scholarly journals Disparities in CD4+ T-Lymphocyte Monitoring Among Human Immunodeficiency Virus-Positive Medicaid Beneficiaries: Evidence of Differential Treatment at the Point of Care

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Anna C. Davis ◽  
Greg Watson ◽  
Nadereh Pourat ◽  
Gerald F. Kominski ◽  
Dylan H. Roby
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cell Count ◽  
T Lymphocyte ◽  
Hiv Positive ◽  
Fee For Service ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Medicaid Beneficiaries ◽  
Cd4 Cell

Abstract Background.  Monitoring of immune function, measured by CD4+ T-lymphocyte (CD4) cell count, is an essential service for people with human immunodeficiency virus (HIV). Prescription of antiretroviral (ARV) medications is contingent on CD4 cell count; patients without regular CD4 monitoring are unlikely to receive ARVs when indicated. This study assesses disparities in CD4 monitoring among HIV-positive Medicaid beneficiaries. Methods.  In this retrospective observational study, we examined 24 months of administrative data on 2250 HIV-positive, continuously enrolled, fee-for-service, Medicaid beneficiaries with at least 2 outpatient healthcare encounters. We used logistic regression to evaluate the association of patient demographics (age, gender, race or ethnicity, and language) with receipt of at least 1 CD4 test per year, controlling for other potentially confounding variables. Results.  Having a history of ARV therapy was positively associated with receipt of CD4 tests. We found racial or ethnic, gender, and age disparities in CD4 testing. Among individuals with a history of ARV use, all racial or ethnic groups were significantly less likely to have CD4 tests than White non-Latinos (African Americans, odds ratio [OR] = 0.35, P < .0001; Asian or Pacific Islanders, OR = 0.31, P = .0047; and Latinos, OR = 0.42, P < .0001). Conclusions.  We identified disparities in receipt of CD4 tests, a finding that may elucidate one potential pathway for previously reported disparities in ARV treatment. Further qualitative and quantitative research is needed to identify the specific factors that account for these disparities, so that appropriate interventions can be implemented.

scholarly journals Plasma Profiles of Inflammatory Markers Associated With Active Tuberculosis in Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Positive Individuals

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Oskar Olsson ◽  
Per Björkman ◽  
Marianne Jansson ◽  
Taye Tolera Balcha ◽  
Daba Mulleta ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cell Count ◽  
Inflammatory Markers ◽  
Area Under The Curve ◽  
Hiv Positive ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Rna Levels

Abstract Background Diagnosis of tuberculosis (TB) in human immunodeficiency virus (HIV)-coinfected individuals is challenging. We hypothesized that combinations of inflammatory markers could facilitate identification of active TB in HIV-positive individuals. Methods Participants were HIV-positive, treatment-naive adults systematically investigated for TB at Ethiopian health centers. Plasma samples from 130 subjects with TB (HIV+/TB+) and 130 subjects without TB (HIV+/TB−) were tested for concentration of the following markers: CCL5, C-reactive protein (CRP), interleukin (IL)-6, IL12-p70, IL-18, IL-27, interferon-γ-induced protein-10 (IP-10), procalcitonin (PCT), and soluble urokinase-type plasminogen activator receptor (suPAR). Analyzed markers were then assessed, either individually or in combination, with regard to infection status, CD4 cell count, and HIV ribonucleic acid (RNA) levels. Results The HIV+/TB+ subjects had higher levels of all markers, except IL12p70, compared with HIV+/TB− subjects. The CRP showed the best performance for TB identification (median 27.9 vs 1.8 mg/L for HIV+/TB+ and HIV+/TB−, respectively; area under the curve [AUC]: 0.80). Performance was increased when CRP was combined with suPAR analysis (AUC, 0.83 [0.93 for subjects with CD4 cell count <200 cells/mm3]). Irrespective of TB status, IP-10 concentrations correlated with HIV RNA levels, and both IP-10 and IL-18 were inversely correlated to CD4 cell counts. Conclusions Although CRP showed the best single marker discriminatory potential, combining CRP and suPAR analyses increased performance for TB identification.

scholarly journals Impact of Human Immunodeficiency Virus on the Severity of Buruli Ulcer Disease: Results of a Retrospective Study in Cameroon

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Vanessa Christinet ◽  
Eric Comte ◽  
Laura Ciaffi ◽  
Peter Odermatt ◽  
Micaela Serafini ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Retrospective Study ◽  
Cell Count ◽  
Buruli Ulcer ◽  
Lesion Size ◽  
Hiv Positive ◽  
Cd4 Cell Count ◽  
Virus Prevalence ◽  
Immunodeficiency Virus ◽  
Cd4 Cell

Abstract Background.  Buruli ulcer is the third most common mycobacterial disease after tuberculosis and leprosy and is particularly frequent in rural West and Central Africa. However, the impact of HIV infection on BU severity and prevalence remains unclear. Methods.  This was a retrospective study of data collected at the Akonolinga District Hospital, Cameroon, from January 1, 2002 to March 27, 2013. Human immunodeficiency virus prevalence among BU patients was compared with regional HIV prevalence. Baseline characteristics of BU patients were compared between HIV-negative and HIV-positive patients and according to CD4 cell count strata in the latter group. Buruli ulcer time-to-healing was assessed in different CD4 count strata, and factors associated with BU main lesion size at baseline were ide.jpegied. Results.  Human immunodeficiency virus prevalence among BU patients was significantly higher than the regional estimated prevalence in each group (children, 4.00% vs 0.68% [P < .001]; men, 17.0% vs 4.7% [P < .001]; women, 36.0% vs 8.0% [P < .001]). Individuals who were HIV positive had a more severe form of BU, with an increased severity in those with a higher level of immunosuppression. Low CD4 cell count was significantly associated with a larger main lesion size (β-coefficient, −0.50; P = .015; 95% confidence interval [CI], −0.91–0.10). Buruli ulcer time-to-healing was more than double in patients with a CD4 cell count below 500 cell/mm3 (hazard ratio, 2.39; P = .001; 95% CI, 1.44–3.98). Conclusion.  Patients who are HIV positive are at higher risk for BU. Human immunodeficiency virus-induced immunosuppression seems to have an impact on BU clinical presentation and disease evolution.

scholarly journals Advanced Human Immunodeficiency Virus Disease at Diagnosis in Mozambique and Swaziland

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Stephanie A Kujawski ◽  
Matthew R Lamb ◽  
Maria Lahuerta ◽  
Margaret L McNairy ◽  
Laurence Ahoua ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cell Count ◽  
Advanced Disease ◽  
Hiv Positive ◽  
Hiv Disease ◽  
Cd4 Cell Count ◽  
Severe Immunosuppression ◽  
Immunodeficiency Virus ◽  
Advanced Hiv Disease ◽  
Cd4 Cell

Abstract Background Early diagnosis of human immunodeficiency virus (HIV) is a prerequisite to maximizing individual and societal benefits of antiretroviral therapy. Methods Adults ≥18 years of age testing HIV positive at 10 health facilities in Mozambique and Swaziland received point-of-care CD4+ cell count testing immediately after diagnosis. We examined median CD4+ cell count at diagnosis, the proportion diagnosed with advanced HIV disease (CD4+ cell count ≤350 cells/μL) and severe immunosuppression (CD4+ cell count ≤100 cells/μL), and determinants of the latter 2 measures. Results Among 2333 participants, the median CD4+ cell count at diagnosis was 313 cells/μL (interquartile range, 164–484), more than half (56.5%) had CD4+ ≤350 cells/μL, and 13.9% had CD4+ ≤100 cells/μL. The adjusted relative risk (aRR) of both advanced HIV disease and severe immunosuppression at diagnosis was higher in men versus women (advanced disease aRR = 1.31; 95% confidence interval [CI] = 1.16–1.48; severe immunosuppression aRR = 1.54, 95% CI = 1.17–2.02) and among those who sought HIV testing because they felt ill (advanced disease aRR = 1.30, 95% CI = 1.08–1.55; severe immunosuppression aRR = 2.10, 95% CI = 1.35–2.26). Age 18–24 versus 25–39 was associated with a lower risk of both outcomes (advanced disease aRR = 0.70, 95% CI = 0.59–0.84; severe immunosuppression aRR = 0.62, 95% CI = 0.41–0.95). Conclusions More than 10 years into the global scale up of comprehensive HIV services, the majority of adults diagnosed with HIV at health facilities in 2 high-prevalence countries presented with advanced disease and 1 in 7 had severe immunosuppression. Innovative strategies for early identification of HIV-positive individuals are urgently needed.

scholarly journals Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Mohammad Reza Jabbari ◽  
Hoorieh Soleimanjahi ◽  
Somayeh Shatizadeh Malekshahi ◽  
Mohammad Gholami ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Cell Count ◽  
Previous History ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

<b><i>Objectives:</i></b> The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count &#x3c;100 cells/mm<sup>3</sup> and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. <b><i>Methods:</i></b> This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count &#x3c;100 cells/mm<sup>3</sup>, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). <b><i>Results:</i></b> Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (<i>p</i> value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (<i>p</i> &#x3c; 0.02). <b><i>Conclusions:</i></b> We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count &#x3c;100 mm<sup>3</sup>/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

scholarly journals Hepatitis C treatment uptake and response among human immunodeficiency virus/hepatitis C virus-coinfected patients in a large integrated healthcare system

2019 ◽  
Vol 30 (7) ◽  
pp. 689-695 ◽  
Author(s):  
Jennifer O Lam ◽  
Leo B Hurley ◽  
Scott Chamberland ◽  
Jamila H Champsi ◽  
Laura C Gittleman ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Drug Abuse ◽  
Cell Count ◽  
Hcv Treatment ◽  
Cd4 Cell Count ◽  
Treatment Uptake ◽  
Immunodeficiency Virus ◽  
Cd4 Cell

U.S. guidelines recommend that patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) be prioritized for HCV treatment with direct-acting antiviral agents (DAAs), but the high cost of DAAs may contribute to disparities in treatment uptake and outcomes. We evaluated DAA initiation and effectiveness in HIV/HCV-coinfected patients in a U.S.-based healthcare system during October 2014–December 2017. Of 462 HIV/HCV-coinfected patients, 276 initiated DAAs (70% cumulative proportion treated over three years). Lower likelihood of DAA initiation was observed among patients with Medicare (government-sponsored insurance) versus commercial insurance (adjusted rate ratio [aRR] = 0.62, 95% CI = 0.46–0.84), patients with drug abuse diagnoses (aRR = 0.72, 95% CI = 0.54–0.97), patients with CD4 cell count <200 cells/µl versus ≥500 (aRR = 0.45, 95% CI = 0.23–0.91), and patients without prior HCV treatment (aRR = 0.68, 95% CI = 0.48–0.97). There were no significant differences in DAA initiation by age, gender, race/ethnicity, socioeconomic status, HIV transmission risk, alcohol use, smoking, fibrosis level, HIV RNA levels, antiretroviral therapy use, hepatitis B infection, or number of outpatient visits. Ninety-five percent of patients achieved sustained virologic response (SVR). We found little evidence of sociodemographic disparities in DAA initiation among HIV/HCV-coinfected patients, and SVR rates were high. Efforts are needed to increase DAA uptake among coinfected Medicare enrollees, patients with drug abuse diagnoses, patients with low CD4 cell count, and patients receiving first-time HCV treatment.

scholarly journals Human Immunodeficiency Virus Type 1 Disease Progression, CCR5 Genotype, and Specific Immune Responses

1998 ◽  
Vol 5 (4) ◽  
pp. 463-466 ◽  
Author(s):  
Ubaldo Visco-Comandini ◽  
Catharina Hultgren ◽  
Christina Broström ◽  
Markus Birk ◽  
Soo Kim ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Responses ◽  
Cell Count ◽  
Disease Progression ◽  
Wild Type ◽  
Cd4 Cell Count ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

ABSTRACT The correlation among the presence of a 32-bp deletion in the CC-chemokine receptor 5 (CCR5) gene, disease progression, and human immunodeficiency virus type 1 (HIV-1)-specific immune responses was analyzed for a cohort of 79 Caucasian HIV-1-infected patients. The CCR5 genotype (CCR5/CCR5 = wild type/wild type or Δ32CCR5/CCR5 = 32-bp deletion/wild type) in peripheral blood mononuclear cells was determined by PCR, followed by sequencing of both wild-type and Δ32CCR5 gene fragments. HIV-1-specific humoral responses to gp41 and V3MN peptides were determined by enzyme immunoassays. The prevalence of the Δ32CCR5 allele was lower among 37 patients with rapid progression (progression to AIDS or to a CD4 cell count of <200 × 106/liter in less than 9 years; P < 0.01) compared to that for 42 patients with slow progression (no AIDS and CD4 cell count of >200 × 106/liter after at least 9 years from infection) or to that for 25 non-HIV-1-infected Swedish blood donors (P < 0.05). No differences were observed in the wild-type CCR5sequences between the different groups of patients. For three analyzed patients, the 32-bp Δ32CCR5 gene deletions were identical. The antibody titers against gp41 and a V3MNpeptide in patients with the Δ32CCR5/CCR5 genotype were not significantly different from those in pair-matchedCCR5/CCR5 controls. However, in 13 analyzed patients, a stronger serum neutralizing activity was associated with the Δ32CCR5/CCR5 genotype. Thus, a CCR5/CCR5genotype correlates with a shortened AIDS-free HIV-1 infection period and possibly with a worse neutralizing activity, without an evident influence on the antibody response to two major antigenic regions of HIV-1 envelope.

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