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Topics in Antiviral Medicine

Aroonsiri Sangarlangkarn, Jessica S Merlin, Rodney O Tucker, Amy S Kelley
In the era of antiretroviral therapy, HIV infection has become a chronic illness with associated multimorbidity, and practitioners are faced with an emerging population of HIV-infected patients with evolving needs for advance care planning (ACP), defined as communication between individuals and their proxies to plan for future health care decisions. This article provides a review of original research studies on ACP in HIV-infected adults in the era of antiretroviral therapy (1996-present) from PubMed, EMBASE, and PsycINFO...
December 2016: Topics in Antiviral Medicine
James H Stein
Current guidelines for managing cholesterol to reduce cardiovascular disease (CVD) risk focus on providing the appropriate intensity of statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) level. There is very little evidence supporting the use of treatments aimed at raising high-density lipoprotein cholesterol level or reducing triglyceride levels. HIV-infected persons have excess risk of CVD compared with the general population. Statins are less effective at reducing LDL-C levels in HIV-infected persons who are also at greater risk for adverse effects from statin treatment...
December 2016: Topics in Antiviral Medicine
Steven C Johnson
Antiretroviral therapy is recommended for all patients with HIV infection. The benefit of immediate antiretroviral therapy was confirmed by results from the START (Strategic Timing of Antiretroviral Treatment) trial, which showed a 57% reduction in risk for the composite end point of AIDS-related events, serious non-AIDS-related events, or death from any cause with immediate treatment in antiretroviral therapy-naive participants with CD4+ cell counts above 500/µL. Other changes in HIV care include the widespread adoption of integrase strand transfer inhibitor-based regimens...
December 2016: Topics in Antiviral Medicine
Susan J Little
Diagnosis of acute HIV infection is important for accurate estimation of HIV incidence, identifying persons who are unaware of their HIV infection, and offering immediate treatment and risk-reduction strategies. The higher viral loads associated with acute HIV infection are associated with an increased risk of transmission. Current treatment recommendations are the same for acute and established infections. Studies of acute HIV infection indicate that initiation of antiretroviral therapy during this period may allow greater recovery of CD4+ T-cell count and function and may result in a smaller latent viral reservoir and a skewing of infection away from central memory CD4+ T cells toward shorter-lived transitional memory CD4+ T cells...
December 2016: Topics in Antiviral Medicine
Michael J Mugavero
The HIV care continuum (or treatment cascade) classifies individuals with HIV infection who are diagnosed, linked to care, retained in care, on antiretroviral therapy, and virally suppressed, to assess the effectiveness of health care and treatment from a population-level health perspective. Initially, it was estimated that only approximately 50% of individuals diagnosed with HIV infection are retained in care, and a lower percentage is virally suppressed. In an HIV clinic, retention in care should be addressed from a system perspective but focus on persons on an individual basis, and success in retention of a high proportion of individuals in care is likely to depend on collaboration with surrounding communities, local health departments, and other agencies...
October 2016: Topics in Antiviral Medicine
Dana W Dunne
Universal screening and frequent retesting are required to reduce the burden of sexually transmitted infections in the HIV-infected population. Dual treatment is available for gonorrhea, expedited partner therapy is effective and legal in most states, sexually transmitted infection rates are high in the context of preexposure prophylaxis, and there is a continuing rise in rates of syphilis, particularly early neurosyphilis. This article summarizes a presentation by Dana W. Dunne, MD, FACP, at the IAS-USA continuing education program, Improving the Management of HIV Disease, held in New York, New York, in March 2016...
October 2016: Topics in Antiviral Medicine
Jennifer J Kiser
The potential for drug-drug interactions is an important consideration in the treatment of HIV/hepatitis C virus (HCV) coinfection. Regimens for HCV genotype 1 infection are discussed in the context of an individual on stable antiretroviral therapy, to determine which HCV treatments may be initiated without requiring a change in antiretroviral regimen or an increase in monitoring for potential drug-drug interactions. The effects of potential interactions between HCV drugs and other therapeutic classes of drugs are also discussed...
October 2016: Topics in Antiviral Medicine
Timothy M Westmoreland
From its beginning, the AIDS epidemic crystallized some of the major flaws of the American health care system. Most private health insurance was associated with employment, and job loss meant insurance loss. Private insurers refused new coverage for people with HIV infection. Medicaid, an important program for uninsured people with low income, was limited to only those in certain categories (eg, pregnant women or children), and although people who had progressed to AIDS were categorized as eligible (ie, "disabled"), those with early stage HIV disease were not...
July 2016: Topics in Antiviral Medicine
Benjamin P Linas
Access to newer therapies for the treatment of hepatitis C virus (HCV) infection is limited by the costs of these treatments. Newer HCV regimens have been shown to be cost-effective in early stages and late stages of the disease, but payers in the United States may refuse to reimburse for treatment of early disease because of budget constraints. Approaches that can maximize patients' access to appropriate therapy include having dedicated staff to handle prior authorizations and appeals, keeping records of successful approaches to prior authorizations and appeals and sharing these approaches with colleagues, and communicating with patients so that they will not be lost to appropriate health care...
July 2016: Topics in Antiviral Medicine
Diane M Janowicz
A recent outbreak of HIV infection centered in the rural town of Austin in Scott County, Indiana, was associated with widespread injection drug use and a socio-economically depressed population. Control of the outbreak required coordinated efforts by state, federal, local, and academic institutions to implement and maintain on-site programs and services that included contact tracing, HIV and hepatitis C virus testing, insurance enrollment, syringe exchange, rehabilitation services, care coordination, preexposure prophylaxis, and HIV treatment...
July 2016: Topics in Antiviral Medicine
Carlos Del Rio
HIV disproportionately impacts populations that have traditionally suffered from health disparities; thus, it is unsurprising that health disparities are a major driver of the ongoing HIV epidemic in the United States. High rates of HIV prevalence and incidence are now seen in the Southern United States and among black men who have sex with men, transgender women, and individuals in low-income settings. In addition, substance use continues to be a major driver of the HIV epidemic and impacts care outcomes. Efforts at reducing HIV transmission must include focus on engagement and retention in care among individuals at risk of being lost to care...
July 2016: Topics in Antiviral Medicine
Barbara S Taylor, Susan A Olender, Hong-Van Tieu, Timothy J Wilkin
The 2016 Conference on Retroviruses and Opportunistic Infections highlighted exciting advances in antiretroviral therapy, including important data on investigational antiretroviral drugs and clinical trials. Clinical trials demonstrated benefits from a long-acting injectable coformulation given as maintenance therapy, examined intravenous and subcutaneous administration of a monoclonal antibody directed at the CD4 binding site of HIV-1, and provided novel data on tenofovir alafenamide. Several studies focused on the role of HIV drug resistance, including the significance of minority variants, transmitted drug resistance, use of resistance testing, and drug class-related resistance...
May 2016: Topics in Antiviral Medicine
Anne F Luetkemeyer, David L Wyles
At the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, Massachusetts, hepatitis C virus (HCV) infection remained a major theme in the context of HIV-associated liver disease, although other causes of liver disease garnered increased attention, including fatty liver disease, hepatitis B, and the impact of HIV disease itself on the liver. Although no data from phase III studies of HCV direct-acting antiviral (DAA) drugs for the treatment of HIV/HCV coinfection were presented at CROI 2016, a broad range of HCV DAA-related topics were presented, including accumulating experience with real-world performance of DAA-based regimens outside of clinical trials, drug interactions between DAA and antiretroviral drugs, treatment of acute HCV infection, and retreatment of individuals whose DAA-based regimens failed and those in whom resistance to DAA drugs emerged...
May 2016: Topics in Antiviral Medicine
Diane V Havlir, Judith S Currier
Noncommunicable conditions such as cardiovascular disease, hypertension, renal and bone diseases, and malignancies as well as infectious complications are an ongoing concern during the course of treated HIV disease. Research in this area continues to focus on the epidemiology and risk factors for these conditions, on identifying the contributions of HIV-related immunopathology to specific and collective end-organ diseases, and on evaluating interventions to prevent or reduce the morbidity associated with these conditions...
May 2016: Topics in Antiviral Medicine
Serena S Spudich, Beau M Ances
The brain remains a major target for HIV infection and a site of potential complications for HIV-infected individuals. Emerging data presented at the 2016 Conference on Retroviruses and Opportunistic Infections suggest that during the early stages of infection, activated CD4+ cells may traffic the virus into the central nervous system (CNS). HIV is detectable in cells and tissues of the CNS in some individuals despite suppressive antiretroviral treatment. A potential source of cerebrospinal fluid HIV escape may be compartmentalized HIV replication within macrophage lineage cells...
May 2016: Topics in Antiviral Medicine
Susan P Buchbinder, Albert Y Liu
The 2016 Conference on Retroviruses and Opportunistic Infections (CROI) highlighted hot spots in HIV infection. Men who have sex with men (MSM), transgender populations, people who inject drugs, fisherfolk, migrants, adolescents, and older adults are heavily impacted in a number of regions. Stigma contributes to risk behaviors and HIV acquisition across populations. HIV testing is a crucial first step in the HIV care continuum, and several large community-based surveys are underway in Africa to increase HIV testing, linkage to care, and uptake of antiretroviral treatment...
May 2016: Topics in Antiviral Medicine
Mario Stevenson
The 2016 Conference on Retroviruses and Opportunistic Infections continued to maintain balance in the representation of different areas of research related to HIV/AIDS. The basic science category encompasses research on viral reservoirs and HIV cure, on cellular factors regulating the interplay between virus and host, and on factors that influence viral pathogenicity. Basic research on factors that influence the interaction between the virus and the host cell continues to unearth surprises with the identification of a new host antiviral factor...
May 2016: Topics in Antiviral Medicine
Jennifer M Gilbert, Kathleen V Fitch, Steven K Grinspoon
HIV infection is associated with increased cardiovascular disease (CVD), and increased rates of myocardial infarction and stroke have been observed in HIV-infected individuals. After traditional risk factors that are more common among people living with HIV infection (such as smoking and diabetes) are accounted for, the excess risk for CVD persists. Recent studies suggest that increased immune activation and inflammation may contribute to excess risk for CVD in the context of HIV infection. Imaging studies in the HIV-infected population have found inflamed, noncalcified plaque that is vulnerable to rupture...
October 2015: Topics in Antiviral Medicine
Marla J Keller
HIV-infected women have higher rates of persistence of human papillomavirus (HPV) infection, of abnormal cervical cytology results, and of cervical cancer than uninfected women. It is currently recommended that HIV-infected, sexually active women have a Papanicolaou (Pap) test performed at the time of initial diagnosis of HIV infection, followed by annual Pap testing if the previous test result is normal. Women whose test results show abnormalities greater than atypical squamous cells of undetermined significance (ASCUS) should be referred for colposcopy...
October 2015: Topics in Antiviral Medicine
Annemarie M Wensing, Vincent Calvez, Huldrych F Günthard, Victoria A Johnson, Roger Paredes, Deenan Pillay, Robert W Shafer, Douglas D Richman
The 2015 edition of the IAS-USA drug resistance mutations list updates the figures last published in July 2014. The mutations listed are those that have been identified by specific criteria for evidence and drugs described. The figures are designed to assist practitioners in identifying key mutations associated with resistance to antiretroviral drugs and, therefore, in making clinical decisions regarding antiretroviral therapy.
October 2015: Topics in Antiviral Medicine
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