Sex, Drugs, and Acholic Stools

HIV ◽  
2020 ◽  
pp. 127-136
Author(s):  
Sarah A. Rojas ◽  
Christian B. Ramers
Keyword(s):  
Chronic Infection ◽  
Spontaneous Clearance ◽  
People Living With Hiv ◽  
Liver Inflammation ◽  
Dark Urine ◽  
Acute Hcv ◽  
Hiv Symptoms ◽  
Direct Acting ◽  
Cure Rates ◽  
Living With Hiv

Hepatitis C virus (HCV) infection causes an acute, sometimes icteric, illness and is typically transmitted through contact with blood of an infected person. Roughly 75% of exposed individuals will develop a chronic infection, and 25% of cases will spontaneously resolve, although slightly lower rates of spontaneous clearance have been observed in people living with HIV. Symptoms of acute HCV are similar to other acute viral hepatidites, such as hepatitis A, B, or E, and include jaundice, scleral icterus, nausea, vomiting, fatigue, dark urine, and acholic stools. However, the majority of patients with acute HCV have few symptoms and do not present to medical care. Chronic infection with HCV can cause liver inflammation, scarring, and damage and can lead to cirrhosis, liver cancer, and death, as well as several extrahepatic manifestations. HCV is a curable infection, and therapies have improved significantly with the development of direct-acting antivirals, which can achieve cure rates of 95% and greater with courses of 2 to 3 months of oral therapy.

Emerging prevalence of fatty liver disease in HIV

2021 ◽  
Vol 16 (1) ◽  
pp. 59-73
Author(s):  
Amreen Dinani ◽  
Ali Khan ◽  
Douglas Dieterich
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Unmet Need ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nonalcoholic Fatty Liver ◽  
Infected People ◽  
Direct Acting ◽  
Living With Hiv

Fatty liver disease is a growing concern in people living with HIV, the main drivers are alcoholic liver disease and nonalcoholic fatty liver disease. It has shown to negatively impact HIV care continuum and result in notable non-HIV related morbidity and mortality. With the advancement in antiretroviral therapy and effective direct acting antivirals, fatty liver disease is surfacing as the next big challenge in this population like that observed in the general population. This review article summarizes the gravity of these two common diseases in HIV-infected people and aims to sheds light on an unmet need to develop effective methods to identify, screen and manage fatty liver disease in this unique population.

scholarly journals HIV-Related Stress Experienced by Newly Diagnosed People Living with HIV in China: A 1-Year Longitudinal Study

2020 ◽  
Vol 17 (8) ◽  
pp. 2681 ◽  
Author(s):  
Yunxiang Huang ◽  
Dan Luo ◽  
Xi Chen ◽  
Dexing Zhang ◽  
Zhulin Huang ◽  
...  
Keyword(s):  
Social Support ◽  
Anxiety Symptoms ◽  
Living Alone ◽  
People Living With Hiv ◽  
Newly Diagnosed ◽  
Younger Age ◽  
Stress Levels ◽  
Physical Functions ◽  
Hiv Symptoms ◽  
Living With Hiv

This study explored the HIV-related stressors that people living with HIV (PLWH) commonly experience and express as stressful at the time of diagnosis and 1 year later. The factors associated with stress levels and whether social support would moderate the negative effects of stress on psychological health (depressive and anxiety symptoms) were also investigated. Newly diagnosed PLWH were consecutively recruited in this study. Participants rated their stress with the HIV/AIDS Stress Scale at baseline and 1 year later. Social support, depression, and anxiety were also self-reported at both time points. There were significant decreases in stress levels 1 year after diagnosis. Stressors regarding confidentiality, disclosure, emotional distress, fear of infecting others, and excessive attention to physical functions were the most problematic at baseline and 1-year follow-up. A younger age, married status, not living alone, less income, presence of HIV symptoms, and lack of social support were associated with higher levels of stress. No stress-buffering effect of social support on depressive and anxiety symptoms was found in this study. Interventions to reduce stress among PLWH should take into consideration the following priority stressors: confidentiality, discrimination/stigma, serostatus disclosure, distressing emotions, fear of infecting others, and excessive attention to physical functions. More attention should be paid to PLWH with younger age, not living alone, less income, presence of HIV symptoms, and lack of social support.

scholarly journals 355. Barriers for Hepatitis C Elimination in HIV/HCV Coinfected Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S187-S187
Author(s):  
Joe Espinoza ◽  
Karen J Vigil ◽  
Ben Barnett
Keyword(s):  
Hepatitis C ◽  
Open Access ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Active Intervention ◽  
Key Stakeholders ◽  
Wide Availability ◽  
Direct Acting ◽  
Treatment Use ◽  
Living With Hiv

Abstract Background Approximately 30% of people living with HIV are co-infected with Hepatitis C virus (HCV). HIV/HCV coinfected patients have faster progression to liver fibrosis, cirrhosis, and increased mortality, compared with monoinfected patients. Therefore, treatment in this population is a priority. The objective of this study was to develop an active program to reach HIV/HCV co-infected patients, with the goal to eliminate Hepatitis C in our local HIV clinic. Methods Beginning in December 2016, our clinic received State funds to support open access to treat HIV/HCV patients with direct-acting antivirals (DAA). From December 2016 to May 2018, the process was based on primarily on physician referrals to treat HIV/HCV patients at our clinic, without an active intervention, and 50 patients were treated. Our active intervention during the second part was based on the identification of all untreated HIV/HCV patients and contacting them directly, to link them to care. Results A total of 462 HIV/HCV co-infected patients were identified who qualified for the state-sponsored treatment program. From June 1, 2018 to July 31, 2018, only 7 patients were linked to care and started on DAA. The four main identified reasons for not getting DAA therapy were: no show up to the clinic appointments, poor adherence to their HIV antiretroviral treatment, use of drugs and not able to be reached (figure). Although drug use was listed as one of the main reasons for not receiving DAA therapy, it was not the defining reason for most patients. A majority of the patients had more than one obstacle preventing them from coming in to be treated. Conclusion Wide availability of DAA and open access to treatment is not enough to eliminate HIV/HCV co-infection. Innovative outreach processes with the active participation of key stakeholders are needed in order to eliminate this viral infection. Disclosures All authors: No reported disclosures.

scholarly journals Low hepatitis C virus reinfection rate despite ongoing risk following universal access to direct-acting antiviral therapy among people living with HIV

AIDS ◽  
2020 ◽  
Vol 34 (9) ◽  
pp. 1347-1358
Author(s):  
Samira Hosseini-Hooshyar ◽  
Marianne Martinello ◽  
Jasmine Yee ◽  
Phillip Read ◽  
David Baker ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Universal Access ◽  
People Living With Hiv ◽  
Reinfection Rate ◽  
Direct Acting Antiviral ◽  
Direct Acting ◽  
Living With Hiv

Low HCV-viremia prevalence yet continued barriers to direct-acting antiviral treatment in people living with HIV in the Netherlands

AIDS ◽  
2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Cas J. Isfordink ◽  
Colette Smit ◽  
Anders Boyd ◽  
Marieke J.A. de Regt ◽  
Bart J.A. Rijnders ◽  
...  
Keyword(s):  
The Netherlands ◽  
Antiviral Treatment ◽  
People Living With Hiv ◽  
Direct Acting Antiviral ◽  
Direct Acting ◽  
Living With Hiv

Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals

2019 ◽  
Author(s):  
A Corma-Gómez ◽  
J Macías ◽  
F Téllez ◽  
C Freyre-Carrillo ◽  
L Morano ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Liver Stiffness ◽  
People Living With Hiv ◽  
Advanced Fibrosis ◽  
Immunodeficiency Virus ◽  
Class B ◽  
Direct Acting ◽  
Living With Hiv ◽  
Liver Complication ◽  
Time Point

Abstract Background Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA). Methods In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR. Results During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant. Conclusions LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.

scholarly journals Patient-reported outcomes among people living with HIV on single- versus multi-tablet regimens: Data from a real-life setting

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262533
Author(s):  
Sophie Degroote ◽  
Linos Vandekerckhove ◽  
Dirk Vogelaers ◽  
Charlotte Vanden Bulcke
Keyword(s):  
Depressive Symptoms ◽  
Mixed Models ◽  
Treatment Satisfaction ◽  
Real Life ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Patient Reported ◽  
Hiv Symptoms ◽  
Living With Hiv ◽  
Over Time

Background The use of single-tablet regimens (STRs) in HIV treatment is ubiquitous. However, reintroducing the (generic) components as multi-tablet regimens (MTRs) could be an interesting cost-reducing strategy. It is essential to involve patient-reported outcome measures (PROs) to examine the effects of such an approach. Hence, this study compared PROs of people living with HIV taking an STR versus a MTR in a real world setting. Materials and methods This longitudinal study included 188 people living with HIV. 132 remained on a MTR and 56 switched to an STR. At baseline, months 1-3-6-12-18 and 24, participants filled in questionnaires on health-related quality of life (HRQoL), depressive symptoms, HIV symptoms, neurocognitive complaints (NCC), treatment satisfaction and adherence. Generalized linear mixed models and generalized estimation equations mixed models were built. Results Clinical parameters and PROs of the two groups were comparable at baseline. Neurocognitive complaints and treatment satisfaction did differ over time among the groups. In the STR-group, the odds of having NCC increased monthly by 4,1% as compared to the MTR-group (p = 0.035). Moreover, people taking an STR were more satisfied with their treatment after 6 months: the median change score was high: 24 (IQR 7,5–29). Further, treatment satisfaction showed a contrary evolution in the groups: the estimated state score of the STR-group increased by 3,3 while it decreased by 0,2 in the MTR-group (p = 0.003). No differences over time between the groups were observed with regard to HRQoL, HIV symptoms, depressive symptoms and adherence. Conclusions Neurocognitive complaints were more frequently reported among people on an STR versus MTR. This finding contrasts with the higher treatment satisfaction in the STR-group over time. The long-term effects of both PROs should guide the decision-making on STRs vs. (generic) MTRs.

scholarly journals Impact of direct-acting antiviral treatment of hepatitis C on the quality of life of adults in Ukraine

2021 ◽  
Author(s):  
Mariet Benade ◽  
Sydney Rosen ◽  
Sergie Antoniak ◽  
Charles S Chasela ◽  
Yulia Stopolianska ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hepatitis C ◽  
Social Functioning ◽  
Health Perception ◽  
Study Entry ◽  
People Living With Hiv ◽  
Direct Acting ◽  
Living With Hiv ◽  
Hiv Negative

Background Direct-acting antivirals (DAAs) are highly effective in achieving sustained virologic response among those with chronic hepatitis C virus (HCV) infection. Quality of life (QOL) benefits for an HCV-infected population with high numbers of people who inject drugs and people living with HIV (PLHIV) in Eastern Europe have not been explored. We estimated such benefits for Ukraine. Methods Using data from a demonstration study of 12-week DAA conducted in Kyiv, we compared self-reported QOL as captured with the MOS-SF20 at study entry and 12 weeks after treatment completion (week 24). We calculated domain scores for health perception, physical, role and social functioning, mental health and pain to at entry and week 24, stratified by HIV status. Results Among the 857 patients included for the final analysis, health perception was the domain that showed the largest change, with an improvement of 85.7% between entry and week 24. The improvement was larger among those who were HIV negative (104.4%) compared to those living with HIV (69.9%). Other domains that showed significant and meaningful improvements were physical functioning, which improved from 80.5 (95% CI: 78.9-82.1) at study entry to 89.4 (88.1-90.7) at 24 weeks, role functioning (64.5 [62.3-66.8] to 86.5 [84.9-88.2], social functioning (74.2 [72.1-76.2] to 84.8 [83.2-86.5] and bodily pain (70.1 [68.2-72.0] to 89.8 [88.5-91.1]). Across all domains, QOL improvements among PLHIV were more modest than among HIV-negative participants. Conclusion QOL improved substantially across all domains between study entry and week 24. Changes over the study period were smaller among PLHIV

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