HIV Outpatient Clinic Research Articles

How Do Time Since Diagnosis and Sociodemographic Factors Influence Attitudes Towards HIV Status Disclosure in People Living with HIV in Poland? Data from Go Holistic Go Beyond Project

The aim of this publication is to present the data from Polish respondents of the Go Holistic Go Beyond Project, which investigates social, professional and intimate relations of people living with HIV in Central and Eastern Europe. We analyze how the patients’ attitude towards disclosing their HIV status changes over time from diagnosis. A questionnaire was distributed among patients by three HIV out-patient clinics. Respondents were compared in three groups defined by the time from diagnosis: over 10 years ago, 6–10 years ago and within 5 years. In total, 381 persons living with HIV participated in the survey, 354 of respondents were male, 23 were female and 4 of the respondents did not identify with any of the above sexes. A significant decrease in hospital-diagnosed cases (from 53% to 39%) was observed, alongside an increased role of private laboratories and voluntary counseling and testing centers. Eighty-nine percent of participants shared their HIV status with at least one social group. There was no significant change in the patterns of HIV status disclosure, reason and form of HIV testing. Our results emphasize the importance of survey-based studies in identifying the needs of people living with HIV in order to improve their general well-being.

'We are fragile, but we are strong': A qualitative study of perspectives, experiences and priority outcomes for people living with HIV and frailty.

Advances in antiretroviral therapy have meant that the focus of HIV care has shifted to chronic disease management. The HIV population is ageing, and the prevalence of frailty is increasing. This study aimed to explore the perspectives and experiences of the impact of living with HIV and frailty and priority outcomes in relation to wellbeing and ageing. In-depth qualitative interviews were undertaken with older people living with HIV who screened positive for frailty using the FRAIL scale. Participants were recruited from a UK outpatient HIV clinic. Interviews were analysed using reflexive thematic analysis. In total, 24 people living with HIV were interviewed. Frailty was described as not being able to do the things you could and living with limitations that impacted physical, psychological and social wellbeing. Being identified as frail was not always surprising, but acceptance of this diagnosis required an understanding of what frailty means and what they can do to address it. For people living with HIV, the word 'frail' was largely acceptable when its clinical meaning was explained. However, participants questioned whether a different term is needed if this is a new 'HIV-associated frailty'. Priority outcomes were slowing the progression of frailty, retaining independence and being treated holistically. When talking about frailty with people living with HIV, professionals need to balance honesty and sensitivity and provide clear information about the meaning and impact for the person. Holistic management plans must recognize the physical and psycho-social impact of frailty and prioritize slowing its progression and reducing its impact on independence.

Sexual behaviors and risk of extended-spectrum β-lactamase-producing Enterobacterales carriage: a cross-sectional analysis

Sexual transmission of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is suspected. We aimed to identify clusters of sexual behavior associated with ESBL-E carriage among individuals at risk of sexually transmitted infections (STI). In this cross-sectional study, patients attending an STI-screening center and HIV outpatient clinic in Paris, France between 2018-2019 were asked questions on the following sexual activities in the last 6 months: receptive/insertive anal intercourse, passive/active rimming, receptive/insertive fellatio, receptive/insertive fisting, receptive/insertive fingering, active/passive cunnilingus. ESBL-E carriage was determined from rectal swabs. Bayesian latent class analysis was used to identify clusters of sexual activity, which were then associated with ESBL-E carriage using logistic regression. Among 1211 men who have sex with men (MSM), those belonging to two latent classes with higher prevalence of insertive fingering and active rimming (ESBL-E prevalence=15.3%, N=124 and 16.0%, N=100) and one class with higher proportions of all behaviors (24.3%, N=70) had a higher risk of ESBL-E carriage compared to those in a class with few sexual behaviors (7.3%, N=259) after adjustment. Among 439 other men and 479 women, no clear associations between sexual clusters and ESBL-E carriage were observed. Sexual behaviors are associated with varying degrees of ESBL-E carriage, particularly among MSM.

Multidimensional program for insomnia in a cohort of people with HIV

Objective: Sleep disorders (SD) are prevalent in people with HIV (PWH), but poorly addressed in HIV care. We evaluated the effectiveness of a multidimensional program for SD in an outpatient HIV clinic. Methods: Interventional study in 175 PWH on ART suffering from insomnia. Insomnia severity index (ISI), sleep quality, mood disorders, and well being were assessed at baseline and at month 6 after counseling for sleep hygiene and referral to tailored pharmacological and/or neuropsychological interventions. Participants were classified as fully, partial, and nonadherent (FA–PA–NA) to the interventions. Mixed-effects models and longitudinal paired tests evaluated the impact of adherence to interventions on SD overtime. Results: Participants (male 65.7%, median age 51 years, 95.4% with viral suppression) were referred to psychologist (94.8%), psychiatrist (9.1%), and neurologist (2.8%), and 30.3% and 20.5% had indication to hypo-inducing drugs and psychotherapy/cognitive-behavioral therapy. Seventy-seven participants (44.0%) were NA, 9.1% PA, and 46.8% FA. ISI improved in all, but the strongest effect size was seen in FA (D = 0.89, P < 0.001). Perceived wellness improved only in FA, and hours slept per night increased in all but more relevantly in FA and PA (both P < 0.001). In adjusted models, adherence to the interventions ISI decreased (improve) overtime only in FA (aβ = −1.24, P = 0.005 vs. NA; aβ = −0.71, P = 0.349 for PA vs. NA). Conclusions: The introduction of multidimensional programs for SD can reduce the prevalence and severity of insomnia and improve sleep quality and wellness in PWH. Such approach should be integrated into daily multidisciplinary clinical practice for HIV care.

Patient experiences with value-based healthcare interventions at the HIV outpatient clinic of the Erasmus Medical Centre.

One of the aims of value-based healthcare (VBHC) is to deliver more patient-centred care. However, little is known about the effect of VBHC interventions on patient experiences. We aim to explore how patients experience VBHC as implemented in an HIV outpatient clinic in an academic hospital in the Netherlands. The HIV outpatient clinic of the Erasmus MC, Rotterdam, the Netherlands, an academic tertiary hospital, implemented a VBHC intervention consisting of 1) implementation of a generic quality of life questionnaire, administered before each visit, 2) a change in consultation schedule; from twice a year face-to-face to one face-to-face double consultation and one remote consultation per year, and 3) a change in consultation structure; from a single face-to-face consultation with the infectious diseases (ID) specialist to a double consultation in which the patient visits both the nurse and the ID specialist. Semi-structured interviews were held with Dutch or English-speaking adult patients, that had been a patient within Erasmus MC for more than 5 years, on their experiences with the implemented changes. Thirty patients were interviewed. Patients had no objections towards completing the questionnaires especially if it could provide the professionals with additional information. Patients were primarily positive about the change in consultation schedule. For the yearly remote consultation they preferred a telephone-consultation above a video-consultation. The change in consultation structure ensured that more topics, including psychosocial and medical aspects could be discussed. Some patients did not see the added value of talking to two professionals on the same day or completing the quality of life questionnaire before their consultation. Patients are generally positive towards the VBHC interventions implemented at the HIV outpatient clinic. Our findings may inform further optimization of VBHC interventions and improve patient-centred care in outpatient HIV clinics.

Prevalence and determinants of depression among patients attending adult HIV clinic of University of Uyo Teaching Hospital, Uyo, Southern Nigeria

Background: Mental health challenges particularly depression is common among people living with HIV/AIDS and has been largely neglected. This is of great concern because depression is associated with high morbidity among its sufferers. An assessment of depression among PLWHA and its predictors will enhance their quality of life and improve their health outcomes. Aim: To determine the prevalence and determinants of depression among patients attending the adult HIV clinic in University of Uyo Teaching Hospital, Uyo, Nigeria. Method: This was a cross-sectional descriptive study conducted at the adult HIV outpatient clinic of University of Uyo Teaching Hospital Uyo. A total of three hundred and fifty one eligible respondents were recruited over three months. Their levels of perceived social support, depression, HIV stigma and substance abuse were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), Patient Health Questionnaire 9 (PHQ 9), Internalized AIDS-related Stigma Scale and CAGE questionnaire respectively. Results: The mean age of the respondents was 39.8 ± 10.7 years. Two hundred and sixty six (75.8%) of the respondents were females, while eighty five (24.2%) were males. The overall prevalence of depression was 10%. Majority of respondents had disclosed their status and were experiencing HIV stigmatization representing 84.6% and 95.4% respectively. Most of the respondents (65.8%) had low perceived social support. Depression was found to be statistically associated with unskilled workers (χ2 = 13.08, p = 0.008), unmarried respondents (χ2 = 8.45, p = 0.03), low perceived social support (χ2 = 7.76, p = 0.02), shorter duration of ART use (χ2 = 8.41, p = 0.04), adverse life events (χ2 = 4.05, p = 0.04) and increasing levels of HIV stigma (χ2 = 7.66, p = 0.02) among the study participants. Conclusion: The findings of this study showed that the prevalence of depression in PLWHA was high. Therefore, the screening and prompt treatment of depression in HIV positive persons should be inculcated into their management plan. Furthermore, policies should be made to minimize discrimination and stigmatization of PLWHA in the communities and healthcare systems. Finally, the relevant stakeholders should work in unison to improve the social welfare conditions of HIV infected persons.

Turkish Translation and Cross-Cultural Validity of WHOQOL-HIV Bref Tool.

The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. In line with WHO guidelines, the tool was translated and tested on 189 PLWH from İstanbul Şişli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

Food insecurity in pediatric HIV: understanding a critical challenge in the United States

ABSTRACT Advancing the well-being of individuals living with HIV necessitates attention to social determinants of health, including food insecurity. Through a clinical and community-based needs assessment, we aimed to gain insight into experiences of food insecurity among patients receiving care at a large pediatric HIV outpatient clinic in the Southeastern United States. We adopted a multimodal assessment approach involving a literature review, community profiling, key informant interviews, focus group discussions with staff, patients and parents and a community stakeholder advisory meeting. Our needs assessment demonstrates that food insecurity is an important aspect of the lived experience of children, adolescents and young adults living with HIV. Clinical staff agreed that food insecurity screening should be incorporated into the patient care workflow but ideally only in concert with providing resources that meet their needs. We formulated a recommendation matrix for addressing food insecurity based on priority importance and feasibility. Collaborative relationships between healthcare practitioners and leaders, community-based organizations and local and federal funding sources are vital for enhancing patients' access to sustainable, reliable solutions to this fundamental determinant of health. Our approach provides a tested model for other clinics seeking to identify and alleviate food insecurity among patients.

Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis

ObjectivesTo assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in...

Acceptability of Switching to Long-Acting Cabotegravir and Rilpivirine Among People Living with HIV on Dolutegravir/Rilpivirine Combination: A Single-Center Experience.

The availability of long-acting cabotegravir and rilpivirine injection combination requires some changes in service delivery of outpatient HIV clinics; it is therefore important for clinicians to know the potential number of people living with HIV (PLWH) who are interested in a long-acting antiretroviral treatment. We aimed to determine in an outpatient clinic the number of PLWH, on dolutegravir/rilpivirine, accepting a switch to an injectable long-acting antiretroviral treatment, and the reasons underlying this choice. In our single-center study, in this subset of HIV-infected patients, the main cause for refusal of a long-acting injectable regimen was the need for the administration to be done in hospital, as required in Italy, suggesting that current regulations about this aspect must be changed.

Abstract 3: Adapting a Tobacco Cessation Treatment Intervention and Implementation Strategies to Enhance Implementation Effectiveness and Clinical Outcomes in the Context of HIV Care in Viet Nam: A Case Study

Abstract Purpose: In Vietnam, tobacco use among men living with HIV/AIDS (PLWH) is substantially higher than among the general population. Tobacco use is responsible for significant disparities in cancer-related health outcomes among PLWH who smoke compared with nonsmokers. Despite the burden of disease, there is a lack of evidence for effective treatment for PLWH. We conducted a randomized-controlled trial comparing the effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV outpatient clinics (OPCs). Methods: Patients identified as current cigarette and dual use smokers at the time of their visit (waterpipe and cigarettes) (n=288) were recruited and randomized into one of three interventions: 1) 3As (Ask about tobacco use, Advise to quit, Assist with brief counseling delivered by physicians)+R (proactively Refer to Vietnam’s National Smoker’s Quitline); 2) 3As+Counsel (6-session counseling intervention tailored to PLWH and delivered by trained nurses); and 3) 3As+Counsel+N (nicotine replacement therapy). The primary outcome is six-month carbon monoxide-confirmed smoking abstinence. We are also assessing hypothesized mediators (e.g., self-efficacy, social support). A formative assessment guided adaptation of the intervention to the local context and population. Results: Mean age was 42.4, 96% of patient were male, 8% live alone, 91% are employed, 53.8% were dual users, mean # cigarettes smoked per day was 15.9, and 21.9% reported drug use in the past 3 months. There were no differences across arms in baseline rates of clinical depression or substance use. At 3 months (n=211, those eligible to date), 45% in Arm 1 and 2, and 43.5% in Arm 3, reported smoking abstinence. Among those eligible and reached (98%) for the 6-month survey, 35.9%, 28.9% and 38.3% reported abstinence respectively. Six-month CO- confirmed quit rates were 15.1, 13.3 and 21.3% respectively. 91% of patient received at least one Quitline call and 94% completed 6 sessions of counseling. Discussion: Results are promising and indicate that smoking cessation interventions adapted for PLWH and delivered by health care providers as part of routine care can be effective. The study is the first to demonstrate the feasibility of integrating a Quitline referral system in the context of HIV care. Therefore, the similar outcome across arms has important policy implications; the Quitline is a sustainable resource requiring fewer OPC resources than more intensive counseling. Citation Format: Donna Shelley, Mari Armstrong-Hough, Lloyd Goldsamt, Gloria Guevera Alvarez, Trang Nguyen, Nam Nguyen. Adapting a Tobacco Cessation Treatment Intervention and Implementation Strategies to Enhance Implementation Effectiveness and Clinical Outcomes in the Context of HIV Care in Viet Nam: A Case Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 3.

Abstract 64: Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis

Abstract Purpose: In Vietnam, tobacco smoking is highly prevalent among people living with HIV (PLWH) and increases their risk of cancer, cardiovascular disease, and life-threatening opportunistic infections. However, research on effective tobacco use treatment (TUT) for PLWH is lacking. To fill this gap, we aimed to identify multilevel barriers and facilitators (B&Fs) of smoking cessation and their implications for TUT implementation for PLWH in Hanoi, Vietnam. Methods: We conducted individual in-depth interviews with 24 patients and 13 healthcare providers at three HIV outpatient clinics (OPCs) in Hanoi to explore B&Fs of smoking cessation at the patient, provider, and system level. Two coders carried out a two-phase abductive thematic analysis using Atlas.ti and guided by the Theoretical Domains Framework. Results: Participants described several patient-level barriers to smoking cessation: limited knowledge, misperceptions about smoking harms, lack of familiarity with cessation aids, exposure to environments in which smoking is common, emotional issues (i.e., stress/depression), substance use, and social norms that promote male smoking and tie smoking to masculinity. Both patients and providers described self-determination to quit as a major facilitator of smoking cessation (Everything can be overcome if there is determination). Patients reported that strong determination to quit is influenced by concerns about the harms of smoking; family support and pressure to quit; and the potential for improving health of themselves and their family and for reducing tobacco-related expenses from tobacco purchases. Provide-reported barriers included a lack of resources and capabilities to assess and intervene on smoking behaviour at the OPCs, and at the system level affordable and accessible tobacco products. However, providers endorsed the importance of supporting patients to quit and were optimistic about tailoring and integrating TUT into OPCs if they were equipped with training, personnel, and financial support. Trust and patient-provider solid relationships were potential facilitators of cessation. Conclusion: The study suggested the need to intervene at patient, provider, and system levels to increase engagement among PLWH in smoking cessation treatment. Provider training, patient education and resources are needed to facilitate treatment. Findings also suggest a need to tailor existing treatment options developed in other contexts to this population and setting. Citation Format: Thanh Hoang, Claire VT Nguyen, Gloria Guevera Alvarez, Trang Nguyen, Nam Nguyen, Louise Adermark, Nawi Ng, Donna Shelley, Mari Armstrong-Hough. Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 64.

Epigenetic ageing accelerates before antiretroviral therapy and decelerates after viral suppression in people with HIV in Switzerland: a longitudinal study over 17 years

Accelerated epigenetic ageing can occur in untreated HIV infection and is partially reversible with effective antiretroviral therapy (ART). We aimed to make a long-term comparison of epigenetic ageing dynamics in people with HIV during untreated HIV infection and during suppressive ART. In this longitudinal study, conducted over 17 years in HIV outpatient clinics in Switzerland, we applied 5 established epigenetic age estimators (epigenetic clocks) in peripheral blood mononuclear cells (PBMCs) in Swiss HIV Cohort Study participants before or during suppressive ART. All participants had a longitudinal set of PBMC samples available at four timepoints (T1-T4). T1 and T2 had to be 3 years or longer apart, as did T3 and T4. We assessed epigenetic age acceleration (EAA) and a novel rate of epigenetic ageing. Between March 13, 1990, and Jan 18, 2018, we recruited 81 people with HIV from the Swiss HIV Cohort Study. We excluded one participant because a sample did not meet quality checks (transmission error). 52 (65%) of 80 patients were men, 76 (95%) were white, and the median patient age was 43 (IQR 37·5-47) years. Per year of untreated HIV infection (median observation 8·08 years, IQR 4·83-11·09), mean EAA was 0·47 years (95% CI 0·37 to 0·57) for Horvath's clock, 0·43 years (0·3 to 0·57) for Hannum's clock, 0·36 years (0·27 to 0·44) for SkinBlood clock, and 0·69 years (0·51 to 0·86) for PhenoAge. Per year of suppressive ART (median observation 9·8 years, IQR 7·2-11), mean EAA was -0·35 years (95% CI -0·44 to -0·27) for Horvath's clock, -0·39 years (-0·50 to -0·27) for Hannum's clock, -0·26 years (-0·33 to -0·18) for SkinBlood clock, and -0·49 years (-0·64 to -0·35) for PhenoAge. Our findings indicate that people with HIV epigenetically aged by a mean of 1·47 years for Horvath's clock, 1·43 years for Hannum's clock, 1·36 years for SkinBlood clock, and 1·69 years for PhenoAge per year of untreated HIV infection; and 0·65 years for Horvath's clock, 0·61 years for Hannum's clock, 0·74 years for SkinBlood clock, and 0·51 years for PhenoAge, per year of suppressive ART. GrimAge showed some change in the mean EAA during untreated HIV infection (0·10 years, 0·02 to 0·19) and suppressive ART (-0·05 years, -0·12 to 0·02). We obtained very similar results using the rate of epigenetic ageing. Contribution of multiple HIV-related, antiretroviral, and immunological variables, and of a DNA methylation-associated polygenic risk score to EAA was small. In a longitudinal study over more than 17 years, epigenetic ageing accelerated during untreated HIV infection and decelerated during suppressive ART, highlighting the importance of limiting the duration of untreated HIV infection. Swiss HIV Cohort Study, Swiss National Science Foundation, and Gilead Sciences.

Consultations for HIV post-exposure prophylaxis before and after health insurance coverage of pre-exposure prophylaxis to a university-based emergency department in Germany

Background: Potential risk contacts for HIV transmission may lead to presentations to the emergency department (ED) for counseling and initiation of post-exposure prophylaxis (PEP). Objective: To examine the impact of German health insurance covering pre-exposure prophylaxis (PrEP) following Sept 1st 2019 for certain risk groups on the frequency and reasons for PEP counseling in a university-based ED in Germany. Methods: In a before-after study design, all persons aged ≥18 years who presented for PEP counseling were analyzed retrospectively. We compared characteristics of presentations in the 18 months prior to PrEP coverage on Sept 1st, 2019, with those in the following 18 months. Results: 154 ED presentations occurred in the first study period, and 155 ED presentations in the second period. Regarding the reasons for ED visits, no statistically significant difference was found [occupational risk contact (18.2 vs. 26.5%, p = 0.081), sexual risk contact (74.7 vs. 69.0%, p = 0.266), other non-occupational risk contact (7.1 vs. 4.5%, p = 0.329)]. For men who have sex with men (MSM), no statistically significant differences were found [38.9 (n = 60) vs. 35.5% (n = 55), p = 0.537]. All persons presenting to the HIV outpatient clinic after ED PEP initiation (n = 60 vs. n = 52) tested negative for HIV 3 months later. Conclusion: In this study, reasons to present for PEP counseling to a university ED showed no change following the implementation of PrEP coverage by health insurances. Therefore, PEP remains an important prevention for HIV transmission and presentations to the ED for PEP counseling may provide an opportunity to educate persons at risk of HIV infection about PrEP, thereby helping to prevent new HIV infections.

Magnitude and factors associated with sensorineural hearing loss in patients with HIV/AIDS attending tertiary hospital in northern zone Tanzania

Background: It is estimated that 20% to 50% of patients with HIV have hearing loss. 70% of people living with HIV worldwide are reported to be in Sub-Saharan Africa, making this region have a probable greater disease burden. However, hearing assessment is missing as a routinely conducted investigation in some treatment guidelines. The study aimed to determine the magnitude and factors associated with sensorineural hearing loss in patients with HIV/AIDS attending a tertiary hospital in Northern Tanzania. Methods: This observational hospital-based cross-sectional study was conducted at the HIV outpatient clinics. The study population comprised children and adults with HIV/AIDS aged between 7 and 60 years old. A structured questionnaire and medical files were used to obtain hearing history and relevant medical information. Tympanometry and pure-tone audiometry was done. Results: This study included 152 study participants. The median age was 46 (36.0 – 53.0) years. 109 (71.7%) were females, and 43 (28.3%) were males. The prevalence of sensorineural hearing loss (SNHL) was 34.9% (53 cases). Conductive hearing loss was 7.2% (11 cases,) and mixed hearing loss was 9.2% (14 cases). There was a statistically significant association between SNHL with nadir CD4 count, current viral load, and ART use duration of more than 10 years. Conclusions: The magnitude of SNHL in patients with HIV/AIDS is alarmingly high. Hearing status should be assessed at baseline and follow-up course of HIV/AIDS management. This will also help analyse the probable impact of ART changes in the treatment guidelines.

Evaluation of Statin Prescribing Practices and Predictors of Statin Underutilization in Persons With HIV.

Persons with HIV (PWH) have an increased risk of cardiovascular disease (CVD) compared with those without HIV. Despite the increased risk, PWH are less likely to be prescribed statin therapy compared with the general population. The purpose of this study is to describe the statin prescribing practices of an outpatient HIV clinic and identify potential predictors of statin underutilization. This study was a retrospective, single-center chart review of PWH ages 40-79 years receiving care at an HIV clinic. Statin eligibility, statin prescribing practices, and appropriateness of statin therapy were evaluated. Logistical regression analyses were conducted to assess for predictors of underutilization of statin therapy. Of the 606 patients, statin therapy was indicated in 362 patients (60%). Among those with a statin indication, 60.2% were prescribed appropriate statin therapy, 11.6% were prescribed statin therapy but not at the indicated intensity, and 28.2% were not prescribed statin therapy. Tobacco use ( P = 0.0023) was identified as a predictor of statin underutilization. The odds of statin prescribing were higher for those with clinical atherosclerotic CVD ( P = 0.004) and hypertension ( P = 0.017). Statin underutilization was significantly higher in PWH smoking tobacco and PWH without atherosclerotic CVD or low-density lipoprotein-cholesterol 190 mg/dL or higher. In addition, this study highlights the need for more robust CVD prevention efforts in PWH. Identifying predictors of statin underutilization may aid in elucidating where gaps in cardiovascular prevention care may exist.

The Clinical Effectiveness and Safety of Vaccinations against COVID-19 in HIV-Positive Patients: Data from Observational Study in Poland.

We performed a retrospective analysis of medical records of HIV-positive individuals routinely followed up between 1 January 2021 and 30 April 2022 that were at the HIV Outpatient Clinic in Warsaw. The analysis included data on the type and date of administration of subsequent doses of COVID-19 vaccination, adverse vaccine reactions, and the history of SARS-CoV-2 infection. In total, 217 patients were included in the analysis, with a median age of 43 years (IQR: 35.5-51.5 years) and median CD4+ count of 591 cells/uL (IQR: 459.5-745.0 cells/uL). Most of the patients were male (191/217, 88.0%) and were vaccinated with the BNT162b2 vaccine (143/217, 65.9%). None of the patients diagnosed with COVID-19 required hospitalization. Vaccine adverse events (VAE) mostly occurred after the 1st dose (in 33/217 (15.2%)), and none of them were severe or required medical care. In our cohort of patients, vaccination against COVID-19 proved to be safe and effective against a severe course of the disease among people living with HIV. However, vaccination, to a lesser degree, protects against mild SARS-CoV-2 infection. Longer observations are required in order to assess the sustainability of protection against severe COVID-19 in this group of patients.

Long-term evolution of comorbidities and their disease burden in individuals with and without HIV as they age: analysis of the prospective AGEhIV cohort study

People with HIV generally have more ageing-associated comorbidities than those without HIV. We aimed to establish whether the difference in comorbidities and their disease burden changes with ageing. In this prospective, longitudinal cohort study, we assessed comorbidities commonly associated with ageing every 2 years in 596 HIV-positive and 550 HIV-negative participants. HIV-positive participants were recruited from the HIV outpatient clinic of the Amsterdam University Medical Centres (Amsterdam, Netherlands). HIV-negative participants were recruited from the sexual health clinic and the Amsterdam Cohort Studies at the Public Health Service of Amsterdam (Amsterdam, Netherlands). Inclusion criteria were participants aged 45 years or older and, for HIV-negative participants, a documented HIV-negative antibody test. The mean number of comorbidities present over time was compared between groups by use of Poisson regression, accounting for dropout and death through joint survival models. Mean disability-adjusted life-years (DALYs) accrued during 2-year intervals were compared between groups by use of an exponential hurdle model. Between Oct 29, 2010, and Oct 9, 2012, participants were enrolled and then prospectively followed up until their last visit before Oct 1, 2018. 1146 participants were followed up for a median 5·9 years (IQR 5·7-6·0), during which 231 participants (20·2%) dropped out: 145 (24·3%) of 596 HIV-positive and 86 (15·6%) of 550 HIV-negative. 38 (3·3%) of 1146 participants died: 31 (5·2%) of 596 HIV-positive and seven (1·3%) of 550 HIV-negative. 24 HIV-positive and two HIV-negative participants died from ageing-associated comorbidities. 15 HIV-positive participants versus one HIV-negative participant died from non-AIDS malignancies. At inclusion, mean number of comorbidities was higher in HIV-positive participants (0·65) than in HIV-negative participants (0·32; p<0·0001). Mean number of comorbidities increased at similar rates over time: rate ratio (RR) per year for HIV-positive participants 1·04 (95% CI 1·00-1·08), RR per year for HIV-negative participants 1·05 (1·01-1·08; pinteraction=0·78). Number of comorbidities was associated with an increased risk of death (hazard ratio 3·33 per additional comorbidity, 95% CI 2·27-4·88; p<0·0001). HIV-positive participants had higher increases in mean DALYs than HIV-negative participants (0·209 per year, 95% CI 0·162-0·256 vs 0·091 per year, 0·025-0·157; pinteraction=0·0045). This difference was reduced when deaths were excluded in establishing DALYs (0·127, 0·083-0·171 vs 0·066, 0·005-0·127; pinteraction =0·11). The larger comorbidity prevalence in HIV-positive participants aged 50-55 years on effective antiretroviral treatment than in HIV-negative participants increased similarly as participants aged and was associated with an increased risk of death, particularly of non-AIDS malignancies. Our findings reinforce the need for strategies to optimise prevention, screening, and early intervention. Netherlands Organization for Health Research and Development, Aidsfonds, Gilead Sciences, ViiV Healthcare, Janssen Pharmaceuticals, and Merck & Co. For the Dutch translation of the abstract see Supplementary Materials section.

Assessing renal impairment in treatment-naïve adolescents living with HIV commencing antiretroviral therapy in Zimbabwe.

People with HIV (PWH) are increasingly experiencing non-communicable complications, including renal impairment, which are associated with worse clinical outcomes. Limited information exists surrounding renal impairment in paediatric PWH, of which the majority live in sub-Saharan Africa, and further information is required to guide clinical practice. This study describes the prevalence of new or worsening renal impairment in adolescents commencing antiretroviral therapy (ART) in Zimbabwe and associated risk factors. Retrospective cohort study. Data were collected between January 2010 to January 2019 from the medical records of adolescents aged 12-17 years initiating ART at an outpatient HIV clinic in Zimbabwe. Renal function (estimated glomerular filtration rate, eGFR) was calculated using the Full Age Spectrum formula. Proteinuria was defined as a single urine dipstick score of ≥1+. Potential predictors of renal impairment at follow-up were assessed by logistical regression. Two hundred and sixty-six adolescents were included in analysis. Baseline renal impairment (eGFR < 90 ml/min/1.73 m 2 ) and proteinuria were present in 13% and 7% of the cohort, respectively. After a median of 4.1 years (interquartile range: 1.9-6.9) following ART commencement, mean eGFR increased by 10 ml/min/1.73 m 2 ( P < 0.01), and the prevalence of renal impairment decreased to 8% ( P < 0.01). Baseline renal impairment predicted renal impairment at follow-up (odds ratio [OR] 8.98; 95% confidence interval [CI] 2.81-28.68; P < 0.01). Proteinuria trended towards association with renal impairment at follow-up (OR 4.39; 95% CI 0.95-20.31; P = 0.06). Renal impairment is common in adolescent ART-naïve PWH, and baseline renal impairment is associated with longstanding renal impairment, whereas baseline proteinuria trended towards an association with longstanding renal impairment.

EXAMINING THE CUMULATIVE EFFECTS OF SOCIAL ISOLATION AND LONELINESS IN OLDER ADULTS WITH HIV

Abstract Social isolation exists when one has limited or lacks social contact with others and is distinct from loneliness, an affective state on the perception of isolation. Social isolation and loneliness are recognized as risks to well-being among older adults. Less in known about the cumulative effects of social isolation and loneliness in older persons with HIV (OPWH). Using cross-sectional data on OPWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA (N=146), we aimed to 1) describe the overlap between social isolation and loneliness and 2) examine the combined effects of social isolation and loneliness on quality-of-life (QoL), HIV-related stigma, depressive symptoms, and comorbidity burden. Loneliness and social isolation were assessed using the PROMIS-Social Isolation Scale and Social Network Index, respectively. Participants were grouped into four categories into ‘lonely only,’ ‘isolated only,’ ‘both lonely and isolated,’ or ‘neither.’ Bivariate and adjusted associations were conducted. Among participants (mean age=56.53), 26.7% (n=39) were considered ‘lonely’ only, 12.3% (n=18) ‘isolated’ only, 15.1% (n=22) ‘both lonely and isolated,’ and 45.9% (n=67) ‘neither.’ In bivariate analyses, individuals categorized as ‘both lonely and isolated’ were likely to have past homelessness and higher depressive symptoms, stigma, and comorbidity burden, and lower QoL. In adjusted models, ‘both isolated and lonely’ significantly predicted QoL, stigma, and depressive symptoms. Findings highlight the critical emphasis on targeting OPWH who are both isolated and lonely.