The end of AIDS: HIV infection as a chronic disease

Deeks, Steven G.; Lewin, Sharon R.; Havlir, Diane V.

doi:10.1016/s0140-6736(13)61809-7

Cited by 1,600 publications

(1,372 citation statements)

References 95 publications

(103 reference statements)

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“…The rate of HIV infection among transwomen is higher than other at high risk groups, yet most tracking systems do not record data on trans people systematically [2,3]. Measurement of the HIV care cascade has played an important role in monitoring progress in test and treat strategies to curb the HIV epidemic and achieve the 90–90–90 goals [4]. The HIV cascade (or continuum) was developed by Gardner et al to measure HIV testing, linkage and retention in HIV care and viral suppression [5].…”

Section: Introductionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

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Introduction: Evidence suggests that, of all affected populations, transgender women (transwomen) may have the heaviest HIV burden worldwide. Little is known about HIV linkage and care outcomes for transwomen. We aimed to estimate population-level indicators of the HIV cascade of care continuum, and to evaluate factors associated with viral suppression among transwomen in Rio de Janeiro, Brazil. Methods: We conducted a respondent-driven sampling (RDS) study of transwomen from August 2015 to January 2016 in Rio de Janeiro, Brazil and collected data on linkage and access to care, antiretroviral treatment and performed HIV viral load testing. We derived population-based estimates of cascade indicators using sampling weights and conducted RDS-weighted logistic regression analyses to evaluate correlates of viral suppression (viral load ≤50 copies/mL). Results: Of the 345 transwomen included in the study, 89.2% (95% CI 55–100%) had been previously tested for HIV, 77.5% (95% CI 48.7–100%) had been previously diagnosed with HIV, 67.2% (95% CI 39.2–95.2) reported linkage to care, 62.2% (95% CI 35.4–88.9) were currently on ART and 35.4% (95% CI 9.5–61.4%) had an undetectable viral load. The final adjusted RDS-weighted logistic regression model for viral suppression indicated that those who self-identified as black (adjusted odds ratio [aOR] 0.06, 95% CI 0.01–0.53, p < 0.01), reported earning ≤U$160/month (aOR 0.11, 95% CI 0.16–0.87, p = 0.04) or reported unstable housing (aOR 0.08, 95% CI 0.01–0.43, p < 0.01) had significantly lower odds of viral suppression. Conclusions: Our cascade indicators for transwomen showed modest ART use and low viral suppression rates. Multi-level efforts including gender affirming care provision are urgently needed to decrease disparities in HIV clinical outcomes among transwomen and reduce secondary HIV transmission to their partners.

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Section: Introductionmentioning

confidence: 99%

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Jalil

Wilson

Luz

et al. 2017

Journal of the International AIDS Society

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“…This corresponds to other studies, which proved that an especially high threat of social rejection exists among PLWH, including deteriorating social status (Samson, Lavigne, & MacPherson, 2009). Notwithstanding, this finding may be interpreted in light of the great progress in HIV treatment, which resulted in HIV/AIDS being perceived as more of a chronic than a terminal condition; thus, psychosocial factors may be more important for well-being among PLWH compared to clinical variables (Deeks, Lewin, & Havlir, 2013). However, it should be noticed also that the study sample consists of highly functional PLWH with a CD4 level comparable to that of the general population (EACS, 2017), which may be the reason why almost all medical variables were not related to PTG among participants.…”

Section: Discussionmentioning

confidence: 96%

Social support and posttraumatic growth in a longitudinal study of people living with HIV: the mediating role of positive affect

Rzeszutek

2017

European Journal of Psychotraumatology

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Background: Psychological research in people living with HIV (PLWH) has been dominated by studies on the negative consequences of HIV infection. However, recently, positive changes following the diagnosis of HIV have been examined, namely the phenomenon of posttraumatic growth (PTG). Objectives: The aim of this one-year longitudinal study was to investigate the level of PTG and its relationship with social support dimensions (perceived support, need for support, actually received support) and positive and negative affect among PLWH. Specifically, this study explored the mediating role of positive and negative affect in the link between social support and PTG. Method: Participants filled out the following psychometric tools: Posttraumatic Growth Inventory (PTGI), Berlin Social Support Scales (BSSS) and Positive and Negative Affect Schedule (PANAS-X). Three assessments were performed. Altogether, 129 patients were recruited for the first assessment, 106 patients participated in the second assessment and 82 participants (63.6%) out of the initial sample of 129 participated in all three assessments. Results: The positive relationship between all examined social support dimensions and PTG was entirely mediated by positive affect. There was no association between negative affect and PTG. Selected socio-medical covariates (sex, employment, higher education, being in a stable relationship and HIV/AIDS status) were related to social support and PTG among participants. Conclusions: This study points to the need for more research on positive aspects of HIV/AIDS, notably PTG. More specifically, interventions focused on enhancement and sustainment of positive affect among PLWH should be an adjunct to traditional mental health screening among this patient group.

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“…Antiretroviral therapy (ART) improves health, prolongs survival, and reduces human immunodeficiency virus (HIV) transmission [1]. Nevertheless, ART-treated individuals living with HIV have greater non-AIDS morbidity and mortality than the general population [2].…”

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confidence: 99%

Asymptomatic CMV Replication During Early Human Immunodeficiency Virus (HIV) Infection Is Associated With Lower CD4/CD8 Ratio During HIV Treatment

et al. 2016

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Background. A low CD4/CD8 ratio in human immunodeficiency virus (HIV)-infected individuals is associated with inflammation and higher risk of non-AIDS morbidity and mortality. In this study, we investigated the effect of subclinical cytomegalovirus (CMV) and Epstein-Barr virus (EBV) replication on CD4 + and CD8 + T-cell dynamics when antiretroviral therapy (ART) is started during early infection.Methods. We investigated 604 peripheral blood mononuclear cell samples from 108 CMV-and EBV-seropositive HIV-infected men who have sex with men, who started ART within a median of 4 months from their estimated date of infection and were followed for a median of 29.1 months thereafter. Levels of CMV and EBV DNA were measured at each timepoint. Mixed-effects asymptotic regression models were applied to characterize CD4 + and CD8 + T-cell dynamics, and Bayesian hierarchical models were used to quantify individual differences in CMV and EBV DNA replication.Results. Higher levels of subclinical CMV replication were associated with lower predicted maximum levels of CD4/CD8 ratio (P < .05), which was driven by higher levels of CD8 + T-cell counts (P < .05), without affecting CD4 + T-cell counts (P > .1). Age was negatively associated with CD4/CD8 levels (P < .05), and this effect was independent of the CMV association (P < .05 for both CMV and age in a multivariate model).Conclusions. Subclinical CMV replication in blood cells during early HIV infection and younger age were associated with lower CD4/CD8 ratios during suppressive ART. These findings suggest that active CMV infection in the setting of treated HIV may represent an attractive potential target for therapeutic intervention.

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The end of AIDS: HIV infection as a chronic disease

Cited by 1,600 publications

References 95 publications

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

HIV testing and the care continuum among transgender women: population estimates from Rio de Janeiro, Brazil

Social support and posttraumatic growth in a longitudinal study of people living with HIV: the mediating role of positive affect

Asymptomatic CMV Replication During Early Human Immunodeficiency Virus (HIV) Infection Is Associated With Lower CD4/CD8 Ratio During HIV Treatment

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