Relationship Between Treatment Comorbidities and HIV Viral Suppression Among People Who Live With AIDSi n Johannesburg.

HIV has globally infected over 37.9 million people, of which 28.2 million (73%) are on antiretroviral treatment, and 66% of those on treatment are virally suppressed. In South Africa, however, low rate of viral suppression (47%) among people living with HIV is a major health problem that has continued to fuel HIV prevalence. A cross-sectional quantitative research design was used to investigate the relationship between treatment comorbidities and viral suppression among HIV-infected adults aged 18–49 who were diabetic, had cancer, or tuberculosis in Johannesburg. HIV Care Continuum formed the theoretical framework for this research. An existing HIV-infected patient de-identifiable dataset (n = 602) was used for the descriptive and logistic regression analysis. Results revealed a statistically significant association between tuberculosis treatment and viral suppression—adjusted OR = 1.534, (1.053, 2.234), and p = 0.02—indicating that treatment of comorbidities, such as tuberculosis, has positive impact on viral suppression outcomes. Results, however, revealed that the model for diabetes treatment and viral suppression—OR = 0.993, (0.658, 1.498), and p = 0.97—and the model for cancer treatment and viral suppression—OR= 1.234, (0.844, 1.805), and p = 0.27—were not statistically significant. Treatment of comorbidities, such as TB and HIV, positively impacts viral suppression outcomes. These findings suggested that concurrent, simultaneous, or integrated treatment models for comorbidities can help to achieve HIV viral suppression. This study contributes to positive social change by highlighting the effect of treatment comorbidities on viral suppression in people living with HIV (PLWHIV) in an under-resourced setting, which could inform policy and influence decisions on HIV care and management. Results however revealed that the model for diabetes treatment and viral suppression—OR = 0.993, (0.658, 1.498), and p = 0.97—and the model for cancer treatment and viral suppression—OR = 1.234, (0.844, 1.805), and p = 0.27—were not statistically significant. Treatment of comorbidities, such as TB and HIV, positively impacts viral suppression outcomes. These findings suggested that concurrent, simultaneous, or integrated treatment models for comorbidities can help to achieve HIV viral suppression. This study contributes to positive social change by highlighting the effect of treatment comorbidities on viral suppression in people living with HIV (PLWHIV) in an under-resourced setting, which could inform policy and influence decisions on HIV care and management

Relationship between Treatment Comorbidities and Viral Suppression of HIV Infections in Johannesburg

HIV has globally infected 37.9 million people, of which 23.3 million (62%) are on antiretroviral treatment (ART). In South Africa, low rate of viral suppression among people living with HIV (PLWHIV) is a major health problem that has continued to fuel HIV persistence. A cross-sectional quantitative research design was used to investigate the relationship between treatment of comorbidities and viral suppression among HIV-infected adults aged 18 – 49 who were diabetic, had cancer, or tuberculosis (TB) in Johannesburg. The HIV care continuum formed the framework for this research. A secondary dataset from the national level survey 2017 was used for the descriptive and logistic regression analyses that were conducted. The results revealed a statistically significant association between TB treatment and viral suppression (adjusted OR=1.534, (1.053, 2.234), and p= 0.02, indicating that treatment of comorbidities such as TB has a positive impact on viral suppression outcomes. The results revealed that medical bills paid by medical aid were associated with viral suppression (OR= 1.789, (1.082, 2.957), p= 0.02. However, the model for diabetes treatment and viral suppression (OR=0.993 (0.658, 1.498), p=0.97), and the model for cancer treatment and viral suppression (OR= 1.234, (0.844, 1.805), p=0.27, revealed no significant associations. These findings indicate that concurrent, simultaneous, or integrated treatment models of comorbidities can help in achieving viral suppression. This study contributes to positive social change by highlighting the effect of the treatment of comorbidities on viral suppression in PLWHIV in an under-resourced setting, which could inform policy and influence decisions on HIV care and management

Relationship between Treatment Comorbidities and Viral Suppression of HIV Infections in Johannesburg

HIV has globally infected 37.9 million people, of which 23.3 million (62%) are on antiretroviral treatment (ART). In South Africa, low rate of viral suppression among people living with HIV (PLWHIV) is a major health problem that has continued to fuel HIV persistence. A cross-sectional quantitative research design was used to investigate the relationship between treatment of comorbidities and viral suppression among HIV-infected adults aged 18 – 49 who were diabetic, had cancer, or tuberculosis (TB) in Johannesburg. The HIV care continuum formed the framework for this research. A secondary dataset from the national level survey 2017 was used for the descriptive and logistic regression analyses that were conducted. The results revealed a statistically significant association between TB treatment and viral suppression (adjusted OR=1.534, (1.053, 2.234), and p= 0.02, indicating that treatment of comorbidities such as TB has a positive impact on viral suppression outcomes. The results revealed that medical bills paid by medical aid were associated with viral suppression (OR= 1.789, (1.082, 2.957), p= 0.02. However, the model for diabetes treatment and viral suppression (OR=0.993 (0.658, 1.498), p=0.97), and the model for cancer treatment and viral suppression (OR= 1.234, (0.844, 1.805), p=0.27, revealed no significant associations. These findings indicate that concurrent, simultaneous, or integrated treatment models of comorbidities can help in achieving viral suppression. This study contributes to positive social change by highlighting the effect of the treatment of comorbidities on viral suppression in PLWHIV in an under-resourced setting, which could inform policy and influence decisions on HIV care and management

CD4 cell count and the risk of AIDS or death in HIV-Infected adults on combination antiretroviral therapy with a suppressed viral load: a longitudinal cohort study from COHERE.

BACKGROUND: Most adults infected with HIV achieve viral suppression within a year of starting combination antiretroviral therapy (cART). It is important to understand the risk of AIDS events or death for patients with a suppressed viral load. METHODS AND FINDINGS: Using data from the Collaboration of Observational HIV Epidemiological Research Europe (2010 merger), we assessed the risk of a new AIDS-defining event or death in successfully treated patients. We accumulated episodes of viral suppression for each patient while on cART, each episode beginning with the second of two consecutive plasma viral load measurements 500 copies/µl, the first of two consecutive measurements between 50-500 copies/µl, cART interruption or administrative censoring. We used stratified multivariate Cox models to estimate the association between time updated CD4 cell count and a new AIDS event or death or death alone. 75,336 patients contributed 104,265 suppression episodes and were suppressed while on cART for a median 2.7 years. The mortality rate was 4.8 per 1,000 years of viral suppression. A higher CD4 cell count was always associated with a reduced risk of a new AIDS event or death; with a hazard ratio per 100 cells/µl (95% CI) of: 0.35 (0.30-0.40) for counts <200 cells/µl, 0.81 (0.71-0.92) for counts 200 to <350 cells/µl, 0.74 (0.66-0.83) for counts 350 to <500 cells/µl, and 0.96 (0.92-0.99) for counts ≥500 cells/µl. A higher CD4 cell count became even more beneficial over time for patients with CD4 cell counts <200 cells/µl. CONCLUSIONS: Despite the low mortality rate, the risk of a new AIDS event or death follows a CD4 cell count gradient in patients with viral suppression. A higher CD4 cell count was associated with the greatest benefit for patients with a CD4 cell count <200 cells/µl but still some slight benefit for those with a CD4 cell count ≥500 cells/µl

Retention in Continuous Care and Sustained Viral Suppression: Examining the Association Among Individuals Living with HIV

Objectives: To examine the relationship between retention in continuous care and sustained viral suppression. Methods: The authors retrospectively followed 653 persons who were virally suppressed and seeking care at an infectious disease clinic in Kentucky for an average of 6 years to determine the rates of retention in medical care (≥2 visits separated by ≥3 months within a 12-month period) and sustained viral suppression (\u3c400 copies/mL). A generalized linear mixed model was used to determine an association between retention and suppression over time. Results: Approximately 61% of the study population were retained in continuous care and 75% had sustained viral suppression for all patient-years. Persons retained in care were 3 times the odds of sustaining viral suppression over time (P \u3c .001). Conclusion: Retention is essential to achieving and maintaining viral suppression. Strategies should be set in place that emphasize increasing the rates of retention, which in turn may increase the rates of suppression

Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades

Background In 2014, the Joint United Nations Programme on HIV and AIDS (UNAIDS) and partners set the ‘90-90-90 targets’; aiming to diagnose 90% of all HIV positive people, provide antiretroviral therapy (ART) for 90% of those diagnosed and achieve viral suppression for 90% of those treated, by 2020. This results in 81% of all HIV positive people on treatment and 73% of all HIV positive people achieving viral suppression. We aimed to analyse how effective national HIV treatment programmes are at meeting these targets, using HIV care continuums or cascades. Methods We searched for HIV treatment cascades for 196 countries in published papers, conference presentations, UNAIDS databases and national reports. Cascades were constructed using reliable, generalisable, recent data from national, cross-sectional and longitudinal study cohorts. Data were collected for four stages; total HIV positive people, diagnosed, on treatment and virally suppressed. The cascades were categorised as complete (four stages) or partial (3 stages), and analysed for ‘break points’ defined as a drop >10% in coverage between consecutive 90-90-90 targets. Results 69 country cascades were analysed (32 complete, 37 partial). Diagnosis (target one—90%) ranged from 87% (the Netherlands) to 11% (Yemen). Treatment coverage (target two—81% on ART) ranged from 71% (Switzerland) to 3% (Afghanistan). Viral suppression (target three—73% virally suppressed) was between 68% (Switzerland) and 7% (China). Conclusions No country analysed met the 90-90-90 targets. Diagnosis was the greatest break point globally, but the most frequent key break point for individual countries was providing ART to those diagnosed. Large disparities were identified between countries. Without commitment to standardised reporting methodologies, international comparisons are complex

po 8397 viral suppression among cameroonian adults adolescents and children receiving antiretroviral therapy in the test treat era

BackgroundGlobal efforts in meeting the 90–90–90 targets reveal that 70% of infected people know their HIV status, 77% of these are receiving antiretroviral therapy (ART) and 82% of treated patients have viral suppression. Since launching the 'test and treat' strategy and wider access to drugs that bring down the viral load (VL), evaluating viral suppression would help to identify those requiring interventions and to make progress towards meeting the targets in Cameroon.MethodsA study was conducted from October 2015 to August 2017 amongst adults (≥20 years), adolescents (10–19) and children (0–9) at 12, 24, 36 and ≥48 months on ART, monitored at the Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management (CIRCB) in Yaoundé, Cameroon. VL was established using Abbott m2000RT-PCR. VS was defined as VL <1000 copies/ml; with p<0,05 considered significant.ResultsA total of 1979 patients (70% female) were enrolled (1825 adults, 112 adolescents, 42 children); 1865 were on first-line (NNRTI-based, duration: 48 [IQR 24–48] months) vs. 114 on second-line (PI/r-based, duration: 48 [IQR 36–48] months); with 19%(368) at Month2, 14%(274) at Month24, 10%(207) at Month36% and 54% (1130) at ≥Month48. Overall, viral suppression was 79.4%, and 64.3% had controlled viral replication (VL <40). On first-line, viral suppression was 79.7% (1487) vs. 72.2%(83) on second-line (p=0,076). By ART duration, viral suppression was 83.4%(Month12), 85.8%(Month24), 74.9%(Month36) and 77.3% (≥Month48); p=0,0011. By age-range, viral suppression was 76.2% in children, 54.5% in adolescents, and 80.9% in adults (p<0,0001). By age and ART-regimen, viral suppression on first vs. second line was: children 76.5% vs. 60%; adolescents 51.7% vs. 65.2%; and adults 81.2% vs. 74.7%.ConclusionAbout 80% of Cameroonian patients might be experiencing viral suppression, with a declining performance at adolescence and by 3 years of ART experience. Thus, meeting the viral suppression target by 2020 requires a closer VL monitoring strategy and an adapted adherence support mechanism for adolescents living with HIV in resource-limited settings sharing similar challenges

Risk Factors for Delayed Viral Suppression on First-Line Antiretroviral Therapy among Persons Living with HIV in Haiti, 2013-2017

Studies of viral suppression on first-line antiretroviral therapy (ART) in persons living with human immunodeficiency virus (PLHIV) in Haiti are limited, particularly among PLHIV outside of the Ouest department, where the capital Port-au-Prince is located. This study described the prevalence and risk factors for delayed viral suppression among PLHIV in all geographic departments of Haiti between 2013 and 2017. Individuals who received viral load testing 3 to 12 months after ART initiation were included. Data on demographics and clinical care were obtained from the Haitian Active Longitudinal Tracking of HIV database. Multivariable logistic regression was performed to predict delayed viral suppression, defined as a viral load ≥1000 HIV-1 RNA copies/mL after at least 3 months on ART. Viral load test results were available for 3,368 PLHIV newly-initiated on ART. Prevalence of delayed viral suppression was 40%, which is slightly higher than previous estimates in Haiti. In the multivariable analysis, delayed viral suppression was significantly associated with younger age, receiving of care in the Ouest department, treatment with lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) combined ART regimen, and CD4 counts below 200 cells/mm3. In conclusion, this study was the first to describe and compare differences in delayed viral suppression among PLHIV by geographic department in Haiti. We identified populations to whom public health interventions, such as more frequent viral load testing, drug resistance testing, and ART adherence counseling should be targeted