People Living With HIV Research Articles

The impact of the COVID-19 pandemic on mental health care utilization among people living with HIV: A real-world data study.

The COVID-19 pandemic has profoundly impacted mental health worldwide, particularly among vulnerable populations such as people living with HIV (PLWH). However, large-scale, real-world data on mental health care utilization and associated factors among PLWH remain limited. This study leveraged electronic health records (EHR) and Basics survey data from the All of Us program to explore mental health care utilization and associated factors among PLWH during the COVID-19 pandemic. Using a retrospective cohort design, we identified and included 4,575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) concept sets from the All of Us program between March 2018 and March 2022. Mental health care utilization was measured using the yearly count of mental health care visits over this period. The pattern of mental health care utilization was compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRR) from the Poisson generalized linear mixed models (GLMM) were used to examine associations between mental health care utilization, history of COVID-19 infection, demographic factors, pre-existing chronic conditions (e.g., hypertension, diabetes), and socioeconomic status. Among 4,575 PLWH, the annual number of mental health care visits decreased significantly during the pandemic period (March 2020 - March 2022) compared to the pre-pandemic period (March 2018 - February 2020) (IRR = 0.89, p < 0.001). The Poisson regression analysis found that a history of COVID-19 infection was associated with a higher number of mental health care visits (IRR = 1.35, p < 0.001). Middle-aged groups with participants aged 30-39 (IRR= 2.35, p = 0.002), 40-49 (IRR= 3.49, p < 0.001), and 50-64 (IRR= 2.07, p = 0.004) had significantly higher visit numbers compared to the youngest group (18-29 years). Black or African American participants were less likely to have visits compared to White participants (IRR = 0.71, p = 0.002). Medicaid health insurance was associated with an increase (IRR = 1.29, p = 0.007), while employer- or union-sponsored insurance was associated with a decrease in mental health care utilization (IRR = 0.54, p < 0.001, p < 0.001). Pre-existing comorbidities greatly increased the number of mental health care visits (one comorbidity: IRR = 5.49, two or more: IRR = 10.4, p < 0.001). Our study reveals a significant decrease in mental health care utilization and the diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. These findings underscore the importance of addressing disparities in mental health care access, particularly during public health emergencies, and suggest the need for tailored interventions to meet the mental health care needs of PLWH.

Real-world treatment outcomes for Hodgkin lymphoma in South Africa: a prospective observational study

BackgroundProspective data from sub-Saharan Africa suggests that treatment outcomes for people living with HIV (PWH) with Hodgkin lymphoma (HL) are similar to those without HIV. However, real-world data from high-resource settings and retrospective studies from sub-Saharan Africa, suggest inferior outcomes. We set out to evaluate the real-world treatment outcomes for HL in South Africa to better understand the disparate outcomes.MethodsWe established a prospective, observational cohort of newly diagnosed, adult (≥ 18 years) HL cases recruited from Chris Hani Baragwanath Academic and Netcare Olivedale Hospitals in Johannesburg, South Africa between March 2021 and March 2023. Participants were followed for up to 18 months after enrollment with data censored on December 23rd, 2023. The primary endpoint was 1-year overall survival.ResultsWe enrolled 47 participants with HL including 31 PWH and 16 HIV-negative. Advanced stage disease and B symptoms were common at time of diagnosis irrespective of HIV status. Bone marrow biopsy, performed during the work-up and evaluation of cytopenias, provided the initial diagnosis of HL in 16/31 (52%) PWH. HIV status and bone marrow involvement were associated with early mortality (within 3 months of diagnosis) and a poorer 1-year overall survival from diagnosis (HIV: 55% vs. 88%; p = 0.03; bone marrow involvement: 50% vs. 80%; p = 0.02). Among evaluable participants, those that received at least 6 cycles of chemotherapy and underwent response assessment, there was no difference between those with and without HIV.ConclusionTraditional laboratory markers of poor prognosis including anemia, lymphopenia and hypoalbuminemia were more common among PWH and those with bone marrow involvement and suggest high risk disease. A better understanding of the drivers of these aggressive presentations is warranted to ensure more PWH are able to tolerate chemotherapy.

Incidence of non-alcoholic fatty liver disease in antiretroviral therapy-naïve people with human immunodeficiency virus who start DTG/ABC/3TC compared to BIC/FTC/TAF at 48-week follow-up.

To determine the incidence of non-alcoholic fatty liver disease (NAFLD) by non-invasive methods in people living with HIV (PLWH). Prospective cohort, in PLWH naïve to antiretroviral therapy, starting bictegravir (BIC) or dolutegravir (DTG) at the Hospital de Infectología "La Raza", in Mexico City, from February 2021 to August 2023. We measured at baseline and 48weeks triglycerides and glucose index (TyG), fatty liver index (FLI), hepatic steatosis index (HSI) and liver ultrasonography; relative risk (RR) for developing NAFLD was determined. At 48weeks, TyG index in BIC-group 4.54 (IQR 4.36-4.75), in DTG-group 4.66 (IQR 4.49-4.80), p = .080; HSI in BIC-group 30.30 (IQR 28.12-33.70), in DTG-group 30.85 (IQR 28.02-34.50), p = .650; FLI in BIC-group 14.88 (IQR 7.91-31.80), in DTG-group 19.49 (IQR 8.49-32.28), p = .729; NAFLD was detected by US in 6 [10.3% (95%CI 4.8%-20.7%)] in BIC-group and, 7 [10.9% (95%CI 6.4%-20.9%)] in DTG-group, p = .916. Risk factors for NAFLD development were baseline BMI ≥25kg/m2, baseline HDL-c <40mg/dL, and FIB-4 >1.3 at 48weeks. There is a high incidence of NAFLD in PLWH who start a second generation INSTI at 48weeks; baseline overweight, low HDL-cholesterol and FIB-4 >1.3 at 48weeks of treatment were independent risk factors for NAFLD development.

A hybrid type II effectiveness-implementation trial of a positive emotion regulation intervention among people living with HIV engaged in Ryan White Medical Case Management: protocol and design for the ORCHID study

BackgroundThe Ryan White Medical Case Management System, which serves more than half of people living with HIV (PLWH) in the USA, is an opportune setting for identifying and addressing depression among PLWH. A growing body of research suggests that interventions that promote positive emotion may lessen symptoms of depression and improve physical and psychological well-being among people experiencing a variety of health-related stress, including living with HIV. Research on how best to integrate standardized mental health screening and referral to evidence-based interventions in Ryan White Medical Case Management settings has the potential to improve the health and wellbeing of PLWH.MethodsThis mixed-methods study will enroll up to N = 300 Ryan White clients who screen positive for depressive symptoms in ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), a web-based, self-guided positive emotion regulation intervention. The study will be conducted in 16 Ryan White Medical Case Management clinics in Chicago, IL. Following pre-implementation surveys and interviews with Medical Case Managers (MCMs) and Supervisors to develop an implementation facilitation strategy, we will conduct a hybrid type 2 implementation-effectiveness stepped wedge cluster randomized trial to iteratively improve the screening and referral process via interviews with MCMs in each wedge. We will test the effectiveness of ORCHID on depression and HIV care outcomes for PLWH enrolled in the program. RE-AIM is the implementation outcomes framework and the Consolidated Framework for Implementation Research is the implementation determinants framework.DiscussionStudy findings have the potential to improve mental health and substance use screening of Ryan White clients, decrease depression and improve HIV care outcomes, and inform the implementation of other evidence-based interventions in the Ryan White Medical Case Management System.Trial registrationClinicalTrials.gov NCT05123144. Trial registered 6/24/2021

Assessing the Disruption of Health Services During the COVID-19 Pandemic Among Adults Living With HIV by Age in Essex County, NJ: A Cross-Sectional Study.

At the onset of the COVID-19 pandemic, clinicians and researchers were concerned about its impact on the health of people living with HIV (PLWH). Although mitigation measures during the early part of the pandemic used telehealth, it was uncertain whether PLWH would be amenable to this type of care and whether health outcomes would be affected. PLWH actively seeking treatment at a large urban outpatient practice in Essex County, New Jersey, were interviewed from October 2020 to June 2021 about their health-related experiences during COVID-19. The sample was dichotomized by age (< 55 and ≥ 55). In all, participants (69.2%, n = 92) used telehealth during this period, 85.0% (n = 113) actively tested for COVID-19, with only 7% (n = 8) testing positive at the time of interview. Our findings demonstrate that PLWH who engaged with health care before the COVID-19 pandemic continued doing that and had relatively favorable health outcomes with few differences by age.

Risk of COVID-19 hospitalisation by HIV-status and SARS-CoV-2 vaccination status during pre- and post-Omicron era in a national register-based cohort study in Sweden

Background Data on the outcomes of COVID-19 in people living with HIV (PLHIV), specifically in relation to vaccination status, are lacking during the Omicron era. Methods This nationwide registry-based study included all resident in Sweden ≥18 years with a positive SARS-CoV-2 PCR test during January 2021–February 2023. We estimated adjusted odds ratios (adjOR) for COVID-19 hospitalisation and severe COVID-19 (ICU admission and 90-day mortality), categorised by SARS-CoV-2 vaccination status (0–1, 2, and ≥3 doses), and HIV-status. Analyses were then categorised by time periods of pre-Omicron, Omicron during public testing, and Omicron after public testing. Results 1348 PLHIV and 1 669 389 people without HIV (PWoH) were included. PLHIV were older, more migrant (65 vs. 22%) and male (59 vs. 46%). Of PLHIV, 96% were on antiretroviral treatment and 94% virally suppressed. AdjORs of COVID-19 hospitalisation were similar irrespective of HIV-status, controlled for demographics, calendar month of infection, comorbidities, and income. PLHIV were more likely to be hospitalised than PWoH during Omicron and public testing (adjOR 2.3, 95% CI 1.1–4.2), but not after public testing. The odds of severe COVID-19 were three times higher in PLHIV compared to PWoH vaccinated with 2 doses (adjOR 3.2, 95% CI 1.3–6.9), but not when vaccinated with ≥3 doses (adjOR 0.7, 95% CI 0.2–1.6). Migrant and low nadir CD4+ T-cells were associated with higher odds of hospitalisation in unvaccinated PLHIV. Conclusions This nationwide study, including mostly well-treated PLHIV, highlights the importance of vaccination with booster dose/s for effective protection against severe COVID-19 in PLHIV. KEY POINT People living with HIV compared to people without HIV did not have higher odds of COVID-19 hospitalisation irrespective of SARS-CoV-2 vaccination status (0–1 dose, 2 doses, ≥3 doses) when adjusting for known risk factors including comorbidities and socioeconomic status.

Perceived Stress and Health Outcomes Among Latinx and Non-Latinx White Adult People With HIV in East Harlem, New York: A Cross-Sectional Study.

Stress and HIV disproportionately affect Latinx adults in the United States, contributing to numerous health inequities. Among people living with HIV (PLWH), increased stress is associated with decreased medication adherence, effectiveness, and higher rates of immunosuppression and comorbidities. Our study (N = 126) examined the relationship between perceived stress and HIV-related health among Latinx (n = 83) and non-Latinx White (n = 43) PLWH. Latinx PLWH reported better HIV-related health outcomes than non-Latinx White PLWH, despite higher viral load (all p's < .05). An interaction effect showed that higher perceived distress was associated with worse health outcomes and lower CD4+ T cell count only in Latinx PLWH (p's < .05). Our findings highlight the consequences of stress on HIV-related health. Notably, higher stress may be especially detrimental among Latinx PLWH, underscoring the need for more culturally tailored interventions in HIV-related care. Future research should include additional sociocultural factors and longitudinal assessment in a larger sample.

Exploring the role of galectin-9 and artemin as biomarkers in long COVID with chronic fatigue syndrome: links to inflammation and cognitive function.

This study aimed to assess plasma galectin-9 (Gal-9) and artemin (ARTN) concentrations as potential biomarkers to differentiate individuals with Long COVID (LC) patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) from SARS-CoV-2 recovered (R) and healthy controls (HCs). Receiver operating characteristic (ROC) curve analysis determined a cut-off value of plasma Gal-9 and ARTN to differentiate LC patients from the R group and HCs in two independent cohorts. Positive correlations were observed between elevated plasma Gal-9 levels and inflammatory markers (e.g. SAA and IP-10), as well as sCD14 and I-FABP in LC patients. Gal-9 also exhibited a positive correlation with cognitive failure scores, suggesting its potential role in cognitive impairment in LC patients with ME/CFS. This study highlights plasma Gal-9 and/or ARTN as sensitive screening biomarkers for discriminating LC patients from controls. Notably, the elevation of LPS-binding protein in LC patients, as has been observed in HIV infected individuals, suggests microbial translocation. However, despite elevated Gal-9, we found a significant decline in ARTN levels in the plasma of people living with HIV (PLWH). Our study provides a novel and important role for Gal-9/ARTN in LC pathogenesis.

Viral load non-suppression among adolescents and youth living with HIV in South Africa.

Despite the increased initiation and uptake of antiretroviral therapy (ART) in South Africa, some people living with HIV (PLHIV) who are on ART still have non-suppressed viral load (VL). This study aimed to determine the prevalence of VL non-suppression among adolescents and youth (aged 12 years - 24 years) living with HIV and on ART in South Africa, as well as the factors associated with it. Data from the 2017 South African national HIV prevalence, incidence, behaviour, and communication survey were analysed. The survey used a multistage-stratified cluster sampling design. A backward stepwise multivariable generalised linear model was used to identify factors associated with VL non-suppression. The study included 340 participants aged 12 years - 24 years, with a median age of 21 (interquartile range [IQR]: 18-23). The proportion of adolescents and youth living with HIV and on ART with non-suppressed VL was 19.2% (95% confidence interval [CI]: 14.4-25.3). Approximately 60% of the participants were not on ART. The odds of VL non-suppression were significantly higher among youth aged 15 years - 19 years (adjusted odds ratio [AOR] = 1.63 [95% CI: 1.24-2.13], p = 0.001) and aged 20 years - 24 years (AOR = 1.22 [95% CI: 1.06-1.41], p = 0.005) compared to adolescents aged 12 years - 14 years. The odds were significantly lower among individuals of other races (AOR = 0.80 [95% CI: 0.69-0.92], p = 0.003) compared to black African people. Findings suggest a need for ART education and counselling as part of treatment support. In addition, the promotion of HIV awareness as part of strengthening the HIV treatment and prevention cascade. The article showed the prevalence of VL non-suppression and associated factors among adolescents and youth.

Utility of an Archival Dried Blood Spot (DBS) Collection from HIV-Infected Individuals with and without Cancer in a Resource-Limited Setting.

The frequency of virus-associated cancers is growing worldwide, especially in resource-limited settings. One of the biggest challenges in cancer research among people living with HIV (PLWH) has been understanding how infection with both HIV and Kaposi sarcoma-associated herpesvirus (KSHV) promotes the pathogenesis of Kaposi sarcoma (KS), the most common cancer among PLWH worldwide and a significant public health problem in regions with high prevalence of HIV such as Sub-Saharan Africa (SSA). The AIDS and Cancer Specimen Resource (ACSR) provides samples for research, including dried blood spots (DBS) that were collected from large clinical epidemiology studies of KSHV and KS in PLWH conducted more than a decade ago in SSA. Here, we validated the quality of DNA derived from DBS samples from SSA studies and provided evidence of quantitative recovery of inflammatory cytokines using these DBS samples through comparison with paired frozen plasma. Significant differences in DNA, protein yields, and inflammatory biomarker levels were also observed between PLWH with/without KS. Establishing the fitness of DBS samples for studies of KS pathogenesis extends the number of projects that can be supported by these ACSR special collections and provides evidence that DBS collection for future KS research is a practical option in resource-limited settings.

Prevention of adverse HIV treatment outcomes: machine learning to enable proactive support of people at risk of HIV care disengagement in Tanzania

ObjectivesThis study aimed to develop a machine learning (ML) model to predict disengagement from HIV care, high viral load or death among people living with HIV (PLHIV) with the goal...

ANAL CANCER SCREENING PRACTICES AMONG HIGHER-RISK POPULATIONS IN AN ACADEMIC MEDICAL SYSTEM.

While some experts recommend anal cancer screening for disproportionally affected populations including people living with HIV (PWH), condyloma acuminata, human papillomavirus (HPV)-associated gynecologic dysplasia and cancers, and solid organ transplants, actual screening practices remain understudied. Our objective was to characterize anal cancer screening practices among higher-risk populations in an academic medical system with access to high-resolution anoscopy (HRA). We extracted outpatient clinical data for the above populations from 01/01/2015 - 08/01/2022 at three sites of an academic medical system. Data included patients' demographics, medical comorbidities, and anal cytology and HPV testing results. We used chi-squared tests and logistic regression to assess for associations between patient characteristics and anal cancer screening. Of 7654 patients, 6.3% received anal cytology screening at least once including 21.7% of PWH, 13.8% of people with condyloma acuminata, 1.1% of people with gynecologic cancers, and 0.5% of people with solid organ transplants. In multivariable analysis, Black patients were 46% less likely to receive screening than white patients (95% confidence interval [CI] 0.40-0.71), and cisgender women were 73% less likely to receive screening than cisgender men (95% CI 0.20-0.38). Of 485 individuals who received anal cytology screening, 37.5% were only screened once and 70.5% had abnormal cytology on one or more screenings. Only one-fifth of PWH received anal cancer screening and other higher-risk populations had even lower screening rates. Black patients and women were also less likely to be screened. Strategies to improve equitable screening practices for anal cancer are needed.

A Confirmatory Factor Analysis of the NIH Emotions Toolbox Among People Living with HIV and Who May Use Methamphetamine.

The National Institutes of Health Toolbox Emotion Battery (NIHTB-EB) was developed to provide researchers and clinicians with a concise tool for measuring emotional health. The NIHTB-EB has been validated and normed in English and Spanish-speaking populations in the United States. However, its application in certain groups, such as people living with HIV (PWH) and who may use methamphetamine has not been tested. This paper evaluates the factor structure in a sample of people without HIV and PWH who may or may not use methamphetamine. The sample included 773 adults ages 18 to 87. The factorial structure of the NIHTB-EB was examined using confirmatory factor analysis (CFA) in the full sample and among four subgroups based on HIV status and methamphetamine use. The CFA confirmed a three-factor structure that mirrors the previously validated structure with latent factors measuring negative affect, social relationships, and psychological well-being for three subgroups. While each latent factor was confirmed in all groups, we could not confirm, with confidence, the full battery in the smallest subgroup (HIV-seronegative participants who use methamphetamine). The three-factor NIHTB-EB is appropriate for use among PWH who may use methamphetamine, but further examination with larger samples is warranted.

Photogallery. HIV infection and neoplastic skin diseases

Malignant neoplasms constitute a group of the most important secondary diseases that develop in people infected with the human immunodeficiency virus (HIV). The first neoplastic disease described in HIV-infected patients is Kaposi's sarcoma. In contrast to other types of Kaposi's sarcoma, its epidemic (AIDS-associated) type is more common in young and middle-aged HIV-positive individuals, especially among men who have same-sex sex. Epidemic Kaposi's sarcoma does not have a favourite localisation. However, there is a tendency to lesions of the scalp (face, ear flaps), upper extremities, anogenital area, oral mucosa. On the trunk, the pathological process spreads along the Langer lines. Skin rashes are represented by spotty, papular, nodular elements of red-brown or purple colour. The aggressive course is characteristic: rapid dissemination and generalisation of rashes. Plasmoblastic lymphoma is associated with immunodeficiency states and is rare. The tumour lesion is usually located in the oral cavity. Few cases of plasmoblastic lymphoma with skin and soft tissue involvement have been described in the literature. Squamous cell skin cancer in the context of HIV infection is a dangerous disease. In people living with HIV, it manifests at a significantly earlier age and is associated with a high risk of local recurrence. The extent of invasion and the likelihood of metastasis are influenced by HIV-associated immunodeficiency. In the vast majority of cases, risk factors and clinical manifestations of basal cell skin cancer do not differ from those in immunocompetent individuals. Basal cell carcinomas rarely metastasise. Nevertheless, metastatic forms lead to unfavourable outcome. Here is a photo gallery of cases of neoplastic skin lesions developed in HIV-positive patients.

Sleep actigraphy results and HIV health outcomes in an urban HIV clinic sample

ABSTRACT Sleep disorders are prevalent and interfering conditions that affect people living with HIV (PLWH) at higher rates than the general population. Lower quality sleep has been associated with poorer health-related quality of life and immune function in PWH, though sleep is typically assessed subjectively. The current study aimed to examine the association between objective sleep/wake patterns measured via actigraphy with HIV outcomes. Participants (N = 87) were recruited from a public, urban HIV clinic located in the Southeastern United States. Participants were instructed to wear actigraphy monitors for one week (Range: 5–8 days). Log viral load and absolute CD4 were obtained via medical chart review. Linear regression analyses predicting HIV RNA Viral Load (log transformed) and CD4 Count were employed with three actigraphy sleep variables: sleep efficiency, wake after sleep onset (WASO), and sleep quantity. Backward entry regression with both significant actigraphy predictors, sleep efficiency and WASO, included as predictors resulted in sleep efficiency remaining in the model and WASO being removed. Separate models revealed that each one-unit increase in sleep efficiency was associated with a b = 0.032-point decrease in the log-transformed HIV RNA viral load (p = 0.03) and for each one-unit increase in wake after sleep onset (WASO) was associated with a b = 0.35-point increase in the log-transformed HIV RNA viral load (p = 0.04). Sleep quantity, however, was not, and none were associated with absolute CD4 count. The findings add to the evidence for an association of objectively measured poorer sleep efficiency being associated with higher HIV RNA viral load. Implications for clinical practice include assessing and addressing sleep efficiency as part of comprehensive clinical HIV care.

Abstract C176: Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination

Abstract Background: Globally, Caribbean countries are among the most heavily burdened by both HIV and cervical cancer (CCA). People living with HIV (PLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in PLWH. Objective: A preliminary quality improvement evaluation of the vaccination program targeting PLWH in Trinidad and Tobago from October 2018 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract HPV vaccination data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 5,615 PLWH were eligible to participate in the HPV Vaccination clinic from October 2018 to May 2024. The average age was 39.6 (age range: 18- 51); 51.4% were women and 48.6% were men. Most (81.7%) PLWH reported their sexual orientation was heterosexual. Among our participants, 62.4% were Afro-Caribbean, 18.6% were Mixed, and 7.4% were East Indian/Indian. The majority of PLWH completed at least secondary education (69.8%). Half were single (50.5%), and 42.1% were employed/self-employed. Among these HPV vaccine-eligible persons, 1,157 patients (20.6%) received HPV vaccines. For those who had received vaccines, 254 patients (22.0%) were vaccinated with at least 1dose of the HPV vaccine, 301 (26.0%) were vaccinated up to dose 2 HPV vaccine, and 602 (52.0%) were vaccinated up to dose 3 HPV vaccine. Importantly, of those who received the HPV vaccine, the rate of uptake varied for each year. The uptake of HPV vaccine from January to May 2024 was 10.5% and in 2023 it was 18.5%. The highest uptake was in 2021 which was 22.4% followed by that in 2022 which was 20.3%. Between 2018 and 2020, the uptakes were 13.7% for 2020, 12.1% for 2019, and 5.3% for 2018. Discussion: Overall, the HPV vaccination rate for PLWH was relatively low; only 1 in 5 was vaccinated. Still, we saw an interesting trend with the highest vaccination uptake during the peak years of COVID-19 vaccinations. Hence, our data suggest that the COVID-19 vaccination program may have boosted HPV vaccination. Given our lessons learned, our goal is to seek funding for an implementation and dissemination science approach for adopting, implementing, and sustaining clinic-based HPV-related cancer prevention by bundling services such as Pap-Testing, PSA testing and/or co-vaccination (e.g., flu, shingles) to improve reach and uptake towards reducing cancer-related morbidity and mortality among PLWH. Citation Format: Tessa Galindo, Jonathan Edwards, Gaole Song, Sharon Soyer, Selena Todd, Gregory Boyce, Kimlin Ashing, Jeffrey Edwards. Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C176.

Abstract A013: Factors associated to tobacco smoking and electronic cigarette use among a Hispanic sample of persons living with HIV in Puerto Rico, Mexico, and San Francisco

Abstract Introduction: People living with HIV (PLWH) are at greater risk of developing conditions related to tobacco smoking, given their increased use of tobacco products. A higher prevalence of electronic cigarette use among PLWH than the general population has been also reported. This study assessed factors associated with tobacco smoking and electronic cigarette use among a Hispanic sample of PLWH in Puerto Rico (PR), Mexico, and San Francisco (SF). Methods: Data from an ongoing cross-sectional study (May 2023 – May 2024) of oral HPV infection among a sample of PLWH ≥21 years old in PR [n=211 (women: 26%, men: 74%)], Mexico [n=30 (women: 90%, men: 10%)], and SF [n=18 (women: 11%, men: 89%)] was analyzed. Eligibility criteria included being a participant in the CAMPO study (NCI#U54CA242646). People who agree to participate in the oral HPV study complete an interview that collects sociodemographic and clinical characteristics, and relevant clinical procedures. Chi-squared test, Fisher exact test, and logistic regression models were used to evaluate factors associated with current smoking and electronic cigarette use. Results: Mean age (years) was 51.0±12.7 SD in PR, 37.2±8.8 SD in Mexico, and 61.2±10.4 SD in SF. History of AIDS diagnosis was 18.1% in PR, 13.3% in Mexico and 37.5% in SF. In PR, 24.2% were current smokers, 8.6% were current users of electronic cigarettes, and 2.8% used both. In Mexico, 33.3% were current smokers, 3.3% were current users of electronic cigarettes, and 3.3% used both. In SF, 16.7% were current smokers, 22.2% were current users of electronic cigarettes, and 5.6% used both. Regarding other behavioral characteristics, 53.1% in PR, 26.7% in Mexico, and 44.4% in SF reported current alcohol intake and 19.0% in PR, 6.7% in Mexico, and 33.3% in SF reported current marihuana use. In PR, Mexico, and SF, the prevalence of lifetime non-injected drug use was 52.9%, 30.0%, and 66.7%, respectively, while the prevalence of injected drug use was 10.4%, 0.0%, and 16.7%, respectively. In the multivariable logistic regression model adjusted for tobacco consumption, persons with history of injection drug use (OR=1.23; 95% CI 1.04-1.50), and non-injection drug use (OR=1.14; 95% CI 1.03-1.27) had higher odds to be current smokers than their counterparts. Meanwhile, people who report current marihuana use had higher odds of electronic cigarettes use (OR=1.14, 95% CI: 1.04-1.26) in comparison to their counterparts. No significant differences were observed by sex-at-birth, age, and site of recruitment. Conclusion: Our results showed a high prevalence of tobacco consumption among Hispanics living with HIV in PR, Mexico, and San Francisco. Higher odds of tobacco consumption were observed among people with a history of drug use. Similarly, higher odds of electronic cigarette use were observed among people who reported marijuana consumption. These results highlight the need for smoking cessation interventions among high-risk population, such as PLWH with a history of drug use. Acknowledgment: NIDCR Grant #R56DE032668-01, NCI Grant #U54CA242646. Citation Format: Sandra I. Garcia-Camacho, Jeslie M. Ramos-Cartagena, Josue Perez-Santiago, Frances E. Vazquez-Sanchez, Michael A. Santiago-Marrero, Jorge Salmeron, Joel Palefsky, Ana P. Ortiz. Factors associated to tobacco smoking and electronic cigarette use among a Hispanic sample of persons living with HIV in Puerto Rico, Mexico, and San Francisco [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A013.

The risk of dyslipidemia on PLHIV associated with different antiretroviral regimens in Huzhou

Background Dyslipidemia is increasingly common in people living with HIV (PLHIV), thereby increasing the risk of cardiovascular events and diminishing the quality of life for these individuals. The study of blood lipid metabolism of PLHIV has great clinical significance in predicting the risk of cardiovascular disease. Therefore, this study aims to examine the blood lipid metabolism status of HIV-infected patients in Huzhou before and after receiving highly active antiretroviral therapy (HAART) and to explore the impact of different HAART regimens on dyslipidemia. Method PLHIV confirmed in Huzhou from June 2010 to June 2022 was included. The baseline characteristics and clinical data during the follow-up period were collected, including some blood lipid indicators (total cholesterol and triglycerides) and HAART regimens. A multivariate logistic regression model and the generalized estimating equation model were used to analyze the independent effects of treatment regimens on the risk of dyslipidemia. Result The overall prevalence of dyslipidemia among PLHIV after HAART was 70.11%. PLHIV receiving lamivudine (3TC) + efavirenz (EFV) + zidovudine (AZT) had a higher prevalence of dyslipidemia compared to those receiving 3TC+EFV+tenofovir disoproxil fumarate (TDF). In a logistic analysis adjusted for important covariates such as BMI, age, diabetes status, etc., we found that the risks of dyslipidemia were higher with 3TC+EFV+AZT (dyslipidemia: odds ratio [OR] = 2.09, 95% confidence interval [Cl]: 1.28–3.41; TG ≥1.7: OR = 2.40, 95%Cl:1.50–3.84) than with 3TC+EFV+TDF. Furthermore, on PLHIV that was matched 1:1 by the HAART regimens, the results of the generalized estimation equation again showed that 3TC+EFV+AZT (TG ≥1.7: OR = 1.84, 95%Cl: 1.10–3.07) is higher for the risk of marginal elevations of TG than 3TC+EFV+TDF. Conclusion The prevalence of dyslipidemia varies according to different antiretroviral regimens. Using both horizontal and longitudinal data, we have repeatedly demonstrated that AZT has a more adverse effect on blood lipids than TDF from two perspectives. Therefore, we recommend caution in using the 3TC+EFV+AZT regimen for people at clinical risk of co-occurring cardiovascular disease.

Factors associated with completion of intensive adherence counseling among people living with HIV at a large referral hospital in Uganda: a retrospective analysis

BackgroundAmong people living with HIV(PHIV) with unsuppressed viral load after six or more months of anti-retroviral therapy (ART), three intensive adherence counseling sessions (IAC) sessions are recommended. However, there is limited information about IAC completion rates. We investigated the factors associated with IAC completion among PLHIV with an unsuppressed viral load on first and second-line ART in mid-western Uganda.MethodsIn this retrospective review of medical records, we abstracted routine HIV data between January 2018 and September 2019 at the Fort Portal Regional Hospital. IAC completion was the primary outcome measured as the receipt of ≥ 3 consecutive good ART adherence scores of ≥ 95.0% during the IAC sessions, spaced one month apart within three months. The modified Poisson regression analysis with robust standard errors was used to determine factors associated with the outcome, reported as risk ratio (RR) and 95% confidence interval (CI).ResultsWe studied 420 participants of whom 204 (48.6%) were aged 20–39 years (mean age, 33.6 ± 13.3 years) and 243 (57.9%) were female. 282 (67.1%) participants completed their IAC sessions. Secondary or higher levels of education (Adjusted RR (aRR) 0.79, 95% CI 0.64–0.98), no follow-up for IAC (aRR 0.76, 95% CI 0.67–0.87), malnutrition (aRR 0.65, 95% CI 0.43–0.99) were associated with a lower likelihood of IAC completion while being in a separated/widowed or divorced relationship (aRR 1.23, 95% CI 1.01–1.49) was associated with a higher likelihood of IAC completion.ConclusionsWe found a low IAC completion rate compared to the desired target of 100%. Nutritional support for malnourished PLHIV receiving IAC, follow-ups, and targeted health education on the importance of IAC are needed to improve the IAC completion rate.

Beyond the 95s: What happens when uniform program targets are applied across a heterogenous HIV epidemic in Eastern and Southern Africa?

The UNAIDS 95-95-95 targets are an important metric for guiding national HIV programs and measuring progress towards ending the HIV epidemic as a public health threat by 2030. Nevertheless, as proportional targets, the outcome of reaching the 95-95-95 targets will vary greatly across, and within, countries owing to the geographic diversity of the HIV epidemic. Countries and subnational units with a higher initial prevalence and number of people living with HIV (PLHIV) will remain with a larger number and higher prevalence of virally unsuppressed PLHIV—persons who may experience excess morbidity and mortality and can transmit the virus to others. Reliance on achievement of uniform proportional targets as a measure of program success can potentially mislead resource allocation and progress towards equitable epidemic control. More granular surveillance information on the HIV epidemic is required to effectively calibrate strategies and intensity of HIV programs across geographies and address current and projected health disparities that may undermine efforts to reach and sustain HIV epidemic control even after the 95 targets are achieved.