Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder

Abstract Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. Methods CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. Results Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001). Conclusions Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

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Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load

Clinical Infectious Diseases ◽

10.1093/cid/ciz299 ◽

2019 ◽

Vol 70 (5) ◽

pp. 867-874 ◽

Cited By ~ 3

Author(s):

Robin M Nance ◽

Maria Esther Perez Trejo ◽

Bridget M Whitney ◽

Joseph A C Delaney ◽

Fredrick L Altice ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Substance Use ◽

Viral Load ◽

Drug Use ◽

Viral Suppression ◽

Illicit Drug ◽

Illicit Drug Use ◽

Hiv Viral Load ◽

Immunodeficiency Virus ◽

The Impact

Abstract Background Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

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Functional Haplotypes in the ADIPOQ Gene are Associated with Underweight, Immunosuppression and Viral Suppression in Kenyan HIV-1 Infected Antiretroviral Treatment Naive and Experienced Injection Substance Users

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i4.4 ◽

2020 ◽

Vol 30 (4) ◽

Author(s):

Shaviya Nathan ◽

Budambula Valentine ◽

Were Tom

Keyword(s):

Human Immunodeficiency Virus ◽

Substance Use ◽

Antiretroviral Treatment ◽

Viral Suppression ◽

Clinical Markers ◽

Adiponectin Gene ◽

Substance Users ◽

Disease Outcomes ◽

Immunodeficiency Virus ◽

Treatment Naïve

BACKGROUND: Human immunodeficiency virus and injection substance use have an influence on genes and gene expression. These effects could be beneficial or detrimental in defining disease outcomes. Adiponectin gene is key in modulating metabolic and immunoregulatory functions. Understanding the effects of human immunodeficiency virus and injection substance use on the gene in the context of antiretroviral therapy is important for predicting disease outcomes.METHODS: This cross-sectional genetic study determined polymorphisms in the promoter region of adiponectin gene. Two variants were analyzed: rs2241766 and rs266729. Polymorphisms were associated with clinical markers of disease outcome; underweight, immunosuppression and viral suppression. The variants were genotyped via random fragment length polymorphism.RESULTS: GC haplotype was associated with higher odds of having underweight (OR, 2.21; 95% CI, 1.83-4.60; P=0.008 vs. OR, 2.30; 95% CI, 1.89-4.71; P=0.006) in antiretroviral treatment -naive and experienced injection substance users andimmunosuppression (OR, 1.90; 95% CI 1.67-3.98, P=0.041) in naive. Bonferroni correction revealed GC haplotype carriers only to have low body mass index in both naive (median, 14.8; IQR, 3.2kg/m2; P<0.002) and experienced (median, 15.2; IQR, 3.2 kg/m2; P<0.002) injection substance users. Circulating total adiponectin levels were higher in naive (median, 19.5; IQR, 7.9 μg/ml) than - experienced (median, 12.0; IQR, 4.4 μg/ml) injection substance users (P<0.0001). GC carriers presented with low serum adiponectin levels in both study groups.CONCLUSION: The study revealed haplotypes of adiponectin gene at loci rs2241766 and rs266729 that could determine disease outcomes in human immunodeficiency virus -1 antiretroviral treatment- naive and experienced injection substance users.

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Implications of the human immunodeficiency virus test and treat strategy on antiretroviral treatment uptake and retention outcomes in Cameroon

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195045 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4716

Author(s):

Rogers A. Awoh ◽

Halle G. Ekane ◽

Anastase Dzudie ◽

Egbe O. Thomas ◽

Adebola Adedimeji ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Retrospective Chart Review ◽

Hiv Care ◽

Retention Data ◽

Hiv Diagnosis ◽

Chi Square ◽

Test And Treat ◽

Art Initiation ◽

Hiv Test ◽

Immunodeficiency Virus

Background: Success of the human immunodeficiency virus (HIV) test-and-treat (T&T) strategy requires high antiretroviral (ART) uptake and retention. However, low ART uptake and retention continue to be reported in ART programs. This study assessed ART uptake and retention outcomes of the HIV T&T strategy in three HIV clinics in Cameroon.Methods: A retrospective chart review was done for 423 patients who initiated HIV care within a period of three months prior to the implementation of the HIV T&T strategy, and for another 423 patients who initiated HIV care within a three-month period following the HIV T&T strategy implementation. For each group, sociodemographic, ART uptake and retention data were collected. Chi square and Student T tests were used to test for differences proportions and means between the two groups at p <0.05 and 95% confidence interval.Results: The mean ages (years) in the pre-T&T and the T&T groups were 39.73 and 39.72, and the proportion of female were 65.85% and 65.08% respectively. ART uptake proportion was higher amongst those enrolled under the T&T strategy (98.08% vs 95.39%, p=0.02). A greater proportion of the patients in the T&T group initiated ART within 2 weeks following HIV diagnosis (55.84% vs 48.17%, p=0.03). However, ART retention at 24th month was lower in the T&T group (78.83% vs. 85.79%, p=0.01).Conclusions: The findings suggest that the T&T strategy is associated with higher ART uptake, earlier ART initiation, and lower ART retention. This underscores a need for strategies to improve ART retention under the HIV T&T guidelines.

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A STUDY ON THE SAFETY AND EFFICACY OF MONOGLYCERIDE OF LAURIC ACID AS ADJUVANT TREATMENT IN PERSONS LIVING WITH HIV INFECTION

CORD ◽

10.37833/cord.v16i02.339 ◽

2000 ◽

Vol 16 (02) ◽

pp. 34

Author(s):

Eric A. Tayag ◽

Edna G. Santiago ◽

Minda A. Manado ◽

Perla N. Alban ◽

Dorothy Mae Agdamag ◽

...

Keyword(s):

Quality Of Life ◽

Human Immunodeficiency Virus ◽

Safety And Efficacy ◽

Aids Pandemic ◽

Persons Living With Hiv ◽

Immunodeficiency Virus ◽

Global Concern ◽

Living With Hiv ◽

The Impact

The AIDS pandemic has caused global concern what with its threat to man’s survival and the enormous cost to prevent and treat the illness. No effective cure is possible but for the last fifteen years, countless studies were made to improve survival, delay disease progression or just improve the quality of life. Various clinical trials were designed to inhibit specific processes that are necessary for the human immunodeficiency virus (HIV) to survive the internal milieu. As important as these discoveries, are the precise methods of measuring the impact of these treatments. Only in the last five years has there been a better understanding of these processes and methods.

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Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

AIDS and Behavior ◽

10.1007/s10461-020-03041-7 ◽

2020 ◽

Author(s):

Melissa A. Stockton ◽

Bradley N. Gaynes ◽

Mina C. Hosseinipour ◽

Audrey E. Pettifor ◽

Joanna Maselko ◽

...

Keyword(s):

Viral Suppression ◽

Hiv Care ◽

People Living With Hiv ◽

Load Testing ◽

Art Initiation ◽

Retention In Hiv Care ◽

Hiv Care Engagement ◽

Care Outcomes ◽

Sub Saharan ◽

Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

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2017 HIV Medicine Association of Infectious Diseases Society of America Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With Human Immunodeficiency Virus

Clinical Infectious Diseases ◽

10.1093/cid/cix848 ◽

2017 ◽

Vol 65 (10) ◽

pp. 1601-1606 ◽

Cited By ~ 9

Author(s):

R Douglas Bruce ◽

Jessica Merlin ◽

Paula J Lum ◽

Ebtesam Ahmed ◽

Carla Alexander ◽

...

Keyword(s):

Chronic Pain ◽

Human Immunodeficiency Virus ◽

Infectious Diseases ◽

Evidence Base ◽

Chronic Noncancer Pain ◽

Persons Living With Hiv ◽

Immunodeficiency Virus ◽

Physician Judgment ◽

Noncancer Pain ◽

Living With Hiv

Abstract Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population. It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.

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A systematic review of the geospatial barriers to antiretroviral initiation, adherence and viral suppression among people living with HIV

Sexual Health ◽

10.1071/sh18104 ◽

2019 ◽

Vol 16 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Kiffer G. Card ◽

Nathan J. Lachowsky ◽

Keri N. Althoff ◽

Katherine Schafer ◽

Robert S. Hogg ◽

...

Keyword(s):

Viral Suppression ◽

Clinical Care ◽

The United States ◽

Hiv Care ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Art Initiation ◽

Pubmed Database ◽

Barriers To Art Initiation ◽

Living With Hiv

Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing – an essential antecedent to clinical care – to date, no reviews have summarised the research with respect to other ART-related outcomes. Methods: Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies. Results: In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes. Conclusions: Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas – particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH).

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From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa336 ◽

2020 ◽

Vol 222 (Supplement_5) ◽

pp. S410-S419

Author(s):

Rebecca Metcalfe ◽

Manon Ragonnet-Cronin ◽

Amanda Bradley-Stewart ◽

Andrew McAuley ◽

Harrison Stubbs ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Phylogenetic Analysis ◽

People Who Inject Drugs ◽

Hiv Care ◽

Viral Load Suppression ◽

Art Initiation ◽

Immunodeficiency Virus ◽

Complex Population ◽

Care Models ◽

The Impact

Abstract An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.

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