“I’ve got HIV and I want to have a baby”

HIV ◽  
2020 ◽  
pp. 67-78
Author(s):  
Thana Khawcharoenporn ◽  
Beverly E. Sha
Keyword(s):  
Hiv Transmission ◽  
Opportunistic Infections ◽  
Perinatal Transmission ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Comprehensive Management ◽  
Art Initiation ◽  
Effective Combination ◽  
Intrapartum Management

Perinatal transmission is one of the important routes of HIV transmission that is preventable in the era of effective combination antiretroviral therapy (ART). This chapter presents the case of a known HIV-infected, ART-naïve pregnant woman who establishes antenatal and HIV care late, at 32 weeks’ gestational age. Her presentation raises concerns about the potential risk of HIV transmission to her baby given limited time to achieve HIV virologic suppression. The appropriate management is discussed, which includes first-encounter screening, management of opportunistic infections and sexually transmitted infections, risk behavior modification and counseling, ART initiation and treatment monitoring, intrapartum management, infant prophylaxis, and postpartum HIV care. The case presentation and discussion highlight the importance of comprehensive management of HIV infection in pregnant women to minimize the risk of mother-to-infant HIV transmission and optimize HIV control in the mothers.

scholarly journals Rapid Antiretroviral Therapy (ART) Initiation at a Community-Based Clinic in Jackson, MS

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Courtney E. Sims Gomillia ◽  
Kandis V. Backus ◽  
James B. Brock ◽  
Sandra C. Melvin ◽  
Jason J. Parham ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Median Time ◽  
Viral Suppression ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Community Based ◽  
Art Initiation ◽  
Healthcare Center ◽  
The Impact

Abstract Background Rapid antiretroviral therapy (ART), ideally initiated within twenty-four hours of diagnosis, may be crucial in efforts to increase virologic suppression and reduce HIV transmission. Recent studies, including demonstration projects in large metropolitan areas such as Atlanta, Georgia; New Orleans, Louisiana; San Francisco, California; and Washington D.C., have demonstrated that rapid ART initiation is a novel tool for expediting viral suppression in clinical settings. Here we present an evaluation of the impact of a rapid ART initiation program in a community-based clinic in Jackson, MS. Methods We conducted a retrospective chart review of patients who were diagnosed with HIV at Open Arms Healthcare Center or were linked to the clinic for HIV care by the Mississippi State Department of Health Disease Intervention Specialists from January 1, 2016 to December 31, 2018. Initial viral load, CD4+ T cell count, issuance of an electronic prescription (e-script), subsequent viral loads until suppressed and patient demographics were collected for each individual seen in clinic during the review period. Viral suppression was defined as a viral load less than 200 copies/mL. Rapid ART initiation was defined as receiving an e-script for antiretrovirals within seven days of diagnosis. Results Between January 1, 2016 and December 31, 2018, 70 individuals were diagnosed with HIV and presented to Open Arms Healthcare Center, of which 63 (90%) completed an initial HIV counseling visit. Twenty-seven percent of patients were provided with an e-script for ART within 7 days of diagnosis. The median time to linkage to care for this sample was 12 days and 5.5 days for rapid ART starters (p < 0.001). Median time from diagnosis to viral suppression was 55 days for rapid ART starters (p = 0.03), a 22 day decrease from standard time to viral suppression. Conclusion Our results provide a similar level of evidence that rapid ART initiation is effective in decreasing time to viral suppression. Evidence from this evaluation supports the use of rapid ART initiation after an initial HIV diagnosis, including same-day treatment.

scholarly journals Factors Associated with Outcomes of Pre-ART HIV Care

2018 ◽  
Vol 17 ◽  
pp. 232595821875960
Author(s):  
Kristen A. Stafford ◽  
Lucy W. Nganga ◽  
Tuhuma Tulli ◽  
Karen G. Fleischman Foreit
Keyword(s):  
Disease Progression ◽  
Opportunistic Infections ◽  
World Health ◽  
Hiv Care ◽  
Cox Models ◽  
Factors Associated ◽  
Art Initiation ◽  
Resource Limited ◽  
Health Organization ◽  
Lost To Follow Up

The World Health Organization recommended removing all CD4 requirements for initiation of antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period to identify and assess factors associated with outcomes of pre-ART care. Four modes of transition out of pre-ART care were considered. Beta estimates from the competing risks Cox models were used to investigate whether the effects of covariates differed by mode of transition. Median CD4 counts at entry showed no meaningful change over time. Advanced disease progression and presence of opportunistic infections were significant predictors of pre-ART mortality. Men were more likely to die before initiating ART, transfer to another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not likely to substantially reduce program mortality prior to ART initiation unless and until patients enroll earlier in disease progression. Care programs should focus on diagnosis and treatment of opportunistic infections to reduce pre-ART mortality.

HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines

2021 ◽  
pp. 095646242098743
Author(s):  
Patrick C Eustaquio ◽  
Steffen S Docken ◽  
Katerina T Leyritana ◽  
Luh Putu Lila Wulandari
Keyword(s):  
The Philippines ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Effective Strategies ◽  
Hiv Care Cascade ◽  
Art Initiation ◽  
Care Cascade ◽  
Key Population ◽  
Hiv Test ◽  
Sex With Men

The HIV epidemic in the Philippines is the fastest growing globally, and disproportionately affects cisgender men who have sex with men (cis-MSM) demanding effective strategies for this key population (KP) group. KP-specific and community-based (CB) interventions have improved the HIV response elsewhere, but these have yet to be evaluated locally. We analyzed the HIV care cascade outcomes in a KP-led, CB HIV test-and-treat center and determined factors that affect these by performing a retrospective study of medical records of 3137 patients diagnosed from January 2016 to March 2019 in LoveYourself in Manila, Philippines. Multivariate logistic regression was performed to determine predictors affecting the likelihood of antiretroviral therapy (ART) initiation and viral load (VL) suppression. As to UNAIDS 90–90–90 targets, LoveYourself had higher rates than national outcomes with 78% initiated ART and 84% achieved VL suppression. Such satisfactory performance is consistent with other studies exploring CB, KP-led approaches among cis-MSM. Patients who presented with WHO Stages 2–4 and those with sexually transmitted infections were less likely to initiate ART. Patients who presented with WHO Stages 2–4 and those whose ART was started late were less likely to be virally suppressed. These findings suggest the need to develop responsive interventions to reach the UNAIDS targets.

scholarly journals Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Jose Lucar ◽  
Rachel Hart ◽  
Nabil Rayeed ◽  
Arpi Terzian ◽  
Amy Weintrob ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Poisson Regression ◽  
Hiv Transmission ◽  
The United States ◽  
Transmission Risk ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Hiv Transmission Risk ◽  
Hiv Acquisition

Abstract Background Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. Methods We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk. Results Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1–8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL. Conclusions STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

scholarly journals 1527. Incident Sexually Transmitted Infections among Southern Men Who Have Sex with Men Living with HIV in the Era of Biomedical Prevention

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S764-S765
Author(s):  
Ronnie M Gravett ◽  
John D Cleveland ◽  
Edgar T Overton ◽  
Jeanne Marrazzo ◽  
Jeanne Marrazzo
Keyword(s):  
Viral Load ◽  
Sexually Transmitted Infections ◽  
Incidence Rate ◽  
Hiv Care ◽  
Virologic Suppression ◽  
Sexually Transmitted ◽  
Sex With Men ◽  
Living With Hiv ◽  
Incident Rates ◽  
The U.S

Abstract Background Sexually transmitted infections (STI) and HIV disproportionately affect men who have sex with men (MSM) in the U.S. Deep South. The South also continues to bear the majority of incident HIV in the U.S.; concomitantly, STIs have increased among MSM in this region. HIV virologic suppression effectively prevents sexual transmission of HIV (treatment as prevention, TasP), but STIs occur commonly in MSM living with HIV despite this. Here, we describe the incidence of gonorrhea and chlamydia in MSM living with HIV in the context of their viral load (VL) management from 2016 to 2019. Methods We analyzed data from adult MSM living with HIV from 2016-2019 in HIV care in Birmingham, AL. Eligible MSM were prospectively enrolled in the CFAR Network of Integrated Clinical Sites (CNICS) and had documentation of at least one HIV viral load and one STI test (gonorrhea or chlamydia at any anatomic site) in the same calendar year. Demographic data is presented by year. STI incident rates were calculated by year by viral load (VL) category, suppressed (VL &lt; 200 copies/ml) and unsuppressed (VL ≥ 200 copies/ml), with incident rate ratios (IRR) and 95% confidence intervals for comparing suppressed VL to unsuppressed VL. Results The study cohort included 943, 1084, 1080, and 1106 MSM in each year from 2016-2019, respectively. Of these men, 551 (58%), 623 (58%), 639 (63%), and 676 (61%) were Black or African American with a median age (years) of 46, 45, 44, and 43 from 2016-2019. Most had VL &lt; 200 (79%, 81%, 82%, and 80% from 2016-2019). There were 100, 131, 139, and 168 men with positive GC or CT results per year from 2016-2019. The annual incident rates per 100 person years (PY) for MSM by suppressed and unsuppressed VL as well as IRR are presented in Table 1; the IRR ranged from 3.00-4.34 through the study period. Figure 1 shows incidence rate by VL category. Figure 1. Incidence Rate by Viral Load Category. PY, person years. Conclusion In this cohort, incident bacterial STIs were common and increased each year in this analysis for both groups, reflecting national STI trends. MSM with suppressed VL had higher bacterial STI incidence rates and higher risk for incident STI compared to MSM with unsuppressed VL. Novel approaches to STI prevention, such as pre- and post-exposure prophylaxis or vaccines, are necessary to alter the STI epidemic in this population and limit its impact on HIV transmission. Disclosures All Authors: No reported disclosures

scholarly journals Estimating the impact of disruptions due to COVID-19 on HIV transmission and control among men who have sex with men in China

2020 ◽  
Author(s):  
Ross. D. Booton ◽  
Gengfeng Fu ◽  
Louis MacGregor ◽  
Jianjun Li ◽  
Jason J. Ong ◽  
...  
Keyword(s):  
Condom Use ◽  
Viral Suppression ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
Hiv Care ◽  
Art Initiation ◽  
Sex With Men ◽  
One Year ◽  
And Control ◽  
The Impact

AbstractIntroductionThe COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China.MethodsRegional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of sexual partners (62%) and consistency of condom use (25%). A deterministic mathematical model of HIV transmission and treatment among MSM in China was used to estimate the impact of these disruptions on the number of new HIV infections and HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over 1 and 5 years for a 3-, 4- or 6-month disruption period.ResultsOur China model predicted that new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions for a 3-month period increasing HIV infections by 5-14% over 1 year and deaths by 7-12%. Observed reductions in condom use increased HIV infections by 5-14% but had minimal impact (<1%) on deaths. Smaller impacts on infections and deaths (<3%) were seen for disruptions to facility testing and ART initiation, but reduced partner numbers resulted in 11-23% fewer infections and 0.4-1.0% fewer deaths. Longer disruption periods of 4 and 6 months amplified the impact of combined disruption scenarios. When all realistic disruptions were modelled simultaneously, an overall decrease in new HIV infections was always predicted over one year (3-17%), but not over 5 years (1% increase-4% decrease), while deaths mostly increased over one year (1-2%) and 5 years (1.2 increase – 0.3 decrease).ConclusionsThe overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19 related disruption on HIV transmission and control among MSM in China.

scholarly journals Automated STI/HIV risk assessments: Testing an online clinical algorithm in Ottawa, Canada

2021 ◽  
pp. 095646242110313
Author(s):  
Patrick O’Byrne ◽  
Alexandra Musten ◽  
Lauren Orser ◽  
Scott Buckingham
Keyword(s):  
Hiv Transmission ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Quadratic Equation ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Sti Testing ◽  
Test Kit ◽  
Two Measures ◽  
Stis And Hiv

Despite the ongoing transmission of sexually transmitted infections (STIs) and HIV, many people became unable to access testing due to COVID-19. To address this, we created a mail-out HIV self-test kit, which could be delivered without restrictions in our region. The uptake and feedback from this project made us realize that comprehensive STI testing was being sought. To ensure testing occurred correctly—that is, it would be targeted at the persons most affected by STIs/HIV—we automated clinical decision-making. We built this model based on a 2-by-2 matrix that plots the risk of STI/HIV transmission and risk of STI/HIV exposure. The intercept of these two measures classifies a person as low, medium, or high risk. After automating this logic, 16 expert clinicians in STI/HIV care tested this system with over 400 test patient cases and refined the algorithm until it yielded the exact outcomes that these clinicians would offer patients based on guidelines. Findings of interest are that the scale of the y-axis is exponential, in that risk factors for exposure do not climb cumulatively but do so according to a quadratic equation. This helps ensure that testing services are targeted at those who are most inequitably burdened by these infections.

Failure of preventive measures leading to mother-to-child hiv transmission. Case report.

Infectio ro ◽  
2018 ◽  
Vol 56 (4) (1) ◽  
pp. 40-43
Author(s):  
Ruxandra Tritean ◽  
Simona Erscoiu ◽  
Andreia Florina Niță ◽  
Mircea Ioan Popa
Keyword(s):  
Hiv Infection ◽  
Hiv Transmission ◽  
Opportunistic Infections ◽  
Perinatal Transmission ◽  
Immunological Parameters ◽  
Transmission Case ◽  
Prophylactic Measures ◽  
Hiv Infection Prevention ◽  
The Moment ◽  
Cmv Disease

Despite significant advances in antiretroviral treatment (ARV) and HIV infection prevention, about 400 children worldwide are still diagnosed daily with HIV infection, most cases due to perinatal transmission. It is estimated that the knowledge and rigorous application of prophylactic measures to reduce the vertical transmission of infection would significantly reduce this risk to less than 1%.  We report the case of a 5 months old infant coming from a pregnancy with HIV risk and multiple risk factors for transmission of the vertical infection, who did not receive postnatal testing and treatment. The diagnosis was established during infancy, falling into the AIDS stage by cytomegalovirus (CMV) disease with retinal sequelae occlusion. ARV treatment was initiated late, but from the moment of diagnosis, requiring further changes due to drug interactions, lack of availability and resistance to TARV. Although the patient’s progression was marked by severe comorbidities: sequelae of CMV disease, mixed HIV and CMV encephalopathy, pulmonary tuberculosis, repetitive respiratory and digestive opportunistic infections, the evolution of immunological parameters was slowly favorable under treatment. Proper implementation of prophylactic measures in the newborn and the pregnant woman could have significantly reduced the risk of HIV transmission to the patient, with a high probability that she would not have been infected. The case reported reflects the failure of strategies to prevent HIV / AIDS infection in pregnant women and newborns; conclusions must be drawn to avoid similar situations.

scholarly journals Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
W. Chris Buck ◽  
Hanh Nguyen ◽  
Mariana Siapka ◽  
Lopa Basu ◽  
Jessica Greenberg Cowan ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Scale Up ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Pediatric Care ◽  
P Value ◽  
Missed Opportunities ◽  
Art Initiation

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

scholarly journals HIV-related stigma in the UK then and now: to what extent are we on track to eliminate stigma? A qualitative investigation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Barbara Hedge ◽  
Karrish Devan ◽  
Jose Catalan ◽  
Anna Cheshire ◽  
Damien Ridge
Keyword(s):  
Antiretroviral Treatment ◽  
Hiv Transmission ◽  
Minority Groups ◽  
Physical Violence ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Health And Social Care ◽  
Related Stigma ◽  
Engagement In Hiv Care

Abstract Background The introduction of effective antiretroviral treatment in the late 1990s led to the perception that HIV was a chronic but manageable condition. Nevertheless, stigma remains one of the major hurdles for people living with HIV (PLWH) to accessing healthcare and biomedical preventions. Thus, Fast Track Cities has set a target of zero HIV discrimination by 2030 as part of its strategy to end HIV transmission. Methods Fifty-three participants from the United Kingdom, including PLWH (n = 21, 40%), health and social care workers (n = 24, 45%), and charity workers and activists (n = 13, 25%), were recruited. Semi-structured interviews investigated stigma and discrimination, focusing on both before and after the widespread use of effective antiretroviral treatment in the late 1990s. Data were analysed using a thematic approach. Results Before effective antiretroviral treatment narratives were shaped by two main themes: 1) the media’s role in influencing public opinion and contributing to misunderstandings of HIV transmission; and 2) personal experiences of HIV-related stigma, which for PLWH included incidents of physical violence and aggression, as well as fears of their HIV status being publicised. Contemporary narratives on stigma experiences were organised around four themes: 1) discrimination in healthcare settings; 2) stigma amongst men who have sex with men (MSM); 3) stigma towards African and Afro-Caribbean PLWH; and 4) the limits of change in public HIV-related knowledge and attitudes. Contemporary narratives indicated a reduction in enacted stigma, but continued anticipation of discrimination and self-reported shame, particularly in MSM and African and Afro-Caribbean PLWH. Conclusion The nature of stigma against those with HIV has evolved. The intersection of PLWH and minority groups (e.g. MSM and African and Afro-Caribbean persons) may enhance anticipatory and internalised stigma, with some suggestion that this may contribute to reduced engagement in HIV care and prevention services. Our findings indicate the need for further research in this area, as well as proactive interventions with community groups to enhance knowledge of HIV.

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