Care Of HIV-infected Patients Research Articles

The impact of attrition on the transmission of HIV and drug resistance: A mathematical modelling study.

Attrition due to loss to follow-up or termination of antiretroviral therapy (ART) among HIV-infected patients in care may increase the risk of emergence and transmission of drug resistance (TDR), diminish benefit of treatment, and increase morbidity and mortality. Understanding the impact of attrition on the epidemic is essential to provide interventions for improving retention in care. We developed a comprehensive HIV transmission dynamics model by considering CD4+ cell count dependent diagnosis, treatment, and attrition involving TDR and acquired drug resistance. The model was calibrated by 11 groups HIV/AIDS surveillance data during 2008-2018 from Guangxi, China, and validated by the prevalence of TDR among diagnosed treat-naive individuals. We aimed to investigate how attrition would affect the transmission of HIV and drug-resistance when expanding ART. In the base case with CD4+ cell count dependent per capita attrition rates 0.025∼0.15 and treatment rates 0.23∼0.42, we projected cumulative total new infections, new drug-resistant infections, and HIV-related deaths over 2022-2030 would be 145 391, 7637, and 51 965, respectively. Increasing treatment rates by 0.1∼0.2 can decrease the above total new infections (deaths) by 1.63∼2.93% (3.52∼6.16%). However, even 0.0114∼0.0220 (0.0352∼0.0695) increase in attrition rates would offset this benefit of decreasing infections (deaths). Increasing treatment rates (attrition rates) by 0.05∼0.1 would increase the above drug-resistant infections by 0.16∼0.30% (22.18∼41.15%). A minor increase in attrition can offset the benefit of treatment expansion and increase the transmission of HIV drug resistance. Reducing attrition rates for patients already in treatment may be as important as expanding treatment for untreated patients.

Hepatitis C diagnosis and treatment in people who use drugs: mind the gap in the linkage to care.

The objective of this study is to identify a simplified rapid screening and linkage-to-care model for HCV among PWUD. The study stems from a collaborative project bringing together two local Italian Centers for Drug Addiction and the Hepatology-Infectious Diseases Department of Lazzaro Spallanzani. A research physician analyzed the available medical records seeking to identify HCV and HIV infected patients in care in the addiction centers. Between March 2018 and January 2020 subjects were selected from among a cohort of 720 PWUD in the two Centers' care. The study comprises three steps: first, screening for HCVAb; second, the linkage to care; third, clinical assessment to treatment. The research physician recruited patients for the first two steps directly in their local addiction center. The third step was conducted in the Spallanzani. The characteristics of those subjects who adhered to the three-step study program were then compared to those of the non-adhering PWUD. 194 were known HCVAb positive patients. Of the 505 PWUD in the care of the two Centers eligible for screening, 364 were enrolled in the study. 144 resulted HCVAb positive. 269 were tested for HCVRNA. 101 underwent a full assessment. 96 patients started antiviral therapy with DAA. Patients who refused first step screening were older patients and mainly heroin users; in the second step, almost all the HIV/HCV co-infected patients agreed to a viremia test; in the third step all the HIV/HCV co-infected patients refused HCV treatment. The study suggests an on-site specialist approach conducted directly in the addiction centers themselves starting from screening; it can bring the goal of HCV PWUD microelimination closer.

Perceptions of dentists about care of HIV infected patients

Introduction: A cross-sectional observational study was performed involving 314 dentists in the city of Teresina, Piaui. Aims: The main objective of the present study was to evaluate the perception of dentists of Teresina, Piaui, in relation to the attitudes of HIV-infected patients. Material and methods: A cross-sectional survey was conducted among dentists of Teresina, Piaui. Positive perception was considered when the answer was “being able” and “not being afraid” to treat HIV-infected patients. Data were collected through a self-administered questionnaire that was statistically analysed using SPSS software version 20. Results: Most presented positive perception with regard to treating HIV-positive patients. Conclusion: Positive perception can be attributed to the continued education of these professionals.

The association between the use of efavirenz and the occurrence of depressive disorders among HIV-treated patients: An application of Bayesian cox regression

OBJECTIVES: Efavirenz therapy plays an important role in controlling the progression of HIV/AIDS. However, efavirenz often causes short-term side effects for the central nervous system, and it remained controversial as to whether efavirenz leads to depression or even suicidal attempt when applied for a longer period of time. The purpose of this study is to determine the association between the use of efavirenz and depressive disorders. METHODS: This study explored the use of efavirenz on HIV-infected patients using National Health Insurance Research Database (NHIRD) in Taiwan by Bayesian survival analysis and investigated whether the use of efavirenz has the risk of depressive disorders. To reduce the dependence of statistical modeling assumptions, this study applied propensity score matching to research data. RESULTS: Based on the result of this study, it can be found that the use of efavirenz (HR = 1.009, 95% CI=–0.505 0.554), gender (HR = 0.324, 95% CI = –2.544 0.381) were not significantly associated with the occurrence of depressive disorders, whereas age of HIV diagnosis (HR = 1.021, 95% CI = 0.011 0.055) was significantly associated with the occurrence of depressive disorders. This study concludes that the use of efavirenz does not in-crease the risk of depressive disorders among HIV-treated patients. CONCLUSIONS: For the care of HIV-infected patients (especially the older ones), the psychological harm from society, such as lack of social support, social stigma or unemployment is higher than the harm of medicine.

Barriers to hepatitis C direct-acting antiviral therapy among HIV/hepatitis C virus-coinfected persons.

Direct-acting antivirals (DAAs) have increased hepatitis C virus (HCV) treatment opportunities for vulnerable HIV/HCV coinfected persons. The aim of this study was to identify the frequency of and potential barriers to DAA prescription in HIV/HCV patients during the first few years of DAA availability in the United States. The AIDS Healthcare Foundation electronic medical record system was queried to identify all HCV viremic HIV-infected patients in care at AIDS Healthcare Foundation Healthcare centers in January 2015-August 2017 and compare characteristics by receipt of a DAA prescription. Multivariate logistic regression analyses were conducted to examine factors associated with DAA prescription. Of 826 eligible patients, 355 (43%) were prescribed a DAA; among those not prescribed a DAA, 301 (64%) had well-controlled HIV (HIV RNA≤200 copies per mL). In multivariate logistic regression analysis, patients with a history of substance use (odds ratio [OR], 0.51 [95% confidence interval 0.35-0.73]) or on select HIV antiretroviral regimens were less likely to be prescribed a DAA. Those who had well-controlled HIV (OR, 5.03 [3.06-8.27]), CD4+T cell count >200 cells per mm3 (OR, 1.85 [1.04-3.30]), estimated glomerular filtration rate >60mL/min/1.73m2 (OR, 3.32 [1.08-10.15]), or established care prior to January 2015 (OR, 1.57 [1.08-2.29] were more likely to be prescribed a DAA. In addition to lack of HIV suppression, select antiretroviral regimens, substance use, and kidney disease appeared to limit DAA prescription in the early interferon-free DAA era. Many were not prescribed DAAs despite HIV suppression. Further research is needed to determine if the observed associations persist today.

Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000–2017, USA

BackgroundSuicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. MethodsUsing clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses. ResultsAmong 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4 years [IQR: 38.7–50.3], median (IQR) CD4+ cell count was 439 cells/mm3 (IQR: 237–686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50 years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36–2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29–2.38), have CD4+ cell count <350 cells/mm3 (aRR 1.32; 95%CI 1.05–1.65), have a viral load ≥50 copies/mL (aRR 1.49; 95%CI 1.12–1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10–1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67–4.52), and drug overdose (aRR 4.09; 95%CI 2.16–7.71). ConclusionRoutine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions.

Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat'AIDS cohort.

Rapid antiretroviral therapy (ART) initiation has been proven beneficial for patients and the community. We aimed to analyze recent changes in timing of ART initiation in France and consequences of early start. We selected from a prospective nationwide cohort, on 12/31/2017, patients with HIV-1 infection diagnosed between 01/01/2010 and 12/31/2015. We described time from (1) diagnosis to first specialized medical encounter, (2) from this encounter to ART initiation, (3) from diagnosis to first undetectable HIV viral load (VL). We analyzed the determinants of measured temporal trends. A multivariate logistic regression was performed to assess characteristics related with 1-year retention in care. In the 7 245 included patients, median time (1) from HIV diagnosis to first medical encounter was 13 (IQR: 6-32) days, (2) to ART initiation was 27 (IQR: 9-91) days, decreasing from 42 (IQR: 13-272) days in 2010 to 18 (IQR: 7-42) in 2015 (p<0.0001), (3) to first undetectable VL was 257 (IQR: 151-496) days, decreasing from 378 (IQR: 201-810) days in 2010 to 169 (IQR: 97-281) in 2015. After one year, proportion of patients alive and still in care was significantly lower in those in the lower quartile of time from first encounter to ART (<9 days) than those in the higher quartile (>90 days), 79.9% and 85.2%, respectively (p<0.0001). In a country with unrestricted rapid access to ART, keeping recently diagnosed HIV infected patients in care remains challenging. Starting ART rapidly did not seem to be profitable for all and every patient.

Parenteral drug use as the main barrier to hepatitis C treatment uptake in HIV-infected patients.

Our objective was to identify patient factors associated with being untreated for hepatitis C virus (HCV) infection in HIV-coinfected patients. A prospective longitudinal study was carried out. HIV-infected patients with active chronic HCV infection included in the HERACLES cohort (NCT02511496) constituted the study population. The main study outcome was receipt of HCV direct-acting antiviral (DAA) treatment from 1 May 2015 to 1 May 2017. The population was divided into patients who were receiving HCV treatment during follow-up and those who were not. Of the 15556 HIV-infected patients in care, 3075 (19.7%) presented with chronic HCV infection and constituted the study population. At the end of the follow-up, 1957 patients initiated HCV therapy (63.6%). Age < 50years, absence of or minimal liver fibrosis, being treatment-naïve, HCV genotype 3 infection, being in the category of people who inject drugs using opioid substitutive therapy (OST-PWID), and being in the category of recent PWID were identified as significant independent risk factors associated with low odds of DAA implementation. When a multivariate analysis was performed including only the PWID population, both OST-PWID [odds ratio (OR) 0.552; 95% confidence interval (CI) 0.409-0.746) and recent PWID (OR 0.019; 95% CI 0.004-0.087) were identified as independent factors associated with low odds of treatment implementation. We identified factors, which did not include prioritization of a DAA uptake strategy, that limited access to HCV therapy. The low treatment uptake in several populations seriously jeopardizes the elimination of HCV infection in the coming years.

Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda.

IntroductionPositive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda.MethodsA cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted.ResultsThe total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01).ConclusionParticipants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs.

550. Adherence and Persistency With Modern Single vs. Multi-Tablet Antiretroviral (ARV) Regimens in First Treatment of HIV in Clinical Practice

550. Adherence and Persistency With Modern Single vs. Multi-Tablet Antiretroviral (ARV) Regimens in First Treatment of HIV in Clinical Practice

Oral health care in HIV-infected patients

Oral health care in HIV-infected patients

The Rational Anti-Retroviral Therapy of HIV-Infected Patients: Opinion of Medical Specialists

The article presents the results of questionnaire sociological survey of medical specialists professionally working in the area of medical and medicinal care of HIV-infected patients. The survey data demonstrated that in spite of active implementation of regulating documents in practice of medical and medicinal support of HIV-infected patients the specialists encounter difficulties in case of choosing medications and evaluation of medicinal therapy schemes, including from position of efficiency and safety of anti-retroviral medications. This is also confirmed by analysis of actual practice of prescriptions. The results of study predetermine necessity of development of informational organizational technologies for optimization of choice, prescription and application of medications on the basis of principles of rational application of medications and according to direction of public policy.

Risk Factors and Incidence of Syphilis in Human Immunodeficiency Virus (HIV)-Infected Persons: The HIV Outpatient Study, 1999-2015.

Since 2000, the incidence of syphilis has been increasing, especially among gay, bisexual, and other men who have sex with men (MSM) in the United States. We assessed temporal trends and associated risk factors for newly diagnosed syphilis infections among human immunodeficiency virus (HIV)-infected patients during a 16-year period. We analyzed data from the HIV Outpatient Study (HOPS) cohort participants at 10 US HIV clinics during 1999-2015. New syphilis cases were defined based on laboratory parameters and clinical diagnoses. We performed Cox proportional hazards regression analyses of sociodemographic, clinical, and behavioral risk factors for new syphilis infections. We studied 6888 HIV-infected participants; 641 had 1 or more new syphilis diagnoses during a median follow-up of 5.2 years. Most participants were male (78%), aged 31-50 years, and 57% were MSM. The overall incidence was 1.8 (95% confidence interval [CI], 1.6-1.9) per 100 person-years (PY) and it increased from 0.4 (95% CI, .2-.8) to 2.2 (95% CI, 1.4-3.5) per 100 PY during 1999-2015. In multivariable analyses adjusting for calendar year, risk factors for syphilis included age 18-30 years (hazard ratio [HR], 1.3 [95% CI, 1.1-1.6]) vs 31-40 years, being MSM (HR, 3.1 [95% CI, 2.4-4.1]) vs heterosexual male, and being non-Hispanic black (HR, 1.6 [95% CI, 1.4-1.9]) vs non-Hispanic white. The increases in the syphilis incidence rate through 2015 reflect ongoing sexual risk and highlight the need for enhanced prevention interventions among HIV-infected patients in care.

I-101 The changing natural history of HIV infection: From opportunistic infections to inflammation and chronic diseases

Clinicians are well aware of the changing natural history of HIV infection in regions where antiretroviral therapy is accessible. Clinical investigations of HIV in the first 20 years of the epidemic focused on the diagnosis, treatment and prevention of opportunistic infections. While there has always been a need to improve management strategies, effective approaches were developed for most opportunistic infections, although the quality and duration of survival were short until antiretroviral therapy became effective and durable. As patients have live longer, morbidity due to comorbidities related to viral diseases (HCV, HBV, HPV, CMV), metabolic disorders, chronic inflammation, and neoplastic processes have become more prevalent. Health care systems have had to augment and expand their screening programs for such morbidities, and develop more comprehensive health care for HIV infected patients who survive with these co morbidities. Washington, D.C. is an example of a city which is realigning its resources to focus on these emerging comorbidities and to integrate care. Data on these comorbidities provide insight into research challenges that must be met.

Predictors of retention in care in HIV-infected patients in a large hospital cohort in Italy.

Retention in care is a key feature of the cascade of continuum of care, playing an important role in achieving therapeutic success and being crucial for reduction of HIV transmission. The aim of this study was to evaluate the rate of retention in care in a large referral centre in the North of Italy and to identify predictors associated with failed retention. All new HIV-infected subjects were consecutive enrolled from 1 January 2008 to 31 December 2014. Demographics, immune-virological status, hepatitis co-infection and timing of initiation of combined antiretroviral therapy (cART) data were collected at baseline and at the time of last observation. Failed retention in care was defined as lack of laboratory data, clinical visits and drug dispensation for more than 6 months from the last visit. Cox regression analysis was used. Multivariate analysis of variables with P<0.05 in univariate analysis was performed. We enrolled 269 patients (mean age 46.1 years). Males were 197 (73%), Italian 219 (81%) with mean length of disease of 5.1 years. cART was prescribed for 257 patients (95%). The rate of retention in care was 78.4% and the rate of virological suppression was 75%. Predictors of being loss to follow-up were foreign origin (P = 0.048), CD4+ count <200/mmc (P = 0.001) and not being treated for HIV infection (P = 0.0004). Predictors of cART efficacy were shorter duration of HIV infection and baseline HIV-RNA <100 000 copies/ml. These findings underline the necessity to improve retention in care by identifying groups at increased risk of being loss to follow-up. Retention in care of vulnerable population is crucial to reach 90-90-90 UNAIDS endpoint.

Characteristics of diagnosis and treatment of obstetrical and gynecological diseases requiring emergency medical care in HIV-infected patients

Characteristics of diagnosis and treatment of obstetrical and gynecological diseases requiring emergency medical care in HIV-infected patients

Mortality and Retention in Care of HIV-Infected Patients According to Year of Admission and Availability of Antiretroviral Drugs in the Chilean National AIDS Program: Fundacion Arriaran 1990–2015

BackgroundThe HIV epidemic reached Chile in the mid 1980s, as response a national AIDS commission was created, AIDS care centers were organized (Fundacion Arriaran [FA] was the first) and free antiretroviral therapy (ART) was later provided with progressive coverage, complexity and availability over the years Objective. Quantify evolution of mortality, retention and abandonment (LTFU) over 25 years according to qualitatively different periods in the national program of access to ART, from no availability to full coverage with current drugs at FA centerMethodsRetrospective analysis of FA updated database of the 5080 adult patients admitted from 1990 to 2014, who were distributed in 4 groups: A: no ART availability (1990–92); B: mono/dual ART (1993–98); C: early modern ART (HAART) (1999–2007) and D: contemporary HAART (2008–14). Mortality, Retention and LTFU were evaluated at 1, 3, 5 and 10 year intervals from admission and at end of 2015. Mortality was included in period of occurrence; LTFU was permanent absence at center of > 6 months during studied period. Local IRB approved the studyResultsMain results shown in Table. Mortality varied from 40% to 2%, and 62% to 7% at 1 and 5 years, for groups A and D respectively; 72% to 16% at 10 years for groups A and C, respectively. Retention at 5 years were 28%, 32%, 72% and 77% for groups A, B, C and D respectively. LTFU was 10%, 17%, 12% and 10% at 5 years for same groups, respectively. At 12/2015 6%, 19%, 61% and 84% from groups A, B, C and D, respectively, remained retained in careMortality (M) Retention (R) and Abandonment (Ab) in %Year 1Year 3Year 5Year 10Dec 2015MRAbMRAbMRAbMRAbMRAb A n 330No ARV available (1990–92)405554845762281071141475615 B n 882Pre HAART therapy (1993–98)29619453914503217542619571920 C n 1690Early HAART (1999–2007)78479781013721216*63*14*176114 D n 2178Contemporary HAART (2008–14)291458387*77*10*4846Mortality, retention and abandonment according to periods of admission and at end of 2015, in %.*Calculated with proportion of patients completing that period.Transfers: 0–8% for each period. Data not in table.ConclusionThis study showed the marked reduction in mortality and increase in retention of HIV patients concomitant to expanded access to therapy although LTFU remains a problem.Disclosures All authors: No reported disclosures.

ACTUAL ISSUES OF PERSONNEL TRAINING ON TUBERCULOSIS ASSOCIATED WITH HIV INFECTION

During the period of registration of tuberculosis associated with HIV infection in Russia (since 1999), its morbidity rate has increased 82.2 times. Changes in pathogenesis of tuberculosis in condition of deep immunodeficiency in patients with HIV infection require improvement of approaches to the training of medical workers who provide anti-tuberculosis care. Aim - improving approaches to personnel training on TB care for people with HIV infection. Methods. Accounting forms 263y-TB "Personal records of patients with TB comorbid with HIV infection" (65,000 records) and reporting forms of Rosstat No. 61 "Data on the population of patients with HIV infection" were analyzed for the period of their validity in the Russian Federation. The study included statistical analysis of the general totality using a computer database, revision of individual records and interview with patients. conclusions. In order to improve the training of personnel on the issues of TB care in HIV infected patients, it is essential to bring the textbooks and regulatory documents in line with the current medical knowledge.

Incidence of Hepatitis C Virus Infection in the Human Immunodeficiency Virus Outpatient Study Cohort, 2000-2013.

There are few recent studies of incident hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected patients in the United States. We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics who had ≥1 clinical encounter during 2000-2013 and ≥2 HCV-related tests, the first of which was a negative HCV antibody test (Ab). Hepatitis C virus incident cases were identified by first positive HCV Ab, viral load, or genotype. We assessed rates of incident HCV overall, by calendar intervals, and by demographic and HIV risk strata, and we explored risk factors for incident HCV using Cox proportional hazards models. The 1941 eligible patients (median age 40 years, 23% female, 61% men who had sex with men [MSM], and 3% persons who injected drugs [PWID]) experienced 102 (5.3%) incident HCV infections for an overall incidence of 1.07 (95% confidence interval [CI], 0.87-1.30) per 100 person-years (py). Hepatitis C virus incidence decreased from 1.83 in 2000-2003 to 0.88 in 2011-2013 (P = .024), with decreases observed (P < .05) among PWID and heterosexuals, but not among MSM. Overall, MSM comprised 59% of incident cases, and PWID were at most risk for incident HCV infection (adjusted hazard ratio [aHR] for PWID = 4.62 and 95% CI = 2.11-10.13; for MSM, aHR = 1.48 and 95% CI = 0.86-2.55 compared with heterosexuals). Among HIV-infected patients in care during 2000-2013, incidence of HCV infection exceeded 1 case per 100 py. Our findings support recommendations for annual HCV screenings for HIV-infected persons, including persons with only MSM risk, to enable HCV diagnosis and treatment for coinfected individuals.

REVIEW OF THE 9th INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE ON HIV INFECTION (PARIS, FRANCE, 23-26 JULY 2017)

From July 23 to July 26, 2017, the 9th Scientific and Practical Conference on HIV was held in Paris (France) on the initiative of the International AIDS Society (IAS) and the French National Agency for AIDS Research (ANRS). The latest scientific developments in the field of HIV research were presented, with an emphasis on translating scientific achievements into practice and the development of science in the context of politics. Particular attention was paid to innovative approaches aimed at reducing immune activation, which are a priority in the strategy for the treatment of HIV infection and in improving care for HIV infected patients. One of the key topics of the conference was the use of new long-acting antiretroviral drugs, as well as preparations with nanoparticles. The researchers reported that the monthly use of the vaginal ring and daily per oral in-taking (Truvada) was safe and acceptable for adolescents. The main focus was on preventing HIV infection. An online study conducted in Europe showed a low level of knowledge about PrEP among risk groups, while high interest in PrEP is emphasized, but low coverage. Significant interest was caused by the results of patients who, after reaching undetectable viremia, stopped taking ARV drugs for approximately 210 days in the first case and 8 years in the second. Experts note the high prevalence of HIV infection among transgender women and anxiety about the problems associated with the spread of drugs in this environment, which may negatively affect their adherence to treatment. The scientific conference has acquired an unexpected political overtones: scientists fear a reduction in the funding of international programs to fight HIV and AIDS by the US. In 2016, thanks to public funding and private investment, it was possible to take in more than $ 19 billion to fight HIV and AIDS. It lacks about 7 billion to achieve the goals set by the UN by 2020.