Category Archives: HIV care

Neurological manifestations of HIV

Dr Faktorovich, Department of Neurology, Icahn School of Medicine, Mt Sinai, New York, NY

From Neurologytimes.com

Human immunodeficiency virus (HIV) is responsible for a wide spectrum of neurological manifestations, with etiologies ranging from inflammatory, infectious, neoplastic. and more. The development of antiretroviral therapy (ART) has dramatically increased life expectancy, however neurological complications remain a significant cause of long-term disability. Understanding and recognizing these conditions is crucial in effectively managing HIV.

Dr Svetlana Faktorovich, Department of Neurology, Icahn School of Medicine, explains the various forms of neurological manifestations of HIV in this Neurologytimes.com article.

How Truvada helped propel the evolution of LGBT health

From The Advocate online

In light of the progress we’ve made over the past decades, it’s tempting to think that we are only steps away from a cure and that our previous advances will protect younger LGBTQ people for generations. While it’s empowering to feel confident in our current position, it is essential that we remember that all of this is fragile. According to a recent statistic from the Centers for Disease Control and Prevention, HIV and AIDS remain persistent problems globally. We’ve come a long way in preventing and treating HIV, but there is still much more to accomplish. Annual HIV infections and diagnoses are declining in the U.S., but progress has been uneven, and annual infections and diagnoses have increased among some groups. The declines can thankfully be attributed to targeted HIV prevention efforts, such as Truvada.

Read the full article.

By 2030, top cancers among people with HIV expected to be prostate and lung

From POZ Magazine online

By 2030, the most common cancers among people with HIV are projected to be prostate and lung cancer.

Publishing their findings in the Annals of Internal Medicine, researchers analyzed data from the National Cancer Institute’s HIV/AIDS Cancer Match study, modeling cancer diagnosis rates during 2000 to 2012 to make projections about how rates will change from 2013 to 2030.

The U.S. HIV population is steadily aging, thanks to effective antiretroviral treatment. In 2006, an estimated 27 percent of the population was age 50 or older, a proportion that increased to 45 percent in 2014. Between 2010 and 2030, the proportion of the population age 65 and older is expected to increase from 8.5 percent to 21.4 percent, while the proportion that is age 45 to 64 is expected to increase from 39.4 percent to 47.7 percent.

Between 2000 and 2012, the 463,300 HIV-positive adults in the HIV/AIDS Cancer Match Study were diagnosed with 23,907 cancers. During this period, the annual diagnosis rates (known as incidence) declined for Kaposi sarcoma (KS), non–Hodgkin lymphoma (NHL), cervical cancer, anal cancer (among men who have sex with men), lung cancer, Hodgkin lymphoma and other cancers among all age types. Colon cancer incidence decreased among those age 65 and older. Meanwhile, prostate cancer incidence increased among men ages 35 to 64.

Overall, cancer incidence among the U.S. HIV population is expected to decline through the next decade.

Among three AIDS-defining cancers, the estimated numbers of diagnoses seen in the U.S. HIV population in 2010 and projected to occur in 2020 and 2030, respectively, according to the study authors’ analysis were: 8,150, 7,490 and 6,690 diagnoses of NHL; 1,490, 750 and 450 diagnoses of KS; and 120, 50 and 30 diagnoses of cervical cancer.

As for non-AIDS-defining cancers, the respective numbers of diagnoses seen in 2010 and projected to occur in 2020 and 2030 were: 5,420, 6,150 and 5,980 diagnoses of lung cancer; 830, 910 and 1,030 diagnoses of prostate cancer; 750, 1,340, 1,590 diagnoses of anal cancer; 360, 460 and 480 diagnoses of liver cancer; 300, 200 and 120 diagnoses of Hodgkin lymphoma; 250, 320 and 340 diagnoses of oral cavity/pharyngeal cancer; 220, 260 and 260 diagnoses of breast cancer; 220, 230 and 200 diagnoses of colon cancer; and 1,910, 1,880 and 1,510 diagnoses of other types of cancers.

The study authors concluded that their findings stress the importance of expanding access to HIV treatment and cancer prevention, screening and treatment.

To read a press release about the study, click here.

To read the study abstract, click here.

HIV patients with depression face serious risks

From Reuters Health

The proportion of time patients with HIV spend depressed is directly related to their likelihood of missing doctor appointments, how well their infection is suppressed and their risk of death from any cause, according to a multi-site U. S. study.

In a large analysis of records for nearly 6,000 patients receiving HIV primary care across the country, the researchers found that for patients depressed during the entire study period, the risk of death was double that of patients with no depression.

Even shorter periods of time spent with depression were tied to increases in viral load, missed appointments and increased mortality, researchers report in JAMA Psychiatry.

“If we can shorten an HIV patient’s exposure to depression by picking it up early and treating it well using evidence based protocols, we can make a difference in their outcomes,” said lead author Brian W. Pence, an associate professor of epidemiology at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.

This is the first time that the impact of cumulative depression has been studied across the whole HIV care continuum, Pence told Reuters Health in a telephone interview.

The results suggest that even short-term, mild depression can have“meaningful negative outcomes on HIV treatment and survival,” Pence and colleagues write.

An estimated 1.1 million people in the U. S. were living with HIV at the end of 2015, according to the latest statistics from the Centers for Disease Control and Prevention. Between 20 percent and 40 percent of people living with HIV also have depression, Pence noted.

“We need to find better ways to integrate mental health care into chronic disease care . . . There’s good evidence that primary care providers and non-specialists can be as effective as psychiatrists using assertive dosing schedules.”

Read the full article.

Free continuing education for clinicians caring for people with HIV

CDC’s MMWR and Medscape are proud to introduce a new FREE continuing education (CE) activity that describes diagnosis delay among persons infected with HIV: Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays — United States.

This activity is intended for infectious disease clinicians, family medicine specialists, internists, nurses, pharmacists, public health officials, and other clinicians caring for patients with or at risk for HIV infection.

Upon completion of this activity, participants will be able to:

  1. Describe diagnosis delay among persons infected with HIV, based on an analysis of data from the Centers for Disease Control and Prevention’s National HIV Surveillance System, and missed opportunities for HIV testing, based on CDC’s National HIV Behavioral Surveillance.
  2. Identify the proportions of persons in various high-risk populations who tested for HIV in the past 12 months.
  3. Determine the clinical and public health implications of these findings regarding HIV testing, missed opportunities for testing, and diagnosis delay among persons infected with HIV.

To access this FREE MMWR / Medscape CE activity visit https://www.cdc.gov/mmwr/cme/medscape_cme.html. If you are not a registered user on Medscape, please register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

HIV care continuum: Effects of depression, alcohol use on early retention in ART

From Infectiousdiseaseadvisor.com

Both alcohol use and depression are associated with increased disengagement from antiretroviral therapy for patients with HIV in South Africa, according to the results of a recent study published in PLoS ONE.

In this prospective cohort study, 136 people living with HIV in South Africa who were initiating antiretroviral therapy were enrolled. Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, and alcohol use disorder was evaluated with the CAGE questionnaire. Researchers also measured internalized stigma and quality of life in participants. The associations between mental health variables and 6-month retention in care and viral suppression were evaluated.

Read the full article here.

HIV and your brain (HIV-Associated Neurocognitive Disorder)

From Poz Magazine online

HIV-associated dementia (known as HAD or AIDS dementia complex, ADC) is rarely diagnosed. However, recent evidence suggests that HIV is still affecting people’s brains—even when HIV levels are undetectable in the blood.

This is certainly no reason to panic. So far, it appears that HIV-associated neurocognitive disorder (HAND) is so mild that people don’t notice it. Often, it can only be picked up with extensive neurological and psychological testing. What’s more, some evidence suggests that people who take ARVs that pass into the brain might be less prone to develop neurocognitive problems.

There is still much we need to understand about how HIV affects the brain in people with well-controlled disease: How common it is, which people are most vulnerable to HIV-related brain damage, and whether and how quickly it can progress from a mild disorder to one that is more serious. Researchers are hard at work to answer these questions and to determine whether there are medications that can slow or minimize HIV-related neurocognitive problems.

In the meantime, there are things that you can do—such as minimizing heavy alcohol and substance use, treating depression and anxiety, and getting physical exercise—to help keep the brain healthy and functioning well. This lesson will help you understand HAND and the latest thinking on how common it is and how it might be prevented or treated.

Read the full article on Poz.com.