scholarly journals Functional Haplotypes in the ADIPOQ Gene are Associated with Underweight, Immunosuppression and Viral Suppression in Kenyan HIV-1 Infected Antiretroviral Treatment Naive and Experienced Injection Substance Users

2020 ◽  
Vol 30 (4) ◽  
Author(s):  
Shaviya Nathan ◽  
Budambula Valentine ◽  
Were Tom
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Antiretroviral Treatment ◽  
Viral Suppression ◽  
Clinical Markers ◽  
Adiponectin Gene ◽  
Substance Users ◽  
Disease Outcomes ◽  
Immunodeficiency Virus ◽  
Treatment Naïve

BACKGROUND: Human immunodeficiency virus and injection substance use have an influence on genes and gene expression. These effects could be beneficial or detrimental in defining disease outcomes. Adiponectin gene is key in modulating metabolic and immunoregulatory functions. Understanding the effects of human immunodeficiency virus and injection substance use on the gene in the context of antiretroviral therapy is important for predicting disease outcomes.METHODS: This cross-sectional genetic study determined polymorphisms in the promoter region of adiponectin gene. Two variants were analyzed: rs2241766 and rs266729. Polymorphisms were associated with clinical markers of disease outcome; underweight, immunosuppression and viral suppression. The variants were genotyped via random fragment length polymorphism.RESULTS: GC haplotype was associated with higher odds of having underweight (OR, 2.21; 95% CI, 1.83-4.60; P=0.008 vs. OR, 2.30; 95% CI, 1.89-4.71; P=0.006) in antiretroviral treatment -naive and experienced injection substance users andimmunosuppression (OR, 1.90; 95% CI 1.67-3.98, P=0.041) in naive. Bonferroni correction revealed GC haplotype carriers only to have low body mass index in both naive (median, 14.8; IQR, 3.2kg/m2; P<0.002) and experienced (median, 15.2; IQR, 3.2 kg/m2; P<0.002) injection substance users. Circulating total adiponectin levels were higher in naive (median, 19.5; IQR, 7.9 μg/ml) than - experienced (median, 12.0; IQR, 4.4 μg/ml) injection substance users (P<0.0001). GC carriers presented with low serum adiponectin levels in both study groups.CONCLUSION: The study revealed haplotypes of adiponectin gene at loci rs2241766 and rs266729 that could determine disease outcomes in human immunodeficiency virus -1 antiretroviral treatment- naive and experienced injection substance users.

scholarly journals Impact of Abstinence and of Reducing Illicit Drug Use Without Abstinence on Human Immunodeficiency Virus Viral Load

2019 ◽  
Vol 70 (5) ◽  
pp. 867-874 ◽  
Author(s):  
Robin M Nance ◽  
Maria Esther Perez Trejo ◽  
Bridget M Whitney ◽  
Joseph A C Delaney ◽  
Fredrick L Altice ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Viral Load ◽  
Drug Use ◽  
Viral Suppression ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Hiv Viral Load ◽  
Immunodeficiency Virus ◽  
The Impact

Abstract Background Substance use is common among people living with human immunodeficiency virus (PLWH) and a barrier to achieving viral suppression. Among PLWH who report illicit drug use, we evaluated associations between HIV viral load (VL) and reduced use of illicit opioids, methamphetamine/crystal, cocaine/crack, and marijuana, regardless of whether or not abstinence was achieved. Methods This was a longitudinal cohort study of PLWH from 7 HIV clinics or 4 clinical studies. We used joint longitudinal and survival models to examine the impact of decreasing drug use and of abstinence for each drug on viral suppression. We repeated analyses using linear mixed models to examine associations between change in frequency of drug use and VL. Results The number of PLWH who were using each drug at baseline ranged from n = 568 (illicit opioids) to n = 4272 (marijuana). Abstinence was associated with higher odds of viral suppression (odds ratio [OR], 1.4–2.2) and lower relative VL (ranging from 21% to 42% by drug) for all 4 drug categories. Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with VL suppression (OR, 2.2, 1.6, respectively). Reducing frequency of illicit opioid or methamphetamine/crystal use without abstinence was associated with lower relative VL (47%, 38%, respectively). Conclusions Abstinence was associated with viral suppression. In addition, reducing use of illicit opioids or methamphetamine/crystal, even without abstinence, was also associated with viral suppression. Our findings highlight the impact of reducing substance use, even when abstinence is not achieved, and the potential benefits of medications, behavioral interventions, and harm-reduction interventions.

scholarly journals Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder

2020 ◽  
Author(s):  
Petra Jacobs ◽  
Daniel J Feaster ◽  
Yue Pan ◽  
Lauren K Gooden ◽  
Eric S Daar ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Substance Use ◽  
Outpatient Care ◽  
Viral Suppression ◽  
Hiv Care ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Immunodeficiency Virus ◽  
Linkage To Hiv Care ◽  
Living With Hiv

Abstract Background Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. Methods CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. Results Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P &lt; .001). Conclusions Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

scholarly journals Achieving Viral Suppression in 90% of People Living With Human Immunodeficiency Virus on Antiretroviral Therapy in Low- and Middle-Income Countries: Progress, Challenges, and Opportunities

2018 ◽  
Vol 66 (10) ◽  
pp. 1487-1491 ◽  
Author(s):  
Jean B Nachega ◽  
Nadia A Sam-Agudu ◽  
Lynne M Mofenson ◽  
Mauro Schechter ◽  
John W Mellors
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Cost Effective ◽  
Term Treatment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Long Term Treatment ◽  
Wide Range ◽  
Immunodeficiency Virus ◽  
Low And Middle Income

Abstract Although significant progress has been made, the latest data from low- and middle-income countries show substantial gaps in reaching the third “90%” (viral suppression) of the UNAIDS 90-90-90 goals, especially among vulnerable and key populations. This article discusses critical gaps and promising, evidence-based solutions. There is no simple and/or single approach to achieve the last 90%. This will require multifaceted, scalable strategies that engage people living with human immunodeficiency virus, motivate long-term treatment adherence, and are community-entrenched and ‑supported, cost-effective, and tailored to a wide range of global communities.

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