bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV infection early diagnosis experience in primary care
Authors: Jover Diaz Francisco , Ortega Paz , Antequera Pedro , Cloquell Blas , Alcaraz Marta , Hernandis Mavi , Nuñez Carlos , Lloret Rosario , Perez Faustino , Jover Perez Sabina , Buñuel Fernando , Gomez Francisco , Sanz Marta , Ordovas Rafael , Torregrosa Francisco , Barceló Ángela , Masegosa Consuelo , Ortiz de la Tabla Victoria , María Cuadrado Jose
Published: November 2014

Introduction

Traditional screening system focus on classic risk factors “lost” a substantial proportion of HIV‐infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost‐effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%).

Objective

To determine prevalence of HIV infection in patients aged 20–55 years in primary care (PC).

Material and Methods

A propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type “Opt‐out” (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan‐Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors.

Results

HIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non‐recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM.

Conclusions

1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower‐risk because of high percentage of women included (58.5%). 3) Performing HIV opt‐in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt‐out screening should be developed in high‐risk populations. It is still to be determined what is the best screening strategy in low‐risk populations such as ours.
Involvement of HIV patients in treatment‐related decisions
Authors: Zanini Matteo , Schulte‐Hermann Kathrin , Leichsenring Birgit , Stefanek Wiltrut , Ernst Dorner Thomas
Published: November 2014

Introduction

The improvement of antiretroviral therapy in the past decades has had a major impact on life expectancy and quality of life of people living with HIV, and also on the relationship between patients and their physicians. What used to be an acute treatment for life threatening complications, and an end‐of‐life therapy in the beginning of the epidemic, turned over the time into a lifelong care. The good relationship between patients and physicians represents the cornerstone of an optimal long‐term therapy. Shared decision making between patients and physicians is a crucial prerequisite for the success of this approach. Several Austrian patient organizations developed an online survey together with MSD (the so‐called “PAB‐test”) aimed to evaluate how people living with HIV perceive the level of care in Austria.

Materials and Methods

An online survey has been developed to evaluate how people living with HIV feel about the relationship with their physicians and to what extent they feel involved in treatment related decisions.

Results

A total of 303 subjects completed the questionnaire. 44% felt “totally” involved in their therapy, 40% “strongly involved”, 12% “fairly involved”, 3% “poorly involved” and 1% “not at all involved” in their therapy. The proportion of subjects who felt totally involved in the therapy was equally distributed between sex, sexual orientation, age groups, groups of various education level, and between patients treated predominantly in intramural or extramural medical care. The most important factor for people living with HIV to feel involved in their therapy is a low amount of long‐term ART‐related side‐effects (Figure 1).

Conclusions

The results show that the majority of people living with HIV in Austria feel involved in therapy related decisions. This proportion is equally distributed in patients with different socio‐demographic or socio‐economic characteristics or level of medical care delivery. According to the survey, the most important reason for people living with HIV to be involved in their therapy is to avoid long‐term side effects.
Improve screening of HCV infection by targeting high prevalence aged groups: analysis of a cohort of HCV and HIV co‐infected patients
Authors: Brogueira Pedro , Costa Ana , Miranda Ana , Peres Susana , Baptista Teresa , Aldir Isabel , Antunes Isabel , Ventura Fernando , Borges Fernando , Mansinho Kamal
Published: November 2014

Introduction

Hepatitis C constitutes a major public health burden. In Portugal, the prevalence is estimated at 1–1.5% [1]. Of these, only 30% are presumed to be diagnosed, which reveals that most infections go unknown. The objective of this study is to identify the age‐range distribution at HCV diagnosis and to identify the high‐prevalence birth groups that could be targeted for screening, as a strategy to increase diagnosis and identify patients who would benefit most from treatment.

Methods

Retrospective observational study of a cohort of chronic HCV‐infected and HIV co‐infected patients followed at an Infectious Diseases Center, diagnosed between 1979 and 2014 (Figure 1). Hepatic fibrosis evaluation was performed by real time elastography using METAVIR score. Epidemiological, demographic, clinical, virological and therapeutic data was retrieved from clinical registries. Statistical analysis was performed using Microsoft Excel 2010®. Chi2, Student T were used for a significant p value of <0.05.

Results

Our study assessed a cohort of 665 patients: 442 (66.5%) HCV/HIV co‐infected and 223 (33.5%) HCV monoinfected. There was a male predominance in both groups (74.9% vs 70.9%). The mean age was 47 HCV/HIV vs 49 years; Portuguese origin in 80% vs 83% and African in 14% vs 12%. The most frequently assumed transmission route was by intravenous drug use (IVDU) (81% vs 72%), followed by sexual contact (18% vs 20%). Mean age at diagnosis was 32 vs 40 years. Mean time since HCV diagnosis was 14, 6 vs 9, 6 years. Fibrosis stage evaluation by real time elastography was available for 133 (30%) and 99 (44.4%) patients (HCV/HIV vs HCV): 16% vs 13% F1; 32% vs 33% F2; 31% vs 35% F3; 21% vs 18% F4. The peak prevalence occurred between the birth intervals of 1960–1969 and 1970–1979 for both groups, corresponding to 81% vs 66,8% (p=0.003) (Figure 1). About three quarters of all patients (76%) were born between the year of 1960 and 1979, with a prevalence of 70% of IVDU.

Conclusions

In our cohort we identify a high risk population for chronically HCV infection, which comprises people born between 1960 and 1979, findings common to those with mono or HIV co‐infection. This finding is concordant with the epidemic of IVDU in Portugal around 1980–1990. These patients should be screened for diagnosis in order to be treated and to prevent further disease progression.
Future prospectives of sub‐Saharan women living with HIV residing in France for more than seven years: prospective pilot study
Authors: Dimi Svetlane , Albucher Dominique , Zucman David
Published: November 2014

Introduction

In 2011, a French national survey of people living with HIV (PLHIV) has shown that 40% of persons diagnosed since 2003 are originated from sub‐Saharan Africa, two thirds of them being women. For them, in the short term, access to social rights is a priority. Today, over 90% of PLHIV are treated effectively and with the aging of this population, questions about their future perspectives arise. Our service provides a multidisciplinary (medical, psychological, social) approach to PLHIV. The aim of our study is to describe the future perspectives of sub‐Saharan women living with HIV residing in France for more than 7 years, because it is the time required for the implementation of fundamental rights and social insertion. Do they plan to return to their country of origin after their retirement? Does the HIV infection force them to stay in France?

Materials and Methods

Prospective pilot mono‐centric study. Between January and April 2014, every HIV‐infected woman born in a sub‐Saharan country, resident in France for at least 7 years, attending for their routine outpatient visit was consecutively included. Data were collected through a structured, semi‐directed interview made by their usual hospital physician or social worker.

Results

Consecutively, 76 women agreed to participate to the interview, none refused. Mean age: 42 years [26–70], time since HIV diagnosis: 12 years [1–25]. HIV diagnosis was made before arriving in France for 3% of them; in 33% diagnosis was made in the year of arrival; diagnosis made several years after arrival in 63%. Even if 69% of these women had been irregularly residing in France for a period, all of them had obtained a regular situation for residence and 50% acquired the French nationality. Mean duration of residence was 15 years [7–33]. Two thirds of them are employed. In the future, although 50% plan to have a shared residence between France and Africa, only 20% of them plan to settle back definitely in Africa and no woman declared that she would look for a medical follow up in Africa for their HIV infection.

Conclusions

This study shows a good integration in France of HIV‐infected sub‐Saharan woman. Their links with Africa remain strong but very few plan to return in their country of origin due to lack of confidence in the African health infrastructures.
Cost‐effectiveness of DTG+ABC/3TC versus EFV/TDF/FTC for first‐line treatment of HIV‐1 in the United States
Authors: Peng Siyang , Tafazzoli Ali , Dorman Emily , Rosenblatt Lisa , Villasis‐Keever Angelina , Sorensen Sonja
Published: November 2014

Introduction

Data from the SINGLE trial demonstrated that 88% of treatment‐naive HIV‐1 patients treated with dolutegravir and abacavir/lamivudine (DTG+ABC/3TC) achieved viral suppression at 48 weeks compared with 81% of patients treated with efavirenz/tenofovir disoproxil fumarate/emtricitabine (EFV/TDF/FTC). It is unclear how this difference in short‐term efficacy impacts long‐term cost‐effectiveness of these regimens. This study sought to evaluate the long‐term cost‐effectiveness of DTG+ABC/3TC versus EFV/TDF/FTC from a US payer perspective.

Materials and Methods

An individual discrete‐event simulation model tracked the disease status and treatment pathway of HIV‐1 patients. The model simulated treatment over a lifetime horizon by tracking change in patients’ CD4 count, occurrence of clinical events (opportunistic infections, cancer and cardiovascular events), treatment switch and death. The model included up to four lines of treatment. Baseline patient characteristics, efficacy and safety of DTG+ABC/3TC and EFV/TDF/FTC were informed by data from the SINGLE trial. The efficacy of subsequent lines of treatment, clinical event risks, mortality, cost and utility inputs were based on literature and expert opinion. Outcomes were lifetime medical costs, quality‐adjusted life‐years (QALYs) (both discounted at 3% per annum) and the incremental cost‐effectiveness ratio (ICER).

Results

Compared with EFV/TDF/FTC, DTG+ABC/3TC increased lifetime costs by $58,188 and per‐person survival by 0.12 QALYs, resulting in an ICER of $482,717/QALY. In sensitivity analyses testing conservative assumptions about EFV/TDF/FTC's efficacy beyond the trial period, ICERs comparing DTG+ABC/3TC to EFV/TDF/FTC remained high (lowest reported ICER of $365,662/QALY). In a scenario in which the price of EFV/TDF/FTC was reduced by 10% to reflect the potential for price reduction as EFV goes off patent, DTG+ABC/3TC's ICER compared to EFV/TDF/FTC was $600,916/QALY. When DTG+ABC/3TC's price was reduced by 10%, the resulting ICER comparing DTG+ABC/3TC to EFV/TDF/FTC was $302,171/QALY.

Conclusions

Compared with EFV/TDF/FTC, DTG+ABC/3TC resulted in substantially higher cost, slightly better QALY over lifetime, and ICERs far exceeding standard cost‐effectiveness thresholds, indicating that the incremental benefit in efficacy associated with DTG+ABC/3TC may not be worth the incremental increase in costs.
The cost‐effectiveness in the use of HIV counselling and testing‐mobile outreaches in reaching men who have sex with men (MSM) in northern Nigeria
Authors: Ifekandu Chiedu , Suleiman Aliyu , Aniekwe Ogechukwu
Published: November 2014

Introduction

Men who have sex with men (MSM) are at increased risk of HIV and other STI infections in Nigeria. This is because MSM are afraid to seek medical help because the healthcare workers in various facilities are afraid of the consequences if they provide services for MSM citing the law as a reason not to intervene. MSM in northern states of Nigeria are facing double‐jeopardy because the few international partners working in MSM in Nigeria are pulling out of these volatile areas because of the fear of attacks by the Boko Haram and the Nigerian law enforcement agencies.

Objectives

The intervention was conducted to promote affordable and sustainable HIV care and treatment for MSM in Nigeria.

Methods

This intervention was conducted in the Boko Haram ravaged cities of Kano and Maiduguri (North‐East Nigeria). Twenty MSM‐key influencers from the two cities were identified and trained on HIV counselling and testing, caregivers, case managers and on initiation process for ARV treatment for new HIV+MSM as well as ethical considerations.

Results

The mean age of the key influencers was 24 years +/−SD. Each of the trained 20 key influencers reached 20 MSM‐peer with condom promotion, HCT, referral to identified MSM‐community health centers and follow‐up/caregiving within the space of one month. The project was able to reach 400 MSM in the two cities. 89% of the peers consented to HCT. HIV prevalence among the participants was at 18%. The project recorded ARV‐successful referral to healthcare facilities for the respondents that tested positive. The key influencers have been following up for ARV‐adherence.

Conclusions

Use of community members should be promoted for sustainability and ownership. It also helps in eradicating socio‐cultural barrier to HIV intervention for MSM. Moreover, this proves to be one of the safest and affordable methods of reaching MSM in Nigeria in this ugly time of legalization of homophobia in the country's constitution.
Determinants of HIV outpatient service utilization according to HIV parameters
Authors: Di Carlo Paola , Immordino Palmira , Mazzola Giovanni , Colletti Pietro , Alongi Ilenia , Mineo Maurizio , Scognamillo Marco , Vitale Francesco , Casuccio Alessandra
Published: November 2014

Introduction

The increased life expectancy of HIV patients in the era of highly active antiretroviral therapy has had profound consequences for the healthcare systems that provide their care. It is useful to assess whether healthcare resources need to be adapted to the different stages of HIV infection or to patient characteristics [1]. To study how patient features influence utilization of out patient services, we retrospectively analyzed the electronic health record of HIV‐positive patients who had followed day‐care programs at the AIDS Center of the University of Palermo, Italy.

Materials and Methods

223 HIV‐infected subjects were recruited and divided into two groups according to CD4 cell counts (117 with a CD4 count ≤500/mm3 and 106 with CD4 count ≥500/mm3). Data on age, gender, race, lifestyle habits (including educational level, drug abuse history, smoking status, alcohol consumption, sexual behaviour) BMI, HIV‐RNA, CD4+ T‐cell count, antiretroviral therapy (ART), comorbidities such as HCV co‐infection, osteoporosis biomarker, dyslipidemia, diabetes, renal function and systolic and diastolic blood pressure were recorded in a purposely designed database and were analyzed in relation to AIN by uni‐ and multivariable logistic regression.

Results

Table 1 shows the characteristics of enrolled patients; the average age of the recruited patients was 45.4±9.5 years. 163 individuals were male (73%), 26 were immigrants (12%) and 91 (40%) were treatment‐naïve. Mean day care access for laboratory tests to evaluate stage of HIV and for treatment monitoring was 6.5 days for CD4 cell count measurements and 9.6 for HIV RNA/drug‐resistance testing. When patients were stratified according to CD4 count, mean day care access for laboratory tests to evaluate HIV stage and to monitor treatment was negatively correlated with CD4 cell counts.

Conclusions

Only patients with CD4 counts ≤500/mm3 showed higher rates of healthcare utilization; these data may be useful for monitoring and revising implementation plans for the different phases of HIV disease.
Outcomes related to 4864 pregnancies with exposure to lopinavir/ritonavir (LPV/r)
Authors: Tookey Pat , Thorne Claire , Martinez‐Tristani Marisol , Norton Michael , van Wyk Jean
Published: November 2014

Introduction

During pregnancy, LPV/r is a common anchor drug employed to treat the mother's HIV‐1 infection in addition to reducing the risk of mother‐to‐child transmission (MTCT). The National Study of HIV in Pregnancy and Childhood (NSHPC) conducts a comprehensive population‐based surveillance of HIV infection in pregnant women exposed to antiretroviral therapy (ART) in the UK and Ireland; in 2003–2012 over a third of pregnancies reported to the NSHPC involved exposure to LPV/r.

Methods

We undertook a retrospective were descriptive analysis of individual NSHPC patient data, using pregnancy as the unit of observation. Clinical outcomes for pregnancies reported by June 2013, where women were exposed to LPV/r and due to deliver between January 2003 and December 2012, are described.

Results

A total of 4864 LPV/r exposed pregnancies in 4118 women were identified. These resulted in 4702 deliveries with 4759 live and 46 stillborn infants. Seventy five percent of women were born in sub‐Saharan Africa, 13% in the UK or Ireland. Median maternal age at conception was 30 years. Nine hundred and eighty (20%) pregnancies were conceived while taking LPV/r, with a median duration of LPV/r exposure of 270 days. A total of 3884 (80%) pregnancies initiated LPV/r after conception, with a median duration of LPV/r exposure of 107 days. Viral load (VL) close to delivery was available for 4083/4702 (87%) deliveries, with VL <50 c/mL in 73% and <1000 c/mL in 94% of women. VL by timing of LPV/r initiation is shown in Table 1. Sixty three percent of deliveries were by C‐section, of which 62% were classified as elective and 38% as emergency. Among singleton liveborn infants, 13% were born prior to 37 weeks gestation (2.5% <32 weeks) and 15% had birth weight <2500 g (2.3% <1500 g). HIV infection status was available for 4039 (89%) singleton infants. For the periods 2003–2007 and 2008–2012, MTCT rates were 1.1% (95% CI 0.6–1.6) and 0.5% (95% CI 0.2–0.8) respectively. Hundred and thirty four live born children (2.8%) had at least one congenital abnormality reported.

Conclusions

In the NSHPC database, in women exposed to LPV/r during pregnancy in the UK and Ireland, MTCT rates are low and continue to decline, and are similar to rates in the entire NSHPC cohort of women with diagnosed HIV [1]. The congenital abnormality rate is comparable with that reported for the uninfected population in this geographic region.
Reduced HIV symptoms and improved health‐related quality of life correlate with better access to care for HIV‐1 infected women: the ELLA study
Authors: Baran Robert , Mulcahy Fiona , Krznaric Ivanka , d'Arminio Monforte Antonella , Samarina Anna , Xi He , Cassetti Isabel , Valdez Madruga Jose , Zachry Woodie , van Wyk Jean , Martinez Marisol
Published: November 2014

Introduction

Global HIV‐1 prevalence is 35.3 million [1]; women comprise >50% of those infected. The majority of women may lack regular care and only one‐fourth are virologically suppressed [2]. ELLA is a cross‐sectional, non‐interventional study conducted across Europe, Latin America, Canada and Asia that describes barriers to care for HIV‐infected women and associations with disease stage, symptoms and health‐related quality of life (HRQoL).

Methods

HIV‐infected women eligible for ELLA (≥18 years) completed: Barrier to Care Scale (BACS) comprising 12 items in four domains (Index range 0–12, Overall range 1–4, greater=more barriers, Overall score ≥2 considered severe); AIDS Clinical Trials Group (ACTG) Health Status Assessment comprising 21 items assessing 9 HRQoL domains (range 0–100, greater=better); and ACTG Symptom Distress Module comprising 20 symptoms rated on bother (range 0–4, greater=more bother). Healthcare providers documented medical history and HIV clinical data. Correlations of BACS response and last reported VL/CD4 count with HIV symptoms and HRQoL were analyzed. Spearman rank order was used to test correlations with statistical significance set at p<0.05.

Results

Enrollment: 1931 women from 30 countries; mean age 40 years (16.9% >50 years); 47.7% education <12 years; 36% unemployed; 82.9% urban residence. HIV was acquired heterosexually in 83.0%; 88.2% of subjects were on ART; 57.5% had VL<50 c/ml; mean CD4 was 540.5 c/µL. Mean [SD] BACS Index and Overall scores were 6.19 [3.47] (N=1818) and 2.09 [0.71] (N=1922), respectively. Stigma was a prominent barrier. Lower (better) BACS Index and Overall scores correlated with better HRQoL on all nine domains (p<0.0001). Lower VL and greater CD4 count were both correlated with better HRQoL for eight of nine domains (p<0.04, p≤0.0002, respectively) excepting pain. Lower BACS Index and Overall scores correlated with fewer symptom count and less symptom bother (p<0.0001). Fewer symptom count and less symptom bother correlated with better HRQoL on all nine domains (p<0.0001). While greater CD4 count correlated with fewer HIV symptoms and less bother (p<0.0001), VL did not significantly correlate with either.

Conclusions

In HIV‐infected women, reduced barriers to care correlated with fewer symptoms, less symptom bother and better HRQoL. Improved HRQoL may be mediated by greater CD4 counts and fewer symptoms. Better access to care may improve HRQoL outcomes in this population.
Analysis of causes of death among HIV‐infected patients of Kiev Regional AIDS Center during 2013
Authors: Stepchenkova Tetiana , Martynenko Olena , Yurchenko Oleksandr
Published: November 2014

Ukraine is a leader in Europe in the prevalence of HIV infection. There are up to 270 thousand people, who are living with HIV. Since 1987, in Ukraine, 33,149 HIV‐infected people died. During the first six months of 2013, of all the dead, who were suffering from HIV and in need of antiretroviral treatment (ART) at the time of death, 41% received treatment and only 5.7% received ART for more than one year. Specialists of Kiev Regional AIDS Center analyzed mortality among the patients of the centre, in order to determine the most frequent cause of death, set the group most at risk and to develop effective measures to reduce mortality among HIV‐infected patients. In Kiev AIDS Center, 10,000 people are under medical observation and 4004 of them are taking ART. During 2013, 305 persons died: 217 were women and 88 were men which included 3 children under 14 years. Most of the dead – 272 (89%) were aged 25–49. Among the total number of the dead, 125 people (41%) were receiving ART, 53 of them (17%) were receiving ART for at least one year and 39 of them (13%) were receiving ART for less than one month. Hundred and fifty‐eight people (52%) required ART and 22 (7%) did not need therapy. Hundred and ninety‐two patients (63%) were in four clinical stage of HIV infection. Hundred and ten of them had HIV+TB co‐infection. Twenty patients died due to TB and 12 patients died due to hepatitis b virus/hepatitis c virus (HBV/HCV). Among these patients, 87 people (39%) were taking ART and 136 persons (61%) were in need of ART, but did not get it. Nineteen patients were diagnosed with cancer. Sixteen patients, who were co‐infected HIV+TB had a CD4 cell count of more than 300. Based on this analysis, we can conclude that the main causes of high mortality among HIV‐infected patients in 2013 were late diagnosis of HIV, besides a large number (52%) of patients, who were in need of ART did not take it. A large number (40%) among those who died were patients co‐infected with HIV+TB, HIV+HBV/HCV. This reinforces the necessity to introduce new schemes for the integrated treatment of these patients, including patients with MDR, XDR TB. Also all HIV‐infected patients who died in 2013, were diagnosed multiple pathology of various organs, which demonstrates the necessity of the introduction of schemes of early diagnosis and approaches to treatment of this disease. A large number of deaths (24%) of patients receiving ART for more than a year, highlight the necessity for changes to existing treatment regimen in HIV patients, with the possibility of the development of viral resistance to certain drugs and taking into account the latest international experience in the treatment of HIV‐infected patient.
Stigma reduces and social support increases engagement in medical care among persons with HIV infection in St. Petersburg, Russia
Authors: Kelly Jeffrey , Amirkhanian Yuri , Yakovlev Alexey , Musatov Vladimir , Meylakhs Anastasia , Kuznetsova Anna , Chaika Nikolay
Published: November 2014

Introduction

The proportion of people living with HIV (PLH) in care and on antiretroviral therapy (ART) in Russia is lower than in Sub‐Saharan Africa [1]. This is undoubtedly due to a variety of systems and structural issues related to poor treatment access, linkage and care delivery models. However, little research has explored the reasons that PLH are not in care from their own perspectives. This information can help to guide the development of approaches for improving HIV care engagement in the country.

Materials and Methods

In‐depth interviews were undertaken with 80 PLH in St. Petersburg who had never been in HIV medical care, had previously been out of care, or had always been in care. Participants were recruited through online PLH forums and Websites, outreach needle exchange and non‐government organisation (NGO) programs, and chain referral. The interviews elicited detailed information about participants’ experiences and circumstances responsible for being out of care, and factors contributing to nonretention in HIV treatment. Verbatim transcriptions of the interviews were coded and analyzed using MAXQDA software to identify emerging themes.

Results

Two types of care engagement barriers most often emerged. Some related to medical services, and others to the family and social environment. The most frequent medical service barriers were poor treatment infrastructure conditions and access; dissatisfaction with quality of services and medical staff; and concerns over confidentiality and HIV status disclosure. Social barriers were fears of potential harm to family relationships, negative consequences if status became known at work, and public stigmatization and myths associated having an HIV+ status. Social support from the PLH community and from family and close friends facilitated care engagement, as did motivation to take care of oneself and one's family. Most participants also described circumstances in which engaging into HIV care was brought about by an urgent issue (opportunistic infections) or was enforced through hospitalization or imprisonment. Trust in one's doctor and simply not wanting to die were also common motives.

Conclusions

Stigma was a major barrier to care engagement, including fear that others would learn of one's HIV+ status, whether at work, in one's family, or in the general community. By contrast, support from family, friends and the PLH community contributed to care engagement.
HCV triple therapy in co‐infection HIV/HCV is not associated with a different risk of developing major depressive disorder
Authors: Fialho Renata , Keller Majella , File Alex , Woods Catherine , Pereira Marco , Yousseff Elaney , Tibble Jeremy , Harrison Neil , Fisher Martin , Rusted Jennifer , Whale Richard
Published: November 2014

Introduction

Hepatitis C (HCV) treatment options have changed with the development of direct activity antivirals (DAAs) and the availability of triple therapies have improved HCV cure rates. A common neuropsychiatric side effect of pegylated‐interferon and ribavirin treatment is major depressive disorder (MDD), however little is known about such adverse events with protease inhibitor‐based triple therapy. The aim of this study was to assess the rate of MDD in co‐infected HIV HCV patients undergoing different HCV treatments.

Methods

All participants were co‐infected HIV HCV attending the Royal Sussex County Hospital Brighton hepatology outpatient clinic between 2010 and 2014. Participants were assessed for DSM‐IV MDD and depression severity (using the Hamilton depression scale (HAMD)) at baseline and monthly after treatment initiation. HIV and HCV stages, genotype, reinfection and standard demographic variables were recorded. Influence of HCV stage (acute vs. chronic) and type of treatment (classic vs triple), emergence of MDD and clearance outcomes were analyzed using repeated measures and logistic regression models.

Results

Fifty participants with a mean age of 42.65 years (SD=10.32) were included; most were male (98%). The majority had contracted HCV genotype 1 (64%) or 4 (26%). The HCV stage and treatment groups were matched for age and depression at baseline. No significant differences were found on virological outcomes considering HCV stage and treatment. From baseline to SVR, there was a significant increase in HAMD scores, F(4,36)=10.09, p<.001; this was not significantly influenced by HCV stage, F(4,35)=0.54, p=.708 or HCV treatment group, F(4,35)=0.60, p=.664. Those with chronic HCV were more likely to transition to MDD than acute infection (OR 7.77, 95% CI 2.04–29.54, p=.003). No differences were found for depression emergence by HCV treatment group (OR 0.83, 95% CI 0.22–3.13, p=.787).

Conclusions

HCV triple therapy was not associated with a different risk of emergence of MDD versus classic treatment. MDD should be assessed before therapy initiation and monitored throughout treatment for any HCV treatment regime. Future research could usefully clarify mechanisms of MDD emergence and risk factors for this.
Experience of acute hepatitis C and HIV co‐infection in an inner city clinic in the UK
Authors: Ward Christopher , Lee Vincent
Published: November 2014

Introduction

Acute hepatitis C infection (HCV) is increasing in the HIV‐infected population, particularly among men who have sex with men (MSM). Patients co‐infected with HCV and HIV progress more rapidly to liver cirrhosis and are at higher risk of hepatocellular carcinoma. We looked at our management of acute HCV to assess treatment outcome.

Materials and Methods

We performed a retrospective and prospective case note review of HIV‐HCV co‐infected patients attending a large inner city sexual health clinic from 2006‐to date. Acute HCV infections (less than six months) were identified and data was collected on demographics, transmission and treatment outcomes. Treatment regime was 48 weeks of weight‐based ribavirin and pegylated interferon α2a.

Results

Sixty‐seven acute HCV infections were identified among 142 co‐infected patients, all of whom were male and 66 (98.5%) were MSM. Median age at diagnosis was 37 (range 20–59) and 58 (86.6%) were White British. Sixty patients (89.6%) were genotype 1, 3 (4.5%) were genotype 4 and 2 (3.0%) were genotype 2/3. A further 2 (3.0%) were re‐infections. A peak in new HCV diagnoses was seen in 2013 with 17 (25.4%). Route of transmission was sexual in all cases with 13 (19.4%) also injecting drugs, pointing to mixed transmission routes. Nine (69.2%) of these occurred in 2013. Nine (13.4%) patients cleared HCV themselves. Of the 58 who didn't clear HCV, 12 (20.7%) were lost to follow up/transferred care, 4 (6.9%) declined treatment awaiting newer agents, and 10 (17.2%) are waiting to start. A total of 32 patients started treatment. Six (18.8%) patients are currently on treatment and three (9.4%) await a final sustained virological response (SVR) test. Six out of twenty‐four (25.0%) stopped treatment due to lack of response and 1 stopped due to side effects. Fifteen (62.5%) achieved SVR and 2 (8.3%) failed to achieve SVR. Eight out of ten (80.0%) patients who had an early virological response (EVR) achieved SVR.

Conclusions

Our data shows good treatment outcomes for acute HCV infection in HIV patients with an SVR rate of 62.5%. We've seen a steady increase in acute HCV infection, particularly in MSM injecting party drugs. Changing risk behaviours, particularly a rise in chem sex parties and club drug use, along with more anonymous partners and disclosure issues create difficulties in managing the HCV epidemic. More education is needed to raise awareness of HCV transmission and disclosure in our MSM population.
Plasmacytoid Dendritic cells (pDCs) in HIV‐infected and HIV/HCV‐co‐infected patients receiving successful treatment
Authors: Khokhlova Olga , Reizis Ara , Serebrovskaya Lidya , Gerasimova Natalia , Pokrovskiy Vadim
Published: November 2014

Introduction

Depletion of cellular pool and constant activation of plasmacytoid dendritic cells (pDCs) in HIV‐infected persons (HIV+) are associated with disease progression and manifestation of opportunistic infections. The influence of highly‐active antiretroviral treatment (HAART) and suppressed HCV‐co‐infection (HIV+/HCV+) on the extent of these changes remains unknown.

Objective

To study parameters of pDCs in peripheral blood of HIV+ and HIV+/HCV+ patients on HAART.

Methods

Twelve uninfected with HIV or HCV volunteers and 37 patients (12 HIV+, 9 HIV+/HCV+ and 16 HCV+) were enrolled. All HIV+ patients received HAART and had undetermined HIV viral load. All HCV+ patients had finished antiviral therapy (Pegasys/ribavirin) with sustained viral response for six months and more. The pDC population was enumerated by flow cytometry. In vitro IFN production in the whole blood in response to pDC‐specific stimulus unmethylated CpG oligonucleotides was determined by enzyme‐linked immunosorbent assay (ELISA).

Results

The percentage of pDCs of peripheral blood mononuclear cells (PBMC) in HIV+/HCV+ was the lowest (0.08±0.02) but statistically not different from HIV+ (0.15±0.03; p=0.11) and significantly lower than HCV+ (0.17±0.015; p=0.4) and controls (0.27±0.045; p=0.03). Absolute number of pDCs in HIV+ on HAART (6.3±1.3) was not significantly lower than the control (10.25±1.75; p=0.09) but in HIV+/HCV+ (5.1±1.2; p=0.03), the difference was valid. IFN‐alpha production by pDCs in patients on HAART in HIV+ (2.4±0.9 pg/µl) and in HIV+/HCV+ (3.7±1 pg/µl) patients were significantly higher than in controls (in controls IFN‐alpha production by pDCs in the native plasma was below the level of detection (3 pg/µl), p=0.02 and p=0.0014).

Conclusions

Absolute number of pDC in HIV‐positive person on HAART with sustained viral response to treatment of HCV‐co‐infection was lower than in HIV‐mono‐infected. IFN‐alpha production by pDC in HIV+ and in HIV+/HCV+ patients receiving HAART remains higher than in uninfected persons.
Analysis of hepatitis non‐treatment causes in a cohort of HCV and HCV/HIV infected patients
Authors: Pereira Karen , Cláudia Miranda Ana , Baptista Teresa , Peres Susana , Antunes Isabel , Ventura Fernando , Borges Fernando , Mansinho Kamal
Published: November 2014

Introduction

The decision to start hepatitis C virus (HCV) treatment and its timing remains controversial. As new treatment regimens are approved, it is essential to identify patients eligible for each regimen in a timed and tailored approach. This study aims to identify the reasons to defer treatment of chronic hepatitis C infection in both HCV and HCV/HIV infected patients.

Materials and Methods

Retrospective observational study of a cohort of HCV chronically infected patients with or without HIV infection, followed in an infectious disease clinic in Lisbon. Demographic, epidemiological, clinical, immunologic and virologic data were collected. Statistical analysis was performed with Microsoft Office®‐ Excel 2012. Kolmogorov‐Smirnov, t‐test, Chi‐square and correlation analysis were performed for a significant p value<0.05.

Results

The study included 669 patients, 225 patients infected with HCV (group A) and 444 patients co‐infected with HCV/HIV (group B). The comparative analysis of those groups (A vs. B) showed: mean age was 49.4 years versus 46.9 (p<0.01), mean time since HCV diagnosis was 9.5 versus 14.6 years (p=0.558) both groups shared a male predominance and HCV acquisition due to intravenous drug use. Regarding genotype characterization, the predominant was 1a in both groups (p<0.01). Evaluation of IL28B polymorphism revealed CC 15.5% (A) versus 9.45% (B) (p<0.01). Group B mean TCD4 count was 585 cells/µL (mean percentage 27.1%). There was spontaneous viral clearance in 10.7% (A) versus 4.1% (B) (p<0.01). There were treated 52.0% (A) versus 32.2% (B) patients (p<0.01). For the untreated ones (107 – group A vs 270 – group B), no reason was identified for treatment deferral in 32.5% (A) versus 48.0% (B) patients. The most frequent reasons for deferring treatment were: withdrawal to follow‐up (33.7%), active staging of disease (7.2%), alcohol abuse (6.0%) and advanced age (6.0%) in group A versus low TCD4 cell count (17.1%), loss to follow‐up (7.5%), poor adherence (7.5%) and alcohol abuse (3.2%) in group B.

Conclusions

One of the highlighted cause for treatment deferral in both mono and co‐infected patients was withdrawal to follow‐up. In co‐infected patients, low TCD4 cell count and poor adherence, also gain prominence, suggesting that strategies to improve retention in care may be needed. Additionally, emergence of direct‐acting antiviral agents is expected to reduce these determinants in starting treatment, namely reduce the impact of low TCD4 count in co‐infected patients.
Incidence of cervical dysplasia and cervical cancer in women living with HIV in Denmark: comparison with the general population
Authors: Thorsteinsson Kristina , Ladelund Steen , Jensen‐Fangel Søren , Lea Katzenstein Terese , Somuncu Johansen Isik , Pedersen Gitte , Junge Jette , Helleberg Marie , Storgaard Merete , Obel Niels , Lebech Anne‐Mette
Published: November 2014

Introduction

Women living with HIV (WLWH) are reportedly at increased risk of invasive cervical cancer (ICC). WLWH in Denmark attend the National ICC screening program less often than women in the general population. We aimed to estimate the incidence of cervical dysplasia and ICC in WLWH in Denmark.

Methods

We studied a nationwide cohort of WLWH and a cohort of age‐matched females from the general population in the period 1999–2010. Pathology samples were obtained from The Danish Pathology Data Bank containing nationwide records of all pathology specimens. The cumulative incidence and hazard ratios (HRs) for time from inclusion to first cervical intraepithelial neoplasia (CIN)/ICC and time from first normal cervical cytology to first CIN/ICC were estimated. Sensitivity analyses were performed to include prior screening outcome, screening intensity and treatment of CIN/ICC in the interpretation of results.

Results

We followed 1,143 WLWH and 17,145 controls with no prior history of ICC for 9,509 and 157,362 person‐years. Compared to controls, the overall incidence of CIN1 or worse (CIN1+), CIN2+ and CIN3+ was higher in WLWH and predicted by young age and CD4 count <200 cells/µL. In women with normal baseline cytology, incidences of CIN1+ and CIN2+ were higher in WLWH. However, incidences were comparable between WLWH and controls adherent to the National ICC screening program.

Conclusions

Overall, WLWH develop more cervical disease than controls. However, incidences of CIN are comparable amongst WLWH and controls adherent to the National ICC screening program and with a normal baseline cytology.
Cancer prevalence in a metropolitan HIV clinic
Authors: Barnes Eleanor , Saxon Cara , Ahmad Sameena
Published: November 2014

Introduction

Morbidity and mortality rates from AIDs defining cancers have fallen significantly since the introduction of highly active antiretroviral therapy (HAART). Patients are now living longer with HIV and are at a greater risk of other HIV‐ and non‐HIV related malignancies. We report what we believe to be the first UK cancer prevalence study in the modern HAART era.

Methods

A retrospective review of electronic clinic letters was performed for all patients currently receiving, and those who had died whilst receiving, their HIV care at our centre. Demographics of patients with pre‐cancerous changes, an active or previous cancer were recorded.

Results

There were 438 active patients (369 male, 69 female) and 18 deceased patients (12 male, 6 female) in April 2014. Thirty‐six out of four hundred fifty‐six (8%) cancer diagnoses were found overall. Thirty‐one out of four hundred thirty‐eight (7%) diagnoses in active patients and 5/18 (28%) in deceased patients. More than half of those diagnosed with cancer were aged 50 or over (17/31 [55%]). In active patients 17/31 (55%) were AIDs defining cancers, with the most common type of cancer diagnosis overall being Kaposi's sarcoma (12/31 [39%]). There were 5/31 (16%) cases of non‐Hodgkin's lymphoma. The most common non‐AIDs defining cancer was basal cell carcinoma of which there were 5/31 (16%) cases, followed by squamous cell carcinoma (3/31 [10%]) and testicular cancer (3/31 [10%]). Other cancers included colorectal (2/31 [6%]) and prostate cancer (1/31 [3%]). In all five deceased patients, cancer was the cause of death. There were four acute presentations with an aggressive glioma, Burkitt's lymphoma, an undiagnosed primary lung malignancy and a late diagnosed cervical cancer. The fifth patient died following the recurrence of a transitional cell cancer of the bladder after an initial diagnosis of seven years earlier. Eighteen out of sixty‐nine (26%) of females were found to have at least mild dyskariosis on cervical screening. Anal intraepithelial neoplasia was diagnosed in 4/438 (1%) of patients.

Conclusions

Non‐AIDS defining malignancies account for almost half of the cancers in our cohort. This number may rise further as patients live longer with HIV. Good communication between oncologists and HIV physicians is paramount to manage the complex interactions of HIV and cancer, increase HIV testing in cancer services and address cancer risk factors in existing HIV patients.
Prevalence and predictors of malignancies in a polycentric cohort of HIV patients from Italy
Authors: Mazzotta Elena , Tontodonati Monica , Gabrielli Chiara , Mazzocato Susanna , Mazzetti Marcello , Falasca Katia , Cenderello Giovanni , Vecchiet Jacopo , Barchiesi Francesco , Francisci Daniela , Parruti Giustino
Published: November 2014

Introduction

HIV infected patients have a higher risk of developing cancer than the general population. Kaposi's sarcoma, non‐Hodgkin's lymphoma, primary CNS lymphoma and invasive cervical cancers are considered as AIDS defining [1]. An increased incidence in recent years has been reported also for other malignancies after the introduction of cART [2,3].

Materials and Methods

We performed a retrospective multicentric evaluation of all HIV infected patients with both AIDS and non‐AIDS defining neoplasms at six Infectious Disease Units spread throughout Italy since 1991 through 2013. Cases were compared with equal number of controls without neoplasia followed at the same institutions, matched for length of HIV infection.

Results

Since 1991, 339 consecutive cases of malignancy were collected from the six convening centres, including approximately an equal proportion of AIDS (51.2%) and non‐AIDS defining tumours. Mean prevalence of tumours among centres was 8.3% (r. 6.1%–9.6%). Mean age at tumour diagnosis was significantly lower than in controls (42.6±11.0 vs 46.8±10.6 years, respectively, p<0.0001). As to risk factors for HIV infection, approximately 1/4 (26.1%) of patients were drug abusers, in equal proportion as in controls. A remarkable higher proportion of cancer patients had CD4 T‐cell counts <200 c/mmc at time of diagnosis (45.2% vs 13.3%, p<0.0001). Seventy percent of tumours occurred in males; 52.8% of tumour patients were diagnosed with AIDS before and 19.0% at the time of tumour diagnosis. Ninety (28.1%) tumour patients were dead at the time of data collection, a much higher proportion than among cases (12.9%, p<0.0001). Deaths among non‐AIDS (20.8%) and AIDS defining tumour patients (35.0%) were significantly different (p=0.005). Predictors of AIDS defining tumours at the time of data collection were: male sex (57.9% vs 40.6%, p=0.004), CD4 T‐cell counts <200 c/mmc (63.6% vs 44.1%, p<0.0001), whereas being cART treated at the time of tumour diagnosis was protective (38.0% vs 68.0%, p<0.0001). In the final multivariate model of logistic regression, male sex (OR=2.0, p=0.03) and not being cART treated (OR=2.5, p=0.001) held as independent predictors.

Conclusions

Our retrospection revealed a considerably high proportion of non‐AIDS defining tumours, apparently at rise in recent years. We registered high prevalence of tumours in each centre. Absence of cART seemed related with AIDS defining tumours: once more prevention of late presentation appeared the way to avoid worse prognosis in this setting.
CNS safety at 48‐week of switching to ATV/r plus 3TC or two nucleos(t)ides in HIV‐suppressed patients on stable ART: the SALT neurocognitive sub‐study
Authors: Pérez Valero Ignacio , Pasquau Juan , Rubio Rafael , Ribero Antonio , Santos Jose , Sanz Jesus , Mariño Ana , Crespo Manel , Hernandez Jose , Antonio Iribarren Jose , Gutierrez Felix , Terron Alberto , Esteban Herminia , Antonio Pérez‐Molina Jose
Published: November 2014

Introduction

Due to their low CNS penetrance, there are concerns about the capacity of non‐conventional PI‐based ART (monotherapy and dual therapies) to preserve neurocognitive performance (NP).

Methods

We evaluated the NP change of aviremic participants of the SALT clinical trial [1] switching therapy to dual therapy (DT: ATV/r+3TC) or triple therapy (TT: ATV/r+2NRTI) who agreed to perform an NP assessment (NPZ‐5) at baseline and W48. Neurocognitive impairment and NP were assessed using AAN‐2007 criteria [2] and global deficit scores (GDS) [3]. Neurocognitive change (GDS change: W48 – baseline) and the effect of DT on NP evolution crude and adjusted by significant confounders were determined using ANCOVA.

Results

A total of 158 patients were included (Table 1). They had shorter times because HIV diagnosis, ART initiation and HIV‐suppression and their virologic outcome at W48 by snapshot was higher (79.1% vs 72.7%; p=0.04) compared to the 128 patients not included in the sub‐study. By AAN‐2007 criteria, 51 patients in each ART group (68% vs 63%) were neurocognitively impaired at baseline (p=0.61). Forty‐seven patients were not reassessed at W48: 30 lost of follow‐up (16 DT‐14 TT) and 17 had non‐evaluable data (6 DT‐11 TT). Patients retested were more likely to be men (78.9% vs 61.4%) and had neurological cofounders (9.6% vs 0%) than patients non‐retested. At W48, 3 out of 16 (5.7%) patients on DT and 6 out of 21 (10.5%) on TT who were non‐impaired at baseline became impaired (p=0.49) while 10 out of 37 (18.9%) on DT and 7 out of 36 (12.3%) on TT who were neurocognitively impaired at baseline became non‐impaired (p=0.44). Mean GDS changes (95% CI) were: Overall −0.2 (−0.3 to −0.04): DT −0.26 (−0.4 to −0.07) and TT −0.08 (−0.2 to 0.07). NP was similar between DT and TT (0.15). This absence of differences was also observed in all cognitive tests. Effect of DT: −0.16 [−0.38 to 0.06]) (r2=0.16) on NP evolution was similar to TT (reference), even after adjusting (DT: −0.11 [−0.33 to 0.1], TT: reference) by significant confounders (geographical origin, previous ATV use and CD4 cell count) (r2=0.25).

Conclusions

NP stability was observed after 48 weeks of follow up in the majority of patients whether DT or TT was used to maintain HIV‐suppression. Incidence rates of NP impairment or NP impairment recovery were also similar between DT and TT.