Sustained HIV viral suppression with dolutegravir, tenofovir, and emtricitabine as initial therapy despite high-level transmitted multi-class resistance

Multi-class high-level transmitted HIV drug resistance is uncommon, and the selection of the optimal initial antiretroviral drug regimen may be challenging. We report a case of extensive transmitted multi-class resistance successfully treated with dolutegravir, tenofovir, and emtricitabine even though the baseline genotype demonstrated full susceptibility to only one drug class, the integrase strand transfer inhibitors. Our case highlights both the high resistance barrier of dolutegravir and the residual antiviral activity of nucleoside reverse transcriptase inhibitors despite extensive resistance on genotype.

Cumulative burden of non-communicable diseases predicts COVID hospitalization among people with HIV: A one-year retrospective cohort study

There continue to be conflicting data regarding the outcomes of people with HIV (PWH) who have COVID-19 infection with most studies describing the early epidemic. We present a single site experience spanning a later timeframe from the first report on January 21, 2020 to January 20, 2021 and describe clinical outcomes and predictors of hospitalization among a cohort of PWH in an urban center in Connecticut, USA. Among 103 PWH with controlled HIV disease, hospitalization occurred in 33% and overall mortality was 1%. HIV associated factors (CD4 count, HIV viral suppression) were not associated with hospitalization. Chronic lung disease (OR: 3.35, 95% CI:1.28–8.72), and cardiovascular disease (OR: 3.4, 95% CI:1.27–9.12) were independently associated with hospitalization. An increasing number of non-communicable comorbidities increased the likelihood of hospitalization (OR: 1.61, 95% CI:1.22–2.13).

EFFECTS OF HAZARDOUS ALCOHOL AND DRUG USE ON ANTIRETROVIRAL ADHERENCE AND HIV VIRAL SUPPRESSION: A MEDIATION ANALYSIS

Background: Little is known regarding the degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication adherence. We hypothesized that the total effects of such use are mediated through adherence. Methods: We included patients with HIV (PWH) receiving care at an urban academic HIV clinic between 2014 and 2018. Eligible patients were those prescribed antiretroviral therapy who completed both patient reported outcome (PRO) questionnaires, and had subsequent plasma viral load (pVL) measurements. Measures included assessments of alcohol use (AUDIT-C), drug use (ASSIST), and self-reported adherence. Substances found in bivariate analysis to predict detectable pVL were modeled separately for mediation effects through adherence. We report natural direct (NDE) and indirect effect (NIE), marginal total effect (MTE) and percentage mediated. Results: Among 3125 Patients who met eligibility criteria, percentages of current use by category were: hazardous alcohol 25.8%, cannabis 27.1%, amphetamines 13.1%, inhalants 11.9%, cocaine 5.3%, sedative-hypnotics 4.5%, opioids 2.9%, and hallucinogens 2.3%. Excellent adherence was reported in 58% and 10% had detectable pVL. Except for sedatives use of other ascertained substances was significantly associated with worse adherence. Bivariate predictors of detectable pVL were [OR(95% CI)]: amphetamine use 2.4 (1.8 -3.2 ) and opioid use 2.3 (1.3 - 4.0) . The percentage mediated by adherence was 36% for amphetamine use, 26.5% for opioid use, and 39% for multiple substance use. Conclusion: Use of amphetamines, opioids, and multiple substances predicted detectable pVL. However, less than 40% of effects were mediated by self-reported adherence.

Viral suppression among middle-aged and aging MSM living with HIV: Partnership type and quality

Functional support—the availability of material aid, emotional support, or companionship—promotes general well-being. For men who have sex with men (MSM) living with HIV, having a person who supports you associates with viral suppression. This study examines the association between supportive partnerships and HIV viral suppression among middle-aged and aging MSM living with HIV. A total of 423 middle-aged and aging MSM (mean age, 58.2 years) from the Multicenter AIDS Cohort Study provided self-reported data about their partnerships. Separate Poisson regression models assessed how partnership type, support, strain, and duration from April 2017 were associated with repeated viral load measurements up to April 2019. Of the follow-up visits (N = 1289), 90.0% of participants were virally suppressed. Most participants reported being non-Hispanic White (61.0%) and college-educated (83.4%). Participants were asked about their primary partnerships (i.e., “someone they are committed to above anyone else”) and secondary partnerships (i.e., those who can also be intimate or supportive but not necessarily romantic or sexual). The participants reported: no partnerships (45.2%), only primary partnerships (31.0%), only secondary partnerships (11.1%), or both primary and secondary partnerships (12.8%). Primary and secondary partnerships had mean (SD) durations of 15.9 (11.3) and 25.2 (16.5) years, respectively. Participants reporting both primary and secondary partnerships (compared with no partnership) showed significantly higher odds of being virally suppressed (adjusted prevalence ratio [aPR], 1.04; 95% CI, 1.00–1.08; p = 0.043). Albeit not statistically significant, primary-only (aPR, 1.01; 95% CI, 0.97–1.06; p = 0.547) or secondary-only (aPR, 1.03; 95% CI, 0.98–1.08; p = 0.224) partnership types were positively associated with viral suppression. Partner support and strain were not associated with viral suppression in any partnership group. Being older and non-Hispanic Black were positively and negatively associated with viral suppression, respectively. Encouraging partnerships should be considered one of clinicians’ many tools to help middle-aged and aging MSM achieve long-term viral suppression.