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Advanced practice HIV clinic

Daniel C Baker
PURPOSE/OBJECTIVES: This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation. BACKGROUND: In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings. DESCRIPTION: A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed...
January 2017: Clinical Nurse Specialist CNS
Shannon M Fuller, Kimberly A Koester, Ryan R Guinness, Wayne T Steward
Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV...
January 2017: Journal of the Association of Nurses in AIDS Care: JANAC
Ying Huang, Peter B Gilbert, Rong Fu, Holly Janes
SummaryBiomarker endpoints measuring vaccine-induced immune responses are essential to HIV vaccine development because of their potential to predict the effect of a vaccine in preventing HIV infection. A vaccine's immune response profile observed in phase I immunogenicity studies is a key factor in determining whether it is advanced for further study in phase II and III efficacy trials. The multiplicity of immune variables and scientific uncertainty in their relative importance, however, pose great challenges to the development of formal algorithms for selecting vaccines to study further...
September 20, 2016: Biostatistics
Brenda Crabtree-Ramírez, Yanink Caro-Vega, Bryan E Shepherd, Beatriz Grinsztejn, Marcelo Wolff, Claudia P Cortes, Denis Padgett, Gabriela Carriquiry, Valeria Fink, Karu Jayathilake, Anna K Person, Catherine McGowan, Juan Sierra-Madero
BACKGROUND: Since 2009, earlier initiation of highly active antiretroviral therapy (HAART) after an opportunistic infection (OI) has been recommended based on lower risks of death and AIDS-related progression found in clinical trials. Delay in HAART initiation after OIs may be an important barrier for successful outcomes in patients with advanced disease. Timing of HAART initiation after an OI in "real life" settings in Latin America has not been evaluated. METHODS: Patients in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) ≥18 years of age at enrolment, from 2001-2012 who had an OI before HAART initiation were included...
2016: PloS One
You-Shyang Chen
BACKGROUND AND OBJECTIVE: The HIV/AIDS-related issue has given rise to a priority concern in which potential new therapies are increasingly highlighted to lessen the negative impact of highly active anti-retroviral therapy (HAART) in the healthcare industry. With the motivation of "medical applications," this study focuses on the main advanced feature selection techniques and classification approaches that reflect a new architecture, and a trial to build a hybrid model for interested parties...
July 2016: Computer Methods and Programs in Biomedicine
Shuihong Cheng, Yan Wang, Zhenxing Zhang, Xun Lv, George F Gao, Yiming Shao, Liying Ma, Xuebing Li
Enfuvirtide (ENF) is a clinically used peptide drug for the treatment of HIV infections, but its poor pharmacokinetic profile (T1/2 = 1.5 h in rats) and low aqueous solubility make the therapy expensive and inconvenience. In this study, we present a simple and practical strategy to address these problems by conjugating ENF with polyethylene glycol (PEG). Site-specific attachment of a 2 kDa PEG at the N-terminus of ENF resulted in an ENF-PEG (EP) conjugate with high solubility (≥3 mg/mL) and long half-life in rats (T1/2 = 16...
October 4, 2016: European Journal of Medicinal Chemistry
April D Kimmel, Erika G Martin, Hadiza Galadima, Rose S Bono, Ali Bonakdar Tehrani, John W Cyrus, Margaret Henderson, Kenneth A Freedberg, Alexander H Krist
With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models...
October 2016: AIDS Care
Monika Roy, Winnie Muyindike, Tara Vijayan, Michael Kanyesigye, Mwebesa Bwana, Megan Wenger, Jeffrey Martin, Elvin Geng
BACKGROUND: The uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary "diagnostic cascade" to understand real-world barriers to active TB case detection. METHODS: We conducted a cohort analysis of new, antiretroviral therapy-naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012-September 30, 2013)...
August 15, 2016: Journal of Acquired Immune Deficiency Syndromes: JAIDS
Beth Rachlis, Donald C Cole, Monique van Lettow, Michael Escobar
BACKGROUND: While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures...
2016: BMC Medical Informatics and Decision Making
Juan Pretell-Mazzini, Ty Subhawong, Victor H Hernandez, Rafael Campo
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management...
May 4, 2016: Journal of Bone and Joint Surgery. American Volume
Suzanne Carlberg-Racich
Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction-which removes judgment and operates at the patient's stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system...
2016: PeerJ
Carmen J Portillo, Suzan Stringari-Murray, Christopher B Fox, Erica Monasterio, Carol Dawson Rose
The increasing demand for primary care services and the current health care workforce shortage is predicted to cause drastic reductions in the number of clinicians who are competent to provide HIV care. For the past decade, the University of California, San Francisco (UCSF) School of Nursing has provided HIV specialty education for Advanced Practice Nursing students in the Master's curriculum. In 2013, UCSF was funded by the Health Resources Services Administration to establish a nurse practitioner (NP) HIV primary care education program to expand the number of NPs prepared to provide culturally appropriate comprehensive HIV primary care...
May 2016: Journal of the Association of Nurses in AIDS Care: JANAC
Brittany E Yee, Nghia H Nguyen, Minjuan Jin, Glen Lutchman, Joseph K Lim, Mindie H Nguyen
BACKGROUND: High sustained virological response at 12 weeks after end of treatment (SVR12) with 12 weeks of simeprevir and sofosbuvir±ribavirin (SMV+SOF±RBV) has been demonstrated in hepatitis C virus genotype 1 (HCV-1) but is based on limited data. Therefore, we performed a meta-analysis of available data evaluating the effectiveness of SMV+SOF±RBV in HCV-1. METHODS: We performed a comprehensive literature search in June 2015 to identify randomised controlled trials (RCTs) and observational studies of HCV-1 patients treated with 12 weeks of SMV+SOF±RBV...
2016: BMJ Open Gastroenterology
Madhavan Nair, Rahul Dev Jayant, Ajeet Kaushik, Vidya Sagar
In spite of significant advances in antiretroviral (ARV) therapy, the elimination of human immunodeficiency virus (HIV) reservoirs from the periphery and the central nervous system (CNS) remains a formidable task. The incapability of ARV to go across the blood-brain barrier (BBB) after systemic administration makes the brain one of the dominant HIV reservoirs. Thus, screening, monitoring, and elimination of HIV reservoirs from the brain remain a clinically daunting and key task. The practice and investigation of nanomedicine possesses potentials for therapeutics against neuroAIDS...
August 1, 2016: Advanced Drug Delivery Reviews
S Abigail Smith, Cynthia A Derdeyn
Recent biological, structural, and technical advances are converging within the HIV-1 vaccine field to harness the power of antibodies for prevention and therapy. Numerous monoclonal antibodies with broad neutralizing activity against diverse HIV-1 isolates have now been identified, revealing at least five sites of vulnerability on the envelope (Env) glycoproteins. While there are practical and technological barriers blocking a clear path from broadly neutralizing antibodies (bNAb) to a protective vaccine, this is not a dead end...
2016: F1000Research
Nicolai Lohse
The work on this thesis began in 2003 when the global HIV epidemic was out of control. A minority of persons with HIV were benefitting fully from the recently introduced highly efficacious antiretroviral therapy (ART) combinations. Among the global challenges were lack of access to good healthcare, drug toxicity, and emergence of drug-resistant virus. It was unknown how long the drugs could maintain their efficacy in the individual even if administered as intended, and there was a fear that the increased drug pressure would increase the prevalence of drug resistance, subsequently leading to transmission of resistant virus from one individual to another, and thereby waning the treatment options available...
February 2016: Danish Medical Journal
Xuezhu Li, Shougang Zhuang
Acute kidney injury (AKI) is increasingly recognized in clinical practice, and common in HIV-infection patients, affecting 18% of hospitalized patients. Preexisting hypertension, advanced HIV-infection, tenofovir toxicity, HCV co-infection, sepsis are risk factors of AKI. AKI can lead to prolonged hospitalization and is associated with increased mortality in HIV-infected patients. This review provides the most recent updates in the definition, diagnosis, pathophysiology, risk factors and treatment options for patients with HIV-associated AKI...
April 2013: Journal of Tropical Diseases
M Walker, H B El-Serag, Y Sada, S Mittal, J Ying, Z Duan, P Richardson, J A Davila, F Kanwal
BACKGROUND: Most clinical practice guidelines recommend screening for HCC in patients with cirrhosis. However, patients with compensated cirrhosis are often asymptomatic and may remain unrecognised for years. AIMS: To determine the extent to which cirrhosis is unrecognised in a US Veteran population with HCC, and to evaluate the association between lack of cirrhosis recognition and stage of HCC at diagnosis. METHODS: We reviewed the electronic medical records of a random sample of HCC cases diagnosed in the national Veterans Affairs system between 2005 and 2011...
March 2016: Alimentary Pharmacology & Therapeutics
Martin Amogre Ayanore, Milena Pavlova, Wim Groot
BACKGROUND: Identifying relevant measures of women's reproductive health needs is critical to improve women's chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa. METHODS: Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed...
January 16, 2016: Reproductive Health
B Burmen, S Modi, J S Cavanaugh, H Muttai, K D McCarthy, H Alexander, K Cain
SETTING: Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya. OBJECTIVE: To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding. DESIGN: Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year...
January 2016: International Journal of Tuberculosis and Lung Disease
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