A Haptoglobin Exon Copy Number Variant Associates With HIV-Associated Neurocognitive Impairment in European and African-Descent Populations

A common two-exon deletion distinguishes the gene encoding the free hemoglobin capturing protein—haptoglobin (HP)–into two alleles: HP1 and HP2. To evaluate the impact of this copy number variant (CNV) on neurocognitive impairment (NCI) in people living with HIV, we imputed this variant in 432 European-descent (EUR) and 491 African-descent (AFR) participants from the CNS HIV Antiretroviral Therapy Effects Research Study using an optimized imputation pipeline and evaluated its associations with NCI. At baseline, in AFR, the HP2 allele decreased the odds of NCI (defined by a global deficit score, GDS, ⩾0.5; Odds Ratio, OR = 0.584, p = 0.022). However, in EUR, HP2 increased the odds (OR = 2.081, p = 0.040) of NCI suggesting a detrimental effect. These effects were extended to longitudinal analyses using repeated measurements where the protective effect of the HP2 allele in AFR became marginally significant (p = 0.054) and in EUR the detrimental effect increased in significance (p = 0.037). In EUR, the HP2 allele slightly reduced the risk of NCI over time (OR = 0.028 per allele per year, p = 0.024). Further analyses of cognitive domain-specific impairment revealed that the HP-NCI effect was based on changes in learning, speed of information processing, and verbal domains over time differing by ancestry groups. Overall, these findings suggest that these functional HP CNV alleles influence the likelihood of NCI and contribute to changes in neurocognitive function over time in people living with HIV.

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

Sexual Health ◽

10.1071/sh16002 ◽

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.

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1683. Empathy Scale Validation Among Expectant Seroconcordant Couples Enrolled in HIV Care and Treatment in Zambézia Province, Mozambique

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1547 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S616-S616

Author(s):

Daniel Sack ◽

Caroline DeSchacht ◽

Graves Erin ◽

Kipp Aaron ◽

Ezequiel Barreto ◽

...

Keyword(s):

Cognitive Empathy ◽

Hiv Care ◽

Reactivity Index ◽

Individual Treatment ◽

People Living With Hiv ◽

Median Baseline ◽

Care And Treatment ◽

Living With Hiv ◽

The Impact ◽

Over Time

Abstract Background Among patients enrolled in HIV care and treatment in rural Mozambique, 30% abandon treatment within a year. A cluster randomized controlled trial assessing the impact of couple-based vs. individual treatment for concordant couples on viral suppression (the HoPS+ trial) hypothesizes that harnessing family support will improve patient outcomes. Individuals with high levels of empathy will likely provide greater social support for treatment retention and adherence. This study validates a locally tailored version of the interpersonal reactivity index (IRI)—cognitive empathy (CE) and affective empathy (AE)—among expectant parents living with HIV in Zambézia province, Mozambique. Methods Using baseline data from 558 participants from the HOPS+ trial, we used a maximum likelihood exploratory factor analysis with a promax oblique rotation to assess the culturally relevant questions from the IRI. We examined discriminant and construct validity through analysis of subscale relationships by sex, age, education, and depression and intra-person reliability over time with an interclass correlation model (n = 119). Results Our participants live in 6 districts and receive health care at 24 health facilities. The median age was 25 (IQR: 22 to 30), 50% were female, and 44% were single. Participants had a median of 5 years of formal education (IQR: 2–7). Half of them report their occupation as “farmer” and 17% screened positive for depression. On a scale of 0–4, the median baseline CE score was 2.6 (IQR: 1.9–3.2) and the median baseline AE score was 1.9 (IQR: 1–2.6). Males (2.6 vs. 2.4, P < 0.01), participants who finished primary school (2.7 vs. 2.5, P < 0.01), and older participants (2.6 vs. 2.5, P = 0.04) had higher CE scores, while depressed participants had higher AE scores (2.3 vs. 1.8, P < 0.01). We found moderate stability over time (CE ICC: 0.63, AE ICC: 0.54) in a subset of 119 study participants. Conclusion While depression is associated with 12.5% higher AE scores, older participants, males, and those high levels of education had higher scores on the CS scale. This preliminary work will inform future work on the HoPS+ trial and guide future interventions aimed at increasing retention in and adherence to treatment in people living with HIV. Disclosures All authors: No reported disclosures.

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Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

BMC Public Health ◽

10.1186/s12889-021-10296-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristie C. Waterfield ◽

Gulzar H. Shah ◽

Gina D. Etheredge ◽

Osaremhen Ikhile

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Care ◽

Hiv Infections ◽

People Living With Hiv ◽

Negative Consequences ◽

Persons Who Inject Drugs ◽

Persons Living With Hiv ◽

Living With Hiv ◽

The Impact

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

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Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

BMC Health Services Research ◽

10.1186/s12913-021-06331-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marwân-al-Qays Bousmah ◽

Marie Libérée Nishimwe ◽

Christopher Kuaban ◽

Sylvie Boyer

Keyword(s):

Socioeconomic Status ◽

Health Expenditure ◽

Antiretroviral Treatment ◽

Catastrophic Health Expenditure ◽

Hiv Care ◽

Free Access ◽

People Living With Hiv ◽

Art Policy ◽

Living With Hiv ◽

The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

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Vaccine responses in ageing and chronic viral infection

Oxford Open Immunology ◽

10.1093/oxfimm/iqab007 ◽

2021 ◽

Author(s):

Chloe Rees-Spear ◽

Laura E McCoy

Keyword(s):

Viral Infections ◽

The Elderly ◽

People Living With Hiv ◽

Chronic Infections ◽

Vaccine Responses ◽

Inflammatory Conditions ◽

Immunological Changes ◽

Cellular Responsiveness ◽

Living With Hiv ◽

The Impact

Abstract Lay Summary Improved life expectancy in recent years has led to a growing population of adults over the age of 60. Age is commonly associated with increased inflammatory conditions and infections. Similar immunological changes have been observed during chronic infections, in particular HIV, where this is compounded by the success of antiretroviral therapy that has increased the number of people living with HIV into their sixties and beyond. The increased susceptibility of these groups to infection makes vaccination all the more important. However, the alterations to their immune systems call into question how effective those vaccinations may be. Here we discuss vaccine efficacy within elderly and chronically infected populations and investigate the immunological changes that may impact vaccine responsiveness. Over the last few decades, changing population demographics have shown that there is a growing number of individuals living past the age of 60. With this expanding older population comes an increase in individuals that are more susceptible to chronic illness and disease. An important part of maintaining health in this population is through prophylactic vaccination, however, there is growing evidence that vaccines may be less effective in the elderly. Furthermore, with the success of anti-viral therapies, chronic infections such as HIV are becoming increasingly prevalent in older populations and present a relatively unstudied population with respect to the efficacy of vaccination. Here we will examine the evidence for age-associated reduction in antibody and cellular responsiveness to a variety of common vaccines, and investigate the underlying causes attributed to this phenomenon, such as inflammation and senescence. We will also discuss the impact of chronic viral infections on immune responses in both young and elderly patients, particularly those living with HIV, and how this affects vaccinations in these populations.

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HIV‐associated neurocognitive impairment in stable people living with HIV on ART in rural Tanzania

HIV Medicine ◽

10.1111/hiv.12979 ◽

2020 ◽

Author(s):

M Sanmartí ◽

AC Meyer ◽

A Jaen ◽

K Robertson ◽

N Tan ◽

...

Keyword(s):

Neurocognitive Impairment ◽

People Living With Hiv ◽

Rural Tanzania ◽

Living With Hiv

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Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape

Sexual Health ◽

10.1071/sh16052 ◽

2017 ◽

Vol 14 (1) ◽

pp. 111 ◽

Cited By ~ 15

Author(s):

Graham Brown ◽

William Leonard ◽

Anthony Lyons ◽

Jennifer Power ◽

Dirk Sander ◽

...

Keyword(s):

Hiv Prevention ◽

Gay Men ◽

Sexual Minorities ◽

Research Policy ◽

Scale Up ◽

People Living With Hiv ◽

Structural Level ◽

Biomedical Technologies ◽

Living With Hiv ◽

The Impact

Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM’s access to and use of these technologies. At the personal level, stigma can affect individual gay men’s sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM’s incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.

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Quality of Life in People Living With HIV: An Exploratory Cross-Sectional Survey in Belgium

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.3.249 ◽

2021 ◽

Vol 33 (3) ◽

pp. 249-264

Author(s):

Gert Scheerder ◽

Sandra Van den Eynde ◽

Patrick Reyntiens ◽

Ria Koeck ◽

Jessika Deblonde ◽

...

Keyword(s):

Quality Of Life ◽

Negative Impact ◽

Sexual Life ◽

People Living With Hiv ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Related Stigma ◽

Living With Hiv ◽

The Impact

This cross-sectional survey explored the quality of life in 505 people living with HIV in Belgium. Several domains of quality of life were impaired: 26% had been diagnosed with depression and 43% had weak social support. HIV-related stigma is still widespread, with 49% believing most people with HIV are rejected and 65% having experienced discrimination due to HIV. The impact of HIV was limited on professional life, but 40% experienced a negative impact on life satisfaction and 41% a negative impact on sexual life. For several domains, people with a recent diagnosis of HIV and long-term survivors had significantly worse scores. This survey also uncovered strengths of people living with HIV, such as positive coping and HIV self-image. Expanding the scope of quality of life in people living with HIV may provide a more complete picture of relevant life domains that may be impacted by living with HIV, but this needs further validation.

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Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

Journal of Aging and Health ◽

10.1177/0898264317724549 ◽

2017 ◽

Vol 31 (1) ◽

pp. 109-138 ◽

Cited By ~ 10

Author(s):

Mark J. Siedner

Keyword(s):

Quality Of Life ◽

Conceptual Framework ◽

Care Delivery ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Sub Saharan ◽

Living With Hiv ◽

The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

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