Racial/ethnic differences in CD4 T cell count and viral load at presentation for medical care and in follow-up after HIV-1 infection

Swindells, Susan; Cobos, Daniel; Lee, Nancy; Lien, Elizabeth A.; Fitzgerald, A; Pauls, Jennifer S.; Anderson, James R.

doi:10.1097/00002030-200209060-00020

Cited by 28 publications

(29 citation statements)

References 10 publications

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“…HIV-infected YMSM initiated ART only if they tested positive and an appropriate amount of time had passed since their exposure to the HIV infection, reflecting current access to treatment and treatment levels 30,37 (online Appendix section SDC 3.2). We assumed that on average all outside partners stratified by race and sex have the same HIV prevalence 31,32 .…”

Section: Methodsmentioning

confidence: 99%

A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men

Beck

Birkett

Armbruster

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Young men who have sex with men (YMSM) in the U.S. have a high HIV incidence with substantial racial disparities that are poorly understood. We use a data-driven simulation model to understand the impact of network-level mechanisms and STI infections on the spread of HIV among YMSM. Methods We designed and parameterized a stochastic agent-based network simulation model using results of a longitudinal cohort study of YMSM in Chicago. Within this model, YMSM formed and dissolved partnerships over time, and partnership-types were stratified by length of partnership, sex and age of the partner. In each partnership, HIV, gonorrhea and chlamydia could be transmitted. Counterfactual scenarios were run to examine drivers of HIV. Results Over a 15 year simulation, the HIV epidemic among YMSM continued to rise with Latino/White YMSM facing a steeper increase in the HIV burden compared to Black YMSM. YMSM in partnerships with older MSM, in particular Black YMSM with older Black MSM, were at highest risk for HIV and one infection prevented with an older partner would prevent 0.8 additional infections among YMSM. Additionally, racial disparities in HIV were driven by differences in the HIV prevalence of YMSM partners. Finally, of all HIV infections among YMSM, 14.6% were attributable to NG and CT infections. Conclusion Network-level mechanisms and STI infections play a significant role in the spread of HIV, and in racial disparities among YMSM. HIV prevention efforts should target YMSM across race, and interventions focusing on YMSM partnerships with older MSM might be highly effective.

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Section: Methodsmentioning

confidence: 99%

A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men

Beck

Birkett

Armbruster

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Under each of the eligibility standards tested, the CD4 cell count-based approach prioritized patients with CD4 cell counts near or less than 200 cells/mL and served a greater proportion of nonwhite individuals, non-English speakers, and unemployed persons-people who have historically had reduced access to HIV care [6][7][8][9][10][11]. Given that there have been recent calls to standardize ADAP coverage [4,14,15], our findings raise the question of whether ADAPs should abandon the first-come, first-served approach.…”

Section: Discussionmentioning

confidence: 99%

“…The order in which individuals apply to ADAP, however, may not be random. Nonwhite persons in the United States are likely to have HIV infection diagnosed later in the course of disease than are white persons [6,12,18], and they are less likely to start antiretroviral therapy [7,8,11,19,20]. Delays in diagnosis and treatment lead directly to delays in applying to ADAP and increase the time that an individual lives with HIV infection before being accepted to the program.…”

Section: Discussionmentioning

confidence: 99%

“…The first-come, first-served approach is administratively expedient, but it may exclude patients with advanced HIV disease in favor of patients at a lower risk of mortality. Furthermore, because nonwhite persons in the United States tend to learn of their HIV infection later in the course of disease than do white persons, the first-come, first-served approach may limit access to care for historically underserved populations [6][7][8][9][10][11][12].…”

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confidence: 99%

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Optimizing Resource Allocation in United States AIDS Drug Assistance Programs

Linas

Zheng

Losina

et al. 2006

Clinical Infectious Diseases

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“…Although this is not an explicit model of treatment-as-prevention interventions, treatment is initiated for most men when they have been diagnosed and infected long enough to have an expected CD4+ count that matches levels observed in practice at treatment initiation in the US [38,39] (as opposed to assuming that treatment guidelines are universally met). Thus, diagnosis is a necessary but not sufficient condition for initiating treatment.…”

Section: Methodsmentioning

confidence: 99%

Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California

Khanna

Goodreau

Wohlfeiler

et al. 2015

Annals of Epidemiology

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Purpose In this paper, we examine the effectiveness of a variety of HIV diagnosis interventions that utilize the preventive potential of post-diagnosis behavior change (PDBC) in recently HIV-diagnosed men who have sex with men (MSM), as measured by reduction in number of new infections. Empirical evidence for PDBC was presented in the behavioral sub-study of the Southern California Acute Infection and Early Disease Research Program (AIEDRP). In previous modeling work, we demonstrated the existing preventive effects of PDBC. However, a large proportion of new infections among MSM are either undiagnosed or diagnosed late, and the preventive potential of PDBC is not fully utilized. Methods We derive empirical stochastic, network-based models to examine the effectiveness over a 10 year period of several diagnosis interventions that account for PDBC among MSM. These interventions involve tests with shorter detection windows, more frequent testing, and individualized testing regimens. Results We find that individualized testing interventions (i.e. testing individuals every 3 partners or 3 months, whichever is first, or every 6 partners or 6 months, whichever is first) result in significantly fewer new HIV infections than the generalized interventions we consider. Conclusions This work highlights the potential of individualized interventions for new public health policies in HIV prevention.

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Racial/ethnic differences in CD4 T cell count and viral load at presentation for medical care and in follow-up after HIV-1 infection

Cited by 28 publications

References 10 publications

A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men

A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men

Optimizing Resource Allocation in United States AIDS Drug Assistance Programs

Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California

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