scholarly journals Decreased Time to Viral Suppression After Implementation of Targeted Testing and Immediate Initiation of Treatment of Acute Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Amsterdam

2020 ◽  
Author(s):  
Maartje Dijkstra ◽  
Martijn S van Rooijen ◽  
Mariska M Hillebregt ◽  
Ard van Sighem ◽  
Colette Smit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Viral Suppression ◽  
Standard Of Care ◽  
Combination Antiretroviral Therapy ◽  
Hiv Diagnosis ◽  
Cart Initiation ◽  
Immunodeficiency Virus ◽  
Targeted Testing ◽  
Sex With Men

Abstract Background Men who have sex with men (MSM) with acute human immunodeficiency virus (HIV) infection (AHI) are a key source of new infections. To curb transmission, we implemented a strategy for rapid AHI diagnosis and immediate initiation of combination antiretroviral therapy (cART) in Amsterdam MSM. We assessed its effectiveness in diagnosing AHI and decreasing the time to viral suppression. Methods We included 63 278 HIV testing visits in 2008–2017, during which 1013 MSM were diagnosed. Standard of care (SOC) included HIV diagnosis confirmation in < 1 week and cART initiation in < 1 month. The AHI strategy comprised same-visit diagnosis confirmation and immediate cART. Time from diagnosis to viral suppression was assessed for 3 cART initiation periods: (1) 2008–2011: cART initiation if CD4 < 500 cells/μL (SOC); (2) January 2012–July 2015: cART initiation if CD4 < 500 cells/μL, or if AHI or early HIV infection (SOC); and (3a) August 2015–June 2017: universal cART initiation (SOC) or (3b) August 2015–June 2017 (the AHI strategy). Results Before implementation of the AHI strategy, the proportion of AHI among HIV diagnoses was 0.6% (5/876); after implementation this was 11.0% (15/137). Median time (in days) to viral suppression during periods 1, 2, 3a, and 3b was 584 (interquartile range [IQR], 267–1065), 230 (IQR, 132–480), 95 (IQR, 63–136), and 55 (IQR, 31–72), respectively (P < .001). Conclusions Implementing the AHI strategy was successful in diagnosing AHI and significantly decreasing the time between HIV diagnosis and viral suppression.

scholarly journals Epidemiology of Human Immunodeficiency Virus in the United States

2007 ◽  
Vol 20 (3) ◽  
pp. 478-488 ◽  
Author(s):  
Susan Hariri ◽  
Matthew T. McKenna
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
The United States ◽  
Population Based ◽  
True Incidence ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Fundamental Shift

SUMMARY The human immunodeficiency virus (HIV) epidemic emerged in the early 1980s with HIV infection as a highly lethal disease among men who have sex with men and among frequent recipients of blood product transfusions. Advances in the treatment of HIV infection have resulted in a fundamental shift in its epidemiology, to a potentially chronic and manageable condition. However, challenges in the prevention of this infection remain. In particular, increasing evidence suggests that transmission of drug-resistant virus is becoming more common and that the epidemic is having a profound impact on morbidity and mortality in ethnic and racial minority subgroups in the United States. New population-based data collection systems designed to describe trends in behaviors associated with HIV transmission and better methods for measuring the true incidence of transmission will better elucidate the characteristics of HIV infection in the United States and inform future public health policies.

Public health counselling following an HIV diagnosis among men who have sex with men: tensions between individual needs and health protection mandates

2020 ◽  
pp. 174498712093296
Author(s):  
Lauren Orser ◽  
Patrick O'Byrne
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Public Health Nurses ◽  
Hiv Diagnosis ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Health Counselling

Background In Ontario, provincial regulations stipulate that public health units must complete post-test counselling with all persons newly diagnosed with human immunodeficiency virus. Public health nurses conduct this follow-up and are responsible for ensuring appropriate surveillance and management of human immunodeficiency virus with the primary objective of reducing ongoing human immunodeficiency virus transmission in their health jurisdiction. To date, little research has explored the effectiveness of this mandatory public health counselling from the perspective of patients – the majority of whom are men who have sex with men. Aims To address gaps in public health nursing practice, a pilot study was conducted with men who have sex with men in Ottawa to explore their attitudes and experiences of receiving mandatory human immunodeficiency virus follow-up after their diagnosis. Methods Qualitative interviews were conducted and interpreted using thematic analysis. Results This analysis revealed a contrariety between the needs of individuals and of public health units, with patients' perceiving their personal wishes to be secondary to public health mandates – and led patients to simultaneously want to evade, and be assisted by, public health nurses. Conclusions Public health units and nurses should consider adopting a more patient-centered approach to HIV case management, which incorporates patients’ experiences of receiving an HIV diagnosis.

scholarly journals Viral Suppression and Immune Restoration in the Gastrointestinal Mucosa of Human Immunodeficiency Virus Type 1-Infected Patients Initiating Therapy during Primary or Chronic Infection

2006 ◽  
Vol 80 (16) ◽  
pp. 8236-8247 ◽  
Author(s):  
Moraima Guadalupe ◽  
Sumathi Sankaran ◽  
Michael D. George ◽  
Elizabeth Reay ◽  
David Verhoeven ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
T Cells ◽  
T Cell ◽  
Hiv Infection ◽  
Microarray Analysis ◽  
Dna Microarray ◽  
Peripheral Blood ◽  
Viral Suppression ◽  
Cell Responses ◽  
Immunodeficiency Virus

ABSTRACT Although the gut-associated lymphoid tissue (GALT) is an important early site for human immunodeficiency virus (HIV) replication and severe CD4+ T-cell depletion, our understanding is limited about the restoration of the gut mucosal immune system during highly active antiretroviral therapy (HAART). We evaluated the kinetics of viral suppression, CD4+ T-cell restoration, gene expression, and HIV-specific CD8+ T-cell responses in longitudinal gastrointestinal biopsy and peripheral blood samples from patients initiating HAART during primary HIV infection (PHI) or chronic HIV infection (CHI) using flow cytometry, real-time PCR, and DNA microarray analysis. Viral suppression was more effective in GALT of PHI patients than CHI patients during HAART. Mucosal CD4+ T-cell restoration was delayed compared to peripheral blood and independent of the time of HAART initiation. Immunophenotypic analysis showed that repopulating mucosal CD4+ T cells were predominantly of a memory phenotype and expressed CD11α, αEβ7, CCR5, and CXCR4. Incomplete suppression of viral replication in GALT during HAART correlated with increased HIV-specific CD8+ T-cell responses. DNA microarray analysis revealed that genes involved in inflammation and cell activation were up regulated in patients who did not replenish mucosal CD4+ T cells efficiently, while expression of genes involved in growth and repair was increased in patients with efficient mucosal CD4+ T-cell restoration. Our findings suggest that the discordance in CD4+ T-cell restoration between GALT and peripheral blood during therapy can be attributed to the incomplete viral suppression and increased immune activation and inflammation that may prevent restoration of CD4+ T cells and the gut microenvironment.

scholarly journals Psychosocial Barriers to Viral Suppression in a Community-based Sample of Human Immunodeficiency Virus–infected Men Who Have Sex With Men and People Who Inject Drugs in India

2019 ◽  
Vol 70 (2) ◽  
pp. 304-313 ◽  
Author(s):  
Sandeep Prabhu ◽  
Allison M McFall ◽  
Shruti H Mehta ◽  
Aylur K Srikrishnan ◽  
Muniratnam Suresh Kumar ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Use ◽  
Alcohol Dependence ◽  
Viral Suppression ◽  
People Who Inject Drugs ◽  
Severe Depression ◽  
Recreational Drug ◽  
Immunodeficiency Virus ◽  
Recreational Drug Use ◽  
Sex With Men

Abstract Background Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)–infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. Methods MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. Results Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI}, .16–.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI, .20–.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI, .09–.57]). Among PWID, daily injection (aPR, 0.51 [95% CI, .31–.82]) was the primary barrier to suppression. Conclusions Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets.

Reaching the Second and Third Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/AIDS 90-90-90 Targets Is Accompanied by a Dramatic Reduction in Primary HIV Infection and in Recent HIV Infections in a Large French Nationwide HIV Cohort

2019 ◽  
Vol 71 (2) ◽  
pp. 293-300
Author(s):  
Adrien Le Guillou ◽  
Pascal Pugliese ◽  
François Raffi ◽  
André Cabie ◽  
Lise Cuzin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
United Nations ◽  
Hiv Infection ◽  
Cell Count ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Nations Programme ◽  
United Nations Programme ◽  
Immunodeficiency Virus ◽  
Cd4 Cell

Abstract Background In late 2013, France was one of the first countries to recommend initiation of combination antiretroviral therapy (cART) irrespective of CD4 cell count. Methods To assess the impact of achieving the second and third Joint United Nations Programme on HIV/AIDS 90-90-90 targets (ie, 90% of diagnosed people on sustained cART, and, of those, 90% virologically controlled) on human immunodeficiency virus (HIV) incidence, we conducted a longitudinal study to describe the epidemiology of primary HIV infection (PHI) and/or recent HIV infection (patients with CD4 cell count ≥500/mm3 at HIV diagnosis; (PRHI) between 2007 and 2017 in a large French multicenter cohort. To identify changes in trends in PHI and PRHI, we used single breakpoint linear segmented regression analysis. Results During the study period, 61 822 patients were followed in the Dat’AIDS cohort; 2027 (10.0%) had PHI and 7314 (36.1%) had PRHI. The second and third targets were reached in 2014 and 2013, respectively. The median delay between HIV diagnosis and cART initiation decreased from 9.07 (interquartile range [IQR], 1.39–33.47) months in 2007 to 0.77 (IQR, 0.37–1.60) months in 2017. A decrease in PHI (−35.1%) and PRHI (−25.4%) was observed starting in 2013. The breakpoints for PHI and PRHI were 2012.6 (95% confidence interval [CI], 2010.8–2014.4) and 2013.1 (95% CI, 2011.3–2014.8), respectively. Conclusions Our findings show that the achievements of 2 public health targets in France and the early initiation of cART were accompanied by a reduction of about one-third in PHI and PRHI between 2013 and 2017. Clinical Trials Registration NCT02898987.

scholarly journals Correlations Between Human Immunodeficiency Virus (HIV) Infection and Rectal Gonorrhea Incidence in Men Who Have Sex With Men: Implications for Future HIV Preexposure Prophylaxis Trials

2019 ◽  
Vol 221 (2) ◽  
pp. 214-217 ◽  
Author(s):  
Charu Mullick ◽  
Jeffrey Murray
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Treatment As Prevention ◽  
Published Data ◽  
Hiv Incidence ◽  
Quantitative Correlation ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
Prevention Trials ◽  
Sex With Men

Abstract Using published data, we found a direct correlation between the incidence of rectal gonorrhea and human immunodeficiency virus (HIV) infection in men who have sex with men who were not using oral preexposure prophylaxis. HIV incidence was predicted using rectal gonorrhea incidence as the determinant in regression analysis. The observed correlation suggest that rectal gonorrhea incidence can potentially serve as a predictor of HIV incidence. If confirmed with additional data, a quantitative correlation for incidence of the 2 infections could be useful in active-controlled HIV prevention trials where low HIV incidence is expected. Widespread improvements in treatment as prevention and gonorrhea control can negatively impact the correlation and its utility.

scholarly journals Knowledge and Awareness of Acute Human Immunodeficiency Virus Infection Among Mobile App-Using Men Who Have Sex With Men: A Missed Public Health Opportunity

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Aaron J. Siegler ◽  
Travis Sanchez ◽  
R. Craig Sineath ◽  
Jeremy Grey ◽  
Erin Kahle ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Online Survey ◽  
Mobile App ◽  
Acute Hiv Infection ◽  
Immunodeficiency Virus ◽  
Acute Hiv ◽  
Sex With Men

Abstract In a national online survey, we assessed awareness and knowledge of acute human immunodeficiency virus (HIV) infection manifestation among 1748 men who have sex with men (MSM). Only 39% of respondents were aware that acute HIV infection may be accompanied by symptoms. Education and increased access to acute HIV testing may facilitate MSM to appropriately seek acute HIV testing.

scholarly journals Lack of Awareness of Human Immunodeficiency Virus (HIV) Infection: Problems and Solutions With Self-reported HIV Serostatus of Men Who Have Sex With Men

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Travis H. Sanchez ◽  
Colleen F. Kelley ◽  
Eli Rosenberg ◽  
Nicole Luisi ◽  
Brandon O'Hara ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Self Report ◽  
Black Msm ◽  
Hiv Status ◽  
Hiv Viral Load ◽  
Hiv Test ◽  
Immunodeficiency Virus ◽  
Surveillance Report ◽  
Sex With Men

Background.  Lack of human immunodeficiency virus (HIV) infection awareness may be a driver of racial disparities in HIV infection among men who have sex with men (MSM). Lack of awareness is typically measured by comparing HIV test result to self-reported HIV status. This measure may be subject to reporting bias and alternatives are needed. Methods.  The InvolveMENt study examined HIV disparities between black and white MSM from Atlanta. Among HIV-positive participants who did not report knowing they were positive, we examined other measures of awareness: HIV viral load (VL) <1000 copies/mL (low VL), antiretroviral (ARV) drugs in blood, and previous HIV case surveillance report. Results.  Using self-report only, 32% (62 of 192) of black and 16% (7 of 45) of white MSM were not aware of their HIV infection (P = .03). Using self-report and low VL, 25% (48 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .18). Using self-report and ARVs, 26% (50 of 192) black and 16% (7 of 45) white MSM lacked awareness (P = .14). Using self-report and surveillance report, 15% (28 of 192) black and 13% (6 of 45) white MSM lacked awareness (P = .83). Conclusions.  Self-report only may overestimate true lack of awareness of HIV status for black MSM. If, as our data suggest, black MSM are not less likely to be aware of their HIV infection than are white MSM, then this factor is not a substantial driver of HIV disparity. Future HIV research that depends on accurate measurement of HIV status awareness should consider including additional laboratory and case surveillance data.

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