Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States

Hall, H. Irene; Frazier, Emma L.; Rhodes, Philip; Holtgrave, David R.; Furlow-Parmley, Carolyn; Tang, Tian; Gray, Kristen Mahle; Cohen, Stacy M.; Mermin, Jonathan; Skarbinski, Jacek

doi:10.1001/jamainternmed.2013.6841

Cited by 320 publications

(312 citation statements)

References 24 publications

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“…3), the AVAMC model had statistically greater proportions in all stages of the cascade ( p < 0.001). The AVAMC IDC VL suppression rate of 52.3% was 33.3% higher than the national estimate presented by Gardner et al 8 and 27.0% higher than the national estimate presented by Hall et al 9 ( p < 0.001).…”

Section: Mangal Rimland and Marconicontrasting

confidence: 52%

“…7 However, two national models have shown that there has been a failure of a significant percentage of PLHIV to progress to the next step in the continuum, with respective estimates of 19% and 25% virologic suppression among PLHIV in the United States. 8,9 This has resulted in the continuum of HIV care becoming a focus for introduction of interventions aimed at improving the delivery of care for PLHIV.…”

Section: Introductionmentioning

confidence: 99%

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The Continuum of HIV Care in a Veterans' Affairs Clinic

Mangal

Rimland²,

Marconi³

2014

AIDS Research and Human Retroviruses

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The cascade of HIV care in the United States has become a focus for interventions aimed at improving the success of HIV treatment. The Atlanta VA Medical Center (AVAMC) Infectious Disease Clinic (IDC) is an urban clinic that provides care for over 1,400 people living with HIV (PLHIV) annually. Using data from the HIV Atlanta VA Cohort Study (HAVACS), we modeled the continuum of care in the AVAMC IDC and explored similarities and differences with national models. We conducted a cross-sectional analysis of 1,474 individuals receiving care in the AVAMC IDC. We estimated total PLHIV and defined several categories within the spectrum of HIV care. We then developed the continuum of care using two methodologies. The first required each stage to be a dependent subset of the immediate upstream stage. The second allowed each stage to be independent of upstream stages. Dependent stage categorization estimated that 95.3% of individuals were diagnosed with HIV, 89.8% of individuals were linked to care, 73.0% of individuals were retained in care, 65.9% of individuals were eligible for antiretroviral treatment (ART), 62.8% were prescribed ART, and 52.4% had a suppressed viral load (VL). Independent stage categorization estimated that 83.9% of individuals were prescribed ART and 61.5% had a suppressed VL. Our analyses showed that the AVAMC IDC estimates were significantly better than national estimates at every stage. This may reflect the benefits of a universal healthcare system. We propose the use of independent stages for the continuum as this more accurately represents healthcare utilization.

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Section: Mangal Rimland and Marconicontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

The Continuum of HIV Care in a Veterans' Affairs Clinic

Mangal

Rimland²,

Marconi³

2014

AIDS Research and Human Retroviruses

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“…[71][72][73][74][75][76][77] Interestingly, this finding is not explained by differences in virological response, as older HIV-infected patients tend to have a superior virological outcome when compared with younger patients. [78][79][80][81][82][83] Some suggests that these finding may be linked with higher adherence in older patients, 78,[84][85] but other authors reported a higher risk of inadequate adherence in HIV patients who have other comorbidities and take other medications besides HAART. [86][87] While virological response seems not to be influenced by age, at least biologically, older patients have lower CD4C T-cell gain compared with younger persons, [88][89][90][91][92][93][94][95] even when adjusted for antiretroviral therapy regimens.…”

Section: Clinical Outcomementioning

confidence: 99%

Immunosenescence and hurdles in the clinical management of older HIV-patients

2017

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People living with HIV (PLWH) who are treated with effective highly active antiretroviral therapy (HAART) have a similar life expectancy to the general population. Moreover, an increasing proportion of new HIV diagnoses are made in people older than 50 y. The number of older HIVinfected patients is thus constantly growing and it is expected that by 2030 around 70% of PLWH will be more than 50 y old. On the other hand, HIV infection itself is responsible for accelerated immunosenescence, a progressive decline of immune system function in both the adaptive and the innate arm, which impairs the ability of an individual to respond to infections and to give rise to long-term immunity; furthermore, older patients tend to have a worse immunological response to HAART.In this review we focus on the pathogenesis of HIV-induced immunosenescence and on the clinical management of older HIV-infected patients.

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“…It has been estimated that, of all the HIV‐infected individuals in the USA, approximately 14% are unaware of their infection, and only 19% to 30% are virally suppressed 2, 3.…”

Section: Introductionmentioning

confidence: 99%

Sweden, the first country to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90‐90‐90 continuum of HIV care targets

et al. 2016

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ObjectivesThe Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90‐90‐90 goals propose that 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy (ART), and 90% of those should have durable viral suppression. We have estimated the continuum of HIV care for the entire HIV‐1‐infected population in Sweden.MethodsThe Swedish InfCare HIV Cohort Study collects viral loads, CD4 counts, and viral sequences, along with demographic and clinical data, through an electronic clinical decision support system. Almost 100% of those diagnosed with HIV infection are included in the database, corresponding to 6946 diagnosed subjects living with HIV‐1 in Sweden by 31 December 2015.ResultsUsing HIV surveillance data reported to the Public Health Agency of Sweden, it was estimated that 10% of all HIV‐infected subjects in Sweden remain undiagnosed. Among all diagnosed patients, 99.8% were linked to care and 97.1% of those remained in care. On 31 December 2015, 6605 of 6946 patients (95.1%) were on ART. A total of 6395 had been on treatment for at least 6 months and 6053 of those (94.7%) had a viral load < 50 HIV‐1 RNA copies/mL.ConclusionsThe 2014 UNAIDS/WHO 90‐90‐90 goals for HIV care means that > 73% of all patients living with HIV should be virologically suppressed by 2020. Sweden has already achieved this target, with 78% suppression, and is the first country reported to meet all the UNAIDS/WHO 90‐90‐90 goals.

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Differences in Human Immunodeficiency Virus Care and Treatment Among Subpopulations in the United States

Cited by 320 publications

References 24 publications

The Continuum of HIV Care in a Veterans' Affairs Clinic

The Continuum of HIV Care in a Veterans' Affairs Clinic

Immunosenescence and hurdles in the clinical management of older HIV-patients

Sweden, the first country to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 90‐90‐90 continuum of HIV care targets

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