HIV Medicine Association Research Articles

Primary Care Guidance for Providers of Care for Persons With Human Immunodeficiency Virus: 2024 Update by the HIV Medicine Association of the Infectious Diseases Society of America.

Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a lifespan approaching that of people without HIV, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the lifespan. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive health care for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while also attending to HIV-specific health concerns. Clinicians must address issues specific to preventive health, including cancer screening, providing recommended vaccinations, as well as promoting sexual health, including sexually transmitted infection diagnosis, treatment, and prevention. Clinicians also must address issues for specific populations, including persons of childbearing potential, including during preconception and pregnancy; children; adolescents; and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates the previous 2020 HIV Primary Care Guidance.

7172 Osteoporosis Associated with Antiretroviral Therapy - Case report

Abstract Disclosure: C.E. Guillen Lopez: None. L.A. Sanchez Ato: None. A. Patel: None. A. Molkina: None. T. Ayub: None. L. Robles: None. A. Arce Gastelum: None. Osteoporosis presents a substantial public health challenge, contributing significantly to morbidity and mortality through fractures. While postmenopausal osteoporosis is common, secondary osteoporosis affects a significant number of patients, including over 30% of postmenopausal and 50-80% of men. People living with HIV (PLWH) experience age-related medical comorbidities earlier and more extensively than those without HIV. The compromised bone health in PLWH is attributed to factors associated with the virus, antiretroviral therapy (ART) side effects, and health disparities such as inadequate nutrition, low body weight, hypogonadism, vitamin D deficiency, and increased recreational substance use. More recently, it has become apparent that vertebral fractures are more common in PLWH, with a prevalence of 11.1% and a 2.30-fold more significant risk than the general population. Low bone mass density (BMD) is twice as common in PLWH, increasing to 3 times as common in PLWH on ART. ART initiation leads to transient bone loss with nucleotide reverse transcriptase inhibitors such as tenofovir disoproxil fumarate (TDF) and protease inhibitors, causing higher BMD loss. In contrast, integrase and specific reverse-transcriptase inhibitors have minimal adverse effects on BMD. The newer formulation, tenofovir alafenamide (TAF), is believed to have a more favorable impact on bone health than TDF. The repercussions of diminished bone health, particularly osteoporotic fractures, have significant medical and economic implications. They are leading to early mortality, disability, and a loss of independence. The HIV Medicine Association (HIVMA) and Infectious Diseases Society of America (IDSA) recommend BMD screening for all HIV-infected patients at 50 years. 58-year-old male PLWH reveals a history of osteoporosis with multiple spinal (L1, L4-5, S1) and bilateral wrist fractures on TDF for 15 years. The patient has been treated with bisphosphonates. Alendronate was initially prescribed, but due to acid reflux side effects, zoledronic acid was a better option. Despite various ART regimens, Dolutegravir/Lamivudine was started four years ago without further fractures. Recent bone density assessments showed improvement in the lumbar spine, returning to a normal range with a T-score of 0.6. However, the left femoral neck remains at -2.5, and the right femoral neck is at -2.2, showing minimal change. To enhance BMD in PLWH on ART, transitioning to alternatives with lower bone loss associations and using bisphosphonates as tolerated are suggested. As the HIV-infected population ages, proactive screening for low BMD is vital to manage evolving health needs and prevent bone-related complications. A holistic approach includes evaluation for secondary etiologies of osteoporosis, medical treatment, and vitamin D and calcium supplementation. Presentation: 6/3/2024

Position of the Infectious Diseases Society of America and the HIV Medicine Association on Team-based Infectious Diseases Care and the Roles of Advanced Practice Providers and Clinical Pharmacists.

Strengthening and expanding interprofessional team-based care is an important component of the Infectious Diseases Society of America's Workforce Development Strategy to expand and promote equitable access to expert infectious diseases (ID) care. This statement defines the roles of care team members and highlights the need for ID curricula and training programs for advanced practice providers to support implementation of ID team-based care.

Principles for Ending Human Immunodeficiency Virus as an Epidemic in the United States: A Policy Paper of the Infectious Diseases Society of America and the HIV Medical Association.

While we have the tools to achieve this goal, the persistent barriers to healthcare services experienced by too many individuals will need to be addressed to make significant progress and improve the health and quality of life of all people with human immunodeficiency virus (HIV). The necessary structural changes require actions by federal, state, and local policymakers and range from ensuring universal access to healthcare services to optimizing care delivery to ensuring a robust and diverse infectious diseases and HIV workforce. In this article, we outlines 10 key principles for policy reforms that, if advanced, would make ending the HIV epidemic in the United States possible and could have much more far-reaching effects in improving the health of our nation.

Receipt of Baseline Laboratory Testing Recommended by the HIV Medicine Association for People Initiating HIV Care, United States, 2015-2019.

BackgroundThe HIV Medicine Association of the Infectious Disease Society of America publishes Primary Care Guidance for Persons with Human Immunodeficiency Virus. We assessed receipt of recommended baseline tests among newly diagnosed patients initiating HIV care.MethodsThe Medical Monitoring Project is a Centers for Disease Control and Prevention survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We analyzed data for 725 participants in the 2015–2019 data collection cycles who received an HIV diagnosis within the past 2 years and had ≥1 HIV provider visit. We estimated the prevalence of having recommended tests after the first HIV provider visit and between 3 months before and 3/6 months after the first HIV provider visit and estimated prevalence differences of having 4 combinations of tests by sociodemographic and clinical characteristics.ResultsWithin 6 months of care initiation, HIV monitoring tests were performed for 91.3% (95% CI, 88.7%–93.8%) of patients; coinfection blood tests, 27.5% (95% CI, 22.5%–32.4%); site-based STI tests, 59.7% (95% CI, 55.4%–63.9%); and blood chemistry and hematology tests, 50.8% (95% CI, 45.8%–55.8%). Patients who were younger, gay, or bisexual were more likely to receive site-based STI tests, and patients receiving care at Ryan White HIV/AIDS Program (RWHAP)–funded facilities were more likely than patients at non-RWHAP-funded facilities to receive all test combinations.ConclusionsReceipt of recommended baseline tests among patients initiating HIV care was suboptimal but was more likely among patients at RWHAP-funded facilities. Embedding clinical decision support in HIV provider workflow could increase recommended baseline testing.

Annals for Educators - March 2022.

Annals for Educators - March 2022.

HIV and Other Sexually Transmitted Infections: Screening Recommendations

Sexually transmitted infections (STIs) have created a significant health burden in the United States. Prevalence and incidence estimates of STIs help portray the magnitude of the burden. These estimates also underscore the need for increased STI screening. Because STIs are often asymptomatic, diagnosis and treatment may be delayed, and a person who is infected may transmit the infection to others unknowingly. Untreated STIs can lead to severe, irreversible health outcomes. Following the United States Preventive Services Task Force and the HIV Medicine Association of the Infectious Diseases Society of America’s screening and testing recommendations will help reduce the burden.

Multisociety statement on coronavirus disease 2019 (COVID-19) vaccination as a condition of employment for healthcare personnel.

This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).

Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America.

Advances in antiretroviral therapy (ART) have made it possible for persons with human immunodeficiency virus (HIV) to live a near expected life span, without progressing to AIDS or transmitting HIV to sexual partners or infants. There is, therefore, increasing emphasis on maintaining health throughout the life span. To receive optimal medical care and achieve desired outcomes, persons with HIV must be consistently engaged in care and able to access uninterrupted treatment, including ART. Comprehensive evidence-based HIV primary care guidance is, therefore, more important than ever. Creating a patient-centered, stigma-free care environment is essential for care engagement. Barriers to care must be decreased at the societal, health system, clinic, and individual levels. As the population ages and noncommunicable diseases arise, providing comprehensive healthcare for persons with HIV becomes increasingly complex, including management of multiple comorbidities and the associated challenges of polypharmacy, while not neglecting HIV-related health concerns. Clinicians must address issues specific to persons of childbearing potential, including care during preconception and pregnancy, and to children, adolescents, and transgender and gender-diverse individuals. This guidance from an expert panel of the HIV Medicine Association of the Infectious Diseases Society of America updates previous 2013 primary care guidelines.

Innovations in Human Immunodeficiency Virus (HIV) Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic: Policies to Strengthen the Ending the Epidemic Initiative-A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association.

The goal of the Ending the HIV Epidemic Initiative is to reduce new infections in the US by 90% by 2030. Success will require fundamentally changing HIV prevention and care delivery to engage more persons with HIV and at-risk of HIV in treatment. While the COVID-19 pandemic reduced in-person visits to care facilities and led to concern about interruptions in care, it also accelerated growth of alternative options, bolstered by additional funding support. These included the use of telehealth, medication delivery to the home and increased flexibility facilitating access to Ryan White HIV/AIDS Program services. While the outcomes of these programs must be studied, many have improved accessibility during the pandemic. As the pandemic wanes, long term policy changes are needed to preserve these options for those who benefit from them. These new care paradigms may provide a roadmap for progress for those with other chronic health issues as well.

Advancing Digital Health Equity: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association.

The SARS-CoV-2 virus pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of Infectious Diseases (ID) and HIV Medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the “digital divide,” emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics.

Abstract C126: Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives

Abstract Purpose: The HIV Medicine Association recommends anal Pap tests for women living with HIV (WLWH) with a history of abnormal cervical Pap tests, ano-receptive intercourse, or genital warts. This study describes current anal cancer screening practices and provider- and staff-identified challenges conducting anal cancer screening for WLWH in an integrated safety-net healthcare institution and community healthcare organization serving underinsured patients in a metropolitan city in Texas. Findings inform our understanding of factors that need to be addressed prior to implementation of system-level anal cancer screening policies and protocols for WLWH, a population at increased risk for anal cancer due to persistent HPV infection. Methods: We purposefully sampled providers, clinical staff, and administrative staff to participate in in-person semi-structured interviews assessing participant experiences with anal cancer screening, documentation, and follow up, and attitudes toward future anal cancer screening among WLWH. Audio-recorded interviews and field notes were transcribed and thematically analyzed using an iterative deductive and inductive coding scheme. Results: We completed interviews with 25 individuals: providers (n=11: 7 safety-net, 4 community), clinical staff (n=10: 8 safety-net, 2 community), and administrative staff (n=4: safety-net). Current practices. No system-level policies or protocols for anal cancer screening existed within the safety-net institution or community organization for WLWH. Instead, HIV providers performed anal Pap tests ad hoc, most frequently as diagnostic evaluations based on visual inspections or patient-reported symptoms. To follow up on abnormal test results, providers referred patients to Proctology Clinic, where wait for an appointment was about one year. Challenges. Without anal cancer screening policies or protocols, clinical teams were unclear on whether the HIV team or gynecology specialty team should lead screening efforts. Electronic health records only recorded cervical Pap test results in the “Pap” field, leaving providers to record anal Pap results in a notes section. This limited the ability to produce systematic reports or track screening. Finally, providers and staff expressed reluctance to conduct systematic anal cancer screening until greater infrastructure existed to manage referrals for abnormal anal Pap test results. Conclusions: Anal cancer screening and follow-up for WLWH require organization and coordination between multiple care teams, and protocols should clarify clinical pathways and responsibilities as patients transition between HIV, gynecology, and proctology teams. Further, clinical information systems must be updated to facilitate teams’ communication and to support anal Pap test ordering and documentation. Finally, downstream infrastructure to support follow-up must accompany upstream implementation of an anal cancer screening policy. Citation Format: Serena A Rodriguez, Robin T Higashi, Andrea B Betts, Cynthia Ortiz, Jasmin A Tiro, Amneris Luque, Arti Barnes. Challenges implementing anal cancer screening for women living with HIV: Clinical providers and staff perspectives [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C126.

760. Assessment of DEXA Scan Ordering Among Infectious Disease Providers at a Large Tertiary-Care Urban Academic Center in the Midwest

BackgroundOsteoporosis is compromised bone strength that predisposes to fracture. It can be diagnosed by Dual-energy x-ray absorptiometry (DEXA) measurement of bone mineral density (BMD). Persons with HIV (PWH) are at higher risk for the development of osteoporosis. As such, the HIV Medicine Association’s (HIVMA) primary care guidelines recommend DEXA screening for all HIV-infected postmenopausal women and men aged ≥50 years. The purpose of this study was to asses the frequency of DEXA utilization within a tertiary-care urban academic center in the Midwest and to identify prevalence of osteoporosis.MethodsA representative sample PWH age ≥50 from our institution’s outpatient infectious disease (ID) clinic were included. All subjects had at least one clinic visit in the last year, were on antiretroviral therapy (ART), and virally suppressed. Unblinded chart review was performed to assess if DEXA was ordered, was DEXA ordered by an ID physician, was DEXA completed, results of DEXA, and whether patients were on a tenofovir disoproxil fumarate (TDF)-containing regimen.Results225 charts were reviewed. 186 (83%) patients were men, with a median age of 58 (range of 50–85). DEXA scans were ordered on 39 (17%) patients, 9 (23%) of which were ordered by their ID provider. Twenty-eight (72%) DEXA scans were performed. Of scans completed, 11 (39%) diagnosed osteoporosis, 15 (54%) osteopenia, and 2 (7%) showed normal BMD. Of all charts reviewed, 29 (13%) were on TDF-containing regimens. Of those individuals with diagnosed abnormal BMD (26), only 1 (4%) was on a TDF-containing regimen.ConclusionDespite HIVMA’s recommendation for osteoporosis screening in PWH, only 17% of eligible patients with well-controlled HIV in our clinic had been referred for DEXA. Of those who had undergone DEXA screening, nearly all (93%) had abnormal BMD. Further investigation is necessary to explore provider and patient barriers for osteoporosis screening in PWH.Disclosures All authors: No reported disclosures.

A Call to Action: The Role of Antiretroviral Stewardship in Inpatient Practice, a Joint Policy Paper of the Infectious Diseases Society of America, HIV Medicine Association, and American Academy of HIV Medicine.

Persons living with human immunodeficiency virus (HIV) and others receiving antiretrovirals are at risk for medication errors during hospitalization and at transitions of care. These errors may result in adverse effects or viral resistance, limiting future treatment options. A range of interventions is described in the literature to decrease the occurrence or duration of medication errors, including review of electronic health records, clinical checklists at care transitions, and daily review of medication lists. To reduce the risk of medication-related errors, antiretroviral stewardship programs (ARVSPs) are needed to enhance patient safety. This call to action, endorsed by the Infectious Diseases Society of America, the HIV Medicine Association, and the American Academy of HIV Medicine, is modeled upon the success of antimicrobial stewardship programs now mandated by the Joint Commission. Herein, we propose definitions of ARVSPs, suggest resources for ARVSP leadership, and provide a summary of published, successful strategies for ARVSP that healthcare facilities may use to develop locally appropriate programs.

Policy Recommendations for Optimizing the Infectious Diseases Physician-Scientist Workforce.

The Infectious Diseases Society of America, HIV Medicine Association, and Pediatric Infectious Diseases Society are concerned by the continued decline in the number of infectious diseases trainees pursuing careers as physician-scientists and the attrition of junior and midcareer physician-scientists. The inability to replace the aging physician-scientist workforce will have a negative, long-lasting impact our biomedical research enterprise and its ability to drive the discovery of new treatments for important infectious diseases. We discuss policy recommendations for securing and optimizing the infectious diseases physician-scientist workforce in the areas of education, training, compensation, and mentorship, as well as ways to improve federal research funding, cross-sector collaboration, and workforce diversity.

2017 HIV Medicine Association of Infectious Diseases Society of America Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With Human Immunodeficiency Virus.

Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Get Rich Quick With Old Generic Drugs! The Pyrimethamine Pricing Scandal.

Get Rich Quick With Old Generic Drugs! The Pyrimethamine Pricing Scandal.

Executive Summary: Clinical Practice Guideline for the Management of Chronic Kidney Disease in Patients Infected With HIV: 2014 Update by the HIV Medicine Association of the Infectious Diseases Society of America

Abstract It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Clinical practice guideline for the management of chronic kidney disease in patients infected with HIV: 2014 update by the HIV Medicine Association of the Infectious Diseases Society of America.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.

Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents — Updated Guidelines

Sponsoring Organizations: Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious