scholarly journals 324. Outcomes of Immunomodulatory and Biologic Therapy in People Living with HIV: A Report from Two Academic Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S171-S172
Author(s):  
Michael J Peluso ◽  
Ingrid Eshun-Wilson ◽  
Timothy J Henrich ◽  
Peter Chin-Hong
Keyword(s):  
At Risk ◽  
Dual Therapy ◽  
Elite Controller ◽  
Selective Reporting ◽  
People Living With Hiv ◽  
Hiv Rna ◽  
Load Following ◽  
Level Data ◽  
Interleukin Inhibitors ◽  
Living With Hiv

Abstract Background The use of immunomodulatory drugs (IMDs) is increasingly common. However, data on outcomes of IMD use in people living with HIV (PLWH) are limited and may be biased due to selective reporting of certain outcomes. Institution-level data reflecting patient-time at risk have not been described. Methods We systematically identified all PLWH prescribed non-steroidal IMDs from 2012 to 2019 at two centers. We defined a treatment episode (TE) as an uninterrupted period on a particular IMD regimen. Patients contributed multiple TEs if interrupting or switching therapy. We excluded those with lymphoproliferative disorders or transplants. We quantified infections and blips, defined as a detectable viral load following an undetectable result. Results 35 patients contributed 55 TEs comprising 24,020 patient-days at risk. 29/35 (83%) were male, median age was 53 (IQR 39–59), median CD4 nadir was 197 (IQR 100–314), and 12/35 (34%) had a prior opportunistic infection. TEs utilized TNF inhibitors (19/55, 35%), PD-1 inhibitors (11/55, 20%), antimetabolites (7/55, 13%), interleukin inhibitors (7/55, 13%), and other agents (7/55, 13%). 4/55 (7%) involved in dual therapy. 32/35 (94%) patients were on antiretroviral therapy (ART) at IMD initiation; one was off therapy, one already on IMDs-acquired HIV, and one was an elite controller. Median CD4 count was 472 (IQR 337–807); CD4 was < 500 in 28/55 TEs (51%). Preceding plasma HIV RNA was undetectable in 36/55 (65%) TEs. Of these, 18 (50%) were associated with a viral blip within 1 year; one blip was >200 copies and none resulted in sustained viremia. Compared with other agents, PD-1 inhibitors were associated with a higher blip rate (incidence rate ratio 4.3, 1.3–12.3). 17/55 (32%) TEs were initiated with detectable plasma HIV RNA, which declined on ART in 13/15 (87%) TEs with follow-up testing; one patient stopped ART and one later suppressed. 9/55 (16%) TEs involved an infectious complication (7 soft-tissue infections, 2 pneumonias), although none was clearly attributed to IMDs. 36/55 (65%) TEs had good therapeutic response. Conclusion IMDs can be used without major complications in PLWH on ART, including those not yet suppressed or with CD4 counts < 500. PD-1 inhibitors may be associated with a higher rate of viral blips, although the clinical significance is unclear. Disclosures All authors: No reported disclosures.

scholarly journals High prevalence of sexually transmitted coinfections among at-risk people living with HIV

2020 ◽  
Author(s):  
Kuan-Yin Lin ◽  
Hsin-Yun Sun ◽  
Tai-Fen Lee ◽  
Yu-Chung Chuang ◽  
Un-In Wu ◽  
...  
Keyword(s):  
At Risk ◽  
People Living With Hiv ◽  
Sexually Transmitted ◽  
High Prevalence ◽  
Living With Hiv

scholarly journals Evolving Toward Shared HIV Care Using the Champlain BASE eConsult Service

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831986821
Author(s):  
Claire E. Kendall ◽  
Janessa E. Porter ◽  
Esther S. Shoemaker ◽  
Rachel Seoyeon Kang ◽  
Michael Fitzgerald ◽  
...  
Keyword(s):  
At Risk ◽  
Primary Care Providers ◽  
Question Type ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Local Health ◽  
Care Providers ◽  
Patients At Risk ◽  
Survey Responses ◽  
Living With Hiv

Background. Electronic consultation (eConsultation) is a potential strategy to improve access to specialist expertise and facilitate collaborative care models. The Champlain BASE eConsult service allows for asynchronous communication between primary care providers (PCP) and specialists on a secure, web-based system. HIV experts accessible include HIV physician specialists, HIV pharmacists, and social workers with expertise in HIV. Objective. This study aims to describe the use, value, and utility of this eConsultation service in the care of people living with HIV and to characterize the common question types and clinical topics asked by PCPs. Methods. We analyzed the data from eConsults sent to the HIV specialty group in Ontario’s Champlain Local Health Integration Network between February 2015 and December 2017. Usage data and close-out survey responses were analyzed using descriptive statistics, eConsults were classified using a predefined list of validated taxonomy, and a thematic analysis was performed on the consultation logs to identify common clinical themes. Results. Among the 46 eConsults, the most common question type related to drug treatment (58.7%, n = 27) and management (19.6%, n = 9). The main clinical themes involved the care of significant complexities in people living with HIV, such as comorbidities and drug interactions, and suggestions of coordinated patient care. As well, eConsult was used for advice regarding pre-exposure prophylaxis for HIV-negative patients at risk of HIV infection. PCPs highly valued the eConsult service (average rating 4.8/5). Conclusion. Overall, this study demonstrates that eConsult provides an efficient and valuable service to PCPs caring for patients living with or at risk for HIV by improving access to HIV specialists and facilitating the delivery of team-based comprehensive care.

scholarly journals Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania

2019 ◽  
Vol 6 (1) ◽  
pp. 1600230 ◽  
Author(s):  
Hellen Siril ◽  
Anna Kaale ◽  
Anna Minja ◽  
Japheth Kilewo ◽  
Ferdinand Mugusi ◽  
...  
Keyword(s):  
At Risk ◽  
Social Network ◽  
Hiv Prevention ◽  
Dar Es Salaam ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Weight gain in people living with HIV switched to dual therapy

AIDS ◽  
2020 ◽  
Vol 34 (1) ◽  
pp. 155-157 ◽  
Author(s):  
Pilar Vizcarra ◽  
María J. Vivancos ◽  
María J. Pérez-Elías ◽  
Ana Moreno ◽  
José L. Casado
Keyword(s):  
Weight Gain ◽  
Dual Therapy ◽  
People Living With Hiv ◽  
Living With Hiv

Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013–2014

Sexual Health ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 188
Author(s):  
Jennifer H. MacLachlan ◽  
Benjamin C. Cowie
Keyword(s):  
At Risk ◽  
Hepatitis B ◽  
Risk Groups ◽  
Hepatitis B Vaccine ◽  
People Living With Hiv ◽  
Department Of Health ◽  
Priority Populations ◽  
Living With Hiv ◽  
The Impact ◽  
Over Time

Background The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. Methods: Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. Results: During the 18-month period assessed, 20 498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). Conclusions: This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013–14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.

scholarly journals Stereotypes About People Living with HIV: Implications for Perceptions of HIV Risk and Testing Frequency Among At-Risk Populations

2012 ◽  
Vol 24 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Valerie A. Earnshaw ◽  
Laramie R. Smith ◽  
Stephenie R. Chaudoir ◽  
I-Ching Lee ◽  
Michael M. Copenhaver
Keyword(s):  
At Risk ◽  
Hiv Risk ◽  
People Living With Hiv ◽  
Testing Frequency ◽  
At Risk Populations ◽  
Living With Hiv

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 Inflammation and Intracellular Exposure of Dolutegravir, Darunavir, Tenofovir and Emtricitabine in People living with HIV

2022 ◽  
Author(s):  
Micol Ferrara ◽  
Elena Salvador ◽  
Alice Trentalange ◽  
Chiara Alcantarini ◽  
Mattia Trunfio ◽  
...  
Keyword(s):  
Triple Therapy ◽  
Plasma Concentrations ◽  
Dual Therapy ◽  
Hiv Positive ◽  
People Living With Hiv ◽  
Drug Penetration ◽  
Cytochrome P450 3A ◽  
Persistent Inflammation ◽  
Hiv Drugs ◽  
Living With Hiv

Background: Antiretroviral therapy reduces systemic inflammation and immune activation, but not to levels like HIV-negative. Limited drug penetration within tissues has been argued as potential mechanism of persistent inflammation. Data on the role of inflammation on plasma/intracellular (IC) pharmacokinetics (PK) of ARV drugs through to downregulation/expression of cytochrome P450 3A/membrane transport proteins are limited. Aim of this study was to investigate the correlation between inflammation markers and plasma/IC PK of different ARVs regimen in HIV-positive patients. Methods: We included in the study ART-treated HIV+ pts switching to 3 different ARV regimens: 1) DTG-based dual-therapy plus boosted-PIs, 2) DTG-based triple-therapy without PIs, 3) DRV/c-based triple-therapy. Plasma and IC ARV drugs concentration means at the end of dosing interval (T0), IM on samples concomitantly with ARV PK determination: sCD14, CRP, IL-6 and LPS were analysed. Results: 60 samples from pts included in the switching study were used for measuring plasma and IC concentrations of HIV drugs. No significative differences between CRP, sCD14, IL-6 and LPS values in 3 arms of therapy were observed. Significant correlation was observed between tenofovir plasma concentrations and sCD14 (p<0.001), DRV plasma concentration and sCD14 (p=0,07) and DRV IC/plasma ratio and Log10 IL-6 concentrations (p=0.04). Furthermore, in 24 pts on DTG-TT, we observed a negative trend between DTG IC concentrations and sCD14 (p=0.09). Conclusions: Our preliminary data support the hypothesis of lower IC concentrations of DRV and DTG in pts with higher plasma IM, suggesting an interplay between HIV drug penetration and persistent inflammation in cART-treated HIV-positive patients.

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 (&gt;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 &gt;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.

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