Determinants of Treatment Access in a Population‐based Cohort of HIV‐positive Men and Women Living in Argentina

Zala, Carlos; Rustad, Clare A; Chan, Keith; Khan, Nabeela; Beltrán, Marcelo A.; Warley, Eduardo; Ceriotto, Mariana; Druyts, Eric; Hogg, Robert S.; Montaner, Julio S. G.; Cahn, Pedro

doi:10.1186/1758-2652-10-4-78

Cited by 10 publications

(13 citation statements)

References 17 publications

(22 reference statements)

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“…Although this sampling method may present limitations regarding generalizability, online surveys via internet-based social/sexual networking may reach an often hidden population of MSM in Latin America (Curioso et al, 2007; Marcus et al, 2009; Young et al, 2015). This is important given the concentration of the HIV/AIDS epidemic among MSM in Latin America (Bastos et al, 2008) and evidence that these individuals may delay ART initiation because of high levels of HIV stigma, resulting in poorer subsequent HIV/AIDS health outcomes (Zala et al, 2008). …”

Section: Discussionmentioning

confidence: 99%

“…Prior research has examined parts of the HIV treatment cascade among MSM in select countries, including Argentina (Carballo-Dieguez et al, 2014), Peru (Sanchez et al 2007), and Brazil (Kerr et al, 2013). These studies have found low HIV testing rates, with less than half of MSM participants having been tested for HIV in Argentina (Carballo-Dieguez et al, 2014) and Brazil (Kerr et al, 2013), high HIV prevalence (14–17%; Carballo-Dieguez et al, 2014; Kerr et al, 2013), and lower rates of ART initiation among MSM (i.e., compared to non-MSM counterparts in Argentina; Zala et al, 2008). …”

Section: Introductionmentioning

confidence: 99%

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Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

et al. 2015

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HIV/AIDS in Latin America is concentrated among men who have sex with men (MSM). However, accurate estimates of engagement in HIV care in this population can be difficult to ascertain because many do not self-identify as MSM. Given evidence of decreased HIV transmissibility in the context of antiretroviral therapy (ART) adherence, identifying individuals not in care who are engaging in HIV transmission risk behavior is crucial for secondary prevention. Primary aims of this study were to examine engagement in care from testing to ART adherence among MSM using online social/sexual networking across Latin America, and whether individuals not in care at each step reported greater sexual transmission risk behavior than those in care. In the overall sample (n=28,779), approximately 75% reported ever being tested for HIV and 9% reported having received an HIV diagnosis. Among known HIV-infected individuals, 20% reported not being in care, 30% reported not taking ART, and 55% reported less than 100% ART adherence. Over one-third of HIV-infected individuals reported sexual HIV transmission risk behavior, defined as unprotected anal intercourse (UAI) with a male partner of different/unknown HIV serostatus in the past three months. HIV-infected individuals not engaged in care more often reported UAI compared to those in care (OR=1.29; 95%CI=1.01–1.66). Although not statistically significant, HIV-infected individuals not on ART more often reported UAI compared to those on ART (OR=1.18; 95%CI=0.94–1.47). Individuals who reported less than 100% ART adherence more often reported UAI compared to individuals with 100% adherence (OR=1.55; 95%CI=1.26–1.90). Findings demonstrate that a substantial portion of HIV-infected MSM in Latin America who are likely not virologically suppressed from lack of ART use or adherence report sexual HIV transmission risk. Tailoring secondary HIV prevention for MSM in Latin America who are not in HIV care or adherent to ART may be warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

et al. 2015

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“…After initiating HAART, transitions will be limited to three final stages containing patients initiating a new or first HAART regimen, patients under successful therapy and patients under non-suppressive therapy. During this last phase of the simulation, rates and probabilities obtained from literature and describing toxicity of HAART regimens [21], success in achieving undetectable viral load [22], [23], [24], discordant responses to treatment [22] and viral rebound [21] are included. Also, viral load and CD4 count are modified according to the different treatment outcomes and in a magnitude that resembles that previously reported in the literature [2], [22], [25], [26].…”

Section: Methodsmentioning

confidence: 99%

Estimation of HIV-Testing Rates to Maximize Early Diagnosis-Derived Benefits at the Individual and Population Level

et al. 2013

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BackgroundIn HIV infection, initiation of treatment is associated with improved clinical outcom and reduced rate of sexual transmission. However, difficulty in detecting infection in early stages impairs those benefits. We determined the minimum testing rate that maximizes benefits derived from early diagnosis.MethodsWe developed a mathematical model of HIV infection, diagnosis and treatment that allows studying both diagnosed and undiagnosed populations, as well as determining the impact of modifying time to diagnosis and testing rates. The model’s external consistency was assessed by estimating time to AIDS and death in absence of treatment as well as by estimating age-dependent mortality rates during treatment, and comparing them with data previously reported from CASCADE and DHCS cohorts.ResultsIn our model, life expectancy of patients diagnosed before 8 years post infection is the same as HIV-negative population. After this time point, age at death is significantly dependent on diagnosis delay but initiation of treatment increases life expectancy to similar levels as HIV-negative population. Early mortality during HAART is dependent on treatment CD4 threshold until 6 years post infection and becomes dependent on diagnosis delay after 6 years post infection. By modifying testing rates, we estimate that an annual testing rate of 20% leads to diagnosis of 90% of infected individuals within the first 8.2 years of infection and that current testing rate in middle-high income settings stands close to 10%. In addition, many differences between low-income and middle-high incomes can be predicted by solely modifying the diagnosis delay.ConclusionsTo increase testing rate of undiagnosed HIV population by two-fold in middle-high income settings will minimize early mortality during initiation of treatment and global mortality rate as well as maximize life expectancy. Our results highlight the impact of achieving early diagnosis and the importance of strongly work on improving HIV testing rates.

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“…Zala et al also reported limited use of HAART in Argentina, and in particular, noted that initiation of HAART was associated with older age, AIDS-defining illness, lower CD4 cell count and higher viral load. 24 Drug shortages and insufficient monitoring of response to HAART has also been reported. 25 In contrast, more recent data from the EuroSIDA Cohort, a prospective study of HIV-infected persons in Europe, Israel, and Argentina, reported that, in Argentina, over 95% of HIV-infected persons with a CD4 cell count <350 cells/mm 3 were receiving HAART.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Levels in HIV- and/or HCV-Infected Drug Users Living in Argentina

Kohli

Winston

Sheehan

et al. 2016

J Int Assoc Provid AIDS Care

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Improved understanding of cholesterol levels in HIV and HCV-infected persons in Argentina will guide optimal antiretroviral therapy. We conducted a cross-sectional study in Argentina to describe associations between HIV, Hepatitis C and cholesterol. Of 202 participants, 21 were HIV-infected, 15 HCV-infected, 46 were HIV/HCV co-infected and 120 were HIV/HCV uninfected. HIV/HCV uninfected participants had the highest total cholesterol (TC) and LDL levels. Multivariate modeling revealed that HIV/HCV co-infected patients had the lowest TC levels (−28.7 mg/dl, p<0.001) compared to the HIV/HCV uninfected reference group. HCV and HIV/HCV co-infection were associated with lower LDL levels (−21.4 mg/dL, p=0.001 and −20.3 mg/dL, p<0.0001, respectively). HIV and HIV/HCV co-infection, but not HCV alone, were associated with lower HDL levels (−9.1 mg/dL, p=0.0008 and −6.8 mg/dl, p=0.0006 respectively). Further study is needed to examine if the more favorable lipid profile observed in HIV/HCV co-infected persons is associated with a reduction in cardiovascular risk.

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Determinants of Treatment Access in a Population‐based Cohort of HIV‐positive Men and Women Living in Argentina

Cited by 10 publications

References 17 publications

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

Engagement in HIV care and sexual transmission risk behavior among men who have sex with men using online social/sexual networking in Latin America

Estimation of HIV-Testing Rates to Maximize Early Diagnosis-Derived Benefits at the Individual and Population Level

Cholesterol Levels in HIV- and/or HCV-Infected Drug Users Living in Argentina

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