A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. 

IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). 

Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. 

The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

Purchase full article at:   http://goo.gl/APdKtR

By:  Wilson KS1,2, Wanje G3, Yuhas K4, Simoni JM5, Masese L6, Vander Stoep A7, Jaoko W3, Hughes JP8, Richardson BA4,8, Scott McClelland R4,7,6,3.

• 1Department of Global Health, University of Washington, Seattle, 98104, USA. ksw@uw.edu.
• 2Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.
• 3Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 4Department of Global Health, University of Washington, Seattle, 98104, USA.
• 5Department of Psychology, University of Washington, Seattle, USA.
• 6Department of Medicine, University of Washington, Seattle, USA.
• 7Department of Epidemiology, University of Washington, Seattle, USA.
• 8Department of Biostatistics, University of Washington, Seattle, USA. 
• AIDS Behav. 2016 May 3. 

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Factors associated with HIV Viral Load "Blips" & the Relationship Between Self-Reported Adherence & Efavirenz Blood Levels on Blip Occurrence

BACKGROUND:

The uncertain etiology of HIV viral load (VL) blips may lead to increased use of clinical resources. We evaluated the association of self-reported adherence (SRA) and antiretroviral (ART) drug levels on blip occurrence in US Military HIV Natural History Study (NHS) participants who initiated the single-tablet regimen efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF).

METHODS:

ART-naïve NHS participants started on EFV/FTC/TDF between 2006 and 2013 who achieved VL suppression (<50 copies/mL) within 12 months and had available SRA and stored plasma samples were included. Participants with viral blips were compared with those who maintained VL suppression without blips. Untimed EFV plasma levels were evaluated on consecutive blip and non-blip dates by high performance liquid chromatography, with a level ≥1 mcg/mL considered therapeutic. SRA was categorized as ≥85 or <85 %. Descriptive statistics were performed for baseline characteristics and univariate and multivariate Cox proportional hazard models were used to assess the relationship between covariates and blip occurrence.

RESULTS:

A total of 772 individuals met inclusion criteria, including 99 (13 %) blip and 673 (87 %) control participants. African-American was the predominant ethnicity and the mean age was 29 years for both groups. SRA ≥ 85 % was associated with therapeutic EFV levels at both blip and non-blip time points (P = 0.0026); however no association was observed between blips and SRA or EFV levels among cases. On univariate analysis of cases versus controls, blips were associated with higher mean pre-treatment VL (HR 1.45, 95 % CI 1.11-1.89) and pre-treatment CD4 count <350 cells/µL (68.1 vs 49.7 %). Multivariate analysis also showed that blips were associated with a higher mean VL (HR 1.42, 95 % CI 1.08-1.88; P = 0.0123) and lower CD4 count at ART initiation, with CD4 ≥500 cells/µL having a protective effect (HR 0.45, 95 % CI 0.22-0.95; P = 0.0365). No association was observed for demographic characteristics or SRA.

CONCLUSION:

Blips are commonly encountered in the clinical management of HIV-infected patients. Although blip occurrence was not associated with SRA or EFV blood levels in our study, blips were associated with HIV-related factors of pre-ART high VL and low CD4 count. Additional studies are needed to determine the etiology of blips in HIV-infected patients.

Self-reported adherence

Characteristic	All	Blip group	Control group	P value
Total self-reported adherence (%)				0.1603
≥85	597 (96.2)	84 (97.7)	513 (96.1)
<85	23 (3.8)	2 (2.3)	21 (3.9)
Last time missed a dose				0.2097
Last week	100 (16.1)	15 (17.4)	85 (15.9)
Longer than last week	521 (83.9)	71 (82.6)	450 (84.1)
Missed a dose in the last weekend				0.1528
No	572 (93.2)	80 (93.0)	492 (93.2)
Yes	42 (6.8)	6 (7.0)	36 (6.8)
Total missed doses in the last 2 weeks				0.1297
0	489 (78.6)	68 (78.2)	421 (78.7)
1 or more	127 (20.4)	17 (19.5)	110 (20.6)
All doses	5 (0.8)	2 (2.3)	3 (0.6)
Don’t know	1 (0.2)	0 (0.0)	1 (0.2)

Data expressed as N (%) or mean (SD)

Full article at:   http://goo.gl/FuL78U

By:  Farmer A1, Wang X2, Ganesan A3, Deiss RG4, Agan BK2, O'Bryan TA5, Akers K6, Okulicz JF7.

• 1Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX USA.
• 2Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
• 3Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Walter Reed National Military Medical Center, Bethesda, MD USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
• 4Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
• 5Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX USA ; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
• 6Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX USA ; United States Army Institute of Surgical Research, Fort Sam Houston, TX USA.
• 7Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX USA ; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD USA. 
• AIDS Res Ther. 2016 Mar 22;13:16. doi: 10.1186/s12981-016-0100-4. eCollection 2016.

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Number of Drinks to "Feel a Buzz" by HIV Status and Viral Load in Men

The impact of HIV and its treatment on the effects of alcohol remain unclear. Blood alcohol concentrations have been noted to be higher in HIV infected individuals prior to antiretroviral initiation. 

Our goal was to compare number of drinks to "feel a buzz or high" among HIV infected and uninfected men, stratified by viral load (VL) suppression. Data includes 1478 HIV infected and 1170 uninfected men in the veterans aging cohort study who endorsed current drinking. 

Mean (SD) number of drinks to feel a buzz was 3.1 (1.7) overall. In multivariable analyses, HIV infected men reported a lower mean number of drinks to feel a buzz compared to uninfected men (coef = -14 for VL < 500; -34 for VL ≥ 500; p ≤ .05). Men with HIV, especially those with a detectable VL, reported fewer drinks to feel a buzz. 

Future research on the relationship between alcohol and HIV should consider the role of VL suppression.

Below:  Number of Drinks to Feel a Buzz by HIV, Viral Load, and Alcohol Use

Below: Number of Drinks to Feel a Buzz by HIV, Viral Load, and Age

Full article at:   http://goo.gl/rYu8ah

By:  Kathleen A. McGinnis,1,2 David A. Fiellin, MD,2,3,4 Janet P. Tate,2,3,4 Robert L Cook,5 R. Scott Braithwaite,6 Kendall J. Bryant,7 E. Jennifer Edelman,2,3,4 Adam J. Gordon,1,8 Kevin L. Kraemer, MD,8 Stephen Maisto,9 Amy C. Justice,2,3,4and For the Veterans Aging Cohort Study

• 1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. kathleen.mcginnis3@va.gov.
• 2Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA. kathleen.mcginnis3@va.gov.
• 3Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
• 4Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
• 5Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, Gainesville, FL, USA.
• 7Department of Population Health, New York University School of Medicine, New York, USA.
• 8National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
• 9Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
• 10Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• 11Department of Psychology, Syracuse University, Syracuse, NY, USA.
• AIDS Behav. 2016 Mar;20(3):504-11. doi: 10.1007/s10461-015-1053-7.

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Reported Church Attendance at the Time of Entry into HIV Care is Associated with Viral Load Suppression at 12 Months

The Southeast has high rates of church attendance and HIV infection rates. We evaluated the relationship between church attendance and HIV viremia in a Southeastern US, HIV-infected cohort. 

Viremia (viral load ≥200 copies/ml) was analyzed 12 months after initiation of care. Univariate and multivariable logistic regression models were fit for variables potentially related to viremia. Of 382 patients, 74 % were virally suppressed at 12 months. 

Protective variables included church attendance, being on antiretroviral therapy, CD4⁺ T lymphocyte count 200-350 cells/mm³ at care entry, and education. Variables predicting viremia included black race and selective disclosure of HIV status. 

Church attendance may provide needed support for patients entering HIV care for the first time.

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By:  Van Wagoner N1, Elopre L2, Westfall AO1, Mugavero MJ1, Turan J3, Hook EW1.

• 1Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
• 2Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, ZRB 206, 1720 2nd Ave South, Birmingham, AL, 35294, USA. lelopre@uabmc.edu.
• 3Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA. 

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Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load among HIV-Positive People Who Use Drugs

We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. 

We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. 

Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9 %) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless as well as not homeless post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. 

These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction.

Purchase full article at:   http://goo.gl/LWwZ9d

By:  Kennedy MC^1,2, Kerr T^1,3, McNeil R¹, Parashar S¹, Montaner J^1,3, Wood E^1,3, Milloy MJ^4,5.

¹British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

²School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada.

³Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.

⁴British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

⁵Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. uhri-mjsm@cfenet.ubc.ca.

AIDS Behav. 2016 Feb 23.

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Projecting the Epidemiological Effect, Cost-Effectiveness & Transmission of HIV Drug Resistance in Vietnam Associated with Viral Load Monitoring Strategies

OBJECTIVES:

The objective of this study was to investigate the potential epidemiological impact of viral load (VL) monitoring and its cost-effectiveness in Vietnam, where transmitted HIV drug resistance (TDR) prevalence has increased from <5% to 5%-15% in the past decade.

METHODS:

Using a population-based mathematical model driven by data from Vietnam, we simulated scenarios of various combinations of VL testing coverage, VL thresholds for second-line ART initiation and availability of HIV drug-resistance tests. We assessed the cost per disability-adjusted life year (DALY) averted for each scenario.

RESULTS:

Projecting expected ART scale-up levels, to approximately double the number of people on ART by 2030, will lead to an estimated 18 510 cases (95% CI: 9120-34 600 cases) of TDR and 55 180 cases (95% CI: 40 540-65 900 cases) of acquired drug resistance (ADR) in the absence of VL monitoring. This projection corresponds to a TDR prevalence of 16% (95% CI: 11%-24%) and ADR of 18% (95% CI: 15%-20%). Annual or biennial VL monitoring with 30% coverage is expected to relieve 12%-31% of TDR (2260-5860 cases), 25%-59% of ADR (9620-22 650 cases), 2%-6% of HIV-related deaths (360-880 cases) and 19 270-51 400 DALYs during 2015-30. The 30% coverage of VL monitoring is estimated to cost US$4848-5154 per DALY averted. The projected additional cost for implementing this strategy is US$105-268 million over 2015-30.

CONCLUSIONS:

Our study suggests that a programmatically achievable 30% coverage of VL monitoring can have considerable benefits for individuals and leads to population health benefits by reducing the overall national burden of HIV drug resistance. It is marginally cost-effective according to common willingness-to-pay thresholds.

Purchase full article at:  http://goo.gl/aYwDSc

By:  Pham QD1, Wilson DP2, Nguyen TV3, Do NT4, Truong LX5, Nguyen LT6, Zhang L7.

• 1Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
• 2Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
• 3Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam.
• 4Department of HIV Care and Treatment, Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam.
• 5Department of Laboratory Analysis, Pasteur Institute, Ho Chi Minh City, Vietnam.
• 6Ministry of Health, Hanoi, Vietnam.
• 7Disease Modelling and Financing Program, Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia Research Center for Public Health, School of Medicine, Tsinghua University, China Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia lzhang@kirby.unsw.edu.au. 
• J Antimicrob Chemother. 2016 Feb 10. pii: dkv473. 

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HIV Community Viral Load & Factors Associated with Elevated Viremia among Men Who Have Sex with Men (MSM) in Vancouver, Canada

BACKGROUND:

We developed estimates of community viral load (VL) and risk factors for unsuppressed VL from a cross-sectional study of men who have sex with men (MSM) in Vancouver, Canada.

METHODS:

MSM were recruited from February 25, 2012 - February 28, 2014 using Respondent-Driven Sampling (RDS). Participants completed a computer assisted self-interview questionnaire and a nurse-administered point-of-care HIV test. For HIV positive participants, we conducted VL and CD4 cell counts. We used RDS-weighted analysis to obtain population estimates of key variables and multivariable logistic regression to examine factors associated with having a VL ≥200 copies/mL among HIV-positive participants.

RESULTS:

We recruited 719 participants, of whom 119 (16.6%) were seeds. Our estimate of the population HIV prevalence was 23.4% (95% CI 15.8 - 31.0%) after RDS-adjustments. We estimated that 18.6% (95% confidence interval [CI] 8.8 - 30.4%) of HIV-positive MSM in Vancouver had a VL ≥200 copies/mL. Having an unsuppressed VL was associated with non-Caucasian ethnicity (adjusted odds ratio [AOR]= 4.34; 95% CI 1.67- 11.1); an annual income of <$15,000 CAD (AOR=6.43; 95%CI 2.08-19.9); using GHB in the previous six months (AOR=4.85; 95%CI 1.79-13.2); unprotected anal intercourse with a known HIV negative or unknown serostatus partner (AOR=3.13; 95%CI 1.10-8.90); and disclosing one's HIV serostatus ≥50% of the time (AOR=7.04; 95%CI 1.01-49.1).

CONCLUSION:

Despite a high prevalence of HIV, we estimated that a small proportion of HIV positive MSM have undiagnosed HIV and unsuppressed VL. Our results highlight the importance of continued work to address health inequities using a social determinants of health framework.

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By:  Moore DM1, Cui Z, Lachowsky N, Raymond HF, Roth E, Rich A, Sereda P, Howard T, McFarland W, Lal A, Montaner J, Corneil T, Hogg RS; Momentum Health Study team.

• 1Department of Medicine, University of British Columbia, Vancouver, Canada 
• 2 BC Centre for Excellence in HIV/AIDS, Vancouver, Canada 
• 3 University of California - San Francisco, San Francisco, United States 
• 4 University of Victoria, Victoria, Canada 
• 5 Positive Living Society of BC, Vancouver, Canada 6Interior Health, Kelowna, Canada 7Simon Fraser University, Burnaby, Canada. 
• J Acquir Immune Defic Syndr. 2016 Jan 27. 

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Higher HIV RNA Viral Load in Recent Patients with Symptomatic Acute HIV Infection in Lyon University Hospitals

INTRODUCTION:

Increased human immunodeficiency virus (HIV) virulence at infection has been suggested by a meta-analysis based on viral load and CD4 T lymphocytes (CD4) count during acute infection. This result was obtained after secondary analyses of large databases, facilitating the detection of differences. Similar finding in cohorts of more modest sample size would indicate that the effect could be more substantial.

METHODS:

Change from initial CD4 count and HIV viral load after acute HIV infection by calendar year was explored in patients treated at Lyon University hospitals. All patients admitted to our hospitals with acute HIV infection between 1996 and 2013 were included in our study. Initial CD4 count and viral load before the start of anti-retroviral treatment were analyzed. Trends over time were assessed in linear models.

RESULTS:

Initial CD4 count remained similar over time. However, in 2006-2013, initial viral load rose significantly (+1.12 log10/ml/year, p = 0.01).

CONCLUSION:

Our data, obtained from a single hospital cohort, confirmed findings from a large meta-analysis, showed increased initial viremia at acute HIV infection since 2006 and suggesting potentially higher HIV virulence in recent years.

Below:  Initial viral load during acute HIV infection by year, Lyon university Hospitals, 1996 to 2013

Full article at:   http://goo.gl/EH4P4R

By:  Girerd-Genessay I1, Baratin D1, Ferry T2, Chidiac C2, Ronin V3, Vanhems P1,4.

• 1Infection Control and Epidemiology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
• 2Department of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.
• 3Infection Control and Epidemiology Unit, Hôpital Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
• 4Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France. 
• PLoS One. 2016 Jan 22;11(1):e0146978. doi: 10.1371/journal.pone.0146978. eCollection 2016.

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