Context.-Plasma human immunodeficiency virus type 1 (HIV-1) viral load and CD4 + cell count are used to predict prognosis of persons infected with HIV. However, whether combining these markers improves prognostic accuracy and whether they predict prognosis for injection drug users (IDUs) and nonwhite persons infected with HIV has not been extensively investigated. Objective.-To evaluate plasma viral load and CD4 + cell count as prognostic indicators for the acquired immunodeficiency syndrome (AIDS) and infectious disease deaths. Design.-Cohort study initiated in 1988 and 1989 with follow-up for up to 7.9 years. Participants.-Injection drug users infected with HIV recruited from the community in Baltimore, Md. Main Outcome Measures.-Plasma HIV-1 RNA and CD4 + cell count measured at baseline compared with time to first clinical AIDS diagnosis and death due to an infectious disease. Results.-Of 522 subjects, 96% were African American, 80% were male, 96% injected drugs within the past 6 months, and the median age was 33 years. A total of 146 cases of AIDS and 119 infectious disease deaths were seen during a median follow-up period of 6.4 years. Time-fixed baseline levels of viral load and CD4 + cell count were independent predictors of progression to AIDS and infectious disease deaths, but in proportional hazards models, viral load had better predictive value than CD4 + cell count. Kaplan-Meier analysis of time to AIDS and to infectious disease deaths by viral load (Ͻ500, 500-9999, 10 000-29 999, Ն30 000 copies/mL) at 3 levels of CD4 + cell count (Ͻ0.20, 0.20-0.49, and Ն0.50ϫ10 9 /L [Ͻ200, 200-499, and Ն500/µL]) was reduced to a 5-stage classification scheme using a backward stepwise regression procedure. The 5-year cumulative probabilities for AIDS and infectious disease deaths ranged from 0% and 0%, respectively, for group I (viral load, Ͻ500 copies/mL; CD4 + cell count, 0.50ϫ10 9 /L) to 81.2% and 76.1% respectively, for group V (viral load, Ն10 000 copies/mL; CD4 + cell count, 0.20ϫ10 9 /L). Conclusions.-In this study, plasma HIV-1 viral load independently and in combination with CD4 + cell count measurements provided powerful prognostic information for progression to AIDS and death caused by infectious disease in a population of predominantly African American IDUs. Combining categories of both markers provided a simple method for prognostically staging HIV disease.

Although high prevalence of hepatitis C virus (HCV) in correctional institutions

Historically, HIV studies have conflated men who have sex with men (MSM) with transgender (trans) women, explicitly excluded trans individuals, or included sample sizes of trans people that are too small to reach meaningful conclusions. Despite the heavy burden of HIV among trans women, conflation of this population with MSM has limited the information available on the social and behavioural factors that increase HIV vulnerability among trans women and how these factors may differ from MSM. Using data sets from quantitative studies among MSM (n = 645) and trans women (n = 89), as well as qualitative in-depth interviews with 30 trans women in Baltimore, we explore what these data tell us about similarities and differences in HIV vulnerability between the two groups and where they leave gaps in our understanding. We conclude with implications for data collection and intervention development.

Although both HIV-seropositive and HIV-seronegative women had high levels of use of medical services, current use of antiretrovirals and OI prophylaxis was low throughout, and IDUs used HIV-related primary health services less and were more likely to receive emergency or episodic care. IDU and African American race were independently associated with decreased use of medical services.