scholarly journals Forgiveness of dolutegravir-based triple therapy compared to older antiretroviral regimens: a prospective multicenter cohort of adherence patterns and HIV-RNA replication

2021 ◽  
Author(s):  
Jean-Jacques Parienti ◽  
Anna L Fournier ◽  
Laurent Cotte ◽  
Marie-Paule Schneider ◽  
Manuel Etienne ◽  
...  
Keyword(s):  
Regression Models ◽  
Treatment Interruption ◽  
People Living With Hiv ◽  
Linear Regression Models ◽  
Logistic Regression Models ◽  
Treatment Groups ◽  
Hiv Rna ◽  
Adherence Pattern ◽  
Living With Hiv ◽  
Rna Levels

Abstract Background For many people living with HIV (PLWH), taking antiretroviral therapy (ARV) every day is difficult. Methods Average adherence (Av-Adh) and log-transformed treatment interruption (TI) to ARV were prospectively measured over 6 months using electronic drug monitoring (EDM) in several cohorts of PLWH. Multivariate linear regression models including baseline confounders explored the influence of EDM-defined adherence (R 2) on 6-month Log10 HIV-RNA. Multivariate logistic regression models were used to compare the risk of HIV-RNA detection within subgroups stratified by lower (≤95%) and higher (>95%) Av-Adh. Results Three hundred ninety nine PLWH were analyzed with different ARV: dolutegravir (n=102), raltegravir (n=90), boosted PI (bPI; n=107), and NNRTI (n=100). In the dolutegravir group, the influence of adherence pattern measures on R 2 for HIV-RNA levels was marginal (+2%). Av-Adh, TI and Av-Adh x TI increased the R 2 for HIV-RNA levels by 54% and 40% in the raltegravir and bPI treatment groups, respectively. TI increased the R 2 for HIV-RNA levels by 36% in the NNRTI treatment group. Compared to dolutegravir-based regimen, the risk of VR was significantly increased for: raltegravir (adjusted OR (aOR), 45.6; 95% confidence interval (CI) [4.5 - 462.1], p=0.001); NNRTIs (aOR, 24.8; 95% CI [2.7 - 228.4], p=0.005) and bPIs (aOR, 28.3; 95%CI [3.4 - 239.4], p=0.002) in PLWH with Av-Adh ≤95%. Among PLWH with >95% Av-Adh, there were no significant differences on the risk of VR among the different ARV. Conclusion These findings support the concept that dolutegravir in combination with two other active ARVs achieves a greater virological suppression than older ARV, including raltegravir, NNRTI and bPI among PLWH with lower adherence.

scholarly journals Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge

2018 ◽  
Vol 146 (10) ◽  
pp. 1308-1311 ◽  
Author(s):  
Y. Caro-Vega ◽  
P. F. Belaunzarán-Zamudio ◽  
B. Crabtree-Ramírez ◽  
B. E. Shepherd ◽  
F. Mejia ◽  
...  
Keyword(s):  
Latin America ◽  
Regression Models ◽  
People Living With Hiv ◽  
South American ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Infected People ◽  
Logistic Regression Models ◽  
The Caribbean ◽  
Living With Hiv

AbstractWe aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.

Challenging the Link Between Early Childhood Television Exposure and Later Attention Problems: A Multiverse Approach

2021 ◽  
pp. 095679762097165
Author(s):  
Matthew T. McBee ◽  
Rebecca J. Brand ◽  
Wallace E. Dixon
Keyword(s):  
Early Childhood ◽  
Regression Models ◽  
Propensity Score Analysis ◽  
Harmful Effect ◽  
Attention Problems ◽  
Linear Regression Models ◽  
Data Set ◽  
Logistic Regression Models ◽  
Score Analysis ◽  
Television Exposure

In 2004, Christakis and colleagues published an article in which they claimed that early childhood television exposure causes later attention problems, a claim that continues to be frequently promoted by the popular media. Using the same National Longitudinal Survey of Youth 1979 data set ( N = 2,108), we conducted two multiverse analyses to examine whether the finding reported by Christakis and colleagues was robust to different analytic choices. We evaluated 848 models, including logistic regression models, linear regression models, and two forms of propensity-score analysis. If the claim were true, we would expect most of the justifiable analyses to produce significant results in the predicted direction. However, only 166 models (19.6%) yielded a statistically significant relationship, and most of these employed questionable analytic choices. We concluded that these data do not provide compelling evidence of a harmful effect of TV exposure on attention.

scholarly journals Quality of life of elderly people living with HIV/AIDS in outpatient follow-up

2018 ◽  
Vol 71 (suppl 1) ◽  
pp. 513-522 ◽  
Author(s):  
Juliano de Souza Caliari ◽  
Lilian Andreia Fleck Reinato ◽  
Daiana Patrícia Marchetti Pio ◽  
Letícia Pimenta Lopes ◽  
Renata Karina Reis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly People ◽  
Treatment Interruption ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Physical Changes ◽  
Living With Hiv ◽  
Hiv Aids

ABSTRACT Objective: To analyze factors related to the quality of life of elderly people living with HIV/AIDS. Method: A cross-sectional study was carried out with people aged 50 years or more in a specialized outpatient clinic. The data collection was by means of an interview. For the analysis of data and characterization of the sample, descriptive statistics and comparison tests were used. The project met the ethical requirements. Results: Participants were 81 users aged 50 to 75 years, mean age was 57.8 (± 6.1) years, 71.6% of whom were men. There was a statistically significant relationship with the quality of life, the following variables: gender, children, occupation, religion, diagnosis time, HIV exposure, adverse effects, treatment interruption, viral load counts, hospitalization, dependence for daily activities and use of drugs. Conclusion: The results suggest that the quality of life deficit is related not only to physical changes, but to the anguish and stigma related to HIV/AIDS.

scholarly journals Acceptability, motivation and the prospect of cure for people living with HIV and their healthcare providers in HIV cure-focused treatment interruption studies

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Jillian S. Y. Lau ◽  
Miranda Z. Smith ◽  
Brent Allan ◽  
Cipriano Martinez ◽  
Jennifer Power ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Treatment Interruption ◽  
People Living With Hiv ◽  
Hiv Cure ◽  
Educational Strategies ◽  
Analytical Treatment ◽  
Clinical Endpoints ◽  
Treatment Interruptions ◽  
Living With Hiv

Abstract Background Analytical treatment interruptions (ATI) are commonly used clinical endpoints to assess interventions aimed at curing HIV or achieving antiretroviral therapy (ART)-free HIV remission. Understanding the acceptability of ATI amongst people living with HIV (PLHIV) and their HIV healthcare providers (HHP) is limited. Methods Two online surveys for PLHIV and HHP assessed awareness and acceptability of ATI, and understanding of the prospect for HIV cure in the future. Responses were collected from July 2017–January 2018. A descriptive analysis was performed and similar questions across the two surveys were compared using χ squared test. Results 442 PLHIV and 144 HHP completed the survey. 105/400 (26%) PLHIV had ever interrupted ART, 8% of which were in a clinical trial. Altruistic motivations were drivers of participation of PLHIV in cure related research. 81/135 (60%) HHP would support their patients wishing to enrol in an HIV cure-focused trial, but fewer would promote and allow such participation (25% and 31% respectively). Compared to HHP, PLHIV were more likely to believe that an HIV cure would be achievable within 10 years (55% vs. 19%, p < 0.001), had less awareness of ATI (46% vs. 62%, p < 0.001) and were less likely to have had experience of either participation or enrolment in an ATI study (5% vs. 18%, p < 0.001) Conclusion PLHIV were more optimistic about the potential for HIV cure. HHP had more direct experience with HIV cure-focused studies. Educational strategies are required for both groups to increase understanding around ATIs in HIV cure research but should be tailored specifically to each group.

scholarly journals Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind

2020 ◽  
Vol 17 (5) ◽  
pp. 458-466
Author(s):  
Anna Grimsrud ◽  
Lynne Wilkinson ◽  
Ingrid Eshun-Wilson ◽  
Charles Holmes ◽  
Izukanji Sikazwe ◽  
...  
Keyword(s):  
Quality Care ◽  
Treatment Interruption ◽  
Patient Choice ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Hiv Status ◽  
Hiv Care Cascade ◽  
Left Behind ◽  
Living With Hiv

Abstract Purpose of Review Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. Recent Findings There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. Summary There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.

Prevalence and adverse impact of extended antibiotic prophylaxis in urologic oncology surgery.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 294-294
Author(s):  
Matthew Mossanen ◽  
Josh Calvert ◽  
Sarah Holt ◽  
Andrew Callaway James ◽  
Jonathan L. Wright ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Regression Models ◽  
Linear Regression Models ◽  
Urologic Oncology ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Provider Characteristics ◽  
Diagnosis Codes ◽  
Postoperative Length ◽  
Hospital Acquired

294 Background: Providers exhibit variation in the selection of the class, dose, and duration of prescribed antibiotic prophylaxis (ABP) to prevent postsurgical infections. We sought to evaluate ABP practice patterns for common inpatient urologic oncology surgeries and ascertain the association between extended ABP and hospital-acquired Clostridium difficile (C. diff) infections. Methods: From the PREMIER database for 2007–2012, we identified patients who underwent radical prostatectomy (RP), radical or partial nephrectomy (Nephx), or radical cystectomy (RC). We defined extended ABP from charges for antibiotics ≥ 2 days after surgery; exclusive of patients with a switch in antibiotic class within 2 postoperative days for presumption of infection. We identified postoperative C. diff infections using ICD-9 diagnosis codes. Hierarchical linear regression models were constructed by procedure to identify patient and provider factors associated with extended ABP. Logistic regression models evaluated the association between extended ABP and postoperative C. diff infection, adjusting for patient and provider characteristics. Results: We identified 59,184 RP patients, 27,921 Nephx patients, and 5,425 RC patients. RC patients were more likely to receive extended ABP (56%) than RP (18%) or Nephx (29%) patients (p<0.001). Other factors associated with extended ABP included prolonged postoperative length of stay (OR ≥ 1.69, p<0.001 for all procedures), and surgical volume (p<0.001 for highest vs. lowest volume quartiles). Hospital identity explained 35% of the variability in ABP after RP, 23% after Nephx, and 20% after RC. Among Nephx and RC patients, extended ABP was associated with significantly higher odds of postoperative C. diff infection (OR 3.79, 95% CI 2.46–5.84, and OR 1.64, 95% CI 1.12–2.39, respectively). Conclusions: We identified marked hospital-level variability in extended ABP following RP, Nephx, and RC, which was associated with significantly increased odds of hospital-acquired C. diff infections. Efforts to increase provider compliance with national ABP guidelines may decrease preventable hospital-acquired infections after urologic cancer surgery.

scholarly journals Clonal Expansion of Infected CD4+ T Cells in People Living with HIV

Viruses ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2078
Author(s):  
John M. Coffin ◽  
Stephen H. Hughes
Keyword(s):  
T Cells ◽  
Cd4 T Cells ◽  
Large Fraction ◽  
Latent Reservoir ◽  
People Living With Hiv ◽  
Resting Cells ◽  
Hiv Rna ◽  
Art Initiation ◽  
Infected Cells ◽  
Living With Hiv

HIV infection is not curable with current antiretroviral therapy (ART) because a small fraction of CD4+ T cells infected prior to ART initiation persists. Understanding the nature of this latent reservoir and how it is created is essential to development of potentially curative strategies. The discovery that a large fraction of the persistently infected cells in individuals on suppressive ART are members of large clones greatly changed our view of the reservoir and how it arises. Rather than being the products of infection of resting cells, as was once thought, HIV persistence is largely or entirely a consequence of infection of cells that are either expanding or are destined to expand, primarily due to antigen-driven activation. Although most of the clones carry defective proviruses, some carry intact infectious proviruses; these clones comprise the majority of the reservoir. A large majority of both the defective and the intact infectious proviruses in clones of infected cells are transcriptionally silent; however, a small fraction expresses a few copies of unspliced HIV RNA. A much smaller fraction is responsible for production of low levels of infectious virus, which can rekindle infection when ART is stopped. Further understanding of the reservoir will be needed to clarify the mechanism(s) by which provirus expression is controlled in the clones of cells that constitute the reservoir.

scholarly journals Associations between subcutaneous fat density and systemic inflammation differ by HIV serostatus and are independent of fat quantity

2019 ◽  
Vol 181 (4) ◽  
pp. 451-459 ◽  
Author(s):  
J E Lake ◽  
P Debroy ◽  
D Ng ◽  
K M Erlandson ◽  
L A Kingsley ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Systemic Inflammation ◽  
Disease Risk ◽  
Subcutaneous Fat ◽  
Density Measurement ◽  
Metabolic Parameter ◽  
People Living With Hiv ◽  
Linear Regression Models ◽  
Hiv Serostatus ◽  
Living With Hiv

Objectives Adipose tissue (AT) density measurement may provide information about AT quality among people living with HIV. We assessed AT density and evaluated relationships between AT density and immunometabolic biomarker concentrations in men with HIV. Design Cross-sectional analysis of men enrolled in the Multicenter AIDS Cohort Study. Methods Abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) density (Hounsfield units, HU; less negative = more dense) were quantified from computed tomography (CT) scans. Multivariate linear regression models described relationships between abdominal AT density and circulating biomarker concentrations. Results HIV+ men had denser SAT (−95 vs −98 HU HIV−, P < 0.001), whereas VAT density was equivalent by HIV serostatus men (382 HIV−, 462 HIV+). Historical thymidine analog nucleoside reverse transcriptase inhibitor (tNRTI) use was associated with denser SAT but not VAT. In adjusted models, a 1 s.d. greater SAT or VAT density was associated with higher levels of adiponectin, leptin, HOMA-IR and triglyceride:HDL cholesterol ratio and lower hs-CRP concentrations in HIV− men. Conversely, in HIV+ men, each s.d. greater SAT density was not associated with metabolic parameter improvements and was significantly (P < 0.05) associated with higher systemic inflammation. Trends toward higher inflammatory biomarker concentrations per 1 s.d. greater VAT density were also observed among HIV+ men. Conclusions Among men living with HIV, greater SAT density was associated with greater systemic inflammation independent of SAT area. AT density measurement provides additional insight into AT density beyond measurement of AT quantity alone, and may have implications for metabolic disease risk.

scholarly journals Does healthcare inequity reflect variations in peoples’ abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeannie Haggerty ◽  
Jean-Frederic Levesque ◽  
Mark Harris ◽  
Catherine Scott ◽  
Simone Dahrouge ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Primary Healthcare ◽  
Social Vulnerability ◽  
Regression Models ◽  
Social Systems ◽  
Social Characteristics ◽  
Linear Regression Models ◽  
Logistic Regression Models ◽  
Wide Range ◽  
Social Vulnerabilities

Abstract Background Primary healthcare services must respond to the healthcare-seeking needs of persons with a wide range of personal and social characteristics. In this study, examined whether socially vulnerable persons exhibit lower abilities to access healthcare. First, we examined how personal and social characteristics are associated with the abilities to access healthcare described in the patient-centered accessibility framework and with the likelihood of reporting problematic access. We then examined whether higher abilities to access healthcare are protective against problematic access. Finally, we explored whether social vulnerabilities predict problematic access after accounting for abilities to access healthcare. Methods This is an exploratory analysis of pooled data collected in the Innovative Models Promoting Access-To-Care Transformation (IMPACT) study, a Canadian-Australian research program that aimed to improve access to primary healthcare for vulnerable populations. This specific analysis is based on 284 participants in four study regions who completed a baseline access survey. Hierarchical linear regression models were used to explore the effects of personal or social characteristics on the abilities to access care; logistic regression models, to determine the increased or decreased likelihood of problematic access. Results The likelihood of problematic access varies by personal and social characteristics. Those reporting at least two social vulnerabilities are more likely to experience all indicators of problematic access except hospitalizations. Perceived financial status and accumulated vulnerabilities were also associated with lower abilities to access care. Higher scores on abilities to access healthcare are protective against most indicators of problematic access except hospitalizations. Logistic regression models showed that ability to access is more predictive of problematic access than social vulnerability. Conclusions We showed that those at higher risk of social vulnerability are more likely to report problematic access and also have low scores on ability to seek, reach, pay, and engage with healthcare. Equity-oriented healthcare interventions should pay particular attention to enhancing people’s abilities to access care in addition to modifying organizational processes and structures that reinforce social systems of discrimination or exclusion.

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