bluuebunny/crossref_metadata_2025_split 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

IntroductionTraditional 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%).ObjectiveTo determine prevalence of HIV infection in patients aged 20–55 years in primary care (PC).Material and MethodsA 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.ResultsHIV 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.Conclusions1) 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

IntroductionThe 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 MethodsAn 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.ResultsA 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).ConclusionsThe 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

IntroductionHepatitis 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.MethodsRetrospective 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.ResultsOur 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.ConclusionsIn 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

IntroductionIn 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 MethodsProspective 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.ResultsConsecutively, 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.ConclusionsThis 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

IntroductionData 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 MethodsAn 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).ResultsCompared 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.ConclusionsCompared 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

IntroductionMen 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.ObjectivesThe intervention was conducted to promote affordable and sustainable HIV care and treatment for MSM in Nigeria.MethodsThis 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.ResultsThe 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.ConclusionsUse 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

IntroductionThe 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 Methods223 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.ResultsTable 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.ConclusionsOnly 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

IntroductionDuring 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.MethodsWe 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.ResultsA 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.ConclusionsIn 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

IntroductionGlobal 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).MethodsHIV‐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.ResultsEnrollment: 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.ConclusionsIn 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.