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Genetic diversity among and within populations of all species is necessary for people and nature to survive and thrive in a changing world. Over the past three years, commitments for conserving genetic diversity have become more ambitious and specific under the Convention on Biological Diversity's (CBD) draft post-2020 global biodiversity framework (GBF). This Perspective article comments on how goals and targets of the GBF have evolved, the improvements that are still needed, lessons learned from this process, and connections between goals and targets and the actions and reporting that will be needed to maintain, protect, manage and monitor genetic diversity. It is possible and necessary that the GBF strives to maintain genetic diversity within and among populations of all species, to restore genetic connectivity, and to develop national genetic conservation strategies, and to report on these using proposed, feasible indicators.
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Partisan animosity has been on the rise in America. Partisan animosity involves blame, wherein political partisans blame outparty members for their beliefs and actions. Here, we examine whether a historicist thinking intervention-drawn from research on blame mitigation-can reduce partisan animosity. The intervention consisted of three components: (1) a narrative about the idiosyncratic development of one political opponent paired with (2) a message about how unique life experiences shape everyone's political beliefs and (3) a suggestion that outparty members can be changed by future formative experiences. Experiments 1 and 2 showed that the intervention reduced cold feelings-measured via Feeling Thermometer-towards the outparty for both Democrats and Republicans. Experiments 3 and 4 focused on more specific emotional changes. Experiment 3 showed that, for Democrats, the intervention increased compassion. Experiment 4 showed that, for Republicans, the intervention reduced disgust, disapproval, anger, and contempt, but had no impact on compassion. For Democrats, but not for Republicans, reductions in animosity were mediated by reduced perceptions of control of self-formation, the mediator identified in prior work on historicist thinking and blame mitigation.
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Cristalino , Lentes , Unionidae , Animales , Emociones , IraRESUMEN
Studies of economic decision-making have revealed the existence of consistent contributors, who always make contributions to the collective good. It is difficult to understand such behavior in terms of mutualistic motives. Furthermore, consistent contributors can elicit apparently altruistic behavior from others. Therefore, although mutualistic motives are likely an important contributor to moral action, there is more to morality than mutualism.
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Conducta de Elección , Matrimonio , Principios Morales , Parejas Sexuales , Femenino , Humanos , MasculinoRESUMEN
The blameworthiness of an offender is often discussed in groups. Yet, the research literature overwhelmingly examines individuals assessing blameworthiness in isolation. To address this gap in the literature, the present study examines group deliberations about blameworthiness, with a particular focus on how group deliberations impact utilization of mitigating information about an offender's unfortunate life history. Participants from introductory psychology courses at a U.S. university were placed in groups of two or three and each group also included a confederate who followed a script. Groups were randomly assigned to one of four conditions. In one condition (deed only), groups learned only about the offender's heinous crimes. In the three remaining conditions, participants also received a historicist narrative regarding how the offender's unfortunate history deformed his moral character. These conditions differed in terms of the confederate's arguments: Neutral arguments, arguments to ignore the narrative, or arguments to give great weight to the narrative. Results showed that the historicist narrative was particularly effective at reducing outrage and increasing compassion when the confederate argued for its utilization. The reduction in outrage mediated a reduction in spiteful punitiveness toward the offender. Interestingly, the confederate who urged fellow deliberators to ignore the historicist narrative had no impact on outrage or compassion. We also examined mediation of the impact of historicist narratives on outrage and compassion. We found that when the confederate remained neutral the impact of historicist narratives on outrage and compassion was mediated via diminished perceptions of the offender's control of self-formation. This mirrors what is typically found in prior work focused on individual judgments. In contrast, when the confederate argued that great weight should be given to the narrative, reductions in outrage were mediated via diminished perceptions of offender freedom of action. This pattern of mediation is not typically found but has been found in one previous study where participants received social encouragement to mitigate blame. Results are discussed in terms of how social influence might alter the inferences draw from historicist narratives. Suggestions for future research on social influence in the context of blame are presented.
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Criminales , Masculino , Humanos , Principios Morales , Crimen , Empatía , JuicioRESUMEN
BACKGROUND: A recent observational study suggested that the risk of cardiovascular events could be higher among antiretroviral therapy (ART)-naive individuals with HIV who receive integrase strand-transfer inhibitor (INSTI)-based ART than among those who receive other ART regimens. We aimed to emulate target trials separately in ART-naive and ART-experienced individuals with HIV to examine the effect of using INSTI-based regimens versus other ART regimens on the 4-year risk of cardiovascular events. METHODS: We used routinely recorded clinical data from 12 cohorts that collected information on cardiovascular events, BMI, and blood pressure from two international consortia of cohorts of people with HIV from Europe and North America. For the target trial in individuals who had previously never used ART (ie, ART-naive), eligibility criteria were aged 18 years or older, a detectable HIV-RNA measurement while ART-naive (>50 copies per mL), and no history of a cardiovascular event or cancer. Eligibility criteria for the target trial in those with previous use of non-INSTI-based ART (ie, ART-experienced) were the same except that individuals had to have been on at least one non-INSTI-based ART regimen and be virally suppressed (≤50 copies per mL). We assessed eligibility for both trials for each person-month between January, 2013, and January, 2023, and assigned individuals to the treatment strategy that was compatible with their data. We estimated the standardised 4-year risks of cardiovascular events (myocardial infarction, stroke, or invasive cardiovascular procedure) via pooled logistic regression models adjusting for time and baseline covariates. In per-protocol analyses, we censored individuals if they deviated from their assigned treatment strategy for more than 2 months and weighted uncensored individuals by the inverse of their time-varying probability of remaining uncensored. The denominator of the weight was estimated via a pooled logistic model that included baseline and time-varying covariates. FINDINGS: The analysis in ART-naive individuals included 10â767 INSTI initiators and 8292 non-initiators of INSTI. There were 43 cardiovascular events in INSTI initiators (median follow-up of 29 months; IQR 15-45) and 52 in non-initiators (39 months; 18-47): standardised 4-year risks were 0·76% (95% CI 0·51 to 1·04) in INSTI initiators and 0·75% (0·54 to 0·98) in non-INSTI initiators; risk ratio 1·01 (0·57 to 1·57); risk difference 0·0089% (-0·43 to 0·36). The analysis in ART-experienced individuals included 7875 INSTI initiators and 373â965 non-initiators. There were 56 events in INSTI initiators (median follow-up 18 months; IQR 9-29) and 3103 events (808 unique) in non-INSTI initiators (26 months; 15-37) in non-initiators: standardised 4-year risks 1·41% (95% CI 0·88 to 2·03) in INSTI initiators and 1·48% (1·28 to 1·71) in non-initiators; risk ratio 0·95 (0·60 to 1·36); risk difference -0·068% (-0·60 to 0·52). INTERPRETATION: We estimated that INSTI use did not result in a clinically meaningful increase of cardiovascular events in ART-naive and ART-experienced individuals with HIV. FUNDING: National Institute of Allergy and Infectious Diseases and National Institute on Alcohol Abuse and Alcoholism.
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Enfermedades Cardiovasculares , Infecciones por VIH , Inhibidores de Integrasa VIH , Adulto , Humanos , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Integrasa VIH/efectos adversos , América del Norte , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Integrasas/uso terapéuticoRESUMEN
Blame permeates our social lives. When done properly, blame can facilitate the upholding of moral norms. When done with excessive intensity or harshness, however, blame can have significant negative impacts. Here, we develop and validate a scale-the Blame Intensity Inventory-to measure individual differences in the propensity for intense blame responses. First, we present evidence for its convergent and divergent validity by examining relations with existing scales. In addition, in two studies, we show that the Blame Intensity Inventory-rooted in an affective conception of blame-predicts hostile responses to offenders better than do measures focused on blame-related cognitive appraisals (e.g., free will, intentionality). Finally, in three studies, we show that Blame Intensity uniquely predicts malicious satisfaction, or gratification upon learning that an offender has suffered gratuitous harm. Results are discussed in terms of important research questions that could be addressed using the Blame Intensity Inventory.
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Víctimas de Crimen , Criminales , Humanos , Principios Morales , Autonomía Personal , Satisfacción PersonalRESUMEN
When one learns that current struggles or transgressions of an individual or group are rooted in an unfortunate history, one experiences compassion and reduced blame. Prior research has demonstrated this by having participants receive (or not) a concrete historicist narrative regarding the particular individual or group under consideration. Here, we take a different approach. We explore the possibility that everyday people show meaningful variation in a broad lay theory that we call lay historicism. Lay historicists believe that-as a general fact-people's psychological characteristics and life outcomes are powerfully molded by their life histories. We present eight studies linking lay historicism to broad tendencies toward compassion and non-blaming. Collectively, Studies 1-5 suggest that lay historicism affects compassion and blame, respectively, via distinct mechanisms: (1) Lay historicism is associated with compassion because it creates a sense that-as a general fact-past suffering lies behind present difficulties, and (2) lay historicism is associated with blame mitigation because historicists reject the idea that-as a general fact-people freely and autonomously create their moral character. Thus, lay historicism increases compassion and decreases blame via distinct mechanisms. The remaining studies diversify our evidence base. Study 6 examines criminal justice philosophies rather than broad moral traits (as in the earlier studies) and shows that lay historicism is associated with preference for humane criminal justice philosophies. Study 7 moves from abstract beliefs to concrete situations and shows that lay historicism predicts reduced blaming of an irresponsible peer who is encountered face-to-face. One additional study-in our Supplemental Materials-shows that lay historicism predicts lower levels of blaming on implicit measures, although only among those who also reject lay controllability theories. Overall, these studies provide consistent support for the possibility that lay historicism is broadly associated with humane responding to the struggles and transgressions of others.
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Principios Morales , Percepción Social , Adulto , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: The co-occurrence of frailty and cognitive impairment in older (50+ years) persons with HIV (PWH) is common and increases the risk of poor outcomes. In HIV clinics, the most commonly used frailty measures are the frailty phenotype (FP), which requires measuring grip strength and gait speed to implement, and the frailty index (FI) based on comprehensive health data collected on patients. We examined construct and criterion-related validity (as it predicts cognition) of the Clinical Frailty Scale (CFS), a less resource-intensive approach for assessing frailty, in relation to these more commonly used frailty assessments (FP and FI). SETTING/METHODS: A total of 143 older (age 50+) PWH (mean age 57 years; 88% male) seen at the Southern Alberta Clinic underwent both frailty screening with the FP, CFS, and FI and neuropsychological testing. Mixed-effects regressions examined the associations between frailty status and cognition. RESULTS: Concordance with the FP was slightly superior for the CFS than the FI. The FP and CFS had similar associations with domain-specific cognitive performance with frail PWH performing worse than nonfrail individuals on tests requiring manual dexterity (Trail Making Part A and B; Symbol Digit; and Grooved Pegboard; P values <0.05). Neither were associated with executive function, learning, or memory performance. The FI was associated with worse fluency, fine motor skills (Grooved Pegboard), and Trail Making Part A. CONCLUSION: The CFS is a simple screening tool with good construct and criterion-related validity. It was associated with a similar pattern of cognitive deficits as the FP. If confirmed and the associations are extended to other clinically significant characteristics and outcomes, the CFS can be considered as an alternative to the FP and FI in assessing frailty in older PWH.
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Anciano Frágil , Fragilidad/diagnóstico , Evaluación Geriátrica/métodos , Infecciones por VIH/complicaciones , Complejo SIDA Demencia/complicaciones , Anciano , Demencia/complicaciones , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Trastornos Neurocognitivos/complicaciones , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To examine the impact of previous interpersonal violence (IPersV) experiences on long-term healthcare engagement and health outcomes in a large Canadian HIV-cohort. DESIGN: People living with HIV (PLHIV) were screened for IPersV, and their healthcare outcomes over the nine subsequent years were analyzed. METHODS: A total of 1064 PLHIV were screened for past and present IPersV experiences through semistructured interviews. Follow-up included core treatment engagement (e.g. clinic visits) and health-status variables (HIV viral load, CD4+ T-cell count, mortality, comorbidities), analyzed descriptively and with longitudinal Cox regressions. RESULTS: At intake, 385 (36%) PLHIV reported past or present IPersV including childhood (nâ=â224, 21%) or adulthood experiences (nâ=â161, 15%) and were offered conventional social work support. Over 9 years, individuals with any IPersV experiences were 36% more likely to discontinue care, 81% more likely to experience viremia, 47% more likely to experience a drop in CD4+ cell counts below 200/µl, and 65% more likely to die compared with patients not reporting IPersV (Pâ<â0.05). Outcomes were similar when adjusted for sociodemographic factors. Childhood IPersV in particular was linked to several of the outcomes, with higher rates of discontinuation of care, viremia, and mortality related to mental health/addiction or HIV-related complications. CONCLUSION: IPersV is associated with an increased risk over time of healthcare discontinuation, poorer long-term HIV-related health outcomes, and increased mortality, especially for patients victimized in childhood. Apart from targeted IPersV screening to initiate conventional supports (e.g. through social work), increased efforts to engage vulnerable populations in their long-term care seems warranted.
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Infecciones por VIH , Adulto , Canadá , Niño , Infecciones por VIH/complicaciones , Estado de Salud , Humanos , Violencia , Carga ViralRESUMEN
Life-history narratives describing how a transgressor developed aversive traits can mitigate blame. How is their effectiveness affected by narrative perspective? In particular, how is blame mitigation impacted when the transgressor appears to be knowledgeable of the story of his self-formation? In three experiments, we compare the effectiveness of narratives that reflect an objective perspective to those that reflect the transgressor's perspective. The experiments contrast two hypotheses. The Perspective Taking hypothesis asserts that the transgressor perspective will be especially effective for blame mitigation because it encourages 'stepping into the shoes' of the transgressor. In contrast, the Should Know Better hypothesis asserts that the transgressor perspective will be especially ineffective because it reveals the transgressor to have self-knowledge, which triggers an inference that he deeply comprehends the suffering he causes. Results support the Should Know Better hypothesis. Furthermore, Experiment 3 shows that the transgressor perspective increases blameworthiness regardless of whether the transgressor's prior life experiences parallel what he inflicts on his victims.
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Acoso Escolar , Principios Morales , Autoimagen , Interacción Social , Percepción Social , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , NarraciónRESUMEN
The data presented in this article are related to the research article entitled "Progress on National Biodiversity Indicator Reporting and Prospects for Filling Indicator Gaps in Southeast Asia " (Han et al., 2020). We examined quantifiable information about biodiversity indicators from the most recent two national reports (i.e., 4th in 2010 and 5th in 2015) to the United Nation's Convention on Biological Diversity (CBD) by the 10-member countries of the Association of Southeast Asian Nations (ASEAN): Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. This article presents the number of indicators, their level of development, and detailed lists of indicators for each country, and demonstrates general improvement in indicator use by the highest level of government reporting about implementation of the CBD at the national scale.
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INTRODUCTION: HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. METHODS: We included HIV treatment-naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS: The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). CONCLUSIONS: In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.
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Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Estudios de Cohortes , Femenino , Humanos , Linfoma no Hodgkin/mortalidad , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/mortalidad , Tuberculosis/mortalidadRESUMEN
Harsh blame can be socially destructive. This article examines how harsh blame can be "civilized." A core construct here is the historicist narrative, which is a story-like account of how a person came to be the sort of person she is. We argue that historicist narratives regarding immoral actors can temper blame and that this happens via a novel mechanism. To illuminate that mechanism, we offer a novel theoretical perspective on lay beliefs about free will. We distinguish 2 senses of free will: (a) Freedom of action, which portrays the will as a dynamic choice-making mechanism and concerns whether the actor can exert volitional control via that mechanism at the time of action, and (b) Control of self-formation, which portrays the will as an enduring disposition (e.g., persistent desire to humiliate) and refers to whether the actor is truly the source of that disposition. Six experiments show that historicist narratives have no effect on perceived freedom of action, but rather temper blame by reducing perceived self-formative control. We also provide evidence against several additional theoretically derived alternative mediators (e.g., intentionality, perceived suffering). Further underlining the need to distinguish free will concepts, we show that biological narratives-unlike historicist narratives-temper blame via reductions in perceived freedom of action. Finally, to illuminate the meaning of "civilized" blame," we show that historicist narratives specifically reduce the urge to inflict spiteful punishments on offenders, but leave intact the urge to nonviolently guide the offender toward moral improvement. (PsycINFO Database Record
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Relaciones Interpersonales , Narración , Autonomía Personal , Conducta Social , Percepción Social , Adulto , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Understanding the flow of patients through the continuum of HIV care is critical to determine how best to intervene so that the proportion of HIV-infected persons who are on antiretroviral treatment and virally suppressed is as large as possible. METHODS: Using immunological and virological data from the Centers for Disease Control and Prevention and the North American AIDS Cohort Collaboration on Research and Design from 2009 to 2012, we estimated the distribution of time spent in and dropout probability from each stage in the continuum of HIV care. We used these estimates to develop a queueing model for the expected number of patients found in each stage of the cascade. RESULTS: HIV-infected individuals spend an average of about 3.1 months after HIV diagnosis before being linked to care, or dropping out of that stage of the continuum with a probability of 8%. Those who link to care wait an additional 3.7 months on average before getting their second set of laboratory results (indicating engagement in care) or dropping out of care with probability of almost 6%. Those engaged in care spent an average of almost 1 year before achieving viral suppression on antiretroviral therapy or dropping out with average probability 13%. For patients who achieved viral suppression, the average time suppressed on antiretroviral therapy was an average of 4.5 years. CONCLUSIONS: Interventions should be targeted to more rapidly identifying newly infected individuals, and increasing the fraction of those engaged in care that achieves viral suppression.
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Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente , Infecciones por VIH/tratamiento farmacológico , Modelos Teóricos , Recuento de Linfocito CD4 , Continuidad de la Atención al Paciente/estadística & datos numéricos , Estudios Transversales , Femenino , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , Humanos , Masculino , Vigilancia de la Población , Estados Unidos/epidemiología , Carga ViralRESUMEN
Essentialist beliefs about social groups can contribute to prejudice and intergroup distancing. To date, little data have been gathered regarding minority group members' essentialistic thinking about the White majority in the U.S. Do essentialist beliefs show a similar structure when minority group members are thinking about the majority as when the majority group is thinking about the minority group? Do minority group essentialist beliefs predict affective prejudice and diminished desire for intergroup contact as they do among White respondents? We sought answers to these questions in a study that included 248 African American participants. We found clear evidence that the structure of Blacks' essentialist thinking about Whites matches the structure of Whites' essentialist thinking about Blacks. Specifically, Black respondents made a distinction between bio-somatic and bio-behavioral essentialism, and reported stronger endorsement of the former as compared to the latter. Also replicating prior studies of Whites' essentialist thinking, only bio-behavioral essentialist beliefs were predictive of negative attitudes. This suggests that essentialism can be linked to prejudice even in contexts that do not involve a dominant group rationalizing its social advantages. Discussion centers on implications of this work for prejudice reduction.
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Negro o Afroamericano/psicología , Grupos Minoritarios/psicología , Prejuicio , Población Blanca/psicología , Adulto , Anciano , Conducta , Femenino , Procesos de Grupo , Humanos , Masculino , Persona de Mediana Edad , Identificación Social , Estereotipo , Adulto JovenRESUMEN
People respond compassionately to transgressors whose immorality is rooted in an unfortunate life history. But, are reactions to such historicist narratives uniformly compassionate? We suggest not. We propose that historicist narratives also have a dark side. Specifically, they encourage blame shifting, in which negative evaluations of humanity arise hand in hand with compassion for the focal transgressor of the narrative. Indeed, historicist narratives portray the focal transgressor as victimized by multiple others, who destroy her goodness and remove her chance to flourish in life. This destruction of another's potential is itself a profound moral violation and thus activates far-reaching blame responses that feed a disdainful view of humanity. In three studies, we provide evidence that historicist narratives evoke compassion for one but disdain for the multitude. We show that the resulting disdain can diminish prosocial behaviour in unrelated contexts, that it is elicited by both experimenter-provided and participant-generated historicist narratives, and that it is created via blame shifting. Our findings question the assumption that proliferation of historicist thinking would necessarily contribute to creating a more compassionate, humane society.
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Empatía , Principios Morales , Narración , Percepción Social , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
An epidemiologically linked HIV-1-infected cohort, in which a nonprogressor donor infected two recipients who progressed to AIDS, was examined. Sequence analysis, over time, of HIV-1 vpr gene quasispecies from uncultured peripheral blood cells revealed an insertion of arginine at position 90 altering a highly conserved C-terminal motif, believed to play a role in Vpr nuclear targeting. Full genome analysis from each patient showed no gene defects in other gene regions, implying that the mutational selection was unique to the vpr gene. A detailed analysis of the vpr quasispecies showed very little amino acid diversity in the nonprogressing donor, whereas, following viral transmission, the amino acid diversity increased dramatically over time in tandem with disease progression in the two recipients. Although the R insertion at position 90 was present in all three individuals, the variable degree of additional amino acid changes over time may have influenced HIV disease in the nonprogressor donor and the two progressing recipients. These data provide the first evidence in favor of vpr gene evolution over time, which was host-driven. The status of the nonprogressing donor was consistent with a highly protective B-57 HLA type, which was absent in the two progressing recipients, implying a role for host HLA type and other immunologic selective pressures in vpr gene selection in vivo.
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Síndrome de Inmunodeficiencia Adquirida/virología , Genes prv , VIH-1/genética , Reacción a la Transfusión , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/transmisión , Secuencia de Aminoácidos , Terapia Antirretroviral Altamente Activa , Estudios de Cohortes , Progresión de la Enfermedad , VIH-1/clasificación , Humanos , Datos de Secuencia Molecular , FilogeniaRESUMEN
BACKGROUND: HIV-infected individuals with a history of transmission through injection drug use (IDU) have poorer survival than other risk groups. The extent to which higher rates of hepatitis C (HCV) infection in IDU explain survival differences is unclear. METHODS: Adults who started antiretroviral therapy between 2000 and 2009 in 16 European and North American cohorts with >70% complete data on HCV status were followed for 3 years. We estimated unadjusted and adjusted (for age, sex, baseline CD4 count and HIV-1 RNA, AIDS diagnosis before antiretroviral therapy, and stratified by cohort) mortality hazard ratios for IDU (versus non-IDU) and for HCV-infected (versus HCV uninfected). RESULTS: Of 32,703 patients, 3374 (10%) were IDU; 4630 (14%) were HCV+; 1116 (3.4%) died. Mortality was higher in IDU compared with non-IDU [adjusted HR 2.71; 95% confidence interval (CI): 2.32 to 3.16] and in HCV+ compared with HCV- (adjusted HR 2.65; 95% CI: 2.31 to 3.04). The effect of IDU was substantially attenuated (adjusted HR 1.57; 95% CI: 1.27 to 1.94) after adjustment for HCV, while attenuation of the effect of HCV was less substantial (adjusted HR 2.04; 95% CI: 1.68 to 2.47) after adjustment for IDU. Both IDU and HCV were strongly associated with liver-related mortality (adjusted HR 10.89; 95% CI: 6.47 to 18.3 for IDU and adjusted HR 14.0; 95% CI: 8.05 to 24.5 for HCV) with greater attenuation of the effect of IDU (adjusted HR 2.43; 95% CI: 1.24 to 4.78) than for HCV (adjusted HR 7.97; 95% CI: 3.83 to 16.6). Rates of CNS, respiratory and violent deaths remained elevated in IDU after adjustment for HCV. CONCLUSIONS: A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Hepatitis C/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adolescente , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento , Carga Viral , Adulto JovenRESUMEN
BACKGROUND: Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. METHODS: Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first full-calendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. RESULTS: Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50-59 (APR = 0.92, 95% CI: 0.75 to 1.13); ≥60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. CONCLUSIONS: These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.