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Trends in HIV Care

Trends in HIV Care

The National Health and Nutrition Examination Survey (NHANES) has provided statistics on the health and nutritional status of non-institutionalized, civilian Americans through household interviews and standardized physical examinations since 1971. Beginning in 1999, approximately 5,000 people are examined every year, with data publically released every 2 years. Monitoring national trends in HIV prevalence and associated risk factors using NHANES data can help increase understanding of the health behaviors and characteristics influencing these trends. Doing so, however, requires assessing data over a period of many years because of the relatively low prevalence of HIV in the general population. For a report published by the CDC, Geraldine M. McQuillan, PhD, and colleagues assessed NHANES data from 2007 to 2012 in order to describe the association of HIV status with key risk factors and examine the prevalence of antiretroviral therapy (ART) use among HIV-infected adults. “For NHANES, people aged 18 to 59 in the general population are surveyed in 15 communities every year,” explains Dr. McQuillan. “A questionnaire asks about demographics, including age, race/ethnicity, household income, and health conditions. Participants also undergo a complex examination that includes phlebotomy to test for, among other things, HIV.” Due to the low prevalence of HIV in the general population, Dr. McQuillan and colleagues could only assess a few measurements among those with the infection. These included, gender, age, race/ethnicity, education, poverty index, and health insurance status. Other factors assessed in the study included whether or not patients had received healthcare in the past 12 months, the number of lifetime sexual partners, the presence of the herpes simplex antibody, a same-sex sexual contact history, a sexually...
Needle Exchange Cuts HIV Transmission

Needle Exchange Cuts HIV Transmission

Research has shown that needle exchange programs can effectively lower the risk of HIV transmission among injection drug users. In 1988, Congress passed legislation prohibiting the use of federal funding for any activities associated with needle exchange. While states and localities were able to use their own revenue to fund such programs, in 1998, the United States Congress passed legislation prohibiting the District of Columbia from using its municipal revenue to fund these programs. Until Congress lifted the ban in 2007, these policies limited access to needle exchange in the city.   A Big Impact “Following the policy change in Washington, DC, it was important to determine whether or not it was going to make a difference,” says Monica S. Ruiz, PhD, MPH. “Clinicians need to know the impact of this policy change on people’s ability to access services.” For a study published in AIDS and Behavior, Dr. Ruiz and colleagues used existing surveillance data from the Department of Health in Washington, DC from September 1996 through December 2011 to project the impact of needle exchange access on the number of new HIV cases associated with injection drug use (IDU). “We used mathematical modeling to estimate the number of infections there would have been without the policy change in order to see if there was a significant difference between that and the number of cases that actually occurred,” Dr. Ruiz explains. “Interrupted time series analyses were used to control for other factors, such as HIV-focused educational campaigns.” The investigators estimated that about 120 infections were averted as a result of the policy change. In the 2 years following the...
CME: Examining AIDS-Defining Opportunistic Infections

CME: Examining AIDS-Defining Opportunistic Infections

Studies have shown that AIDS-defining opportunistic infection (AIDS-OIs) were a leading cause of mortality and morbidity among patients with HIV prior to the advent of antiretroviral therapy (ART) in 1997. Despite substantial improvements in the treatment of HIV and OIs during the last 2 decades, data indicate that OIs remain a major contributor of HIV-related morbidity and mortality. Previous research has provided unclear results regarding the outcomes of HIV patients with OIs, and few were population-based. Recent estimates of survival following an AIDS-OI in the United States are lacking.   OI Survival Analysis To examine whether survival following an OI has improved with advancements in HIV treatment, John T. Brooks, MD, and colleagues had a study published in the Journal of Infectious Diseases. The authors used HIV surveillance data to estimate survival probabilities after a first OI diagnosis among adults with AIDS in San Francisco during three treatment eras: 1981-1986, 1987-1996, and 1997-2012. “Most patients meet the AIDS criteria from a national surveillance perspective based on their CD4 cell count,” explains Dr. Brooks, “but the San Francisco Department of Public Health has continuously monitored the clinical courses of all people infected with AIDS in the city, including survival after an OI.” The health department has collected data on initial and subsequent OIs—as well as CD4 cell counts, viral loads, immunizations received—and demographic information for nearly 21,000 patients through follow-ups approximately every 18 to 24 months. “We found that survival has markedly increased following an AIDS-OI since 1981,” says Dr. Brooks (Figure). “The 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012.” The researchers suspect that this...
Examining AIDS-Defining Opportunistic Infections

Examining AIDS-Defining Opportunistic Infections

Studies have shown that AIDS-defining opportunistic infection (AIDS-OIs) were a leading cause of mortality and morbidity among patients with HIV prior to the advent of antiretroviral therapy (ART) in 1997. Despite substantial improvements in the treatment of HIV and OIs during the last 2 decades, data indicate that OIs remain a major contributor of HIV-related morbidity and mortality. Previous research has provided unclear results regarding the outcomes of HIV patients with OIs, and few were population-based. Recent estimates of survival following an AIDS-OI in the United States are lacking.   OI Survival Analysis To examine whether survival following an OI has improved with advancements in HIV treatment, John T. Brooks, MD, and colleagues had a study published in the Journal of Infectious Diseases. The authors used HIV surveillance data to estimate survival probabilities after a first OI diagnosis among adults with AIDS in San Francisco during three treatment eras: 1981-1986, 1987-1996, and 1997-2012. “Most patients meet the AIDS criteria from a national surveillance perspective based on their CD4 cell count,” explains Dr. Brooks, “but the San Francisco Department of Public Health has continuously monitored the clinical courses of all people infected with AIDS in the city, including survival after an OI.” The health department has collected data on initial and subsequent OIs—as well as CD4 cell counts, viral loads, immunizations received—and demographic information for nearly 21,000 patients through follow-ups approximately every 18 to 24 months. “We found that survival has markedly increased following an AIDS-OI since 1981,” says Dr. Brooks (Figure). “The 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012.” The researchers suspect that this...
The Effects of HAART on HBV

The Effects of HAART on HBV

Research has shown that highly active antiretroviral therapy (HAART) can decrease the risk of acquiring hepatitis B virus (HBV), regardless of a patient’s HIV infection status. Other studies have shown that men who have sex with men (MSM) are at increased risk for HBV infection. However, data on the effects of HAART on incident HBV infection in MSM who are infected and not infected with HIV are limited. “Little is known about how the rates of incident HBV infection changed from the era prior to HAART availability through the present day,” says Chloe Thio, MD. A Closer Look For a study published in Annals of Internal Medicine, Dr. Thio and colleagues sought to determine predictors of incident HBV infection in nearly 2,400 MSM in the Multicenter AIDS Cohort Study. Participants were not infected with HBV at baseline but had HIV or were at risk for contracting the virus. “The study was designed to understand more about how HAART affected new hepatitis B infection,” adds Dr. Thio. “Enrollment began in 1984, 12 years before HAART became available.” During more than 25,000 person-years of follow-up, 244 incident HBV infections occurred. Overall, unadjusted incidence rates of HBV infection were higher in HIV-infected participants than in those without HIV; rates were significantly lower during the HAART era than during the pre-HARRT era among those with and without HIV. “Most importantly, effective HAART that reduced HIV RNA levels to less than 400 copies/mL was protective against incident HBV infection independent of whether an anti-HBV drug was part of the HAART regimen,” says Dr Thio. During a median follow-up of 9.5 years, MSM with HIV...
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