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Open Forum Infect Dis ; 5(8): ofy180, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30568989


Prompt determination of HIV infection status is critical during follow-up visits for patients taking pre-exposure prophylaxis (PrEP) medication. Those who are uninfected can then continue safely taking PrEP, and those few who have acquired HIV infection can initiate an effective treatment regimen. However, a few recent cases have been reported of ambiguous HIV test results using common testing algorithms in PrEP patients. We review published reports of such cases and testing options that can be used to clarify true HIV status in these situations. In addition, we review the benefits and risks of 3 antiretroviral management options in these patients: (1) continue PrEP while conducting additional HIV tests, (2) initiate antiretroviral therapy for presumptive HIV infection while conducting confirmatory tests, or (3) discontinue PrEP to reassess HIV status after a brief antiretroviral-free interval. A clinical consultation resource is also provided.

Am J Epidemiol ; 187(9): 1962-1969, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635352


The US Centers for Disease Control and Prevention has estimated human immunodeficiency virus (HIV) viral suppression (VS) using 2 data sources. The National HIV Surveillance System estimate (50% of HIV-diagnosed persons in 2012) is derived from viral load reporting from a subset of jurisdictions that vary yearly. The Medical Monitoring Project (MMP) estimate (42% of HIV-diagnosed persons in 2012) is based on a sample of persons receiving HIV care during the first 4 months of each year. We developed the cohort-adjustment method to reconstruct VS estimates, accounting for persons receiving care later in the year. Using the HIV Outpatient Study cohort, we assessed timing of care receipt, demographics, and VS at last test (<200 vs. ≥200 copies/mL), standardizing MMP to HIV Outpatient Study data using multivariable regression models and yielding adjusted VS estimates. We estimated that 52% (95% CI: 48, 56) of HIV-diagnosed persons achieved VS in 2012. Differences from previously published estimates were due to: 1) 23% underestimation of persons receiving HIV care, and 2) lower VS rates among persons receiving care outside versus inside the 4-month MMP sampling period (79% vs. 88%). This methodology yielded VS estimates closer to the National HIV Surveillance System estimate than previously published. Use of more, geographically diverse cohort data may enable assessment of temporal trends.

Infecções por HIV/terapia , Vigilância da População/métodos , Carga Viral/estatística & dados numéricos , Adolescente , Adulto , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
AIDS Behav ; 21(3): 619-625, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27624729


Few groups in the United States (US) are as heavily affected by HIV as men who have sex with men (MSM), yet many MSM remain unaware of their infection. HIV diagnosis is important for decreasing onward transmission and promoting effective treatment for HIV, but the cost-effectiveness of testing programs is not well-established. This study reports on the costs and cost-utility of the MSM Testing Initiative (MTI) to newly diagnose HIV among MSM and link them to medical care. Cost and testing data in 15 US cities from January 2013 to March 2014 were prospectively collected and combined to determine the cost-utility of MTI in each city in terms of the cost per Quality Adjusted Life Years (QALY) saved from payer and societal perspectives. The total venue-based HIV testing costs ranged from $18,759 to $564,284 for nine to fifteen months of MTI implementation. The cost-saving threshold for HIV testing of MSM was $20,645 per new HIV diagnosis. Overall, 27,475 men were tested through venue-based MTI, of whom 807 (3 %) were newly diagnosed with HIV. These new diagnoses were associated with approximately 47 averted HIV infections. The cost per QALY saved by implementation of MTI in each city was negative, indicating that MTI venue-based testing was cost-saving in all cities. The cost-utility of social network and couples testing strategies was, however, dependent on whether the programs newly diagnosed MSM. The cost per new HIV diagnosis varied considerably across cities and was influenced by both the local cost of MSM testing implementation and by the seropositivity rate of those reached by the HIV testing program. While the cost-saving threshold for HIV testing is highly achievable, testing programs must successfully reach undiagnosed HIV-positive individuals in order to be cost-effective. This underscores the need for HIV testing programs which target and engage populations such as MSM who are most likely to have undiagnosed HIV to maximize programmatic benefit and cost-utility.

Sorodiagnóstico da AIDS/economia , Infecções por HIV/diagnóstico , Infecções por HIV/economia , Homossexualidade Masculina , Programas de Rastreamento/economia , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adulto , Análise Custo-Benefício , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/métodos , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Minorias Sexuais e de Gênero , Estados Unidos/epidemiologia
Am J Public Health ; 103(1): 141-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23153150


OBJECTIVES: To report on indicators of the National HIV/AIDS Strategy, we analyzed data collected through the national HIV surveillance system. METHODS: We analyzed data from adults and adolescents aged 13 years or older diagnosed with HIV in 13 US jurisdictions that have laboratory reporting of CD4+ T-lymphocyte (CD4) and viral load (VL) test results and enter CD4 and VL test results into the national surveillance system. RESULTS: Of 4899 people diagnosed in 2009, 81.7% had at least 1 CD4 or VL test performed within 3 months of diagnosis. A higher proportion of Whites (86.2%) than Blacks (78.4%) and Hispanics (82.6%) had a CD4 or VL test. Of 53,642 people diagnosed through 2008 and living with HIV at the end of 2009 who had a VL test, 69.4% had a most recent VL of 200 copies per milliliter or less. The proportion of people with suppressed VLs differed among Blacks (60.2%), Hispanics (70.3%), and Whites (77.4%) and among people aged 13 to 24 years (44.3%) compared with people aged 65 years or older (84.2%). Of men who have sex with men, 74.2% had a suppressed VL. CONCLUSIONS: The findings highlight disparities in access to and success of care.

Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Vigilância da População , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Feminino , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Carga Viral , Adulto Jovem
J Acquir Immune Defic Syndr ; 60(1): 77-82, 2012 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-22267016


BACKGROUND: Monitoring immunologic and virologic responses to antiretroviral therapy in HIV-1-infected patients is an important component of treatment in the United States. However, little population-based information is available on whether HIV-infected persons receive the recommended tests or continuous care. METHODS: Using data from 13 areas reporting relevant HIV-related tests to national HIV surveillance, we determined retention in care in persons older than 12 years living with HIV at the end of 2009. We assessed retention in care, defined as ≥2 CD4 or viral load tests at least 3 months apart in the past year, by demographic, clinical, and risk characteristics and calculated prevalence ratios and 95% confidence intervals. We also assessed the percentage established in care within 12 months after HIV diagnosis in 2008 (≥2 tests, ≥3 months apart). RESULTS: Among 100,375 persons living with HIV, 45% had ≥2 tests at least 3 months apart. A higher percentage of whites were retained in care (50%) compared with blacks/African Americans (41%, prevalence ratio: 0.83, 95% confidence interval: 0.82 to 0.84) and Hispanics/Latinos (40%, prevalence ratio: 0.90, 95% CI: 0.87 to 0.92). Compared with heterosexual women (50%), fewer men who have sex with men (48%), heterosexual men (45%), and male (37%) and female (43%) injection drug users had ≥2 tests. Approximately 64% established care within 12 months of diagnosis. CONCLUSIONS: Less than half of persons living with HIV had laboratory evidence of ongoing clinical care and only two thirds established care after diagnosis. Further assessments determining modifiable barriers to accessing care could assist with achieving public health targets.

Fármacos Anti-HIV/administração & dosagem , Monitoramento de Medicamentos/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos/epidemiologia , Carga Viral , Adulto Jovem
Sex Transm Dis ; 34(10): 744-8, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17565334


OBJECTIVES: Surveillance findings consistently indicate that black men who have sex with men (MSM) experience a disproportionate burden of HIV/AIDS compared with white MSM. This study tested the hypothesis that black MSM engage in greater levels of HIV risk behaviors than white MSM and sought to determine if self-reported HIV serostatus moderated any of the observed differences. METHODS: A cross-sectional study of MSM was conducted by recruiting men from gay-identified venues in a large metropolitan area of the southern United States. Data were collected by face-to-face interview. RESULTS: The hypothesis was only supported for one measure of HIV risk behavior: The average number of main (steady) sex partners in the past year was significantly greater among black men (P < 0.0001). However, black and white MSM did not significantly differ in unprotected sex with serodiscordant partners. Racial differences in sexual risk behavior were found only for HIV-negative men and indicated greater protective behavior for black men. DISCUSSION: These findings suggest that fewer black MSM, compared with white MSM, engage in HIV sexual risk behaviors but only among HIV-negative men. Identifying the epidemiologic dynamics driving HIV infection among black MSM that go beyond individual-level risk behaviors may be warranted.

Infecções por HIV/etnologia , Homossexualidade Masculina/etnologia , Adolescente , Adulto , Afro-Americanos , Idoso , Preservativos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Estados Unidos/epidemiologia , Sexo sem Proteção/etnologia