HIV Diagnosis Research Articles

Impact of Expanded HIV Testing and Rapid Antiretroviral Therapy Initiation in Southwest China: An Interrupted Time-Series Analysis.

This study evaluates the impact of an expanded HIV testing initiative, launched in June 2018 in Luzhou, Sichuan, China, on antiretroviral therapy (ART) initiation rates among people living with HIV (PLWH). Using an uncontrolled interrupted time-series design, we analyzed data from 11,040 PLWH between June 2016 and December 2022, extracted from 108 health facilities via the Center for Disease Control and Prevention's ART database. The primary outcome measures were ART initiation rates within 7 and 30 days of HIV diagnosis. Results showed a significant improvement in the 30-day ART initiation rate following expanded testing, increasing from 46.1% to 90.9% by the study's end. The 7-day initiation rate also improved but remained below 30%. The study found that expanded testing enhanced the role of primary health care institutions in ART initiation. However, the COVID-19 pandemic, beginning January 2020, negatively impacted ART initiation rates, with a slight effect on 30-day rates but a persistent negative impact on 7-day rates. Despite these challenges and an increased HIV burden, Luzhou's ART initiation rates surpassed the national average. This study emphasizes the effectiveness of expanded HIV testing in ensuring timely ART access, crucial for HIV epidemic control, and improved patient outcomes. It also reveals challenges in maintaining HIV services during public health crises, offering insights into health care system resilience. Future research should focus on evaluating long-term treatment outcomes and strategies to support ending the AIDS epidemic.

Preferences for Starting Daily, On-Demand, and Long-Acting Injectable HIV Preexposure Prophylaxis Among Men Who Have Sex With Men in the United States (2021-2022): Nationwide Online Cross-Sectional Study.

Long-acting (LA) injectable preexposureprophylaxis (PrEP) and on-demand PrEP may improve overall PrEP uptake among men who have sex with men (MSM), but little is understood about the PrEP option preferences of MSM in practical scenarios where they may choose between various PrEP options. This study aims to examine the preferences for starting various PrEP options among a US nationwide online convenience sample of MSM from September 2021 to February 2022. Participants reporting no prior HIV diagnosis were provided brief descriptions of each PrEP option and were asked, "If [PrEP option] were available from your local doctor and you could access it for free, would you go to your doctor in the next month to start [PrEP option]?" Those who said "yes" to multiple options were asked to rank them in order of preference. MSM currently taking daily oral (DO) PrEP were asked whether they would switch to on-demand or LA PrEP options. Log binomial models were created to examine the association between willingness to start or switch to on-demand and LA PrEP with various sociodemographic and behavioral factors. In the analytic sample (N=7760), among the participants who did not use any PrEP in the past 12 months (n=5108, 66%), 54% (n=2445) reported willingness to start at least 1 PrEP option and 41% (n=1845) of participants showed interest in starting multiple PrEP options. Overall, the highest willingness was reported for on-demand PrEP (n=2235, 44%), followed by DO PrEP (n=2174, 43%) and LA PrEP (n=1482, 29%). LA PrEP was ranked first among those interested in multiple options. Characteristics associated with ranking LA PrEP as a first option to start PrEP versus DO or on-demand PrEP were region of residence (residing in the West vs Northeast), report of sexually transmitted infection diagnosis in the past year, report of illicit drug use other than marijuana in the past year, and prior awareness of LA PrEP. Among current DO PrEP users (n=2379, 31%), 58% (n=1386) were willing to switch to on-demand or LA PrEP, and LA PrEP was ranked first among participants who were open to switching to both options. Willingness to switch to LA PrEP was higher among those who used illicit drugs other than marijuana in the past year, who heard of LA PrEP prior to the survey, and those who took 15 or less doses of oral PrEP in the last 30 days. LA PrEP was the highest-ranked option among most MSM who were willing to try multiple options or switch from DO PrEP. These findings highlight that LA PrEP might fill coverage gaps among MSM who use illicit drugs, have had a recent sexually transmitted infection diagnosis, and have less than optimal DO PrEP adherence.

The incidence of symptomatic CSF viral escape in patients on antiretroviral therapy in western India: a retrospective cohort study.

Antiretroviral treatment (ART) effectively suppresses viral loads in both plasma and cerebrospinal fluid (CSF). Patients with discordant plasma and CSF viral loads may experience chronic-progressive or fluctuating neurocognitive dysfunctions. This study examined the incidence of symptomatic CSF viral escape (CSFVE) in patients receiving ART. This retrospective cohort study was conducted between 2000 and 2023. The primary outcome measure was the incidence of symptomatic CSFVE. Nonparametric Mann-Whitney U and Fisher exact/χ 2 tests were applied for continuous and categorical variables, respectively. The cumulative incidence function with Gray's test was used to compare the incidence of CSFVE across the treatment regimens. During the study period, 52 of the 8415 patients were diagnosed with CSFVE. The median duration of HIV diagnosis in patients with CSF VE was 150 (12-288) months, with a median nadir CD4 + T-cell count 96.5 (13-601 cells/L)], and 75% of the patients were on a ritonavir-boosted protease inhibitor (PI/r) regimen. The cumulative incidence of symptomatic CSFVE at a follow-up of 14 years was 1% (95% CI, 0-1%). PI/r (HR 34.73; 95% CI 13.5 to 89.4; p < 0.001) and integrase strand transfer inhibitor (INSTI) (HR 3.42; 95% CI 1.94 to 6.02; p < 0.001) regimens were significantly more likely to be associated with CSFVE than the Non-nucleoside reverse transcriptase inhibitors (NNRTIs) regimens. NNRTIs had the lowest risk of CSFVE compared to the PI/r and INSTI regimens. A rapid and complete recovery is possible with symptomatic CSFVE if it is diagnosed and treated early.

Clinical staff attitudes towards opt-out consent for blood-borne virus screening in emergency departments in England.

Opt-out screening for blood-borne viruses (BBVs) in emergency departments (EDs) has been established in areas with a high prevalence of HIV diagnoses in England. This multi-site study explored the attitudes of healthcare workers (HCWs) towards BBV screening in EDs post-implementation. This was a cross-sectional electronic survey of HCWs. Between November 2023 and February 2024, HCWs across 33 EDs in England participating in opt-out BBV screening were invited to complete a survey about the feasibility and acceptability of screening, including the opt-out consent process. Factors independently associated with acceptability of opt-out screening were identified using multivariable logistic regression. Free-text responses were analysed thematically. Responses from 610 HCWs in 19 EDs were provided: 50.4% were nurses, 43.1% doctors, and 6.5% other healthcare professionals. Acceptability of the screening programme and opt-out consent was high (90.3% and 77.7%, respectively), with some variation between EDs. Acceptability of opt-out consent was greater among doctors than among other HCWs, and among HCWs who proactively discussed screening further with patients who opted out. However, 50.8% of HCWs felt that patients should be verbally reminded at blood draw, and 44.3% of HCWs wanted more training in discussing opt-out screening with patients. Free-text answers suggested changes to test-ordering systems, including simple integration of tick boxes to document whether patients opted out and to block repeated testing. There was substantial support from ED HCWs for routine opt-out ED BBV screening, including opt-out consent. Key areas suggested for improvement included changes to test-ordering systems and additional training for HCWs. Frequent preference for verbal reminders at the point of blood draw suggests continued HIV testing exceptionalism.

Abstract 4138220: Traditional and HIV-specific Risk Factors Are Associated with Incident Non-valvular Atrial Fibrillation and Atrial Flutter among Underrepresented Racial and Ethnic Minority Groups Living with HIV

Introduction: With effective antiretroviral therapy (ART), HIV can now be managed as a chronic disease. Chronic disease and cardiovascular risk factor management is especially important for underrepresented racial and ethnic minority groups (UREG). Non-valvular atrial fibrillation and atrial flutter (NVAF) have not been adequately studied in UREG with HIV. Research Questions: Among UREG with HIV, what is the incidence of NVAF? What factors are associated with incident NVAF? Aims: To narrow an evidence gap among UREG with HIV by 1) describing the incidence of NVAF and 2) identifying factors associated with incident NVAF. Methods: This is an ancillary study of the Pathways to Cardiovascular Disease Prevention and Impact of Specialty Referral in Underrepresented Racial and Ethnic Minorities with HIV (PATHWAYS) study, a retrospective population-based study of HIV care patterns among UREG with HIV. Patients without a known history of NVAF entered our study cohort at the date of their first documented HIV diagnosis. We computed the cumulative incidence of NVAF over five years of follow-up (mean 3.4, SD 1.6), handling death as a competing risk. Cox regression analysis was used to examine the univariate associations between characteristics at HIV diagnosis and incident NVAF, adjusting for site and date of HIV diagnosis. Results: From 2015-2019, 10,945 UREG meeting entry criteria were identified. On average, patients were 67.1% male, 94.4% Black, and 8.5% Hispanic. Average CHA2DS2VASc score was 0.92 (SD 1.1) and 63.4% were on ART. Cumulative incidence of NVAF at one and five years after HIV diagnosis were 0.48% (95% CI 0.36-0.63) and 2.16% (95% CI 1.85-2.51), respectively. HIV-related factors associated with incident NVAF included baseline CD4 count &lt;200 (HR 1.84, 95% CI 1.20-2.80) and initial ART including protease inhibitors (HR 1.56, 95% CI 1.14-2.13) and/or integrase strand transfer inhibitors (HR 1.47, 95% CI 1.08-1.99). Additional associated factors included older age, Medicare, cardiology visit(s) in prior year, and co-morbid diseases including hypertension, hyperlipidemia, coronary and peripheral artery disease, prior stroke/transient ischemic attack, heart failure, and chronic kidney disease. Conclusions: In a large cohort of UREG living with HIV, both traditional and HIV-specific risk factors are associated with increased risk of incident NVAF. Interventions to mitigate NVAF risk in this population will require interdisciplinary, team-based approaches.

Dynamics of clustering rates in the rhode Island HIV-1 epidemic.

: Characterizing HIV clustering rates and their trends over time can improve understanding a local epidemic and enhance its control. Leveraging an academic-public health partnership in Rhode-Island, we explored longitudinal dynamics of statewide clustering rates among key populations from 1991 to 2023. Partial HIV-1 pol sequences were grouped by year of HIV-1 diagnosis. Molecular clusters were identified in cumulative annual phylogenies. Overall clustering rates, and clustering rates of newly-diagnosed and prevalent infections, and of specific socio-demographic characteristics of key populations over time were determined. Mann-Kendall statistics were used to estimate clustering rate trends and relationships among groups. By the end of 2023, 2,630 individuals with sequences represented the statewide epidemic in Rhode Island. Overall clustering rates increased from 7% in 1991 to 46% in 2023, correlating with cumulative sequence increase. Clustering rates of newly-diagnosed and prevalent infections significantly increased over time, higher in newly-diagnosed individuals since the early 2000 s. Increases were also observed among groups defined by gender, age, transmission risks, race, mental illness, HIV-1 subtypes, and country of birth, with some crossovers and divergence patterns over time. Exploring dynamics of HIV clustering rates over three decades in a statewide HIV-1 epidemic expanded its characterization and provided insight into its evolving changes. These dynamics may indicate a gradual shift towards a more concentrated and localized HIV-1 epidemic, highlighting important opportunities for targeted interventions to effectively prevent new HIV transmissions.

“Early Mortality and Health Care Costs in Patients Recently Diagnosed with Kaposi Sarcoma at the National Cancer Institute, Mexico City”

Abstract Background Kaposi Sarcoma (KS) is a marker of advanced HIV disease; it is still the most frequent AIDS-associated malignancy in Mexico despite universal access to antiretroviral therapy, reflecting a gap in early HIV diagnosis. Objectives To describe people with HIV (PWH) with KS who died within 30 days of admission at INCan and quantify resources and years of life lost (YLL). Methodology We collected demographic data, HIV-related variables, all diagnostic and therapeutic procedures, hospitalizations, and estimated YLL and Disability-Adjusted Life Years (DALYs). Results Eighteen (6.7 %) PWH with KS from 270 patients admitted at INCan from 2014-2021 were included. The median age was 31 years (IQR 27-36), and the median days from admission to death were 15 (IQR 6-24), and from HIV diagnosis to death, 73 days (IQR 30-857). Upon admission, the median HIV viral load was 314,476 copies/mL (IQR 140,709-695,613), CD4+ T cells count was 93 cells/mL (IQR 35-124), and CD4/CD8 ratio was 0.08 (IQR 0.06-0.12), coinfections were diagnosed in 14 (77.7 %) patients, The average expenditure per patient was 7685.99 USD, and the total YLL was 737.4, a median of 42 years (IQR 37.7-47) per patient. The total care cost was 183,947.48 USD, equivalent to a screening program in key populations, which would have allowed the early detection of 1227 cases and saved 8,410 DALYs. Conclusions Reinforcement of early HIV infection detection in key population programs should be prioritized to reduce KS-associated deaths and YLL and for rational use of health budgets.

Viral hepatitis knowledge and vaccination awareness among men who have sex with men (MSM) in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017.

BackgroundRecent hepatitis A virus outbreaks in Europe affecting men who have sex with men (MSM) and ongoing hepatitis B virus transmission among MSM underscore the ongoing need for viral hepatitis prevention in this population.AimTo describe viral hepatitis knowledge and associated factors among MSM in the WHO European Region to inform targeted prevention.MethodsIn the European MSM Internet Survey (EMIS-2017), basic knowledge was defined as correctly identifying at least 4 of 5 statements about viral hepatitis and vaccination. We described basic knowledge by country. In a multilevel logistic regression model, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for having basic knowledge and explanatory variables: sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, sexual orientation disclosure at last sexually transmitted infections (STI) test and outness.ResultsOf 113,884 participants across 43 WHO European Region countries, 68% demonstrated basic knowledge, ranging from 50% in Israel to 80% in the Netherlands. Basic knowledge was significantly associated with older age (≥ 40 years vs < 25 years, aOR: 2.9, 95% CI: 2.7-3.0), a history of hepatitis C and/or HIV diagnosis (aOR: 1.8, 95% CI: 1.7-1.9) and sexual orientation disclosure at last STI test (aOR: 1.3, 95% CI: 1.2-1.3), among other factors.ConclusionsWe found a knowledge disparity regarding viral hepatitis and hepatitis vaccination awareness among MSM across Europe, highlighting a need to address these gaps. A non-judgemental, accepting climate that allows individuals attending medical services to safely disclose their sexual orientation is fundamental to enable healthcare professionals to target information and preventative measures more effectively.

Increasing engagement in HIV prevention among cisgender women in New York City with sexual health self-testing kits: A MaxDiff analysis.

Despite accounting for approximately 20% of new HIV diagnoses in the United States, cisgender women are consistently under-represented and under-engaged in HIV prevention services such as HIV testing and pre-exposure prophylaxis (PrEP). Black and Latina cisgender woman (BLCW) are disproportionately impacted by HIV, and face additional barriers to accessing prevention services due to racial/ethnic bias, sexism, and their intersection. Offering self-testing for sexually transmitted infections (STIs) and HIV is one potential strategy for increasing access to-and engagement in-preventative sexual health care among BLCW. We conducted a study in consultation with the New York City Department of Health and Mental Hygiene (NYC DOHMH) and their collaborators in order to identify preferences for sexual health kits-including HIV and STI tests-among BLCW in New York City. We assessed the extent to which BLCW would be willing to accept and use HIV and STI self-testing. Additionally, we identified the components of potential sexual health kits that would make them most attractive and would most increase the reach of a sexual health kit program in NYC. Finally, we examined differences in acceptability and preferences (by demographic factors, sexual behavior, and past service utilization) that may impact the development of future programs and interventions. Self-testing for STIs and HIV represents a promising strategy for engaging BLCW in preventative sexual health services and increasing access to care.

The value of a PET scan in selecting the best lymph node to biopsy, and confirming the diagnosis of idiopathic multicentric Castleman disease with HLH and EBV viremia in a previously healthy adult

Introduction: Castleman disease (CD) is a rare lymphoproliferative disorder having a variegated clinical presentation. Diagnosis of the idiopathic HIV- and HHV8-negative multicentric CD (iMCD) subtype poses a challenge given its non-specific clinical manifestations. iMCD presents as diffuse lymphadenopathy with inflammatory manifestations, primarily driven by interleukin-6 (IL-6). Treatment includes suppressing the inflammation by targeting IL-6 with monoclonal antibodies such as siltuximab and, in severe cases, immuno-chemotherapy to control B- and plasma-cell activation. Case description: A previously healthy 43-year-old male presented to the emergency department with fever, night sweats, anasarca, anaemia, thrombocytopenia and acute renal insufficiency. Extensive blood and imaging workup was initiated. Several diagnoses were entertained including viral infections (comprising COVID-19), haemophagocytic lymphohistiocytosis, lymphoma and autoimmune conditions. Initial axillary lymph node biopsy was not diagnostics. A positron emission tomography (PET) scan showed diffuse and symmetrical cervical and hilar/mediastinal lymphadenopathies. A mediastinal lymph node biopsy was then performed and indicated iMCD. The patient was treated with high-dose steroids and siltuximab. An Epstein-Barr virus (EBV) PCR was positive, and rituximab was added to the treatment. The patient recovered and felt well after two months. Conclusions: Non-specific symptoms, non-diagnostic first biopsy and iMCD resemblance to haemophagocytic lymphohistiocytosis further complicated the diagnosis. A PET scan allowed the best selection of a lymph node to be biopsied. Anti-IL6 is the recommended treatment; however, we are lacking information on the duration of siltuximab, and the long-term toxicity and immunosuppressive effect of this treatment. The contribution of EBV reactivation in the development and treatment of iMCD needs further investigation.

HIV Self-Testing: A Discussion on the Benefits, Limitations, and Implications for Public Health with a Focus on Poland

Background/Objectives: A late HIV diagnosis represents a significant public health concern in Poland, with approximately 50% of patients being identified as late presenters (LPs), resulting in the delayed initiation of treatment. This study assesses the potential of HIV self-testing (HIVST) to enhance early detection, particularly among heterosexual individuals, and evaluates its advantages and limitations within the Polish context. Methods: This study examines the advantages and disadvantages of HIVST by analyzing data from various studies. It focuses on the acceptability, sensitivity, and specificity of HIVST, comparing blood-based and oral fluid-based tests. Moreover, the economic impact and potential public health benefits of HIVST in Poland are evaluated. Results: HIVST is well-accepted, especially among key populations; it can reduce stigma and enhance privacy. The results of studies conducted in Poland indicate that heterosexuals are more inclined to use self-testing methods than traditional diagnostic procedures. On the other hand, HIVST has the potential for false-negative results due to the serological window and the possibility of missed diagnoses of other sexually transmitted infections (STIs). Moreover, the cost of HIVST remains a significant barrier, as it is not publicly funded in Poland. Conclusions: Despite its limitations, HIVST offers a number of significant benefits, including increased rates of testing and earlier detection, which could prove vital in reducing the transmission of HIV in Poland. This study proposes that increased funding, the integration of HIVST into public health strategies, and further research to enhance its implementation, alongside education and support for its effective use, should be prioritized.

Association among therapeutic adherence, health literacy, and engagement in care: How to increase health-conscious management of HIV disease.

In the context of People Living with HIV (PLWH), poor health literacy (HL) seems to be linked to poorer health outcomes and reduced engagement in care. Additionally, the level of HL can affect HIV knowledge and may impact adherence to antiretroviral therapy (ART). This research explored the connection between ART adherence, HL, and engagement in care in a cohort of 250 PLWH receiving ART in Italy. A questionnaire was given to PLWH at Policlinico Gemelli in Rome to assess their health literacy and adherence to therapy. The Brief Health Literacy Screening (BHLS) and the Newest Vital Sign (NVS) were used to evaluate subjective and objective HL. Adherence levels were self-reported as poor, good, or excellent, and the assessment included the Patient Health Engagement Scale (PHE-S). Notably, the majority of the sample comprised male individuals (67.9%), with 69.2% reporting a 10-years or longer duration between their HIV diagnosis and their initiation of ART. It was found that PLWH with poor adherence had low schooling, had been living with HIV for 1-5years, were HCV co-infected, had a viremia >50copies/mL, poor health status, poor engagement in care, and poor HL (p = <0.001). They exhibited lower mean scores on the subjective HL scale and lower CD4 T-cell counts and nadir CD4 T-cell counts (p < .001). Our study demonstrated a positive correlation between higher HL levels and improved disease management, treatment adherence, and overall physical and mental well-being. Enhanced HL capabilities are paramount in bolstering health management and treatment adherence.

Initial HIV-1 viral load in French Guiana: Factors associated with viral load set point differences.

Background. HIV viral load set points may vary between virus subtypes and host characteristics. The HIV epidemic in French Guiana entails a mix of viruses and populations of cosmopolitan origins. In this epidemiological context, we aimed to determine whether at the scale of our territory, we could identify differences in HIV-1 viral load setpoints in our hospital cohort. MethodsThe French Guiana hospital cohort was retrospectively analyzed between 1992 and 2023. Bootstrapped (100 replications) quantile (median) regression modelled the initial HIV-1 viral load with age, sex, nationality, and CD4 count at diagnosis as independent variables. ResultsAfter adjusting for period of analysis and CD4 count at diagnosis, bootstrapped quantile regression (median) showed that Haitians (minus 20 088 copies, P<0.0001) and Guyanese (minus 14087, P=0.039) had a significantly lower viral load at HIV diagnosis than French, males had a greater viral load at HIV diagnosis than females (plus 16 430 copies, P<0.0001), each additional year of age was associated with more copies (+345 per year, P=0.002). When compared to those with more than 500 CD4 per ml, persons with CD4 counts at diagnosis below 200 per ml had a greater initial viral load (plus 94 932 copies, P<0.0001), as did those with 200-350 CD4 per ml (plus 13 088 copies, P<0.0001), and those with [350-500 CD4 per ml] (plus 5 643 copies, P<0.0001). Non B viruses seemed to have an independently greater viral load at diagnosis than B viruses (plus 58402, P=0.029). Conclusions: We show some significant differences in the viral load set point of different groups. For nationalities we are inclined to attribute this to differences in the frequency of infecting subtypes. This suggests that models of incidence or date of infection based on CD4 decline may be distorted by this situation.

Assessing Barriers and Facilitators to Participation in a Nurse-Driven, Opt-Out HIV Screening Program in the Emergency Department

Emergency department (ED) HIV screening is a key component of the strategy to end the HIV epidemic, reaching populations with limited access to care for screening and early diagnosis. Many screening programs rely primarily on participation from ED nurses; however, little is known about the factors affecting nurse participation in screening. Guided by the Consolidated Framework for Implementation Research, 20 semi-structured interviews were conducted with ED nurses to explore perceptions of HIV screening, barriers and facilitators to participation, and implementation insights. Nurses were categorized as either high adopters or low adopters based on the number of HIV tests ordered 3 months prior to interviews. The Stanford Lightning Report Method, a rapid qualitative analysis approach, was used to analyze field notes. All participants generally agreed that the ED was an appropriate location for screening and that frequent, multimodal education about screening was needed. Integration of screening into standard workflows, education about the public health impact of screening, and the use of peer champions and mentors were identified as important strategies to increase participation. By incorporating these findings into implementation strategies, EDs may be able to increase nurse participation in screening, addressing important health equity issues in HIV diagnosis.

Association between differentiated HIV care delivery model and low-level viremia among people living with HIV in Rwanda

BackgroundLow-level viremia (LLV) (HIV-RNA 51–999 copies/mL) is associated with increased risk of non viral load suppression (HIV-RNA ≥ 1000 copies/mL). We assessed the association between differentiated service delivery model (DSDM) and LLV among people living with HIV (PLHIV) in Rwanda.MethodsWe conducted a retrospective cohort analysis using routinely collected data of adults living with HIV from 28-healthcare facilities in Rwanda before and after the introduction of DSDM. Under DSDM, PLHIV initiated treatment within seven days of HIV diagnosis and medication pick-up up to six months for those with sustained viral load suppression suppression. Proportions of LLV at 6,12 and 18 months were quantified. Multivariable log binomial regression models were used to assess the effect of DSDM on LLV. To handle missing data, multiple imputations was performed.ResultsOf 976 people living with HIV, 645(66.0%) were female and 463(47.4%) initiated treatment during DSDM. The median age was 37 (interquartile range: 32–43) years. LLV was 7.4%, 6.6% and 5.4%, at 6,12 and 18 months, respectively. Compared to those who initiated treatment before DSDM, starting treatment during DSDM increased six-month LLV [adjusted risk ratio (aRR) = 2.8: 95%CI (1.15–6.91)] but not at 12 [aRR = 2.3: 95%CI (0.93–5.75)] and 18 months [aRR = 0.3: 95%CI (0.09–1.20)]. Using imputed datasets, the association between DSDM and LLV persisted.ConclusionsDSDM was associated with increased risk of LLV at 6-months. possibly due to the minimal amount of time PLHIV had in pondering and accepting the HIV diagnosis. Continued support is needed among people receiving early antiretroviral therapy initiation to prevent development of LLV.

Nucleic Acid Amplification Testing using Dried Blood Spots to Confirm the Diagnosis of HIV-1 in Adults

Nucleic Acid Amplification Testing using Dried Blood Spots to Confirm the Diagnosis of HIV-1 in Adults

Effectiveness, safety, and patient-reported outcomes of emtricitabine/tenofovir alafenamide-based regimens for the treatment of HIV-1 infection: Final 24-month results from the prospective German TAFNES cohort study.

Tenofovir alafenamide (TAF) was introduced in the European Union in 2015 as a novel prodrug of tenofovir showing similar efficacy in clinical trials and a more favorable safety profile than tenofovir disoproxil fumarate (TDF). The German TAFNES cohort study (2016-2019) was conducted to generate real-world evidence. Treatment-naïve (TN) and treatment-experienced (TE) people with HIV (PWH) receiving elvitegravir/cobicistat/emtricitabine/TAF (E/C/F/TAF), rilpivirine/F/TAF (R/F/TAF) or F/TAF + 3rd agent were included. Month (M) 24 outcomes included virologic effectiveness (HIV RNA <50 copies/mL), treatment persistence, adverse drug reactions (ADRs) and patient-reported outcomes, using the HIV Symptom Index (HIV-SI), 36-Item Short Form Health Survey (SF-36) and HIV Treatment Satisfaction (HIVTSQ) questionnaires. The study included 767 PWH (92% men, median age 46 years; 301 TN, 466 TE; E/C/F/TAF [n = 318], R/F/TAF [n = 192], F/TAF + 3rd agent [n = 257]). Among TN, 35% had late HIV diagnosis (CD4 < 350/μL and/or AIDS). Of TE, 95% were on suppressive antiretroviral therapy (ART) before switching. D:A:D (Data Collection on Adverse Effects of Anti-HIV Drugs) 5-year risks for chronic kidney disease were high for about 1 in 10 TN and 4 in 10 TE. Overall treatment persistence at M24 was 81% (E/C/F/TAF: 88%; R/F/TAF: 86%; F/TAF + 3rd agent: 70%, with ART simplification of multiple-tablet regimens in 13%). M24 viral suppression (missing = excluded) was 96% (479/501). Discontinuations due to virologic failure or ADRs were rare, 2% (12/767) and 4% (30/767), respectively. HIV-SI and SF-36 summary scores improved in TN; HIVTSQ change scores showed an improvement in treatment satisfaction in TE. Real-world data confirmed a favorable safety profile and high virologic effectiveness with high treatment satisfaction on F/TAF-based ART.

Subclinical myocardial disfunction detected by left ventricle myocardial work impairment in patients with long standing human inmmunodeficiency virus infection

Abstract Heart failure is a known complication in patients living with human inmmunodeficiency virus (HVI) infection. Detection of subclinical disfunction is nowadays possible by echocardiographic strain techniques. Myocardial work is a novel technique based on global longitudinal strain (GLS) that measures global work efficiency of left ventricle (GWE) and would allow early detection of subclinical myocardial damage. Methods We performed a cross sectional echocardiographic study of patients with long standing HIV infection, and no previous cardiopathy, assessing GLS of left ventricle (LV), left atrium (LA) and free wall of right ventricle (RV-FW GLS). We identified patients with subclinical disfunction expressed by an impaired GWE , and studied its determinants by lineal regression. Results 110 patients, 78.2% male, median age 53.3 (51.2-55.4) were included. Time from diagnosis was 20.5 (18.6-22.3) years. Myocardial work strain analysis showed an impaired GWE: 91.9% (90.9-92.9);p&amp;lt;0.001) and a GW index of 1840.8 mmHg%(1758.7-1922.9):p&amp;lt;0.001. The rest of deformation parameters laid into normal range: LV GLS was -19.5% (-19.0- -20.0) GLS dispersion 55.1 (50.1-60.1), LA GLS (reservoir) 32.8% (31.2-34.5), and RV free wall GLS -22.3% (-21.4 - -23.2). By univariate analysis, determinants of impaired GWE were age, Score2 risk, time from HIV diagnosis, QRS Interval duration, long QTc Interval, LV ejection fraction (LVEF),diastolic disfunction by doppler tissue imaging, CD4 count nadir, initial and maximun viral load, and exposure to didanosine treatment. After adjustment by cardiovascular risk and diastolic function (Ea velocity by tissue Doppler) , GWE impaired depended on duration of infection (Beta 0.3;95%CI:0.04-0.56;p=0.023), initial viral load (Beta -1.1;95%CI:-2.1- -0.02;p=0.046) and exposure to stavudine (Beta -6.3;95%IC: -11.5- -1.1;p=0.019). Conclusions Subclinical myocardial disfunction is prevalent in long standing HIV infection. Global work efficiency is a very sensitive parameter for detection, even in patients with normal GLS values, and it was related to duration of infection, initial viral load, and exposure to stavudine in our patients.Determinants of Global Work Efficiency

Cardiac biomarkers can detect and track subclinical HIV-associated myocardial disease in newly diagnosed people living with HIV

Abstract Background Cardiovascular disease (CVD) in people living with HIV (PLWH) remains poorly understood, and the profile of disease differs between high-income and low- and middle-income settings[1]. Subclinical cardiovascular abnormalities may be present at the time of HIV diagnosis and serve as potential substrate for future CVD[2]. Biochemical markers are fundamental in cardiac evaluation, and various novel assays have recently been discovered. Purpose To assess the presence and evolution of subclinical myocardial disease, we prospectively assessed the hearts of newly diagnosed PLWH and matched, HIV-uninfected controls using cardiac biomarkers and correlated our findings with cardiovascular magnetic resonance imaging (CMR). Methods Newly diagnosed, antiretroviral treatment (ART) naïve PLWH were recruited along with HIV uninfected, age- and sex-matched controls in the Western Cape Province of South Africa. All participants underwent measurement of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble ST2 (sST2), Galectin-3, and a CMR study with multiparametric mapping. The HIV group started ART and was re-evaluated 9 months later. The cardiac biomarkers and their correlation with CMR parameters were evaluated in, and between groups. Results Compared with controls (n=22), hs-cTnT (4.0 ng/l vs 5.1 ng/l; p=0.004) , NT-proBNP (23.2 ng/l vs 40.8 ng/l; p=0.02), and Galectin-3 (6.8 ng/ml vs 9.0 ng/ml; p=0.002) were all significantly higher in the ART naïve group (n=73). After 9 months of ART, hs-cTnT (5.1 ng/l vs 4.3 ng/l; p=0.02) and NT-proBNP (40.8 ng/l vs 28.5 ng/l; p=0.03) both decreased significantly, and a trend of decrease was seen in sST2 (16.5 ng/ml vs 14.8 ng/l; p=0.08). Galectin-3 did not demonstrate decrease over time (9.0 ng/ml vs 8.8 ng/ml; p=0.6). The cardiac biomarkers that showed the best correlation with CMR measurements native T1, T2, and ECV, were NT-proBNP (rs≥0.4, p&amp;lt;0.001) and Galectin-3 (rs≥0.3, p&amp;lt;0.01). Conclusion Our cardiac biomarker data supports the presence of subclinical myocardial injury, remodelling, and fibrosis at HIV diagnosis and ART had a positive influence on these blood markers. It remains unclear if the underlying pathological processes were fully addressed by ART. The elevation of Galectin-3 despite ART may be indicative of ongoing cardiac remodelling that may incur future risk of CVD, and necessitates further study. The ability of cardiac biomarkers to detect and track tissue abnormalities diagnosed with CMR, showed promise. With additional research, this could lead to improvements in screening and monitoring myocardial abnormalities, even in CMR-limited settings.

Reduction of aortic stiffness in newly diagnosed persons with HIV-infection: modifiable vascular dysfunction after antiretroviral therapy?

Abstract Background People living with HIV (PLWH) are at an increased risk of cardiovascular disease (CVD), which is underestimated by contemporary risk stratification systems[1]. Subclinical cardiovascular abnormalities may be present at the time of HIV diagnosis and serve as potential substrate for future CVD. Aortic stiffness, as measured with pulse wave velocity (PWV), is a validated predictor of CVD [2,3] and has been shown to be elevated in PLWH at the time of HIV diagnosis compared to HIV-uninfected persons[4]. Purpose To prospectively assess the influence of contemporary antiretroviral therapy (ART) on aortic stiffness in a group of newly diagnosed PLWH in a low- to middle-income setting. Methods A group of ART naïve PLWH with modest cardiovascular risk and free from known CVD, was recruited at the time of HIV diagnosis from the Western Cape Province of South Africa. Aortic stiffness was measured using carotid-femoral PWV on a commercially available device that simultaneously measured the carotid and femoral waveforms on a supine patient in a temperature-controlled room utilising established methodology[4]. The algorithmically-calculated time delay between the upstroke of the carotid and femoral wave-forms provided the transit time (TT). Carotid femoral path distance (path length) was measured using surface anatomy. PWV was calculated as direct path length divided by TT. Aortic distensibility was expressed according to the Bramwell-Hill equation as 3.57/PWV(squared)[5]. ART was initiated and PWV was re-evaluated 9 months later. Results Seventy-three participants completed follow-up and were included. The cohort was relatively young (mean age 32±7 years) with good female representation (n=33, 45%). Most received tenofovir/lamivudine/dolutegravir (n=71, 97%) Half of the group smoked cigarettes. Two participants were controlled hypertensives, and two participants had metabolic syndrome. A significant decrease in PWV (with scaling factor of 0.8) was observed at 9 months of ART (5.93 ±1.0 vs. 5.69 ±1.0 m/s; p=0.01). Aortic distensibility increased significantly as well (0.20 [IQR: 0.16 to 0.26] vs. 0.21 [IQR: 0.19 to 0.27] mmHg-1; p=0.02). Conclusion Improvement in aortic stiffness was observed in a group of newly diagnosed PLWH after 9 months of ART-initiation. This provides evidence of a modifiable component of vascular dysfunction and, in turn, cardiovascular risk with the use of contemporary ART at 9 months. It is unknown if this effect will be sustained long-term. The use of aortic stiffness (alone or in combination with other parameters) as a predictor of cardiovascular outcomes in the ART era requires further study.Abstract figureAbstract table