scholarly journals Increasing HIV Subtype Diversity and Its Clinical Implications in a Sentinel North American Population

2013 ◽  
Vol 24 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Reed AC Siemieniuk ◽  
Brenda Beckthold ◽  
M John Gill
Keyword(s):  
Public Health Research ◽  
Hiv Care ◽  
North American Population ◽  
Subtype B ◽  
Southern Alberta ◽  
B Virus ◽  
Clinical Consequences ◽  
Proportional Increase ◽  
Dramatic Shift ◽  
Developed World

BACKGROUND: HIV-1 is a highly diverse virus; subtypes may exhibit differences in rates of transmission, disease progression, neurotoxicity, antiretroviral treatment failure profiles and accuracy of viral load measurements. To date, the HIV epidemic in Canada and the rest of the developed world has been largely due to subtype B; however, shifts in subtype epidemiology could have significant implications.OBJECTIVE: To determine whether there has been an increase in HIV subtype diversity in southern Alberta, Canada.METHODS: All 2358 patients receiving any HIV care between December 31, 2001 and December 31, 2010 were included in a retrospective analysis of subtype prevalence and incidence. In an indexed analysis, subtype trends from 1994 to 2010 were also evaluated.RESULTS: Between 2001 and 2010, the prevalence of non-B HIV subtypes in patients with a known subtype increased from 7% to 24%. In 2010, the most prevalent non-B subtypes were C (65%), A (11%), CRF02_AG (9.7%), CRF01_AE (4.9%), D (3.9%), G (2.9%) and CRF06_cpx (1.5%). In the indexed analysis, there was an overall proportional increase in non-B subtypes of 2.3% per year. The year-over-year increase in the prevalence of patients infected with a nonsubtype B virus increased from 13% from 1995 to 2002 to 27% from 2003 to 2010 (P=0.01). Incident non-B subtype cases increased from 9.6% to 32.4% over these time periods.CONCLUSIONS: This recent and dramatic shift in HIV strain diversity in Canada is unprecedented and may have important public health, research and clinical consequences.

HIV-associated kidney disease in the context of an aging population

Sexual Health ◽  
2011 ◽  
Vol 8 (4) ◽  
pp. 485 ◽  
Author(s):  
Claire Naftalin ◽  
Bavithra Nathan ◽  
Lisa Hamzah ◽  
Frank A. Post
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Risk Factor ◽  
Antiretroviral Therapy ◽  
Kidney Disease ◽  
General Population ◽  
Life Expectancy ◽  
Hiv Care ◽  
Developed World

Acute renal failure and chronic kidney disease are more common in HIV-infected patients compared with the general population. Several studies have shown age to be a risk factor for HIV-associated kidney disease. The improved life expectancy of HIV-infected patients as a result of widespread use of antiretroviral therapy has resulted in progressive aging of HIV cohorts in the developed world, and an increased burden of cardiovascular and kidney disease. Consequently, HIV care increasingly needs to incorporate strategies to detect and manage these non-infectious co-morbidities.

Prevalence and Determinants of Hepatitis B Virus (HBV) Infection in a Cohort of HIV-1 Discordant Couples in Western Kenya: Implications for HIV Care

2014 ◽  
Vol 30 (S1) ◽  
pp. A280-A280
Author(s):  
Dismas C.O. Oketch ◽  
Eunice Kaguiri ◽  
Nereo Murgor ◽  
Cosmas Apaka ◽  
Paul Ayuo ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hbv Infection ◽  
Hiv Care ◽  
Western Kenya ◽  
B Virus ◽  
Discordant Couples ◽  
Hiv 1

scholarly journals High incidence and persistence of hepatitis B virus infection in individuals receiving HIV care in KwaZulu-Natal, South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nokukhanya Msomi ◽  
Kogieleum Naidoo ◽  
Nonhlanhla Yende-Zuma ◽  
Nesri Padayatchi ◽  
Kerusha Govender ◽  
...  
Keyword(s):  
South Africa ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hbv Infection ◽  
Hiv Care ◽  
Care Provision ◽  
Hbsag Positivity ◽  
Kwazulu Natal ◽  
B Virus ◽  
Clinical Records

Abstract Background Hepatitis B virus (HBV), Human Immunodeficiency virus (HIV) and Tuberculosis (TB) are common infections in South Africa. We utilized the opportunity of care provision for HIV-TB co-infected patients to better understand the relationship between these coinfections, determine the magnitude of the problem, and identify risk factors for HBV infection in HIV infected patients with and without TB in KwaZulu-Natal, South Africa. Methods This retrospective cohort analysis was undertaken in 2018. In-care HIV infected patients were included in the analysis. Results from clinical records were analysed to determine the prevalence, incidence, persistence and factors associated with HBsAg positivity in HIV-infected patients with or without TB co-infection. Results A total of 4292 HIV-infected patients with a mean age of 34.7 years (SD: 8.8) were included. Based on HBsAg positivity, the prevalence of HBV was 8.5% (363/4292) [95% confidence interval (CI): 7.7–9.3] at baseline and 9.4% (95%CI: 8.6–10.3%) at end of follow-up. The HBV incidence rate was 2.1/100 person-years (p-y). Risk of incident HBV infection was two-fold higher among male patients (HR 2.11; 95% CI: 1.14–3.92), while severe immunosuppression was associated with a greater than two-fold higher risk of persistent infection (adjusted risk ratio (RR) 2.54; 95% CI 1.06–6.14; p = 0.004. Additionally, active TB at enrolment was associated with a two-fold higher risk of incident HBV infection (aHR 2.38; 95% CI: 0.77–7.35). Conclusion The provision of HIV care and treatment in high HBV burden settings provide a missed opportunity for HBV screening, immunization and care provision.

scholarly journals Perceptions of molecular epidemiology studies of HIV among stakeholders

2017 ◽  
Vol 6 (3) ◽  
Author(s):  
Cynthia Schairer ◽  
Sanjay R. Mehta ◽  
Staal A. Vinterbo ◽  
Martin Hoenigl ◽  
Michael Kalichman ◽  
...  
Keyword(s):  
Molecular Epidemiology ◽  
Qualitative Interviews ◽  
Public Health Research ◽  
Hiv Care ◽  
Willingness To Participate ◽  
Research Subjects ◽  
Privacy Breaches ◽  
Epidemiology Studies ◽  
Study Participants ◽  
Design And Methods

Background: Advances in viral sequence analysis make it possible to track the spread of infectious pathogens, such as HIV, within a population. When used to study HIV, these analyses (i.e., molecular epidemiology) potentially allow inference of the identity of individual research subjects. Current privacy standards are likely insufficient for this type of public health research. To address this challenge, it will be important to understand how stakeholders feel about the benefits and risks of such research. Design and Methods: To better understand perceived benefits and risks of these research methods, in-depth qualitative interviews were conducted with HIV-infected individuals, individuals at high-risk for contracting HIV, and professionals in HIV care and prevention. To gather additional perspectives, attendees to a public lecture on molecular epidemiology were asked to complete an informal questionnaire. Results: Among those interviewed and polled, there was near unanimous support for using molecular epidemiology to study HIV. Questionnaires showed strong agreement about benefits of molecular epidemiology, but diverse attitudes regarding risks. Interviewees acknowledged several risks, including privacy breaches and provocation of anti-gay sentiment. The interviews also demonstrated a possibility that misunderstandings about molecular epidemiology may affect how risks and benefits are evaluated. Conclusions: While nearly all study participants agree that the benefits of HIV molecular epidemiology outweigh the risks, concerns about privacy must be addressed to ensure continued trust in research institutions and willingness to participate in research.

Prevalence of hepatitis C and B virus among patients infected with HIV: a cross-sectional analysis of a large HIV care programme in Myanmar

2013 ◽  
Vol 43 (3) ◽  
pp. 113-115 ◽  
Author(s):  
Sai Ko Ko Zaw ◽  
Sai Thein Than Tun ◽  
Aye Thida ◽  
Thet Ko Aung ◽  
Win Maung ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Hiv Care ◽  
Cross Sectional ◽  
Care Programme ◽  
Cross Sectional Analysis ◽  
B Virus ◽  
Sectional Analysis

Heterogeneity and penetration of HIV-1 non-subtype B viruses in an Italian province: public health implications

2010 ◽  
Vol 138 (9) ◽  
pp. 1298-1307 ◽  
Author(s):  
C. TORTI ◽  
G. LAPADULA ◽  
I. IZZO ◽  
G. BRINDICCI ◽  
G. LABBATE ◽  
...  
Keyword(s):  
Resistance Testing ◽  
Targeted Prevention ◽  
South American ◽  
Genotypic Resistance ◽  
Subtype B ◽  
Genotypic Resistance Testing ◽  
B Virus ◽  
G 12 ◽  
Hiv Acquisition ◽  
Hiv 1

SUMMARYThis study assessed changes in prevalence and distribution of HIV-1 non-subtype B viruses in Italian and immigrant patients over two decades in a province in Italy. All HIV-positive patients who underwent genotypic resistance testing were selected. Prevalence of non-subtype B viruses in 3-year periods was calculated. All sequences of non-subtype B and those provided by REGA as unassigned were analysed for phylogenetic relationships. In total, 250/1563 (16%) individuals were infected with a non-subtype B virus. Prevalence increased over time, reaching a peak (31·5%) in 2004–2006. In Italian patients, the most frequent subtypes were B (92·5%) and F1 (4%). F1 subtype was also prevalent in patients from South America (13·6%); in patients of African origin, CRF02_AG (54·9%) and G (12·3%) were the most frequent. HIV-1 non-subtype B infections in Italians were mostly found in patients who acquired HIV sexually. A phylogenetic relationship between F subtypes in Italian and representative HIV-1 sequences from Brazil was found. C subtypes in Italians were phylogenetically related to subtypes circulating in Brazil. Inter-subtype recombinants were also found in the latest years. The HIV-1 epidemic in Brescia province evolved to the point where about 1/3 patients recently diagnosed harboured non-B HIV subtypes. The distribution of HIV-1 non-B subtypes in Italian patients resembled that in South American patients and phylogenetic relatedness between some Italian and South American HIV-1 strains was found. The possible epidemiological link between these two populations would have been missed by looking only at risk factors for HIV acquisition declared by patients. The evidence of inter-subtype recombinants points to significant genetic assortment. Overall our results support phylogenetic analysis as a tool for epidemiological investigation in order to guide targeted prevention strategies.

scholarly journals The Direct Medical Costs of Late Presentation (<350/mm3) of HIV Infection over a 15-Year Period

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hartmut B. Krentz ◽  
M. John Gill
Keyword(s):  
Cost Savings ◽  
Medical Costs ◽  
Late Presentation ◽  
Hiv Care ◽  
First Year ◽  
Late Presenters ◽  
Cd4 Counts ◽  
Direct Medical Costs ◽  
Southern Alberta ◽  
Routine Hiv Testing

We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm3(“late presenters”). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm3despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.

scholarly journals The Changing Demographics of Women Living with HIV/AIDS in Southern Alberta from 1982 to 2006

2012 ◽  
Vol 23 (2) ◽  
pp. e36-e40
Author(s):  
Liana Hwang ◽  
Jesse Raffa ◽  
Michael John Gill
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Care ◽  
Screening Methods ◽  
Newly Diagnosed ◽  
Female Population ◽  
Opt Out ◽  
Hiv Test ◽  
Southern Alberta ◽  
The Impact

INTRODUCTION: Women account for a growing proportion of HIV infections in Canada. This has implications with respect to prevention, diagnosis and treatment.OBJECTIVE: To describe the female population presenting for HIV care in southern Alberta and to examine the impact of opt-out pregnancy screening.METHODS: A retrospective review of demographic and clinical characteristics of all patients presenting to the Southern Alberta HIV Clinic (SAC) care program from 1982 to 2006, was performed.RESULTS: The proportion of newly diagnosed patients who were female increased from 7.5% before 1998 to 21.5% after 1998. Women were more likely to be from vulnerable populations, such as intravenous drug users (31.3% versus 13.7%, P<0.001), aboriginals/Métis (21.5% versus 8.7%, P<0.001), blacks (28.9% versus 4.9%, P<0.001) and immigrants (36.6% versus 14.7%, P<0.001). Heterosexual intercourse was the main risk factor for HIV acquisition (43.7%). Women were less likely than men to have requested HIV testing (20.9% versus 37.8%, P<0.001). Opt-out pregnancy screening accounted for 12.7% of HIV-positive tests in women, following its introduction in 1998. Of the women diagnosed by pregnancy screening, 62.1% were from HIV-endemic countries. There was an association between reason for testing and CD4 count at presentation; women who requested their HIV test had higher median CD4 counts than those diagnosed because of illness (478 cells/mL, interquartile range [IQR]=370 cells/mL versus 174 cells/mL, IQR=328 cells/mL, P<0.001) or pregnancy screening (478 cells/mL, IQR=370 cells/mL versus 271 cells/mL, IQR=256 cells/mL, P=0.001).CONCLUSIONS: Women were less likely than men to have requested HIV testing and were more likely to be diagnosed by population-based screening methods. Women, especially vulnerable groups, account for a growing number and proportion of newly diagnosed HIV infections in Alberta. The implications of expanded screening in this population merit further consideration.

scholarly journals HIV Care Prioritization using Phylogenetic Branch Length

2019 ◽  
Author(s):  
Niema Moshiri ◽  
Davey M. Smith ◽  
Siavash Mirarab
Keyword(s):  
Public Health ◽  
Public Health Intervention ◽  
Branch Length ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Terminal Branch ◽  
Simple Strategy ◽  
Subtype B ◽  
Public Health Officials ◽  
Living With Hiv

AbstractIn HIV epidemics, the structure of the transmission network can be dictated by just a few individuals. Public health intervention, such as ensuring people living with HIV adhere to antiretroviral therapy (ART) and are continually virally-suppressed, can help control the spread of the virus. However, such intervention requires utilizing the limited public health resource allocations. As a result, the ability to determine which individuals are most at-risk of transmitting HIV could allow public health officials to focus their limited resources on these individuals. Molecular epidemiology suggests an approach: prioritizing people living with HIV based on patterns of transmission inferred from their sampled viral sequences. In this paper, we introduce ProACT (Prioritization using AnCesTral edge lengths), a phylogenetic approach for prioritizing individuals living with HIV. ProACT uses a simple idea: ordering individuals by their terminal branch length in the phylogeny of their virus. In simulations and also on a dataset of HIV-1 subtype B pol sequences obtained in San Diego, we show that this simple strategy improves the effectiveness of prioritization compared to state-of-the-art methods that rely on monitoring the growth of transmission clusters defined based on genetic distance.

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