Category Archives: HIV care

Implementing rapid ART initiation to successfully manage HIV

As countries across the globe continue the fight against HIV, treatments that are quickly initiated and effective are crucial for getting patients with HIV virally suppressed both to improve their clinical outcomes and to stop the transmission of infection.

Addressing both of these issues, Mary Montgomery, MD, associate physician in the Division of Infectious Diseases at Brigham and Women’s Hospital, and an instructor of medicine at Harvard Medical School, discussed emerging treatment strategies for managing HIV during a session at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

More and more, clinicians are understanding the benefit of prescribing antiretroviral therapy (ART) to patients the day they are diagnosed with HIV, otherwise known as rapid ART initiation.

The literature has shown that rapid ART initiation is associated with a more favorable mortality profile, as well as quicker viral suppression. In one study,1 the median time to viral suppression was 56 days for those who initiated treatment at diagnosis, compared with 126 days for those who began treatment consistent with prior recommendations for universal ART and 219 days for those who received CD4-guided ART.

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Post a selfie to help end stigma

From plus online…

The campaign captures 24 hours in the lives of people affected by HIV stigma, which impacts everyone regardless of age, race, or status. The social media-driven campaign, now in its tenth year, is an opportunity for people to share a moment of their day and tell their story, while breaking down the barriers that stigma creates and raising awareness about HIV, as stated in a press release.

“Stigma can isolate and scare people,” said Positively Aware art director Rick Guasco, who created the campaign. “It can also prevent people from accessing care and treatment. A Day with HIV brings people together; it shows that we’re all affected by stigma, and that people living with HIV are just like everyone else.”

We encourage you to take a picture and post it to your social media with the hashtag #ADayWithHIV and include a caption that gives the time, location, and what inspired you to take the photo.

Images can also be uploaded to ADayWithHIV.com, where they will be considered for publication in a special section of the November/December issue of Positively Aware.

Check out some of last year’s photos

Celebrating those who are aging with HIV

From the LA Blade
by Frank Gulli

I was living in the Castro in San Francisco in 1978 where optimism and liberation were in the air. Harvey Milk was an openly gay City Supervisor, gays and lesbians marched in the street for equal rights, and gay liberation was on display from Folsom Street to Golden Gate Park.

Frank Gulli

There was a real sense of belonging to a community. Our world shook when Harvey Milk and Mayor Moscone were assassinated by former Supervisor Dan White that year. Then it shook again when San Francisco became ground zero of the AIDS epidemic.

By 1985, the city was full of heartbreak and dying. My friends and I lived among it, terrified that we would be next. I was diagnosed with HIV that year, forever making 1985 a pivotal year.

Many of my friends who hadn’t been tested for HIV ended up in the ER at San Francisco General in respiratory failure. I was blindsided as an entire group of my friends and neighbors seemed to disappear overnight. There were no medical treatments, other than some antibiotics that seemed to prolong death for many.

For whatever reason, maybe by the grace of God, or good Italian food, I don’t know, I never got sick from HIV and I held on to hope for a better day. But my life and times would never be the same as it was back in 1978, before the shooting death of Harvey, when we felt liberated, before AIDS wiped out my entire phonebook.

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Care providers reluctant to tell HIV patients *undetectable equals untransmittable*

From Medscape

WASHINGTON, DC — HIV treatment that leads to viral suppression for at least 6 months is 100% effective in preventing the transmission of HIV, even in the absence of condoms or HIV prevention drugs, according to the Centers for Disease Control and Prevention. But not all care providers tell their patients that.

A survey in the Midwest showed that 22% of HIV physicians still don’t feel comfortable explaining to patients the science behind what is known in the community as U=U, or undetectable equals untransmittable.

And that number is even higher among the physician assistants, nurse practitioners, advanced practice nurses, and traditional registered nurses who serve people living with HIV, said Emily Petran, MPH, from the Minnesota site of the Midwest AIDS Training and Education Center (MATEC) in Minneapolis.

The survey — which was more of a needs assessment than a scientific survey — points to the need for education so that people with HIV have all the information they need to care for themselves and their partners, she said here at the United States Conference on AIDS 2019.

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NIH bolsters funding for HIV implementation research in high-burden U.S. areas

From HIV.gov

The National Institutes of Health has awarded approximately $11.3 million to 23 institutions across the United States to collaborate with community partners to develop locally relevant plans for diagnosing, treating and preventing HIV in areas with high rates of new HIV cases.

The awards will help enhance the implementation science knowledge base needed for the proposed Ending the HIV Epidemic: A Plan for America. The plan aims to leverage the powerful data and tools now available to reduce new HIV diagnoses in the United States by 75 percent in five years and by 90 percent by 2030. President Donald J. Trump announced this bold new initiative during the State of the Union Address in February. If funds are appropriated by Congress, the 10-year initiative will begin in fiscal year 2020. The awards announced today are one-year awards to support pilot and formative studies to prepare for more extensive implementation science research proposals expected in 2020.

“With existing, powerful HIV treatment and prevention tools, we can end the epidemic in the United States,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. “The new initiative is a practical, achievable implementation plan. By working directly with health departments and other community organizations, researchers can find the best ways to use the highly effective methods at our disposal to diagnose, prevent and treat HIV in the United States.”

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Study: People with HIV more likely to have high blood pressure

From MyHIVteam

People with HIV are more likely than people without the virus to have high blood pressure, in part because of treatments and repercussions of the condition itself, a new review of research shows.

Learning more about the underlying mechanisms of high blood pressure in people with HIV is critical in preventing one of the leading conditions that can cause premature cardiovascular disease in those adults, the researchers said. The implications are important in a population that has seen the rate of people dying from heart disease and stroke skyrocket over the last decade.

“I think that we really need to pay special attention to this population,” said Dr. Sasha Fahme, the study’s lead author and a global health research fellow at Weill Cornell Medical College in New York City. “Now that people [with HIV] are living longer, we are seeing the non-infectious consequences of HIV, and hypertension [high blood pressure] is one of them.”

In the Weill Cornell Medicine-led research review, published May 18 in the American Heart Association journal Hypertension, Fahme and her colleagues included 24 medical articles published between 2005 and 2017 that looked at high blood pressure among adults with HIV and those who didn’t have the virus. The study populations included the United States, Brazil, China, Italy, Tanzaniaand other countries.

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Living with HIV

From U.S. News and World Report

According to the Centers for Disease Control and Prevention, an estimated 1.1 million people in the United States are living with HIV. In 2017, 38,739 people received an HIV diagnosis, and when they first heard the word “positive,” many were thrust into feelings of anger, sadness, denial and fear.

“There are some people who suspect they are HIV-positive but go a very long time without testing, and then there are other people who test for whatever reason and turn out positive,” says Mallory Johnson, a clinical psychologist and professor at the University of California–San Francisco School of Medicine and co-director of the NIH-funded Center for AIDS Prevention Studies. “Those tend to be the extremes of the experience.” Disbelief and shock, Johnson says, are the most common responses.

Of those living with the virus in the U.S., about 14%, or 1 in 7, are unaware of their infection. HIV weakens the immune system by destroying cells meant to combat infection and disease; AIDS is the final stage of the infection, when the immune system has been severely damaged. Not all HIV-positive individuals will develop AIDS – antiretroviral therapies and other medications now allow people with the virus to live long, healthy lives.

Still, receiving a chronic diagnosis like HIV is likely to produce emotional distress. Here’s a look at the toll such a diagnosis takes, as well as how patients can tend to their psychological health.