Trends of and factors associated with live-birth and abortion rates among HIV-positive and HIV-negative women

Little is known about fertility choices and pregnancy outcome rates among HIV-infected women in the current combination ART era

Differential CD4+ cell count increase and CD4+ : CD8+ ratio normalization with maraviroc compared with tenofovir

Studies exploring the immunologic effects of maraviroc (MVC) have produced mixed results; hence it remains unclear whether MVC has unique immunologic effects in comparison to other antiretroviral drugs. We sought to determine whether MVC has differential effects compared to tenofovir disoproxil fumarate (TDF) during initial antiretroviral therapy

Food Insecurity and Frailty Among Women With and Without HIV in the United States: A Cross-Sectional Analysis

Introduction: Frailty is frequently observed among people with HIV, and food insecurity is associated with frailty in the general population. Evidence is scarce on the associations between food insecurity and frailty among women with HIV who maybe particularly vulnerable to the impacts of food insecurity. The goal of this study was to assess associations between food insecurity and frailty among women with and without HIV. Methods: There were 1265 participants from the Women’s Interagency HIV Study who participated in frailty assessments in2017. Frailty was measured using the Fried Frailty Phenotype, and women were subsequently categorized as robust, pre-frailor frail. Food insecurity was assessed using the U.S. Household Food Security Survey Module, with women categorized as having high, marginal, low or very low food security. Multinomial logistic regression models were conducted to examine cross-sectional associations between food insecurity and frailty while adjusting for socio-demographic, behavioural and HIV status covariates. Results and discussion: Approximately one-third (31.9%) of the women had marginal, low or very low food security, and the proportions of women who met the criteria for frailty or pre-frailty were 55.6% and 12.4% respectively. In the adjusted model, the relative risk ratio (RRR) of frailty for women with very low food security versus women with high food security was 3.37(95% CI [1.38 to 8.24],p Conclusions: Very low food security was associated with more frequent frailty and pre-frailty among women with and without for HIV. HIV serostatus was not associated with frailt

Less Bone Loss With Maraviroc- Versus Tenofovir-Containing Antiretroviral Therapy in the AIDS Clinical Trials Group A5303 Study

Background. There is a need to prevent or minimize bone loss associated with antiretroviral treatment (ART) initiation. We compared maraviroc (MVC)- to tenofovir disoproxil fumarate (TDF)–containing ART

Factors associated with adherence to guideline-recommended cardiovascular disease prevention among HIV clinicians.

Integrating cardiovascular disease (CVD) prevention in routine HIV care remains a challenge. This study aimed to identify factors associated with adherence to guideline-recommended CVD preventive practices among HIV clinicians. Clinicians from eight HIV clinics in Atlanta were invited to complete an online survey. The survey was informed by the Consolidated Framework for Implementation Research and assessed the following: clinician CVD risk screening and advice frequency (never to always), individual characteristics (clinician beliefs, self-efficacy, and motivation), inner setting factors (clinic culture, learning climate, leadership engagement, and resources available), and outer setting factors (peer pressure and patient needs). Bivariate correlations examined associations between these factors and guideline adherence. Thirty-eight clinicians completed the survey (82% women, mean age 42 years, 50% infectious disease physicians). For risk screening, clinicians always check patient blood pressure (median score 7.0/7), while they usually ask about smoking or check their blood glucose (median score 6.0/7). For advice provision, clinicians usually recommend quitting smoking, controlling cholesterol or controlling blood pressure (median score 6.0/7), while they often recommend controlling blood glucose, losing weight, or improving diet/physical activity (median score 5.5/7). Clinician beliefs, motivation and self-efficacy were positively correlated with screening and advice practices (r = .55-.84), while inner setting factors negatively correlated with lifestyle-related screening and advice practices (r = -.51 to -.76). Peer pressure was positively correlated with screening and advice practices (r = .57-.89). Clinician psychosocial characteristics and perceived peer pressure positively influence adherence to guideline-recommended CVD preventive practices. These correlates along with leadership engagement could be targeted with proven implementation strategies

\u3ci\u3eTrichomonas vaginalis\u3c/i\u3e and spontaneous preterm birth in a high-risk obstetric cohort in Atlanta, GA

Background: Trichomonas vaginalis (TV) is the most prevalent nonviral sexually transmitted infection globally, but routine screening is not recommended in HIV-negative individuals. There is a significant racial/ethnic health disparity in TV infection rates. Evidence regarding the association between TV and adverse perinatal outcomes is conflicting, but a recent large meta-analysis found a modest increased risk of preterm birth with TV infection (odds ratio, 1.27; 95% confidence interval, 1.08-1.50). The current study was undertaken to evaluate whether TV infection increases the risk of spontaneous preterm birth (sPTB) in a high-risk obstetric cohort in Atlanta, GA. Methods: We conducted a retrospective cohort study of women delivering at a safety-net hospital in Atlanta between July 2016 and June 2018. Women delivering a singleton live fetus at \u3e20 weeks\u27 gestation were included. The diagnosis of TV was by nucleic acid amplification testing. The outcome of interest was sPTB before 37 weeks\u27 gestation. Multivariable Cox proportional hazards modeling was used to estimate the effect of TV on sPTB, controlling for confounding variables, including clinical and demographic characteristics. Several sensitivity analyses were undertaken. Results: There were 3723 deliveries during the study period, and approximately half (46%) were screened for TV with nucleic acid amplification testing. After exclusions, the analytic cohort included 1629 women. Median age was 26 years (interquartile range, 22-31 years), and 70% of participants were listed as non-Hispanic Black in the electronic medical record. The prevalence of TV was 16% (n = 257). The sPTB rate was 7% (n = 112). In multivariable Cox proportional hazards modeling, TV infection was not associated with a statistically significantly increased risk of sPTB (hazard ratio, 1.34; 95% confidence interval, 0.84-2.13; P = 0.22). Factors associated with sPTB included history of PTB, adequate plus or transfer of prenatal care (vs. adequate/intermediate prenatal care utilization using the Kotelchuck index), recreational substance use, and Chlamydia trachomatis diagnosed during the current pregnancy. Results were not substantively different in sensitivity analyses. Conclusions: The prevalence of TV was high in this cohort. Its infection was not associated with a statistically significantly increased risk of sPTB. Nevertheless, the magnitude of effect is consistent with prior meta-analyses

Frequency of high-grade squamous cervical lesions among women over age 65 years living with HIV

BACKGROUND: Current U.S. cervical cancer screening guidelines recommend a stop to screening at age 65 years provided women have adequate prior screening and no history of precancer. Women living with the human immunodeficiency virus (HIV) are at higher risk for cervical cancer than uninfected women, but data a few to quantify risk among women who otherwise would qualify for screening cessation OBJECTIVE: To determine whether guidelines recommending women stop cervical cancer screening at 65 years are appropriate for women living with the human immunodeficiency virus (HIV). STUDY DESIGN: Semiannual Pap testing was done as part of surveillance visits in the Women’s Interagency HIV Study (WIHS). WIHS is the federally funded U.S. multisite cohort study that has enrolled 3678 women living with HIV and 1304 HIV-negative women that launched in October, 1994; we included data through September, 2019. Conventional Pap smears were collected at scheduled six-month visits and read centrally according to 1991 Bethesda System criteria. Results were analyzed among women at least 65 years of age. The primary endpoint was high grade cytology, including high grade squamous intraepithelial lesion, atypical glandular cells, atypical squamous cells cannot exclude high grade lesion, and malignant cytology. Wilcoxon rank-sum tests were used to compare the continuous variables, and Chi-square tests or Fisher’s exact tests were used to compare the categorical variables. The Kaplan-Meier method was used to calculate the cumulative incidence. Poisson regression was used to compare two incidence rates. RESULTS: Of 169 eligible women (121 women living with HIV, 48 HIV negative) who contributed 678.4 woman-years of observation after reaching age 65 years, 2.2% had high grade cytologic abnormalities. No cancers were found. Twenty women had prior precancer and 74 had abnormal Pap results in the prior decade. Among 50 women (38 women living with HIV and 12 HIV negative) with prior hysterectomy and no history of cervical precancer, the cumulative incidence of HSIL was 0.6 (95% C.I 0.0, 3.2)/100 woman-years for WLWH, and 0.0 (0.0, 8.1)/100 woman-years for HIV-patients (p = 0.61).Only 48 women (27 women living with HIV, 21 HIV negative) had cervices and met current guidelines to stop screening; their risk of a high grade squamous intraepithelial lesion was 2.2 (95% C.I. 0.6, 5.5)/100 woman-years overall and did not vary by HIV status (2.3, 95% C.I. 0.5, 6.8 for women living with HIV and 1.8, 95% C.I. 0.0, 9.8/100 woman years, p = 0.81). CONCLUSION: Most women living with HIV do not meet criteria for stopping cervical cancer screening and will need to continue beyond 65 years of age, but women who meet criteria for screening cessation have risks for high grade squamous lesions similar to those of HIV negative women and may elect to stop

Effects of the Covid-19 pandemic on ART initiation and access to HIV viral load monitoring in adults living with HIV in West Africa: a regression discontinuity analysis

International audienceOBJECTIVES: Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on ART initiation and HIV viral load (VL) monitoring in three West African countries. METHODS: We used routinely collected data from five clinics contributing to the IeDEA collaboration in Burkina Faso, Côte d'Ivoire and Nigeria. We included ART-naïve adults living with HIV (ALWH) initiating ART from 01/01/2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country. RESULTS: In clinics in Burkina Faso and Côte d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95%CI -5.5, 5.9, -0.9 p 95%CI -8.5,8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI -10.8, -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all three countries (-17.0 p 95%CI -25.3, -8.6 in Burkina Faso, -118.4 p 95%CI -171.1, -65.8 in Côte d'Ivoire and -169.1p 95%CI-282.6, -55.6 in Nigeria). CONCLUSIONS: Access to ART was maintained for newly diagnosed ALWH despite pandemic-related physical/social distancing measures. However, VL monitoring was severely disrupted and did not return to pre-pandemic levels approximately one year after the beginning of the pandemic. While HIV services in West Africa appear rather resilient, the impact of disruptions in VL monitoring on virological and clinical outcomes should continue to be monitored