The Importance of Meanings of Antiretroviral Treatment and Care Providers for Adherence and Transitioning to Adult Services Among Youth With Perinatally Acquired HIV Infection

Co-infection with hepatitis C virus (HCV) and/or hepatitis B virus (HBV) is becoming a rampant disparity in HIV-infected patients. The advent of antiretroviral therapy has led to agents that are effective for suppression of both HIV and HBV; however, this can not be extrapolated to patients who are coinfected with HCV. Treatment of HCV disease is often strenuous and can lead to untoward adverse effects. Co-infection with HIV often leads to higher rates of cirrhosis and liver failure in patients with HBV or HCV, compromising antiretroviral treatment in this patient population due to the hepatotoxicity of these agents. The purpose of this review is to familiarize health care providers to the management of HIV infection in patients who are also co-infected with HBV or HCV.

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Support From Health Care Providers and Parental Uncertainty During the Diagnosis Phase of Perinatally Acquired HIV Infection

Journal of the Association of Nurses in AIDS Care ◽

10.1016/s1055-3290(06)60287-2 ◽

2000 ◽

Vol 11 (2) ◽

pp. 63-75 ◽

Cited By ~ 9

Author(s):

Sheila J. Santacroce

Keyword(s):

Health Care ◽

Hiv Infection ◽

Health Care Providers ◽

Care Providers ◽

Perinatally Acquired

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Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection

AIDS ◽

10.1097/qad.0000000000002410 ◽

2020 ◽

Vol 34 (2) ◽

pp. 261-266 ◽

Cited By ~ 3

Author(s):

Caroline Foster ◽

Sara Ayers ◽

Susan Mcdonald ◽

Graham Frize ◽

Srishti Chhabra ◽

...

Keyword(s):

Young Adults ◽

Hiv Infection ◽

Clinical Outcomes ◽

Adult Services ◽

Perinatally Acquired

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Benefits and Limits of Antiretroviral Drug Monitoring in Routine Practice

Current HIV Research ◽

10.2174/1570162x17666190903232053 ◽

2019 ◽

Vol 17 (3) ◽

pp. 190-197

Author(s):

Thomas Maitre ◽

Patrice Muret ◽

Mathieu Blot ◽

Anne Waldner ◽

Michel Duong ◽

...

Keyword(s):

Hiv Infection ◽

Therapeutic Range ◽

Drug Monitoring ◽

Antiretroviral Treatment ◽

University Hospital ◽

Therapeutic Drug ◽

Routine Practice ◽

Hiv Viral Load ◽

Measured Concentration ◽

The University

Background: HIV infection is a chronic disease for which therapeutic adherence and tolerance require particular attention. Objective: This study aimed to assess whether and when therapeutic drug monitoring (TDM) could be associated with a benefit in routine practice. Methods: All HIV-infected patients who underwent at least one TDM at the University Hospital of Dijon (France) between 1st January 2009 and 31st December 2012 were retrospectively included. Compliance with the recommendations, the results (antiretroviral concentrations), any subsequent therapeutic modifications, and the virological results at 4-8 months were analysed each time TDM was performed. TDM was defined as “practically relevant” when low or high antiretroviral concentrations led to a change in therapy. Results: Of the 571 patients who followed-up, 43.4% underwent TDM. TDM complying with recommendations (120 patients) was associated with a higher proportion of antiretroviral concentrations outside the therapeutic range (p=0.03). Antiretroviral treatment was modified after TDM in 22.6% of patients. Protease inhibitors, non-nucleoside reverse transcriptase inhibitors and raltegravir were more significantly modified when the measured concentration was outside the therapeutic range (p=0.008, p=0.05 and p=0.02, respectively). Overall, 11.7% of TDM was considered “practically relevant”, though there was no significant correlation between subsequent changes in antiretroviral treatment and undetectable final HIV viral load. Conclusions: TDM may be a useful tool in the management of HIV infection in specific situations, but the overall benefit seems moderate in routine practice. TDM cannot be systematic and/or a decision tool per se, but should be included in a comprehensive approach in certain clinical situations.

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Impact of Delaying Antiretroviral Treatment during Primary HIV Infection on Telomere Length

The Journal of Infectious Diseases ◽

10.1093/infdis/jiab186 ◽

2021 ◽

Author(s):

Marieke Raffenberg ◽

Tanja Engel ◽

Isabella C Schoepf ◽

Neeltje A Kootstra ◽

Peter Reiss ◽

...

Keyword(s):

Hiv Infection ◽

Telomere Length ◽

Antiretroviral Treatment ◽

Mononuclear Cells ◽

Multivariable Analysis ◽

Limited Effect ◽

Peripheral Blood Mononuclear ◽

Primary Hiv Infection ◽

Hiv Seroconversion ◽

Chronic Hiv Infection

Abstract Background Telomere length (TL) shortens during aging, HIV-seroconversion and untreated chronic HIV infection. It is unknown whether early antiretroviral therapy (ART) start is associated with less TL shortening during primary HIV infection (PHI). Methods We measured TL in peripheral blood mononuclear cells by quantitative PCR in participants of the Zurich PHI Study with samples available for >6 years. We obtained uni-/multivariable estimates from mixed-effects models and evaluated the association of delaying ART start or interrupting ART with baseline and longitudinal TL. Results In 105 participants with PHI (median age 36 years, 9% women), median ART delay was 25, 42, and 60 days, respectively, in the 1 st (shortest), 2 nd, and 3 rd (longest) ART delay tertile. First ART delay tertile was associated with longer baseline TL (p for trend=0.034), and longer TL over 6 years, but only with continuous ART (p<0.001), not if ART was interrupted >12 months (p=0.408). In multivariable analysis, participants in the 2 nd and 3 rd ART delay tertile had 17.6% (5.4-29.7%; p=0.004) and 21.5% (9.4-33.5%; p<0.001) shorter TL, after adjustment for age, with limited effect modification by clinical variables. Discussion In PHI, delaying ART start for even a matter of weeks was associated with significant and sustained TL shortening.

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1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1722 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S770-S771

Author(s):

Christian C Lamb ◽

Joseph Yabes ◽

Shilpa Hakre ◽

Jason Okulicz

Keyword(s):

Primary Care ◽

Hiv Infection ◽

Air Force ◽

Clinical Laboratory ◽

Medical Center ◽

Previous History ◽

Primary Care Providers ◽

Care Providers ◽

National Guidelines ◽

Hiv Diagnosis

Abstract Background The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. Methods All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Results Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone. Table 1 Table 2 Conclusion EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening. Disclosures All Authors: No reported disclosures

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