Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 55
Filtrar
1.
HIV Med ; 25(5): 608-613, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38243621

RESUMO

BACKGROUND: Although HIV-related deaths among people with HIV have dramatically decreased, deaths from other medical conditions and non-medical events have increased. The location of death among people with HIV remains underreported. OBJECTIVES: We reviewed the deaths, causes of death, and reported location of death (i.e. within or outside of medical settings) of all people with HIV with the Southern Alberta Cohort, Calgary, Canada, between 1 January 2010 and 1 January 2022. METHODS: This was a retrospective longitudinal cohort study reviewing all deaths within a comprehensive geographically defined HIV cohort over 11 years. RESULTS: Deaths from HIV-related causes decreased from 52% of all deaths in 2010 to 14% in 2021. In 2021, non-HIV medical deaths increased from 38% to 44%, and non-medical deaths (e.g. violence, suicide, drug overdose) increased from 0.5% to 39%. Of non-medical deaths, 67% resulted from substance use/overdose. Overall, deaths in any medical setting decreased from 91% in 2010 to 39% in 2021; 61% of all deaths occurred in a medical setting (e.g. hospital/emergency department or supported/long-term/hospice care), 27% in a residence, and 9% in the community. CONCLUSION: The shifting causes of death (i.e. fewer HIV-related deaths, more overdose deaths) and location of death (i.e. fewer in medical settings, more at home/in the community) requires close monitoring so future resources can be matched to predicted patient needs.


Assuntos
Causas de Morte , Infecções por HIV , Humanos , Infecções por HIV/mortalidade , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Longitudinais , Alberta/epidemiologia , Adulto Jovem , Idoso
2.
AIDS Care ; 33(1): 114-120, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32408758

RESUMO

Retention in care remains an important concern for health care providers. However, accurately identifying who is or is not retained in care can be problematic. Not all patients believed to be engaged in care are actually in care, and not all patients believed to be disengaged are truly disengaged. Identifying the status of individuals within populations is important for clinical, administrative and surveillance concerns. As part of the Linkage and Retention in Care Project at St Michael's Hospital in Toronto, Canada, we investigated the status of patients diagnosed with HIV. Detailed investigation determined who was actually Lost-to-Follow-Up (i.e., disengaged from care >12 months) and who had disengaged for known reasons. This approach determined more precisely who was currently followed in care and who was not, and to target efforts to contact and reengage patients more effectively. This study illustrates the importance of accurately monitoring populations enhancing disease management.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Perda de Seguimento , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pacientes Desistentes do Tratamento/psicologia , Retenção nos Cuidados/estatística & dados numéricos , Canadá/epidemiologia , Estudos Transversais , Gerenciamento Clínico , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Estigma Social , Fatores Socioeconômicos
3.
BMC Infect Dis ; 18(1): 125, 2018 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-29534681

RESUMO

BACKGROUND: Syphilis is a global health concern disproportionately affecting HIV-infected populations. In Alberta, Canada, the incidence of syphilis in the general population has recently doubled with 25% of these infections occurring in HIV-infected patients. The Southern Alberta HIV Clinic (SAC) and Calgary STI Program (CSTI) analyzed the epidemiologic characteristics of incident syphilis infections in our well-defined, HIV-infected population over 11 years. METHODS: Since 2006, as routine practice of both the Southern Alberta Clinic (SAC) and Calgary STI Programs (CSTI), syphilis screening has accompanied HIV viral load measures every four months. All records of patients who, while in HIV care, either converted from being syphilis seronegative to a confirmed seropositive or were re-infected as evidenced by a four-fold increase in rapid plasma reagin (RPR) after past successful treatment, were reviewed. RESULTS: Incident syphilis was identified 249 times in 194 HIV-infected individuals. There were 36 individuals with repeated infections (28.5% of episodes). Following a prior decline in annual incident syphilis rates, the rates have tripled from 8.08/1000 patient-years (95% confidence interval (CI): 4.14-14.75) in 2011, to 27.04 per 1000 person-years (95% CI: 19.45-36.76) in 2016. Half of the syphilis episodes were asymptomatic. Patients diagnosed with syphilis were twice as likely not to be taking ART and had a higher likelihood of having plasma HIV RNA viral loads > 1000 copies/mL (19%). Incident syphilis was seen predominantly in Caucasians (72%, P < 0.001), males (94%, P < 0.001) and men who have sex with men (MSM) as their HIV risk activity (75%, P < 0.001). CONCLUSIONS: We have highlighted the importance of a regular syphilis screening program in HIV-infected individuals demonstrated by increasing rates of incident syphilis in our region. Targeted preventative strategies should be directed towards HIV-infected populations identified at highest risk, including; MSM, prior alcohol abuse, prior recreational drug use and those with prior syphilis diagnoses.


Assuntos
Infecções por HIV/diagnóstico , Sífilis/diagnóstico , Adulto , Idoso , Alberta , Alcoolismo/complicações , Instituições de Assistência Ambulatorial , Canadá/epidemiologia , Feminino , HIV/genética , HIV/isolamento & purificação , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Estudos Retrospectivos , Fatores de Risco , Sífilis/complicações , Sífilis/epidemiologia , Carga Viral , Adulto Jovem
4.
AIDS Care ; 29(5): 564-569, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27642701

RESUMO

Despite strong evidence of a clinical benefit from initiating antiretroviral therapy (ART) immediately after diagnosis some patients remain ART naïve. We examined explanations, over a four-year period in a centralized HIV clinical cohort under universal health care, for newly diagnosed patients, while being fully engaged and retained in HIV care, delaying ART initiation for >180 days following their HIV diagnosis. All patients followed at the Southern Alberta Clinic, Calgary, Canada between 1 January 2010 and 1 January 2014 were included and followed until they moved, were lost to follow-up, died or until 1 January 2015. Of 269 patients, 56 (21.8%) deferred ART >180 days; 26 (9.7%) remained ART naïve until the end of the study. Patients delaying or deferring ART were younger, Canadian-born, and with higher CD4 counts (p < .01). "No clinical urgency" especially for patients with higher CD4 counts, was most often listed for deferring ART, however when ART was offered "patient not ready", "unstable substance use", "difficulties adjusting" or "wanting to wait" were often cited regardless of CD4 levels. At times ART, when offered, was adamantly declined by the patient. The physician's assessment of a patient's ability to adhere to lifelong ART was an issue in some cases. While structural or financial issues may impact ART initiation, our results suggest that, even in an environment of free and easy access to ART, many challenges still exist at the implementation stage. Intense efforts in both patient and physician education will be required if the benefits of early ART as recommended by the WHO in their recent guidelines, are to be achieved at the individual and population level.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Recusa do Paciente ao Tratamento , Adaptação Psicológica , Adulto , Alberta , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/sangue , Infecções por HIV/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Transtornos Relacionados ao Uso de Substâncias/complicações , Fatores de Tempo
5.
AIDS Care ; 28(8): 1073-8, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26829326

RESUMO

With improved life expectancy, the medical records of HIV-infected patients are likely to be transferred repeatedly between HIV caregivers. The challenges, and risk for introducing medical error from incomplete record transfers are poorly understood. We measured number of requests for record transfer, the workload incurred, and explore, using genotypic antiretroviral resistance testing results (GART), the potential risk of incomplete records. Using retrospective database and chart review, we examined all patients followed at the Southern Alberta Clinic between 1 January 2004 and 1 January 2015, and determined how many patients transferred care into and out our program, the associated requests and the workload for record transfer. Using a complete record of all GART tests, the potential importance of absent historic records in current treatment decisions was analyzed. The annual churn rate was 22 ± 3.4%. We received requests for only 70% of patient records who had left our care. Median time for receipt of incoming medical records was 28 days; average clerical time for processing data was 2 hours/record. Of all GART results, 25% exhibited resistance. Of 111 patients with potentially misleading GART results (i.e., documented historical resistance not visible on more recent GART), 34 (30.6%) had moved in from elsewhere. Rigorous maintenance of the continuity of the HIV record is not universally practiced. Resources, costs and logistic challenges as well as a lack of appreciation of risks clearly shown by GART testing, may be relevant barriers. Addressing such issues is pressing as aging and transfers of care are increasingly common.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por HIV/terapia , Prontuários Médicos , Transferência de Pacientes , Adulto , Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Feminino , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
AIDS ; 38(1): 49-58, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-37702419

RESUMO

OBJECTIVES: The aim of this study was to define the frequency, risk factors, and clinical outcomes of both AIDS-defining and non-AIDS-defining neurologic infections among people with HIV (PWH). DESIGN: We conducted a retrospective observational cohort study by linking the clinical database at the Southern Alberta HIV Clinic (SAC) with the regional hospital and microbiology databases to identify cases and the associated morbidity and mortality for these neurologic infections from 1995 to 2018. METHODS: Neurologic infections were categorized into AIDS-defining and non-AIDS defining. Annual incidence rates per 1000 person-years were calculated. Cox proportional hazards models estimated adjusted hazard ratios (aHR) and 95% confidence intervals of risk factors for neurologic infections in PWH and mortality outcomes. RESULTS: Among 2910 PWH contributing 24 237 years of follow-up, 133 (4.6%) neurologic infections were identified; 107 (80%) were AIDS-defining and 26 (20%) non-AIDS defining. While the incidence of AIDS-defining neurologic infections declined over time, no change was seen in incidence of non-AIDS defining infections. The risk of having any neurologic infection was greater among black PWH (aHR = 2.5 [1.6-4.0]) (vs. white PWH) and those with a CD4 + T-cell nadir of less than 200 cells/µl (aHR = 6.6 [4.0-11.1]) (vs. ≥200 cells/µl). More AIDS-defining neurologic infections occurred in PWH with lower CD4 + T-cell counts and higher HIV viral loads. PWH with any neurologic infections experienced more seizures, strokes, all-cause mortality (aHR = 2.2 [1.5-3.2] and HIV-related mortality (aHR = 6.4 [3.9-10.7] (vs. no neurologic infection). CONCLUSION: Both AIDS and non-AIDS defining neurologic infections continue to occur in PWH resulting in significant morbidity and mortality. Early diagnosis and initiation of ART remain crucial in preventing neurological infections in PWH.


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Humanos , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Modelos de Riscos Proporcionais , Contagem de Linfócito CD4
7.
Curr HIV/AIDS Rep ; 10(4): 380-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23943348

RESUMO

Intimate partner violence (IPV) is a common and negative social determinant of health. IPV also increases vulnerability to risks associated with HIV transmission and contributes to HIV transmission. IPV is therefore predictably common among people living with HIV. It is increasingly being recognized as an important predictor of poor outcomes for those living with HIV by affecting retention to care, mental health, adherence to therapy, frequency of follow-up; all of which lead to more hospitalizations and progression to AIDS. HIV care providers can safely and effectively screen all HIV patients for IPV. Screening offers the opportunity to identify those at risk for poor outcomes and mitigate its effects. Further research is required in further defining the risk factors and outcomes of IPV and optimizing interventions. We review the association between HIV infection and IPV and make recommendations for IPV screening of HIV-positive individuals and those at high risk for HIV.


Assuntos
Violência Doméstica/estatística & dados numéricos , Infecções por HIV/epidemiologia , Violência Doméstica/prevenção & controle , Infecções por HIV/prevenção & controle , Humanos , Prevalência , Fatores de Risco
9.
AIDS Patient Care STDS ; 37(1): 1-10, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36576421

RESUMO

Unsuppressed HIV viremia damages immunity and increases the risk for secondary HIV transmission. Successful engagement of persons with HIV (PWH) into care resulting in viral suppression is vital. PWH already engaged in care, who, after achieving viral suppression, experience viral breakthrough episodes (VBEs) with a sequence of suppressed/unsuppressed/suppressed viral loads remain problematic. We examined the frequency and outcomes of PWH experiencing VBE. HIV care is provided at no cost to all patients under Alberta's universal health program. All PWH followed at Southern Alberta Clinic, Canada, with two or more viral load tests between January 1, 2010, and January 1, 2020, were evaluated. Sociodemographic, clinical, and lifestyle variables were determined along with health outcomes (CD4 levels, HIV-related hospitalizations, and HIV/AIDS-related mortality). Descriptive and multi-variable analyses were performed comparing PWH with and without VBEs. Of 2096 PWH, 386 (18%) experienced one or more VBEs. A higher risk of VBEs was seen in adjusted analyses in those diagnosed age ≤40 years. Increased risk of VBE was seen with injection drug use (46%) and in heterosexuals (56%) compared with MSM. Experience of intimate partner violence, unstable housing, homelessness, and past incarceration also increased risks by 36%, 44% 79%, and 51%, respectively. PWH with VBEs experienced lower CD4 counts (median -417/mm3 vs. 576/mm3), higher rates of HIV-related hospitalizations (16% vs. 5%), and a 67% increased risk of death (95% confidence interval 1.17-2.39) over the study period. Nearly 20% of all PWH, after achieving viral suppression, experienced VBEs. Distinct clinical, lifestyle, and life experiences predict PWH at greatest risk for more than one VBEs. Serious negative health outcomes of VBEs were identified, suggesting that novel customized care programming is required for PWH at greatest risk.


Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Humanos , Adulto , Alberta/epidemiologia , Infecções por HIV/complicações , Saúde Pública , Síndrome da Imunodeficiência Adquirida/complicações , Contagem de Linfócito CD4
10.
Curr Opin HIV AIDS ; 18(5): 273-279, 2023 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-37535042

RESUMO

PURPOSE OF REVIEW: The improved health of persons with HIV (PWH) resulting from antiretroviral therapy (ART) has led to recommendations for reduced laboratory monitoring. We studied, for all PWH in care over 20 years at the Southern Alberta Clinic (SAC), Canada, the changing use and results of HIV-specific laboratory testing [i.e., CD4+ testing, plasma HIV viral load (PVL), and genotypic antiretroviral resistance testing (GART)].In this descriptive retrospective longitudinal cohort observational study, we examined HIV-specific laboratory testing for all PWH from 2000 to 2020 within the context of HIV-related health outcomes, program costs, and mortality. RECENT FINDINGS: The number of PWH in care increased from 755 in 2000 to 2050 in 2020. Annual CD4+ testing per PWH increased from 2.7 per person in 2000 peaking to 3.5 in 2005 but decreasing to 1.4 by 2020. Annual PVL tests per PWH gradually decreased from 3.2 in 2000 to 2.0 in 2020. GART increased from 93 tests in 2000 to 315 in 2008 decreasing to 127 in 2020. Patients received GART at baseline, and after a viral breakthrough when indicated. Viral suppression rates for the population increased from 66 to 96%; median CD4+ cell count increased from 443 to 470 cells/µl, and overall morbidity decreased from 9.2 to 2.0% by 2020, respectively. Annual per patient laboratory costs decreased from a high of $302 in 2008 to $161 by 2020. SUMMARY: The reduced annual laboratory surveillance per PWH associated with modern ART resulted in modest cost savings and no apparent loss in quality of HIV care.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Humanos , Fármacos Anti-HIV/uso terapêutico , Estudos Retrospectivos , Contagem de Linfócito CD4 , Antirretrovirais/uso terapêutico , Carga Viral , Estudos Observacionais como Assunto
11.
Sci Rep ; 13(1): 20610, 2023 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-37996521

RESUMO

People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.


Assuntos
COVID-19 , Infecções por HIV , Adulto , Feminino , Masculino , Humanos , Vacinas contra COVID-19 , Hesitação Vacinal , COVID-19/epidemiologia , COVID-19/prevenção & controle , Alberta/epidemiologia , Infecções por HIV/epidemiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-36340845

RESUMO

BACKGROUND: Many challenges remain in successfully engaging people with HIV (PWH) into lifelong HIV care. Living in non-urban or rural areas has been associated with worse outcomes. Uncertainties remain regarding how to provide optimal HIV care in non-urban areas. METHODS: Using a retrospective descriptive analysis framework, we compared multiple measurable HIV care metrics over time on the basis of urban versus non-urban residency, under a centralized HIV care model. We examined rates of HIV diagnosis, access to and retention in HIV care, and longitudinal outcomes for all newly diagnosed PWH between January 1, 2008, and January 1, 2020, categorized by their home location at the time of HIV diagnosis in southern Alberta. RESULTS: Of 719 newly diagnosed PWH, 619 (86%) lived in urban areas and 100 (14%) lived in non-urban areas. At HIV diagnosis, the groups had no significant differences in initial CD4 count or clinical characteristics (p = 0.73). Non-urban PWH, however, had slightly longer times to accessing HIV care and initiating antiretroviral therapy (ART) (p < 0.01). Non-urban PWH showed trends toward slightly lower retention in care and lower sustained ART use, with higher rates of unsuppressed viral loads at 12, 24, and 36 months after diagnosis (p < 0.01). However, by 2020 both cohorts had suppression rates above 90%. CONCLUSIONS: Sustained retention in care was more challenging for non-urban PWH; however, adherence to ART and viral suppression rates were more than 90%. Although encouraging, challenges remain in identifying and reducing unique barriers for optimal care of PWH living in non-urban areas.


HISTORIQUE: Il reste de nombreux défis à relever pour mobiliser les personnes atteintes du VIH (PAV) à adhérer aux soins du VIH jusqu'à la fin de leurs jours. La résidence en région non urbaine ou rurale est associée à des résultats cliniques plus négatifs. Il reste des incertitudes quant aux moyens d'offrir des soins optimaux du VIH hors des régions urbaines. MÉTHODOLOGIE: Au moyen d'une analyse descriptive rétrospective, les chercheurs ont comparé de multiples mesures des soins du VIH au fil du temps d'après le lieu de résidence en milieu urbain ou non urbain, en fonction d'un modèle de soins du VIH centralisé. Ils ont examiné les taux de diagnostic du VIH, l'accès aux soins du VIH et la rétention de ces soins, ainsi que les résultats cliniques longitudinaux de toutes les PAV nouvellement diagnostiquées entre le 1er janvier 2008 et le 1er janvier 2020, classées d'après leur lieu de résidence au moment du diagnostic de VIH dans le sud de l'Alberta. RÉSULTATS: Sur les 719 PAV nouvellement diagnostiquées, 619 (86 %) vivaient en région urbaine et 100 (14 %), en région non urbaine. Au diagnostic du VIH, les groupes ne présentaient pas de différence significative pour ce qui est de la numération initiale des CD4 ou des caractéristiques cliniques (p = 0,73). Cependant, il fallait légèrement plus de temps aux PAV de milieu non urbain pour accéder aux soins du VIH et entreprendre une thérapie antirétrovirale (TAR) (p < 0,01). Ainsi, 12, 24 et 36 mois après le diagnostic, les PAV des milieux non urbains affichaient des tendances vers une rétention légèrement plus faible des soins et une utilisation soutenue légèrement plus faible du traitement antirétroviral (TAR), de même que des charges virales non supprimées plus élevées (p < 0,01). Cependant, en 2020, les deux cohortes présentaient des taux de suppression supérieurs à 90 %. CONCLUSIONS: Il était plus difficile de maintenir une rétention soutenue des soins pour les PAV hors des milieux urbains, mais l'adhésion au TAR et les taux de suppression virale étaient supérieurs à 90 %. C'était encourageant, mais il reste des défis pour déterminer et réduire les obstacles à des soins optimaux chez les PAV qui habitent hors des milieux urbains.

13.
AIDS Patient Care STDS ; 36(1): 1-7, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910887

RESUMO

The emergence of dual therapy for antiretroviral (ARV)-experienced persons living with HIV (PWH) offers the opportunity to reduce lifetime exposure to unnecessary ARV drugs while maintaining viral suppression and reducing the cost of care. Our objective, using retrospective analysis of a quality care initiative, was to examine in routine clinical practice the clinical impact of switching PWH stable on a three-drug to a two-drug single-tablet formulation (STF) ARV regimen. We also examined the cost implications of this STF adjustment. Between January 1, 2020 and January 1, 2021 eligible patients (i.e., virally suppressed, no active hepatitis B infection, no documented nucleoside reverse transcriptase inhibitors/integrase strand transfer inhibitor resistance) were offered, on a convenience basis and as part of routine care, the opportunity to adjust their current three-drug STF to a two-drug STF (dolutegarvair/lamivudine). The acceptance, clinical efficacy, safety, tolerability, and cost of treatment were measured for patients who switched in 2020. Of 989 eligible PWH, 408 were approached and 391 (39.5%) switched to two-drug regimen; 99% remained on the two-drug STF at year's end (median 240 days follow-up). Only 2/391 patients who switched lost viral control. The total ARV drug cost for all 989 patients decreased by 10.3% generating an actual savings of $1,596,666 among patients approached and switched in 2020. Patient interest and uptake in switching to two-drug STF was substantial and resulted in few discontinuations for any reason. It provided significant and immediate cost savings within the first year. Our results bring clarity to discussions on whether using two-drug regimens would be practical and acceptable in nonclinical trial settings.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Redução de Custos , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Retrospectivos , Comprimidos/uso terapêutico
14.
Open Forum Infect Dis ; 9(8): ofac395, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36004318

RESUMO

Background: Varicella-zoster virus (VZV) infection disproportionately affects people with HIV (PWH), primarily presenting as herpes zoster. However, VZV seroprevalence, its association with zoster, and clinical outcomes remain understudied in era of modern antiretroviral therapy (ART). We assessed VZV seroprevalence, rates of VZV illness, and associated health care costs in a large cohort of PWH over 20 years. Methods: We performed retrospective chart reviews of patients followed at a regional HIV clinic from January 1, 2000, to December 31, 2020. Serological, immunization, clinical, and costing data were extracted from in-house databases. VZV-related inpatient admissions, emergency department (ED), and urgent care (UC) visits were identified using relevant International Classification of Disease (ICD-10) codes and validated where possible by 2 physicians. Health care utilization costs were adjusted to 2020 Canadian dollars. Results: Of 3006 PWH, VZV serology was available for 2628; of these, 2503 (95.2%) were seropositive. Only 39% of known seronegative patients were subsequently immunized for varicella. During 29 768 years of patient follow-up, 38 hospitalizations and 138 ED/UC visits due to VZV infection were identified. Most occurred in VZV-seropositive PWH <50 years of age (82%) who were unimmunized (99.2%) and not on ART (64.8%). Nearly 25% of hospitalizations were due to laboratory-confirmed VZV meningitis/encephalitis. The average admission cost was CDN$33 001; the total measured cost of VZV illness was CDN$1 258 718. Conclusions: Despite ART and vaccines for chickenpox and shingles, VZV still caused significant costs and morbidity for PWH, occurring at younger ages and often as encephalitis/meningitis. Supporting ART adherence may reduce VZV illness and hospitalization costs in PWH, and the cost-effectiveness of expanding shingles vaccine use warrants further study.

15.
Int J STD AIDS ; 32(11): 1066-1073, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34009078

RESUMO

We aimed to identify "high-cost" patients with HIV (PWH) and determine drivers behind higher costs. All PWH at the Southern Alberta HIV Clinic, Canada, and active in 2017 were included. Sociodemographic, clinical, and healthcare utilization data were collected. The direct care costs from the payers' perspective including antiretroviral drugs (ARV), outpatient visits, and hospital admissions were determined for 2017. Patients' annual total costs were grouped into top 5% (i.e., high-cost), top 20%, middle 60%, and bottom 20%. High-cost patients were older, Caucasian or indigenous Canadian, and more likely acquired HIV from intravenous drug use (all p < 0.05). High-cost patients had lower nadir CD4, more comorbidities, missed more clinic appointments, had more ARV interruptions, and developed more ARV resistance (p < 0.01). The overall median cost of HIV care was US$14,064 [IQR US$13,121-US$17,883] (2017 Cdn$). High-cost patients had a median cost of US$29,902 [IQR US$27,229-US$37,891] and accounted for 14% of total costs and 84% of all inpatient costs. Hospitalizations constituted 58% of costs for high-cost patients. Although heterogeneous, high-cost patients have distinct sociodemographic and clinical characteristics driving their healthcare utilization. Addressing these social determinants of health and using novel ARV administration approaches may preserve health and save costs.


Assuntos
Infecções por HIV , Alberta/epidemiologia , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde , Humanos
16.
AIDS ; 35(5): 801-809, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369906

RESUMO

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 (n = 224, 21%) or adulthood experiences (n = 161, 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 (P < 0.05). 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.


Assuntos
Infecções por HIV , Adulto , Canadá , Criança , Infecções por HIV/complicações , Nível de Saúde , Humanos , Violência , Carga Viral
17.
BMC Neurol ; 10: 44, 2010 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-20565780

RESUMO

BACKGROUND: Anti-epileptic drugs (AEDs) are frequently prescribed to persons with HIV/AIDS receiving combination antiretroviral therapy (cART) although the extent of AED use and their interactions with cART are uncertain. Herein, AED usage, associated toxicities and immune consequences were investigated. METHODS: HIV replication was analysed in proliferating human T cells during AED exposure. Patients receiving AEDs in a geographically-based HIV care program were assessed using clinical and laboratory variables in addition to assessing AED indication, type, and cumulative exposures. RESULTS: Valproate suppressed proliferation in vitro of both HIV-infected and uninfected T cells (p <0.05) but AED exposures did not affect HIV production in vitro. Among 1345 HIV/AIDS persons in active care between 2001 and 2007, 169 individuals were exposed to AEDs for the following indications: peripheral neuropathy/neuropathic pain (60%), seizure/epilepsy (24%), mood disorder (13%) and movement disorder (2%). The most frequently prescribed AEDs were calcium channel blockers (gabapentin/pregabalin), followed by sodium channel blockers (phenytoin, carbamazepine, lamotrigine) and valproate. In a nested cohort of 55 AED-treated patients receiving cART and aviremic, chronic exposure to sodium and calcium channel blocking AEDs was associated with increased CD4+ T cell levels (p <0.05) with no change in CD8+ T cell levels over 12 months from the beginning of AED therapy. CONCLUSIONS: AEDs were prescribed for multiple indications without major adverse effects in this population but immune status in patients receiving sodium or calcium channel blocking drugs was improved.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Anticonvulsivantes/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Síndrome da Imunodeficiência Adquirida/virologia , Adulto , Antígenos CD4/metabolismo , Antígenos CD8/metabolismo , Bloqueadores dos Canais de Cálcio/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Estudos de Coortes , Feminino , HIV/efeitos dos fármacos , HIV/fisiologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueadores dos Canais de Sódio/uso terapêutico , Linfócitos T/efeitos dos fármacos , Linfócitos T/imunologia , Linfócitos T/virologia , Fatores de Tempo , Resultado do Tratamento , Ácido Valproico/uso terapêutico , Replicação Viral/efeitos dos fármacos
18.
Int J STD AIDS ; 31(12): 1169-1177, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32936718

RESUMO

Despite guidelines, many individuals are not routinely tested for HIV within healthcare settings. Our objective was to quantify and characterize preceding clinical encounters by newly-diagnosed persons living with HIV in southern Alberta, Canada. We discuss the clinical impact of missed HIV testing, and options for remediation. Clinical encounters prior to HIV diagnosis including the discharge diagnosis were collected between 1 April 2011 and 1 April 2016. We followed the HIV Indicator Diseases across Europe Study criteria to identify HIV Clinical Indicator Conditions (HCICs) present at clinical encounters. Patients accessing prior care were compared to those who had not previously accessed care. Of 393 individuals, 231 (58.7%) had ≥1 encounter prior to diagnosis; 224 (57%) of encounters occurred in outpatient clinics, 130 (33.1%) in emergency departments, and 39 (9.9%) in urgent care clinics. Approximately 25% (n = 57) of patients who engaged healthcare had ≥ 1 recognized HCIC but did not receive HIV testing. The most frequent HCICs were infection (n = 34; 60%) and hematological disorders (n = 12; 21%). The median CD4 cell count at HIV diagnosis for patients with an HCIC was 127 cells/mm3. In this population, three of five patients had accessed healthcare prior to diagnosis with one of four presenting with HCICs but were not offered HIV testing. Protocols beyond the current recommendations are urgently required to address missed HIV diagnostic opportunities who engaged healthcare.


Assuntos
Infecções por HIV/diagnóstico , HIV/isolamento & purificação , Instalações de Saúde/estatística & dados numéricos , Programas de Rastreamento/métodos , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Canadá/epidemiologia , Atenção à Saúde , Serviço Hospitalar de Emergência , Feminino , Infecções por HIV/epidemiologia , Teste de HIV , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Health Policy ; 90(2-3): 296-302, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19022519

RESUMO

OBJECTIVES: To evaluate the impact of policy changes to Canada's Immigration Act and changing migration patterns on a regional HIV population. METHODS: All HIV-positive individuals enrolled in care at the Southern Alberta Cohort between 2001 and 2007 were included and subdivided by self-reported country of birth. Demographic, clinical, and health utilization data were collected at each visit. We compare data and outcomes for each group and analyze changes since policy implementation. RESULTS: The proportion of immigrants/refugees increased significantly over the past five years. They present with lower CD4 counts, different HIV-subtypes, and previously rare co-morbidities. Management of disease progression necessitates more clinical visits and laboratory testing. Immigrants/refugees require greater social support to engage in, and to continue to access health care. Outcomes in HIV care were, however, equivalent to the Canadian-born population. CONCLUSIONS: The impact of changes to immigration policies is evident five years after implementation. Immigrant medical screening identifies increasing numbers of immigrants diagnosed with HIV. Immigrants require engagement in health care to achieve the full benefits of HIV management. Developed countries with increasing immigrant populations should be aware of how policy changes affect HIV prevalence rates, modes diagnosis and presentation, future clinical demands, and health care utilization.


Assuntos
Surtos de Doenças , Emigração e Imigração/tendências , Infecções por HIV/epidemiologia , Política de Saúde , Refugiados/estatística & dados numéricos , Canadá/epidemiologia , Comorbidade , Humanos , Fatores Socioeconômicos
20.
J Int Assoc Provid AIDS Care ; 18: 2325958218822304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30672364

RESUMO

INTRODUCTION: The use of lifelong antiretroviral therapy (ART) results in increased costs of care; the ability to finance and control sustained costs of ART needs to be discussed. APPROACH: The Southern Alberta Clinic initiated a practical cost savings approach that switched select patients from a branded ART to a less expensive generic variation. Our approach surveyed physicians and patients on their acceptance of switching and then launched a program asking patients if they would switch to generic variations for cost control purposes. RESULTS: Our early findings found >50% of patients approached agreed to switch. We found no evidence of increased risk of viral breakthrough, resistance, side effects, or displeasure with generic drugs. Measured cost savings in the first year were >$1.1 million with annual projected savings of between $4.3 million and $2.6 million (in 2017 Cdn$). CONCLUSION: Our approach can provide an option for controlling costs of HIV care without compromising quality.


Assuntos
Antirretrovirais/economia , Terapia Antirretroviral de Alta Atividade/economia , Redução de Custos , Medicamentos Genéricos/economia , Alberta , Antirretrovirais/uso terapêutico , Substituição de Medicamentos , Medicamentos Genéricos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Pacientes/psicologia , Médicos/psicologia , Inquéritos e Questionários , Comprimidos/economia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA