharmacokinetic strata: extensive (EXT), intermediate (INT), and slow metabolizers (Figure 1). The primary outcomes were viral suppression, defined by an undetectable viral load in the first measurement a minimum of three months after ART initiation, and incident depression in the first two years, defined by a mean score &gt;1.75 on the Hopkins Symptom Checklist. We fitted standard and generalized estimating equations (GEE) logistic regression models for viral suppression and depression, respectively. Models were adjusted for clinical and demographic covariates that reached a significance of P &lt; 0.25 in unadjusted models. Results Among 103 participants with genotyping, there were no differences in pre-ART viral load or depression by metabolism strata (P &gt; 0.5). Minor allele frequencies for rs3745274, rs28399499, and rs4803419 were 33%, 7%, and 4%, respectively. Approximately 79%, 78%, and 94% of participants were suppressed at their first viral load measurement in the extensive, intermediate, and slow metabolizer strata, respectively (Figure 2; P = 0.35). In adjusted models, metabolism strata were not associated with viral suppression (AORINT 0.81, 95% CI 0.26–2.56; AORSLOW 3.92, 95% CI 0.39–39.40) or with depression (AORINT 1.95, 95% CI 0.75–5.09; AORSLOW 0.72, 95% CI 0.17–3.02; Table). Conclusion We did not identify an association between efavirenz-metabolizing polymorphisms and viral suppression or depression in a cohort of HIV-infected individuals initiating ART in southwestern Uganda. Future work should reassess these relationships with larger samples and longer-term outcomes and explore additional polymorphisms that may be associated with efavirenz metabolism in this population. Disclosures P. Hunt, Merck: Consultant, Consulting fee; Gilead: Consultant, Consulting fee; Viiv: Consultant, Consulting fee

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