Background Understanding the impact of hepatitis B virus (HBV) coinfection on HIV outcomes in the HAART era continues to be a critical priority given the high prevalence of coinfection and the potential for impaired immunologic, virologic and clinical recovery. Methods Participants from the U.S. Military HIV Natural History Study with an HIV diagnosis, on HAART and serologically confirmed HBV infection status at HAART initiation (HI) were classified into four HBV infection (HB) groups. HIV virologic, immunologic, and clinical outcomes were evaluated by HB status. Results Of 2536 HIV positive HAART recipients, with HBV testing results available to determine HB status in the HI window, HB status at HI was classified as HB negative (n=1505; 66%), resolved HB (n=518; 23%); isolated HBcAb (n=139; 6%) or; chronic HB (n=131; 6%). HIV virologic suppression and failure at 6 months or 1 year were not significantly different by HB status. A significantly faster rate of increase in CD4 cell count during the period between 4 and 12 years was observed for chronic HB relative to HB negative. Chronic and resolved HB were associated with an increased risk of AIDS/death compared to HB negative individuals (chronic HB; HR=1.68; 95% CI 1.05–2.68, resolved HB; HR=1.61; 95% CI 1.15–2.25). Conclusions HB status did not have a significant impact on HIV virologic outcomes, however, CD4 cell count reconstitution post HI and the risk of an AIDS event or death post HI may be associated with HB status.
In this cohort, additional BPG doses did not affect treatment response. Our data support the current recommendations for the use of a single dose of BPG to treat HIV-infected persons with early syphilis.
Background The effects of at-risk drinking on HIV infection remain controversial. We investigated the impact of self-reported alcohol consumption on surrogate markers of HIV progression among individuals initiated on highly active antiretroviral therapy (HAART). Methods We analyzed individuals who were surveyed on alcohol use within a year of HAART initiation between 2006-14. At-risk drinking was defined as consumption of at least three or four drinks/day, or seven and 14 drinks/week among women and men, respectively. We performed time-updated generalized estimating equation (GEE) logistic regression to determine the effect of at-risk drinking on virologic failure (VF) and mixed-effects linear regression on CD4 count reconstitution, controlling for potential confounders. Results Of 907 individuals initiated on HAART, 752 individuals with alcohol survey data were included in the analysis. Of these, 45% (n=336) met criteria for at-risk drinking at HAART initiation on at least one survey. The rates of VF were 4.30 per 100 person-years (95%CI [2.86, 6.21]) for at-risk drinkers and 2.45 per 100 person-years (95%CI [(1.57,3.65)] for individuals without at-risk drinking. At-risk drinking was not significantly associated with VF (OR 1.73, 95% CI [0.92, 3.25]) 0.087 or CD4 reconstitution (CD4 increase 11.4; 95% CI [-19.8, 42.7]) in univariate analyses; however, in our multivariate model, a statistically significant relationship between VF and at-risk drinking was observed (OR 2.28 [95% CI 1.01, 5.15]). Conclusions We found a high proportion of at-risk drinking in our military cohort, which was predictive of VF in multivariate analysis. Given alcohol's effect on myriad HIV and non-HIV outcomes, interventions to decrease the prevalence of at-risk drinking among HIV-infected individuals are warranted.
Background The Veterans Aging Cohort Study (VACS) Index is a weighted combination of age and eight clinical variables. It has been well correlated with all-cause mortality among HIV-infected patients. The U.S. Military HIV Natural History Study (NHS) cohort provides a different validation population profile, being younger and healthier. A significant portion of the US HIV population is similarly composed, so evaluation of the VACS Index in this population is of great interest. Methods NHS subjects have medical history and laboratory data collected at six month visits. We performed an external validation of the VACS Index in the NHS evaluating correlation, discrimination, and calibration for all-cause mortality following HAART initiation (HI). We then tested whether combining longitudinal VACS Index values at different time points improves prediction of mortality. Results The VACS Index at one year after HI was well correlated with all-cause mortality (Harrell’s c-statistic 0.78), provided good discrimination (log-rank p <0.05), and was marginally well calibrated using Brier score. Accounting for VACS Index at HI and 6 months after HI significantly improved a standard model including only the VACS Index at 1 year after HI (Net Reclassification Improvement=25.2%, 10.9-48.9% 95% CI). Conclusions The VACS Index was well correlated and provided good discrimination with respect to all-cause mortality among HAART initiating subjects in the NHS. Moderate overprediction of mortality in this young, healthy population suggests minor recalibration could improve fit among similar patients. Considering VACS Index at HI and 6 months improved outcome prediction and allowed earlier risk assessment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.