Enhancing the Benefits of Antiretroviral Therapy in Vietnam: Towards Ending AIDS

Kato, Masaya; Long, Nguyễn Hoàng; Duong, Bui Duc; Nhan, Do Thi; Nguyen, Thi Thuy; Hai, Nguyen Huu; Giang, Lê Minh; Hoa, Do Mai; Văn, Nguyễn Thành; Suthar, Amitabh B.; Fontaine, Christopher; Nadol, Patrick; Lo, Ying-Ru; McConnell, Michelle S.

doi:10.1007/s11904-014-0235-7

Cited by 33 publications

(37 citation statements)

References 21 publications

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“…This finding is consistent with a high prevalence of late presentation to care in Vietnam [33]. Despite expanding access to ART in the country, the median CD4 cell count at ART initiation was 197 cells/mm 3 in 2013 [23,34]. In our study, 68% presented with CD4 <250 cells/mm 3 and 35% with clinical stage IV.…”

Section: Discussionsupporting

confidence: 88%

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

et al. 2017

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High HIV viral load (VL >100,000 cp/ml) is associated with increased HIV transmission risk, faster progression to AIDS, and reduced response to some antiretroviral regimens. To better understand factors associated with high VL, we examined characteristics of patients presenting for treatment in Hanoi, Vietnam. We examined baseline data from the Viral Load Monitoring in Vietnam Study, a randomized controlled trial of routine VL monitoring in a population starting antiretroviral therapy (ART) at a clinic in Hanoi. Patients with prior treatment failure or ART resistance were excluded. Characteristics examined included demographics, clinical and laboratory data, and substance use. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Out of 636 patients, 62.7% were male, 72.9% were ≥30 years old, and 28.3% had a history of drug injection. Median CD4 was 132 cells/mm3, and 34.9% were clinical stage IV. Active cigarette smoking was reported by 36.3% with 14.0% smoking >10 cigarettes per day. Alcohol consumption was reported by 20.1% with 6.1% having ≥5 drinks per event. Overall 53.0% had a VL >100,000 cp/ml. Male gender, low body weight, low CD4 count, prior TB, and cigarette smoking were associated with high VL. Those who smoked 1–10 cigarettes per day were more likely to have high VL (aOR = 1.99, 95% CI = 1.15–3.45), while the smaller number of patients who smoked >10 cigarettes per day had a non-significant trend toward higher VL (aOR = 1.41, 95% CI = 0.75–2.66). Alcohol consumption was not significantly associated with high VL. Tobacco use is increasingly recognized as a contributor to premature morbidity and mortality among HIV-infected patients. In our study, cigarette smoking in the last 30 days was associated with a 1.5 to 2-fold higher odds of having an HIV VL >100,000 cp/ml among patients presenting for ART. These findings provide further evidence of the negative effects of tobacco use among HIV-infected patients.

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Section: Discussionsupporting

confidence: 88%

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

et al. 2017

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“…In a cohort of Swedish and Danish PLWH[70], PWID were less likely to be “successfully managed” (viral suppression among those eligible for ART or at least annual CD4 testing among those ineligible) than MSM or heterosexuals (78% among PWID vs 92%). PWID initiate care later than those who do not inject drugs, as found by a study in Vietnam where PWID started ART at 69 CD4+ cells/mm 3 compared to 96 CD4+ cells/mm 3 among non-injectors[71]. Another study found PWID in Belgium diagnosed in 2007–2010 were less likely to be retained in HIV care compared to heterosexuals[72].…”

Section: Cascade Outcomes In Key Populationsmentioning

confidence: 99%

“…Recent studies have found that OST among PWID is associated with higher CD4+ cell count at ART initiation[71], ART initiation and access[83,84], ART medication adherence[85,86], decreases in ART discontinuation[87], and decreases in delayed care visits[88]. …”

Section: Recent Work In Interventions To Improve Outcomes For Key Popmentioning

confidence: 99%

HIV treatment cascade in MSM, people who inject drugs, and sex workers

Risher

Mayer

Beyrer

2015

Current Opinion in HIV and AIDS

123

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Purpose of review People who inject drugs (PWID), sex workers and men who have sex with men (MSM) simultaneously bear a high burden of HIV and stigma and discrimination. The purpose of this review was to summarize recent information about the understanding of the HIV care cascade among PWID, sex workers, and MSM populations around the globe. Recent findings A review of the published literature relating to the care cascade in these three key populations was conducted. Data on the care cascade among key populations is sparse, particularly for PWID and sex workers. In the twelve countries in which a study or report of the care cascade was available stratified by these populations, all three populations have care cascade outcomes that are far below the 90-90-90 target set by UNAIDS for 2020. Culturally-tailored interventions including co-location of services and peer navigators can improve care cascade outcomes among key populations. Summary Key populations’ care cascade outcomes must be included in international reporting metrics to expand cascade data for these groups. Improving care cascade outcomes in these key populations through culturally-tailored interventions should be a priority in the coming years.

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“…For PWID in Vietnam, low levels of education may serve as a barrier for HIV and substance use treatment . We believe the limited number of females in Indonesia and Vietnam accurately reflects the population of PWID in these countries based on culture and historic precedence . The gender distribution in Ukraine is similar to the distribution in Russia and the Baltic States .…”

Section: Discussionmentioning

confidence: 85%

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

et al. 2018

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IntroductionPeople who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention.MethodsWe present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two‐arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV‐positive index and their HIV‐negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours.ResultsThe majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self‐reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test – Alcohol Consumption Questions (AUDIT‐C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions.ConclusionsWhile regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

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Enhancing the Benefits of Antiretroviral Therapy in Vietnam: Towards Ending AIDS

Cited by 33 publications

References 21 publications

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam

HIV treatment cascade in MSM, people who inject drugs, and sex workers

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

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