In a cohort of 1028 children and adolescents infected with human immunodeficiency virus type 1 (HIV-1), the use of combination therapy including protease inhibitors increased from 7 percent in 1996 ...to 73 percent in 1999. Over the four-year period, mortality declined from 5.3 percent to 0.7 percent. This analysis was adjusted for multiple potentially confounding variables; the authors estimate that the use of combination therapy including protease inhibitors in HIV-1–infected children reduces the risk of death by 67 percent.
The use of combination therapy reduces the risk of death by 67 percent.
The combination of human immunodeficiency virus (HIV)–specific protease inhibitors with nucleoside reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, or both has been demonstrated in adults to slow the progression of HIV type 1 (HIV-1) disease dramatically and to lower mortality.
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Recent studies provide some evidence of the efficacy and safety of these regimens in children and adolescents,
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but there is only limited evidence of reductions in mortality and morbidity.
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Current guidelines for the treatment of HIV infection in both adults and children recommend combination therapy including protease inhibitors.
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We undertook the present study to estimate the effect of . . .
The estimated one in three women worldwide victimized by intimate partner violence (IPV) consistently demonstrate elevated STI/HIV prevalence, with their abusive male partners' risky sexual ...behaviours and subsequent infection increasingly implicated. To date, little empirical data exist to characterise the nature of men's sexual risk as it relates to both their violence perpetration, and STI/HIV infection.
Data from a cross-sectional survey of men ages 18-35 recruited from three community-based health clinics in an urban metropolitan area of the northeastern US (n = 1585) were analysed to estimate the prevalence of IPV perpetration and associations of such violent behaviour with both standard (eg, anal sex, injection drug use) and gendered (eg, coercive condom practices, sexual infidelity, transactional sex with a female partner) forms of sexual-risk behaviour, and self-reported STI/HIV diagnosis.
Approximately one-third of participants (32.7%) reported perpetrating physical or sexual violence against a female intimate partner in their lifetime; one in eight (12.4%) participants self-reported a history of STI/HIV diagnosis. Men's IPV perpetration was associated with both standard and gendered STI/HIV risk behaviours, and to STI/HIV diagnosis (OR 4.85, 95% CI 3.54 to 6.66). The association of men's IPV perpetration with STI/HIV diagnosis was partially attenuated (adjusted odds ratio (AOR) 2.55, 95% CI 1.77 to 3.67) in the multivariate model, and a subset of gendered sexual-risk behaviours were found to be independently associated with STI/HIV diagnosis-for example, coercive condom practices (AOR 1.67, 95% CI 1.04 to 2.69), sexual infidelity (AOR 2.46, 95% CI 1.65 to 3.68), and transactional sex with a female partner (AOR 2.03, 95% CI 1.36 to 3.04).
Men's perpetration of physical and sexual violence against intimate partners is common among this population. Abusive men are at increased risk for STI/HIV, with gendered forms of sexual-risk behaviour partially responsible for this association. Thus, such men likely pose an elevated infection risk to their female partners. Findings indicate the need for interwoven sexual health promotion and violence prevention efforts targeted to men; critical to such efforts may be reduction in gendered sexual-risk behaviours and modification of norms of masculinity that likely promote both sexual risk and violence.
UNAIDS established fast-track targets of 73% and 86% viral suppression among human immunodeficiency virus (HIV)-positive individuals by 2020 and 2030, respectively. The epidemiologic impact of ...achieving these goals is unknown. The HIV-Calibrated Dynamic Model, a calibrated agent-based model of HIV transmission, is used to examine scenarios of incremental improvements to the testing and antiretroviral therapy (ART) continuum in South Africa in 2015. The speed of intervention availability is explored, comparing policies for their predicted effects on incidence, prevalence and achievement of fast-track targets in 2020 and 2030. Moderate (30%) improvements in the continuum will not achieve 2020 or 2030 targets and have modest impacts on incidence and prevalence. Improving the continuum by 80% and increasing availability reduces incidence from 2.54 to 0.80 per 100 person-years (-1.73, interquartile range (IQR): -1.42, -2.13) and prevalence from 26.0 to 24.6% (-1.4 percentage points, IQR: -0.88, -1.92) from 2015 to 2030 and achieves fast track targets in 2020 and 2030. Achieving 90-90-90 in South Africa is possible with large improvements to the testing and treatment continuum. The epidemiologic impact of these improvements depends on the balance between survival and transmission benefits of ART with the potential for incidence to remain high.
Recent studies have reported on the utility of audio computer-assisted self-interviewing (ACASI) in surveys of human immunodeficiency virus (HIV) risk behaviors that involve a single assessment. This ...paper reports the results of a test of ACASI within a longitudinal study of HIV risk behavior and infection. Study participants (gay men (n = 1,974) and injection drug users (n = 903)) were randomly assigned to either ACASI or interviewer-administered assessment at their second follow-up visit 12 months after baseline. Significantly more of the sexually active gay men assessed via ACASI reported having sexual partners who were HIV antibody positive (odds ratio = 1.36, 95% confidence interval: 1.08, 1.72), and a higher proportion reported unprotected receptive anal intercourse. Among injection drug users (IDUs), our hypothesis was partially supported. Significantly more IDUs assessed via ACASI reported using a needle after another person without cleaning it (odds ratio = 2.40, 95% confidence interval: 1.34, 4.30). ACASI-assessed IDUs reported similar rates of needle sharing and needle exchange use but a lower frequency of injection. Participants reported few problems using ACASI, and it was well accepted among members of both risk groups. Sixty percent of the participants felt that the ACASI elicited more honest responses than did interviewer-administered questionnaires. Together, these data are consistent with prior research findings and suggest that ACASI can enhance the quality of behavioral assessment and provide an acceptable method for collecting self-reports of HIV risk behavior in longitudinal studies and clinical trials of prevention interventions.
Background. Previous observational studies found highly active antiretroviral therapy (HAART) to be associated with improved survival among human immunodeficiency virus (HIV)– infected children and ...adolescents. However, these studies had limited follow-up of HIV-infected children undergoing HAART. Given that HIV infection is chronic and that exposure to HAART is likely to be life-long, there is a need to evaluate the long-term effect of HAART on survival in this population. Methods. The study included 1236 children and adolescents who were perinatally infected with HIV, who were on study or enrolled after January 1996 in a United States-based multicenter prospective cohort study (Pediatric AIDS Clinical Trials Group 219/219C), and who were not receiving HAART at baseline; subjects were observed for a maximum of 10 years through June 2006. A weighted Cox regression model was used to estimate the effect of HAART on survival, appropriately adjusted for time-varying confounding by severity. Results. At the end of the 10-year follow-up period (median duration of follow-up, 6.3 years; interquartile range, 4.3– 9.8 years), 70% of participants had initiated HAART. Lower CD4 cell percentages, total lymphocyte counts, and albumin levels were associated with an increased probability of initiating HAART. Eighty-five deaths were observed, and the mortality hazard ratio associated with HAART, compared with non-HAART regimens, was 0.24 after adjusting for measured confounding by severity (95% confidence interval, 0.11– 0.51). Conclusions. The use of HAART was highly effective in reducing mortality during the period 1996– 2006 among children and adolescents infected with HIV. With improved long-term survival, continued follow-up is necessary to evaluate the effects of prolonged use of HAART on potential adverse events, immune function, growth, sexual maturation, and quality of life in this population.
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This cost-effectiveness analysis compared routine screening for HIV with current detection of HIV through selective screening and patients who present with opportunistic infections. One-time ...screening cost $38,000 per quality-adjusted life-year gained when HIV prevalence is 1 percent, and $113,000 for the general population of the United States (0.1 percent prevalence). Screening for HIV has the potential to reduce the transmission of HIV and may be associated with lower cost-effectiveness ratios.
Screening for HIV has the potential to reduce the transmission of HIV and may be associated with lower cost-effectiveness ratios.
Of the estimated 900,000 Americans currently infected with human immunodeficiency virus (HIV), roughly 280,000 are unaware of their infection.
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These people receive neither demonstrated life-prolonging care nor counseling to prevent further transmission.
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Borne disproportionately by the most vulnerable communities,
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the burden of undetected HIV persists despite the availability of technology for accurate and efficient detection.
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Although studies have assessed the cost-effectiveness of increased screening for HIV among specific high-risk populations (e.g., pregnant women
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and attendees at clinics for patients with sexually transmitted diseases
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), the value of routine, population-based HIV counseling, testing, and referral (HIVCTR) in the era of . . .
Methods for identification of primary HIV infections seem increasingly important to understand pathogenesis, and to prevent transmission, which is particularly efficient during acute infection. Most ...current algorithms for HIV testing are based on detection of HIV antibodies and are unable to identify early infections before seroconversion. The efficiency of prospective cohorts, which is a standard approach for identifying primary HIV-1 infection, depends on a variety of epidemiological and cultural factors including HIV incidence and stigma and, not surprisingly, varies significantly in different geographical areas. We report a voluntary counseling and testing (VCT)-based approach to identifying primary HIV-1C infection that was developed as part of a primary HIV-1 subtype C infection study in Botswana. The referral strategy was based on: (1) collaboration with VCT centers at city clinics operated by the Ministry of Health; (2) partnering with the busiest non-government VCT center; (3) educating healthcare workers and the community about primary HIV infection; and (4) pairing with diverse VCT providers, including NGOs and private-sector organizations. Acute HIV-1 infections were defined by a negative HIV-1 serology combined with a positive HIV-1 RT-PCR test. Recent HIV-1 infections were identified by detuned EIA testing according to the classic STARTH algorithm. The VCT-based referral strategy resulted in the successful identification of 57 cases of acute and early HIV infection. A referral strategy of expanded VCT with viral RNA (Ribonucleic acid) testing to a national program in Botswana may be a promising approach for identification of primary HIV infections on a countrywide level. The program should offer VCT with viral RNA testing to the general public, facilitate proper counseling and risk reduction, and allow initiation of early HAART, and may reduce new viral transmissions.
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DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
CONTEXT.— Multiple options are now available for prophylaxis of opportunistic
infections related to the acquired immunodeficiency syndrome (AIDS). However,
because of differences in incidence rates ...as well as drug efficacy, toxicity,
and costs, the role of different types of prophylaxis remains uncertain. OBJECTIVE.— To determine the clinical impact, cost, and cost-effectiveness of strategies
for preventing opportunistic infections in patients with advanced human immunodeficiency
virus (HIV) disease. DESIGN.— We developed a Markov simulation model to compare different strategies
for prophylaxis of Pneumocystis carinii pneumonia
(PCP), toxoplasmosis, Mycobacterium avium complex
(MAC) infection, fungal infections, and cytomegalovirus (CMV) disease in HIV-infected
patients. Data for the model were derived from the Multicenter AIDS Cohort
Study, randomized controlled trials, and the national AIDS Cost and Services
Utilization Survey. MAIN OUTCOME MEASURES.— Projected life expectancy, quality-adjusted life expectancy, total lifetime
direct medical costs, and cost-effectiveness in dollars per quality-adjusted
life-year (QALY) saved. RESULTS.— For patients with CD4 cell counts of 0.200 to 0.300×109/L
(200-300/µL) who receive no prophylaxis, we projected a quality-adjusted
life expectancy of 39.08 months and average total lifetime costs of $40288.
Prophylaxis for PCP and toxoplasmosis with trimethoprim-sulfamethoxazole for
patients with CD4 cell counts of 0.200×109/L (200/µL)
or less increased quality-adjusted life expectancy to 42.56 months, implying
an incremental cost of $16000 per QALY saved. Prophylaxis for MAC for patients
with CD4 cell counts of 0.050×109/L (50/µL) or less
produced smaller gains in quality-adjusted life expectancy; incremental cost-effectiveness
ratios were $35000 per QALY saved for azithromycin and $74000 per QALY saved
for rifabutin. Oral ganciclovir for the prevention of CMV infection was the
least cost-effective prophylaxis ($314000 per QALY saved). Results were most
sensitive to the risk of developing an opportunistic infection, the impact
of opportunistic infection history on long-term survival, and the cost of
prophylaxis. CONCLUSIONS.— The cost-effectiveness of prophylaxis against HIV-related opportunistic
infections varies widely, but prophylaxis against PCP or toxoplasmosis and
against MAC delivers the greatest comparative value. In an era of limited
resources, these results can be used to set priorities and explore new alternatives
for improving HIV patient care.
In the past decade, there have been dramatic changes in the treatment of human immunodeficiency virus (HIV) disease.
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The use of combination antiretroviral therapy has led to decreased morbidity ...and mortality among patients with advanced HIV infection and the acquired immunodeficiency syndrome (AIDS).
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Published guidelines currently recommend a three-drug antiretroviral regimen as the standard of care for the treatment of HIV-infected patients in the United States.
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However, antiretroviral drugs are expensive, with wholesale prices ranging from about $2,500 per person per year for the nucleosides to $8,000 per person per year for one of the protease inhibitors. . . .
A simplified version of the HIVNET prototype HIV vaccine process was developed for adolescents at risk of HIV by: (1) reducing reading level; (2) reorganizing; (3) adding illustrations; and (4) ...obtaining focus group feedback. Then adolescents (N = 187) in three cities were randomly assigned to the standard or simplified version. Adolescents receiving the simplified version had significantly higher comprehension scores (80% correct vs. 72% correct), with 37% of items significantly more likely to be answered correctly. They were also significantly more likely to recall study benefits and procedures. Overall, adolescents were less willing to participate in a potential HIV vaccine trial after presentation than prior to presentation. The present study indicates that it would be feasible for adolescents to participate in a vaccine trial, as simplification of vaccine information, combined with illustrations to depict key concepts, resulted in improved scores for adolescents on the comprehension and recall test.
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