"Moving Fourth": A Vision Toward Achieving Healthy Living with HIV Beyond Viral Suppression

Guaraldi, Giovanni; Arends, Joop E.; Buhk, Thomas; Cascio, Mario; Curran, Adrían; Teófilo, Eugénio; Berk, Guido van den; Verger, Christian

doi:10.24875/aidsrev.19000088

Cited by 6 publications

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“…The viewpoints and opinion pieces retrieved (Table 2) reflect the picture of the ongoing debate around the 4th 90 [7, 9–11, 21, 22]. These perspectives evolved over time.…”

Section: Resultsmentioning

confidence: 99%

The ‘4th 90’ target as a strategy to improve health‐related quality of life of people living with HIV in sub‐Saharan Africa

Mvilongo

Vanhamel

Siegel

et al. 2022

Tropical Med Int Health

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Objectives: Next to monitoring the clinical health of people living with HIV through the triple 90 targets, a 4th 90 target was proposed in 2016 to improve HIV healthrelated quality of life (HrQoL) by addressing comorbidities and other psychosocial challenges. This scoping review aimed at understanding related psychosocial determinants, including strategies to improve HrQoL for people living with HIV in sub-Saharan Africa (SSA), as an initiative to ameliorate the continuum of care. Methods: This scoping review followed PRISMA guidelines. We searched PubMed and Wiley databases from 01 January 2011 to 19 April 2021 for articles on HrQoL, including determinants and related interventions in SSA. We also conducted a manual search to retrieve grey literature on the '4th 90' target. The six domains of HrQoL defined in the most widely used instrument (i.e., WHOQOL-HIV-BREF tool) served as a guiding framework. Results: Thirty-three articles were included for analysis. Seven articles illustrated the ongoing debate on the 4th 90 target, highlighting challenges with measuring indicators. Nine articles discussed HrQoL domains, reporting the highest scores in the spirituality and physical domains and lowest scores in the social and environmental domains. The presence of stigma and depressive symptoms was associated with low HrQoL. Seventeen articles discussed HrQoL interventions, highlighting that improved HrQoL enhanced health-seeking behaviour. Only two interventions addressed the environmental domain highlighting the fact that selection of intervention aims were not evidence led. Conclusion: Introducing the 4th 90 target in SSA as a strategy to enhance HrQoL amongst people living with HIV could improve the HIV continuum of care; however, efforts are required to effectively address environmental and structural determinants. K E Y W O R D S health related quality of life, HIV, scoping review, sub-Saharan Africa

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“…The viewpoints and opinion pieces retrieved (Table 2) reflect the picture of the ongoing debate around the 4th 90 [7, 9–11, 21, 22]. These perspectives evolved over time.…”

Section: Resultsmentioning

confidence: 99%

The ‘4th 90’ target as a strategy to improve health‐related quality of life of people living with HIV in sub‐Saharan Africa

Mvilongo

Vanhamel

Siegel

et al. 2022

Tropical Med Int Health

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“…These results suggest that there may be value in taking a more nuanced approach to HRQoL assessment, one in which the findings are used to describe the complexity of PLHIV’s experiences and inform tailored strategies to reduce stigma and discrimination in the health care setting. Moreover, health systems could consider setting HRQoL targets, collecting HRQoL data, devising protocols to craft HRQoL patient-profiles, and collaborating with patients to create individualized plans for improving HRQoL (Guaraldi et al, 2019; Lazarus et al, 2016; Safreed-Harmon et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Here, more nuanced patterns of HRQoL emerged among PLHIV. PLHIV more often suffer from more multiple morbidities than HIV-negative persons, including a variety of physical and mental ailments (Brandt et al, 2017; Farahani et al, 2017; Guaraldi et al, 2019; Maciel et al, 2018). Since PLHIV represent a heterogenous population, they are likely to have different illness experiences with regard to these morbidities, resulting in different HRQoL patterns.…”

Section: Discussionmentioning

confidence: 99%

“…For the All Problems class, which by far had the strongest association with HIV-related health care stigma and discrimination, this may be partially explained by the number of problems reported. PLHIV with a wider variety of health issues, including HIV-related and non-HIV-related health issues—as was likely the case for those in the All Problems class—interact with the health system much more extensively and frequently than those with fewer health issues (Guaraldi et al, 2019; Kendall et al, 2014; Maciel et al, 2018; Schouten et al, 2014). This higher frequency of interactions with a wider range of providers yields more opportunities to be exposed to stigma and discrimination, especially if stigma-mitigation efforts have not reached all health care and service providers, as may be the case for non-HIV specialist providers, such as general practitioners and dentists (Okala et al, 2018; Stigma Index U.K., 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a recent meta-analysis found that HIV-related stigma and discrimination were associated with greater depression and anxiety, lower social support, lower access to and use of health and social services, poorer physical health, and lower ART-adherence (Rueda et al, 2016). HIV-related stigma and discrimination in the health care setting may be especially consequential, given the extent to which PLHIV interact with and rely on health care systems for survival and the management of multiple physical and mental health comorbidities (Guaraldi et al, 2019; Safreed-Harmon et al, 2019). Such experiences may discourage PLHIV from staying engaged in HIV treatment or from accessing other types of necessary care, which may hasten HIV disease progression and leave other conditions untreated (Rueda et al, 2016; Sweeney & Vanable, 2016).…”

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confidence: 99%

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HIV-related stigma and discrimination in health care and health-related quality of life among people living with HIV in England and Wales: A latent class analysis.

et al. 2023

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Though life expectancy of people living with HIV (PLHIV) is now comparable to that of HIV-negative persons, their health-related quality of life (HRQoL) lags behind. Lower HRQoL among PLHIV may vary meaningfully, shaped in part by social factors, including stigma. Using data from Positive Voices, a national cross-sectional probability survey of adults ≥18 years living with HIV and accessing HIV care services in England and Wales (N = 4,422), we conducted latent class analysis on responses to a HRQoL measure (problems with mobility, usual activities, self-care, pain/discomfort, anxiety/depression) to identify HRQoL patterns, followed by multinomial logistic regression to examine relationships between HRQoL classes and a 4-item measure of HIV-related stigma and discrimination in health care. Four classes emerged: All Problems (18% prevalence); Pain and Distress (18%); Pain and Mobility (9%); No Problems (55%). Scale scores of HIV-related stigma and discrimination in health care were positively, significantly associated with membership in the All Problems (adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI] = 1.94, 2.41), Pain and Distress (aOR = 1.62; CI = 1.46, 1.81), and Pain and Mobility classes (aOR = 1.33; CI = 1.16, 1.52) compared to the No Problems class. A similar trend was observed for individual stigma and discrimination items. HRQoL among PLHIV in England and Wales varies and may be underpinned or exacerbated by HIV-related stigma and discrimination in health care. Ensuring stigma-mitigation interventions reach all health care systems/providers and emotional support services reach all PLHIV may improve HRQoL for PLHIV.

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Two-Drug Regimens Dolutegravir/Lamivudine and Dolutegravir/Rilpivirine Are Effective with Few Discontinuations in US Real-World Settings: Results from the TANDEM Study

Schneider,

Blick,

Burke

et al. 2024

Infect Dis Ther

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Introduction Dolutegravir/lamivudine (DTG/3TC) and dolutegravir/rilpivirine (DTG/RPV) are fixed-dose, complete, single-tablet, two-drug regimens (2DRs) indicated for HIV-1. DTG/3TC is approved for antiretroviral therapy (ART)-naive people with HIV-1 and virologically suppressed individuals to replace current ART; DTG/RPV is indicated for virologically suppressed individuals as a switch option. Virologic efficacy and effectiveness of these DTG-based 2DRs have been demonstrated in phase 3 clinical trials and real-world cohorts, primarily from Europe. This study characterized real-world use of DTG-based 2DRs for HIV-1 treatment in the USA. Methods TANDEM was a retrospective medical chart review across 24 US sites. Individuals aged ≥ 18 years who initiated DTG/3TC or DTG/RPV before September 30, 2020, with ≥ 6 months of follow-up were included. One cohort included ART-naive people who initiated DTG/3TC ( n = 126), and two other cohorts included virologically suppressed (HIV-1 RNA < 50 copies/mL) people on stable ART regimens for ≥ 3 months before switch to either DTG/3TC ( n = 192) or DTG/RPV ( n = 151). Clinical characteristics, treatment history, and outcomes are described. Results Virologically suppressed individuals were older than those who were ART-naive, and the ART-naive cohort had higher proportions of individuals assigned male at birth and of Hispanic ethnicity. The most common healthcare provider-reported reason for choosing a DTG-based 2DR was avoidance of long-term toxicities (25–33% across cohorts), followed by simplification/streamlining of treatment. Among ART-naive people on DTG/3TC, 94% achieved virologic suppression after initiation, and 83% maintained suppression at last follow-up; discontinuation rate was < 1%. Among cohorts who switched to DTG-based 2DRs, 96% maintained virologic suppression on DTG/3TC and 93% on DTG/RPV; 2% on DTG/3TC and 3% on DTG/RPV discontinued. Conclusion Motivation for selecting DTG-based 2DRs was primarily driven by a desire to avoid or manage toxicities and simplify treatment. Results demonstrate that DTG/3TC and DTG/RPV are effective in real-world settings, with few discontinuations, reflecting data from clinical trials. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-024-00961-y.

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"Moving Fourth": A Vision Toward Achieving Healthy Living with HIV Beyond Viral Suppression

Cited by 6 publications

References 0 publications

The ‘4th 90’ target as a strategy to improve health‐related quality of life of people living with HIV in sub‐Saharan Africa

The ‘4th 90’ target as a strategy to improve health‐related quality of life of people living with HIV in sub‐Saharan Africa

HIV-related stigma and discrimination in health care and health-related quality of life among people living with HIV in England and Wales: A latent class analysis.

Two-Drug Regimens Dolutegravir/Lamivudine and Dolutegravir/Rilpivirine Are Effective with Few Discontinuations in US Real-World Settings: Results from the TANDEM Study

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