Mean HIV Viral Load Research Articles

Site-Randomized Controlled Trial of a Combined Cognitive Behavioral Therapy and a Medication Management Algorithm for Treatment of Depression Among Youth Living With HIV in the United States.

Depression is frequent among youth living with HIV (YLWH). Studies suggest that manualized treatment guided by symptom measurement is more efficacious than usual care. This study evaluated manualized, measurement-guided depression treatment among YLWH, aged 12-24 years at 13 US sites of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network. Using restricted randomization, sites were assigned to either a 24-week, combination cognitive behavioral therapy and medication management algorithm (COMB-R) tailored for YLWH or to enhanced standard of care, which provided standard psychotherapy and medication management. Eligibility included diagnosis of nonpsychotic depression and current depressive symptoms. Arm comparisons used t tests on site-level means. Thirteen sites enrolled 156 YLWH, with a median of 13 participants per site (range 2-16). At baseline, there were no significant differences between arms on demographic factors, severity of depression, or HIV status. The average site-level participant characteristics were as follows: mean age of 21 years, 45% male, 61% Black, and 53% acquired HIV through perinatal transmission. At week 24, youth at COMB-R sites, compared with enhanced standard of care sites, reported significantly fewer depressive symptoms on the Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR score 6.7 vs. 10.6, P = 0.01) and a greater proportion in remission (QIDS-SR score ≤ 5; 47.9% vs. 17.0%, P = 0.01). The site mean HIV viral load and CD4 T-cell level were not significantly different between arms at week 24. A manualized, measurement-guided psychotherapy and medication management algorithm tailored for YLWH significantly reduced depressive symptoms compared with standard care at HIV clinics.

HIV-related non-Hodgkin lymphomas affecting the oral cavity: a clinicopathologic study of 11 cases.

Background HIV-related non-Hodgkin lymphomas of the oral cavity are rare lesions with aggressive clinical behaviour. The aim of this study is to describe the clinicopathological features of a series of HIV-related oral non-Hodgkin lymphomas.Material and Methods Eleven cases of oral lymphomas affecting HIV-positive patients were retrieved from 2012 to 2019. Clinicopathological features regarding age, sex, tumour location, clinical presentation, laboratory findings, disease stage and follow-up were obtained. Histologic, immunohistochemical and in situ hybridization for EBV detection were done for diagnosis confirmation. Overall survival was estimated by Kaplan–Meier curve.Results Males predominated, with a mean age of 40.3 years-old. Maxilla and mandible were the mostly affected. Plasmablastic lymphoma and diffuse large B-cell lymphoma not otherwise specified (NOS) were the main histological types. Lesions presented as reddish ulcerated swellings, representing the first sign of AIDS in six cases. Stage IV were common (7 cases) and the mean HIV viral load was 10,557 copies/mL, with a mean of 266 CD4+ cells/mm3, 1,278 CD8+ cells/mm3 and a CD4+/CD8+ ratio of 0.26. Eight patients died of the disease (72.7%). Overall survival revealed that 78.2% of the patients died after 21 months of follow-up.Conclusions HIV-related oral lymphomas present a poor prognosis usually diagnosed in advanced stages and in our series plasmablastic lymphoma was the most common subtype. Key words:Oral cancer, non-Hodgkin lymphoma, HIV, survival, prognosis.

Abstract 64: The Prevalence of Hepatocellular Carcinoma in HIV-Infection: Results of Large-Scale Liver Ultrasound Screening Program in HIV-Infected Nigerians

Abstract Purpose: In Nigeria, over 3 million people are infected with HIV (prevalence rates 6.1-8.0%). Rates of co-infection with HBV and HCV among HIV-infected are common ranging from 9-12.3% (HBV) and 6-20% (HCV). Given the high burden of HIV/HBV co-infection, it is hypothesized that there are high rates of HCC among HIV-infected individuals in Nigeria. This abstract describes the pattern of liver diseases detected by abdominal ultrasound, including abnormalities suggestive of HCC, from a screening program. Methods: In this cross-sectional study, all consenting adults (>18) HIV-infected subjects underwent an abdominal ultrasound using the N2 full Digital Ultrasound and completed a structured questionnaire. Ultrasonography findings were recorded. Basic descriptive statistics was performed. Results: Two thousand seven hundred and twenty-seven subjects were enrolled into the program [1950 (71.5%) females; mean age 46.40±10.15 years]. All subjects were receiving antiretroviral therapy (ART). The majority of study subjects (2149, 78.8%) had a normal liver ultrasound scan. The most common liver abnormality was hepatomegaly, seen in 298 (10.9%) of the study subjects. One hundred and nine (4.0%) had a diffusely hyper-echogenic liver, suggestive of fatty liver. Seventy-two (2.6%) had a hypo-echogenic liver with starry sky appearance, suggestive of active inflammation. Thirty-eight (1.4%) of the study subjects had features consistent with liver cirrhosis. Liver nodules or solid masses were seen in 4 (0.01%) of the study subjects. Mean HIV viral load was significantly higher among those with hepatomegaly compared to those with a normal scan (log103.74 vs.log105.21 p=0.015). Conclusion: The prevalence of HCC among HIV-infected was extremely low 4(0.01%). This is reassuring given the relatively large number of subjects screened and high prevalence of other risk factors for HCC in this population. An effect of ART on reducing incidence of HCC in this population is surmised, however, requires further exploration in long-term follow up studies. Citation Format: Pantong Davwar, Nyam David, Emuobor Odeghe, Duguru Mary, Claudia Hawkins, Ganiyat Oyeleke, Edith Okeke, Lesi Olufunmilayo, Lewis Roberts, Atiene Sagay, Lifang Hou, Robert Murphy, Godwin Imade. The Prevalence of Hepatocellular Carcinoma in HIV-Infection: Results of Large-Scale Liver Ultrasound Screening Program in HIV-Infected Nigerians [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 64.

1010. Effective Management of HIV in Rural Georgia Using Telemedicine

BackgroundThe increasing incidence of HIV and lack of care in rural areas contributes to the ongoing epidemic. The dearth of specialized health services within remote communities and access of this population to available services poses a challenge to HIV care. Telemedicine (TM) is a potential tool to improve HIV care in these remote communities, but little is known about its effectiveness when compared to traditional (face-to-face) (F2F) care. The objective of this study is to examine the effectiveness of HIV care delivered through TM, and compare to F2F care.MethodsThis is a retrospective chart review of all HIV positive patients who attended either the F2F clinic (Augusta, GA) or the TM clinic (Dublin, GA) between May 2017 to April 2018. Data extracted included demographics, CD4 count, HIV PCR, co-morbidities, dates of clinic attendance, HIV resistance mutations and ART changes. Viral suppression and gain in CD4 counts were compared. T-test was conducted to test differences in characteristics and outcomes between the two groups.Results385 cases were included in the study (52.5% black, 82% females, F2F=200, TM=185). Mean CD4 count in the TM group was statistically higher (643.9 cells/mm3) than the F2F group (596.3 cells/mm3) (p< 0.001). There was no statistically significant difference in mean HIV viral load (F2F= 416.8 cp/ml, TM=713.4 cp/ml, p=0.3) and rates of year-round viral control (F2F= 73% vs TM = 77% p= 0.54). 38 patients achieved viral suppression during the study period (F2F= 24, TM =14) with a mean change of -3.34 x 104 vs -1.24 x 104, respectively. The difference in mean change was not statistically significant by Snedacor’s W Statistics. This indicates there was no significant difference between the two populations in terms of mean viral suppression among patients who were otherwise not suppressed before the study period.ConclusionTo achieve an HIV cure, HIV care is required to extend to rural areas of the country and the world. Through delivery of care using TM, trained specialists can target communities with little or no health care. Moreover, use of TM achieves target outcome measures comparable to F2F clinics. Increase in the use of TM will improve the access to specialty HIV care and help achieve control of HIV in rural communities.Disclosures All Authors: No reported disclosures

HSV-2 Infection as a Potential Cofactor for HIV Disease Progression and Selection of Drug Resistance Mutations in Adults under WHO-Recommended First-Line Antiretroviral Therapy: A Multicentric, Cross-Sectional Study in Cameroon, Central African Republic, Chad, and Gabon.

Although herpes simplex virus-2 (HSV-2) infection is a known cofactor for HIV transmission in Central Africa, its role in HIV disease progression is unclear. The aim of this study was to examine the potential link between HSV-2 infection and HIV disease progression, in addition to identifying the presence of genes conferring HIV antiretroviral resistance mutations. This was a cross-sectional study involving 302 HIV-infected adults in Central Africa with virological failure (viral load >1000 copies/mL) on first-line antiretroviral therapy from four different countries. The seroprevalence of HSV-2 was 32% (96/302). Amongst the HIV-infected individuals who were HSV-2 seropositive, the mean HIV viral load and CD4 count were 4.82 ± 0.83 log copies/mL and 243 ± 144 cells/microliter, respectively. Among the HIV-infected individuals who were HSV-2-seronegative, the mean HIV viral load and CD4 count were 3.48 ± 0.44 log copies/mL and 646 ± 212 cells/microliter, respectively (p < 0.001). There was a statistically significant relationship (p < 0.001) between HSV-2 seropositivity and the presence of resistance mutations to antiretrovirals (ARV), non-nucleoside reverse transcriptase inhibitors (NNRTI), and nucleoside reverse transcriptase inhibitors (NRTI) with odds ratios of 9.7, 10, and 11.9, respectively. There was no link between HSV-2 serostatus and protease inhibitor (PI) resistance mutations. There was a substantial accumulation of resistance mutations in HSV-2-seropositive compared to -seronegative patients. These findings support the link between HIV disease progression and HSV-2 infection. An association was observed between the presence of NNRTI and NRTI resistance mutations and HSV-2 seropositivity.

Anal Cancer Precursor Lesions in HIV-Infected Persons: Tissue Human Papillomavirus Type Distribution and Impact on Treatment Response

Data on tissue distribution of human papillomavirus types in anal high-grade squamous intraepithelial lesions are limited and the impact on treatment outcomes poorly understood. We aimed to investigate potential predictors of treatment failure after electrocautery ablation, including human papillomavirus type(s) isolated from index lesions. This was a retrospective cohort study. The study was conducted at a tertiary academic referral center in New York City. Seventy-nine HIV-infected patients with a diagnosis of anal high-grade squamous intraepithelial lesions between January 2009 and December 2012 were included, and genomic DNA was extracted from biopsy tissue. The prevalence of human papillomavirus types in index lesions and surveillance biopsies after electrocautery ablation were analyzed to evaluate treatment response. Of 79 anal high-grade squamous intraepithelial lesions, 71 (90%) tested positive for ≥1 human papillomavirus type; 8 (10%) had no human papillomavirus detected. The most common type was 16 (39%), followed by 33 (15%). Human papillomavirus type 18 was seen in 3%. Sixty-one patients (77%) underwent electrocautery ablation and had subsequent surveillance biopsies. Surveillance biopsies yielded benign findings or low-grade squamous intraepithelial lesions in 31 (51%) of 61 and recurrent high-grade squamous intraepithelial lesions in 30 (49%) of 61 patients (mean follow-up: 35 mo). Ablation response did not differ significantly based on baseline demographics, smoking history, history of anogenital warts, mean CD4 T-cell count, antiretroviral-therapy use, and HIV viral load (<50 copies/mL). The recurrence of high-grade lesions was not significantly associated with high-risk human papillomavirus types detected in index lesions. Human papillomavirus genotyping in surveillance biopsies was not performed. Anal high-grade squamous intraepithelial lesions in HIV-infected patients contain a wide range of human papillomavirus types, and individual lesions commonly harbor multiple types concomitantly. Recurrence of anal high-grade squamous intraepithelial lesions after electrocautery ablation occurs frequently and is not affected by high-risk human papillomavirus types. See Video Abstract at http://links.lww.com/DCR/A833.

2262. Not a Disease of the Past: A Case Series of Progressive Multifocal Leukoencephalopathy in the Established Antiretroviral Era

BackgroundProgressive multifocal leukoencephalopathy (PML) and PML immune reconstitution inflammatory syndrome (PML-IRIS) can be a devastating neurologic process associated with HIV, but limited knowledge on their characteristics in the established antiretroviral (ART) era is available. We conducted a case series to evaluate the clinical course of PML and PML-IRIS at our urban safety-net hospital in Atlanta, GA.MethodsAll HIV-positive individuals with a positive JCV DNA PCR in the spinal fluid between May 1, 2013 to June 1, 2017 were identified through electronic medical records (EMR) query. Demographics, symptom presentation, laboratory data, imaging results, treatment, and outcomes were abstracted from the EMR. PML, and PML-IRIS were defined using the American Association of Neurology criteria.ResultsThere were 26 patients included in this study, 15 (58%) HIV-positive patients with PML and 11 (42%) with PML-IRIS (2 with an unmasking presentation and 9 with a paradoxical presentation). The average age was 45 years, 23 (88%) were black, and 20 (77%) were male. Mean CD4 and HIV viral load were 65 cells/µL and 4.11 log10 copies/mL, respectively. The most common presenting symptoms were motor weakness (18, 69%), cognitive deficits (15, 58%), and dysarthria (11, 42%). Twenty-four (92%) patients had white matter changes on magnetic resonance imaging (MRI). Enhancement on MRI and presentation with ataxia, dysarthria, or motor or visual deficits were found to be associated with PML-IRIS. Eleven (42%) patients were on ART at the time of diagnosis, and 24 (92%) of patients were on ART afterward. Corticosteroids were used in 9 patients with PML-IRIS and in 3 with PML. Maraviroc was used in 3 patients with PML-IRIS. Presenting with speech deficits or visual changes, having edema on MRI, and developing PML-IRIS were each positively associated with progression to hospice or withdrawal of care, although these values were not statistically significant. Outcomes were dismal with 7/15 (46.7%) patients with PML and 9/11 (81.8%) with PML-IRIS dying or being referred to hospice.ConclusionDespite widespread access to ART, patients with PML continue to have poor outcomes, particularly among those who develop PML-IRIS. More research is needed to understand the risks for and prevention of PML-IRIS.Disclosures V. Marconi, ViiV: Investigator, Research support and salary. Bayer: Investigator, Research support. Gilead: Investigator, Research support.

Modified Population Viral Load Indices and HIV Acquisition Risk

Population viral load (PVL) is used to describe the mean HIV viral load within a community and is typically calculated by averaging known viral loads

Cell of Origin By Immunohistochemistry Is Not Prognostic of Overall Survival in HIV Associated DLBCL- Analysis of Clinical Pathological Markers in HIV DLBCL

Introduction:Diffuse large B-Cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) in HIV population and the survival rate at 2 years is still only 50% (Olszewski AJ et al, Cancer 2016). Based on the cell-of-origin (COO) by immunohistochemistry (IHC), DLBCL is classified into germinal center B-cell like (GCB) and activated B-cell like (ABC or non-GCB) subtypes. While it is well accepted that the ABC subtype is associated with poor outcome in non-HIV DLBCL, the prognostic value of the COO classification in HIV DLBCL has been an issue of debate (Chadburn et al JCO 2009, Dunleavy et al 2010). Current clinical trials stratify patients based on COO in non-HIV DLBCL as the ABC subtype responds better to novel agents like Ibrutinib than GCB. Hence it is important to know whether the two subtypes retain their biological differences in HIV related DLBCL. In order to understand the effect of prognostic variables including subtype and treatment, on survival we conducted a retrospective review of HIV DLBCL in a large single center cohort.Methods:We conducted a retrospective analysis of all HIV infected patients diagnosed with DLBCL (excluding primary CNS) at Montefiore Medical Center between 2000- 2014. The variables that were utilized in the analysis are time of diagnosis of DLBCL, stage, COO subtype of DLBCL (GCB vs non-GCB based on Hans method), LDH (high = >391 u/L), extra-nodal involvement, CD4 count at diagnosis, combination anti-retroviral therapy (cART) at diagnosis, type of chemotherapy, use of rituximab and survival status. Time was divided in 5-year increments -2000 to 2005 (E1), 2005 to 2010 (E2) and 2010 to 2014 (E3).Results:A total of 128 patients with HIV-DLBCL were identified. The mean age was 47 years with a male predominance (70%). Features of high-risk disease were advanced stage III/IV (77%), presence of extra-nodal involvement (65%), and high LDH (51%) seen in 87% of patients. COO classification by IHC (n=75) showed that most were non-GCB (63%) and the rest were GCB (37%) phenotype. HIV specific factors at diagnosis were -CD4 0 to 50 cells (21%), 50-200 (53%) and >200 (25%), mean HIV viral load of 16,459 copies/ml and 61% were on cART. Overall 89% of all patients received treatment and 82% received combination chemotherapy with anthracyclines. There was no significant association between rituximab use (46%) and CD4 counts at diagnosis (p=0.24) while rituximab use was higher in E3 than E1 time period, as expected (p=0.01).The median OS was 26.6 months. On univariate analysis, high LDH (p=0.03), not receiving rituximab (p=0.01) and extensive stage disease (p= 0.034) were significantly associated with poor OS. There was no difference in survival between the 3 time periods (p=0.96). COO subtypes (non-GCB vs GCB) was not predictive of OS (P=0.90), as were HIV specific factors at diagnosis -CD4 (p=0.88) and ART (p=0.51). Cox proportional hazards model showed only rituximab use (HR=0.48 p=0.02) as an independent predictor of survival but not age (HR=1.02, p=0.09), stage (HR=1.95, p=0.09), LDH (HR=1.37, p=0.31) and extra-nodal disease (HR=1.67, p=0.1). Rituximab was the only independent predictor even when subtype was included in the model (n=58) or when restricted to the subset that received treatment (n=94).Conclusions:This is one of the largest cohorts of HIV-DLBCL analyzed. This study shows that the median age of HIV DLBCL is lower, presents with high-risk disease -higher stage, extra nodal involvement and high LDH. HIV specific risk factors like ART and CD4 counts at diagnosis were not prognostic in the era of cART. Even though stage, LDH and extranodal involvement were significant in the univariate analysis, only rituximab use was independently associated with OS in the multivariate analysis. Rituximab use was not significantly different based on CD4 counts, whilst there was an increase in use with time; OS was not significantly different between the time periods. These findings show that rituximab should be used in all HIV DLBCL independent of CD4 counts.The other important finding is that the COO sub classification was not predictive of prognosis in contrast to non HIV-DLBCL where the ABC subtype has an inferior prognosis. Higher expression of c-myc present in HIV-DLBCL may negate the better prognosis of GCB subtype (Chao C et al, CCR 2015). This needs to be explored further, new pathological prognostic markers are to be identified to risk stratify patients and therapeutic subgroups. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A community-engaged randomized controlled trial of an integrative intervention with HIV-positive, methamphetamine-using men who have sex with men.

BackgroundContingency management (CM) is an evidence-based intervention providing tangible rewards as positive reinforcement for abstinence from stimulants such as methamphetamine. Integrative approaches targeting affect regulation could boost the effectiveness of CM in community-based settings and optimize HIV/AIDS prevention efforts.Methods/DesignThis randomized controlled trial with HIV-positive, methamphetamine-using men who have sex with men (MSM) is examining the efficacy of a 5-session, individually delivered positive affect regulation intervention – Affect Regulation Treatment to Enhance Methamphetamine Intervention Success (ARTEMIS). ARTEMIS is designed to sensitize individuals to non-drug-related sources of reward as well as assist with managing depression and other symptoms of stimulant withdrawal during CM. HIV-positive, methamphetamine-using MSM who are enrolled in a community-based, 12-week CM program are randomized to receive ARTEMIS or an attention-matched control condition. Follow-up assessments are conducted at 3, 6, 12, and 15 months after enrollment in CM. Four peripheral venous blood samples are collected over the 15-month follow-up with specimen banking for planned biomarker sub-studies. The primary outcome is mean HIV viral load. Secondary outcomes include: sustained HIV viral suppression, T-helper cell count, psychological adjustment, stimulant use, and potentially amplified transmission risk behavior.DiscussionImplementation of this randomized controlled trial highlights the importance of delineating boundaries between research activities and community-based service provision. It also provides insights into best practices for integrating the distinct agendas of academic and community partners in clinical research. This trial is currently enrolling and data collection is anticipated to be completed in September of 2018.Trial registrationThis trial was registered on clinicaltrials.gov (NCT01926184) on August 16, 2013.

A-104 Gender and Neurocognitive Impairment among HIV Infected Individuals in Nigeria

Background: Neurocognitive impairment (NCI) in HIV infection occurs as a frequent complication of HIV infection and, among HIV infected individuals in Nigeria, can be detected during the early stages of infection. The presence and severity of NCI can correlate with elevation of plasma levels of monocyte activation markers. In this study was examined the potential role of gender in the occurrence of NCI and associations between NCI and levels markers of HIV disease activity. Methods: One hundred thirty-three antiretroviral-naive seropositive (SP; 94 women and 59 men) and 56 seronegative (SN; 38 women and 18 men) participants received neuropsychological testing in 7 ability domains with calculation of demographically adjusted domain scores and a global deficit score (GDS). Also measured were plasma HIV RNA levels and plasma levels of the monocyte activation markers soluble CD163 and soluble CD14. Results: SP women in the study were younger than SP men, and SP women and men were less educated than their SN counterparts. CD4+ T cell counts, which were lower SP than for SN individuals, were higher for SN woman and SP women than for their male counterparts. Within the various ability domains, SP women scored worse than SN women with respect to verbal fluency and motor function and had higher overall mean GDS scores. In addition, SP women scored worse than SP men with respect to learning and memory. Mean log HIV viral load was higher and the frequency of non-detectable virus was lower for SP women than for SP men. Among SP women there was a borderline statistically significant correlation between sCD163 levels and GDS, and sCD14 levels were higher for impaired SP women than for non-impaired SP women. Viral load was higher for impaired SP men than non-impaired men and did not differ for impaired versus non-impaired SP women. Conclusions: Gender can have a significant impact on the occurrence of NCI among HIV infected individuals in Nigeria. This association appears to be linked to specific immune and viral factors, which require further study.

Assessment of HTLV-I proviral load, HIV viral load and CD4 T cell count in infected subjects; with an emphasis on viral replication in co-infection.

HTLV-I and HIV virus quantification is an important marker for assessment of virus activities. Since there is a direct relationship between the number of virus and disease progression, HTLV-I and HIV co-infection might have an influence on the development of viral associated diseases, thus, viral replication of these viruses and co-infection were evaluated. In this study, 40 subjects were selected; 14 HIV infected, 20 HTLV-I infected and 6 HTLV-I/HIV co-infected subjects. The amount of viruses was measured using qPCR TaqMan method and CD4 and CD8 lymphocytes were assessed by flow cytometry. The mean viral load of HIV infected subjects and HTLV-I infected individuals were 134626.07±60031.07 copies/ml and 373.6±143.3 copies/10(4) cells, respectively. The mean HIV viral load in co-infected group was 158947±78203.59 copies/ml which is higher than HIV infected group. The mean proviral load of HTLV-I in co-infected group was 222.33±82.56 copies/ml which is lower than HTLV-I infected group (P<0.05). Also, the mean white blood cell count was higher in co-infected group (5666.67±1146.49 cells/μl). However, the differences between these subjects did not reach to a statistical significance within 95% confidence interval level (P =0.1). No significant differences were observed regarding CD4 and CD8 positive lymphocytes between these groups. HTLV-I/HIV co-infection might promote HIV replication and could reduce the HTLV-I proviral load, in infected cells. Considering the presence of both viruses in Khorasan provinces, it encourages researchers and health administrators to have a better understanding of co-infection outcome.

Positive affect promotes engagement in care after HIV diagnosis.

Revised Stress and Coping Theory proposes that positive affect serves adaptive functions, and its beneficial effects are heightened during stressful periods. This study examined the prospective relationship between positive affect and engagement in care during the 18 months after a HIV seropositive diagnosis. The Coping, HIV, and Affect Interview (CHAI) cohort study enrolled 153 individuals who had recently received a HIV seropositive diagnosis. Using logistic and linear regression, baseline positive affect was examined as a predictor of linkage to HIV care, antiretroviral therapy (ART) persistence (i.e., starting ART and remaining on it during subsequent follow-up assessments), and mean log₁₀ HIV viral load over follow-up. After controlling for education, T-helper (CD4+) count, HIV viral load, and negative affect, higher baseline positive affect independently predicted increased odds of linkage to HIV care at 3 months postdiagnosis (adjusted OR [AOR] = 1.10; 95% CI = 1.01-1.21) and ART persistence over the 18-month follow-up period (AOR = 1.08; 95% CI = 1.01-1.16). Positive affect was not directly associated with lower mean HIV viral load over follow-up. However, one standard deviation higher positive affect indirectly predicted 6.7% lower HIV viral load via greater odds of ART persistence (βindirect = -0.18, p < .05). Greater positive affect predicts linkage to HIV care and ART persistence. ART persistence, in turn, is associated with lower HIV viral load. Clinical research is needed to examine whether interventions designed to enhance positive affect can boost the effectiveness of HIV treatment as prevention.

Falls in HIV-infected patients: a geriatric syndrome in a susceptible population.

Falls is a common geriatric syndrome that has not been well characterized in HIV-infected populations. We retrospectively reviewed our database and identified patients who fell over the last 12 months. Thirty-two patients were identified (incidence rate of 16 × 1000 patients per year). Twenty-five percent were female and 75% male. Sixty-seven percent were African American with 33% Caucasians. Average age was 48.19, number of years with HIV infection on average was 9.38 years, mean CD4 count 347.2 cell/mm(3), mean HIV viral load was 31 379 copies/mL. The average number of medications was 8.7 with a mean of 3.48 comorbidities. The mean vitamin D level was 27.20. Sixty-two percent of patients were compliant with antiretroviral therapy. Univariate and multivariate analysis showed that number of medications (< .005 medications; P < .005), more than 3 comorbidities (P < .005), and noncompliance (P < .001) were related to falls in this population. Falls is a common geriatric syndrome. Associated risk factors in our cohort included number of medications, more than 3 comorbidities, and noncompliance. Larger studies are needed to properly characterize this geriatric syndrome in HIV-infected patients. As HIV-infected populations age, a shift into a more comprehensive geriatrics care including fall risk evaluation may be needed.

High acceptability of cognitive screening in HIV‐infected patients: a pilot study

With combined antiretroviral therapy (cART) life expectancy of HIV-infected persons is close to the one of non-infected persons. Identifying neurocognitive deficits in ageing HIV-infected individuals is important. This study aimed to evaluate the acceptability of screening neurocognitive deficits in HIV-infected patients. Thirty patients (26 men, 4 women) from the HIV clinic were examined with a new screening test and an in-depth neuropsychological examination. The screening tests consisted of questions and examinations on cognition in everyday situations, mood and selected cognitive functions (word list memory, grooved pegboard, psychomotor speed, trail-making test, psychomotor speed and executive functions, digit symbol test). Also, patients received a questionnaire to evaluate test acceptance. The mean age of the patients was 52.5 (30–74) years, mean education 12.5 (8–18) years. Seven patients had HIV-stage CDC A, 12 B and 11 CDC stage C. The mean CD4 count was 657 cells/µl, the mean HIV viral load<20 cop./µl. All patients were treated with cART (7 with efavirenz). The screening test was done assisted by a nurse and lasted 26 minutes (mean). The screening indicated pathological signs of neurocognitive function in 11 (42%) patients. The in-depth neuropsychological assessment revealed pathological conditions in 25 (83%) of patients; i.e. 16 (53%) patients had ANI (asymptomatic neurocognitive impairment), 8 (27%) had MND (mild neurocognitive disorder) and 1 (3%) had HAD (HIV-associated dementia). Most patients (43.3%) judged the test as not too difficult and 56.6% as partly difficult. 96.6% of patients viewed the instructions of nurses as clear, 3.3% as unclear. 93.3% felt the test has not affected privacy and 83.3% estimated the screening as valuable and not worriesome. 83.4% of all patients were interested in their results and for none of the patients the test was too long. The test acceptability by the study nurses was also good. Only in 3.4% of tested persons they judged the test as too difficult for the patient. In 86.7% of tests they estimated the screening as valuable and in again 86.7% as not worrisome. For none of the nurses the test duration was too long. Only 16.6% of the patients had a completely normal neurocognitive testing. A short screening test lasting less than half an hour to search neurocognitive disorders assisted by a nurse is widely accepted by patients and nurses.

Tuberculosis among HIV-1-infected subjects in a tertiary out-patient service in São Paulo city, Brazil

TB is currently considered to be the most important infectious disease among HIV-1-infected subjects in developing countries, such as Brazil. A retrospective analysis of TB cases was performed, occurring from January 1995 to December 2010 in our cohort of 599 HIV positive patients. The primary outcome was the occurrence of active TB. Forty-one TB cases were diagnosed over this period of 16 years, among 599 HIV positive patients in an open cohort setting in the city of Sao Paulo, Brazil. All-time lowest mean CD4 T cell count at the time of TB diagnosis was 146 and 186 cells/mm³, respectively. The mean HIV viral load was 5.19 log10 copies/mL, and 59% of the patients were on HAART. TB incidence was 1.47 per 100 person-years, for a total follow-up time of 2775 person-years. The probability of surviving up to 10 years after diagnosis was 75% for TB patients as opposed to 96% for patients with other, non-TB opportunistic diseases (p = 0.03). TB can be considered a public health problem among people living with HIV in Brazil despite of the widespread use of antiretrovirals for the treatment of HIV infection/AIDS.

Short Communication: Methicillin-ResistantStaphylococcus aureusInfections in Children and Young Adults Infected with HIV

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) infections, in particular with Panton-Valentine leukocidin (PVL)-positive strains, has not been well characterized in children and young adults with HIV infection. It is not known if PVL-positive strains of MRSA cause an increased morbidity in this population compared to PVL-negative strains. The purpose of this study was to retrospectively analyze the epidemiology of PVL-positive and PVL-negative MRSA infections in children and young adults with HIV from 2000 to 2007. Molecular typing was performed by polymerase chain reaction (PCR) for detection of the PVL genes. Staphylococcus Cassette Chromosome (SCC) mec and spa typing were performed on all PVL-positive isolates. The number of HIV patients with MRSA infection increased significantly between 2000 and 2007 ( p=0.0015). Twenty seven (87%) of the 31 MRSA isolates were from skin and soft tissue infections (SSTI). Clindamycin resistance was observed in 19% of the MRSA isolates. PVL-positive isolates bearing the type IV SCC mec element comprised 16 of 31 (52%) MRSA isolates. All the PVL-positive isolates belonged to the USA300 pulsed-field type. There was no difference in the mean CD4 count and HIV viral load between patients with PVL-positive and PVL-negative MRSA infections. PVL-positive MRSA infections were associated with more SSTI ( p=0.043) but not with increased morbidity or a higher risk of complications compared to PVL-negative MRSA infections in children and young adults with HIV.

Plasma Levels of VCAM-1, ICAM-1, E-Selectin, and P-Selectin in 99 HIV-Positive Patients Versus 51 HIV-Negative Healthy Controls

Plasma Levels of VCAM-1, ICAM-1, E-Selectin, and P-Selectin in 99 HIV-Positive Patients Versus 51 HIV-Negative Healthy Controls

HIV-associated prostate cancer

16089 Background: HIVpositive men being treated with highly active antiretroviral therapy (HAART) are living longer. As a result, these ageing patients are more likely to develop non-AIDS defining cancers such as prostate cancer. The aim of this study was to characterize HIV-infected patients diagnosed and treated for prostate carcinoma. Methods: A retrospective, multi-institutional study involving HIV positive men with concomitant prostate carcinoma. We caputred data on demographics, HIV status, PSA level, symptoms/signs, radiologic findings, Gleason score, stage, cancer treatment, and outcome (response, survival). Data was analyzed using descriptive statistics. Results: 17 patients (8 White, 3 Black, 2 Hispanic, 1 Haitian, 2 unknown race) with HIV-associated prostate carcinoma that were of mean age 59 years (range, 46 to 79). Mean CD4 count was 336 cells/mm3 (range 24 to 759) and mean HIV viral load 17,319 copies/ml (range, undetectable to >100,000). 14 (82%) of these men were receiving HAART. Most patients were diagnosed with carcinoma following an abnormal screening PSA. Mean PSA in this group was 30 ng/mL (range, 4.5 to 77; median 20). Only 6 (35%) men had an abnormal prostate on exam. The mean Gleason score was 6.8 (range 6 to 8), and in most cases cancer was confined to the prostate gland (stage T1 in 64%; 1 case had bone metastases). Most patients were amenable to curative treatment with either hormonal therapy (used alone in 2 cases), radiation (brachytherapy only in 3 cases), and/or prostatectomy (resection alone in 3 cases). Besides hot flushes in 4 men after hormonal therapy, there were no serious side effects. One patient remained untreated. All treated patients had a complete response (undetectable PSA). Most patients were long term survivors. Documented death in 5 cases was unrelated to prostate cancer. Conclusion: Management of HIV-positive men with prostate carcinoma in is becoming increasingly important. Our data shows that in men receiving HAART, their age, PSA levels, clinical presentation, management, and outcome from treated prostate carcinoma does not appear to be significantly altered by HIV status. Therefore, we recommend that patients with prostate cancer and well controlled HIV viremia be managed like their HIV negative counterparts. Further research related to screening for prostate cancer in this setting is required. No significant financial relationships to disclose.

Angiolipomas, a rare manifestation of HIV-associated lipodystrophy

Angiolipomas, a rare manifestation of HIV-associated lipodystrophy