Trends in practice: attitudes and challenges in the diagnosis, treatment and management of <scp>HIV</scp> infection in Australia

Smith, Don; Woolley, Ian; Russell, Darren; Bisshop, Fiona; Furner, Virginia

doi:10.1111/imj.15129

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…With a similar efficacy and safety profile as DTG-based 3DR [ 40 , 41 ], it could be surmised that B/F/TAF was less likely to be discontinued due in part to its novelty. Indeed, a survey of Australian medical practitioners revealed that DTG/ABC/3TC and B/F/TAF were the preferred regimens for ART initiation due to their high barrier to resistance, and over two-thirds selected B/F/TAF as the anticipated preferred regimen for PLW eventually switching ART in the next 3 to 6 months [ 42 ]. The advantages of a single-tablet regimen for adherence and simplification also cannot be ignored [ 35 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Advanced HIV Infection in Treatment-Naïve Individuals: Effectiveness and Persistence of Recommended 3-Drug Regimens

Mounzer

Brunet²,

Fusco³

et al. 2022

Open Forum Infectious Diseases

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Background Approximately 20% of newly diagnosed people with HIV (PWH) in the U.S. have advanced HIV infection, yet literature on current antiretroviral therapy (ART) options is limited. Discontinuation/modification and effectiveness of common regimens were compared among ART-naïve people with advanced HIV infection (CD4 cell count <200 cells/μL). Methods ART-naïve adults with advanced HIV infection initiating bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) or a boosted darunavir (bDRV)-, dolutegravir (DTG)- or elvitegravir/cobicistat (EVG/c)-based three-drug regimen between 1JAN2018 and 31JUL2019 in the OPERA cohort were included. The association between regimen and discontinuation or viral suppression (<50 or <200 copies/mL) was assessed using Cox proportional hazards models with inverse probability of treatment weights. Results Overall, 961 PWH were included (416 B/F/TAF, 106 bDRV, 271 DTG, 168 EVG/c); 70% achieved a CD4 cell count ≥200 cells/μL over a 16 months median follow-up. All regimens were associated with a statistically higher likelihood of discontinuation than B/F/TAF (bDRV aHR: 2.65 [95% CI: 1.75, 4.02], DTG: 2.42 [1.75, 3.35], EVG/c: 3.52 [95% CI: 2.44, 5.07]). Compared to B/F/TAF, bDRV initiators were statistically less likely to suppress to <50 copies/mL (0.72 [0.52, 0.99]) and <200 copies/mL (0.55 [0.43, 0.70]); no statistically significant difference was detected with DTG or EVG/c. Conclusions Among people with advanced HIV infection, those initiating B/F/TAF were less likely to discontinue/modify their regimen than those on any other regimen, and more likely to achieve viral suppression compared to those on bDRV but not compared to those on other integrase inhibitors.

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Section: Discussionmentioning

confidence: 99%

Advanced HIV Infection in Treatment-Naïve Individuals: Effectiveness and Persistence of Recommended 3-Drug Regimens

Mounzer

Brunet²,

Fusco³

et al. 2022

Open Forum Infectious Diseases

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“…Nonetheless, for s100 GPs working in private practice in community, an array of health system barriers impacts their management of HIV including limited access to resources, constraints imposed by short clinical consultation times, poor levels of remuneration and low caseloads that undermine the maintenance of professional expertise (Newman et al., 2015; Smith et al., 2018). Addressing the broad and often complex needs of many PLHIV requires more resources and time than private practitioners working in primary care can afford (Newman et al., 2015; Smith et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives

Khalpey

Fitzgerald

Howard³

et al. 2021

Health Social Care Comm

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The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV‐based community health organisations seeking to support PLHIV’s biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi‐structured in‐depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.

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“…Moreover, bictegravir was the latest oral ARV recommended for initial therapy during the study period, and a tendency to use newer treatment options has been observed over the years in the OPERA cohort. This was captured in a survey targeting Australian medical practitioners where a majority reported that B/F/TAF would be the preferred regimen to switch to in the next 3–6 months [41].…”

Section: Discussionmentioning

confidence: 99%

Immune response to ART initiation in advanced HIV infection

Mounzer

Brunet²,

Fusco³

et al. 2023

HIV Medicine

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Objectives Our objective was to compare the immunological responses to commonly used antiretroviral therapy (ART) regimens among people with advanced HIV in the USA and to assess virological outcomes and regimen persistence. Methods This study included ART‐naïve adults with advanced HIV infection (CD4 cell count <200 cells/μL) initiating ART with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c)‐containing regimens between 1 January 2018 and 31 December 2020 in the Observational Pharmaco‐Epidemiology Research and Analysis (OPERA) cohort. Cox proportional hazards models and linear mixed models with random intercept were fit with inverse probability of treatment weighting. Results Overall, 1349 people with advanced HIV (816 B/F/TAF, 253 DTG, 146 EVG/c, 134 bDRV) were followed for a median of 22 months. Compared with B/F/TAF, a lower likelihood of achieving a CD4 cell count ≥200 cells/μL was observed with bDRV (hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.60–0.96), DTG (HR 0.82; 95% CI 0.69–0.98), and EVG/c (HR 0.73; 95% CI 0.57–0.93). All groups had a similar pattern of CD4:CD8 ratio changes: a rapid increase in the first 6 months (ranging from +0.15 to +0.16 units), followed by a slower increase thereafter. Only 40 individuals (4%) achieved CD4:CD8 ratio normalization (≥1). B/F/TAF was associated with a faster time to virological suppression (viral load <200 copies/mL) and a slower time to discontinuation compared with other regimens. Conclusions Among people with advanced HIV infection, B/F/TAF initiation was associated with faster CD4 cell count recovery and favourable virological outcomes compared with bDRV‐, DTG‐, and EVG/c‐based regimens, although no difference was observed in CD4:CD8 ratio changes over time across regimens.

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Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia

Cited by 5 publications

References 16 publications

Advanced HIV Infection in Treatment-Naïve Individuals: Effectiveness and Persistence of Recommended 3-Drug Regimens

Advanced HIV Infection in Treatment-Naïve Individuals: Effectiveness and Persistence of Recommended 3-Drug Regimens

Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives

Immune response to ART initiation in advanced HIV infection

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