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Find video protocols related to scientific articles indexed in Pubmed.
Costs of Health Resource Utilization Among HIV-Positive Individuals in British Columbia, Canada: Results From a Population-Level Study.
Pharmacoeconomics
PUBLISHED: 11-19-2014
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Through delayed HIV disease progression, highly active antiretroviral therapy (HAART) may reduce direct medical costs, thus at least partially offsetting therapy costs. Recent findings regarding the secondary preventive benefits of HAART necessitate careful consideration of funding allocations for HIV/AIDS care. Our objective is to estimate non-HAART direct medical costs at different levels of disease progression and over time in British Columbia, Canada.
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Process Monitoring of an HIV Treatment as Prevention Program in British Columbia, Canada.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 07-30-2014
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In light of accumulated scientific evidence of the secondary preventive benefits of antiretroviral therapy, a growing number of jurisdictions worldwide have formally started to implement HIV Treatment as Prevention (TasP) programs. To date, no gold standard for TasP program monitoring has been described. Here, we describe the design and methods applied to TasP program process monitoring in British Columbia (BC), Canada.
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Modeling scenarios for the end of AIDS.
Clin. Infect. Dis.
PUBLISHED: 06-14-2014
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At the end of 2012, 3 decades after the human immunodeficiency virus (HIV) was first identified, neither a cure nor a fully preventive vaccine was available. Despite multiple efforts, the epidemic remains an exceptional public health challenge. At the end of 2012, it was estimated that, globally, 35 million people were living with HIV, 2.3 million had become newly infected, and 1.6 million had died from AIDS-related causes. Despite substantial prevention efforts and increases in the number of individuals on highly active antiretroviral therapy (HAART), the epidemic burden continues to be high. Here, we provide a brief overview of the epidemiology of HIV transmission, the work that has been done to date regarding HIV modeling in different settings around the world, and how to finance the response to the HIV epidemic. In addition, we suggest discussion topics on how to move forward with the prevention agenda and highlight the role of treatment as prevention (TasP) in curbing the epidemic.
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Tuberculosis in HIV-infected persons in British Columbia during the HAART era.
Can J Public Health
PUBLISHED: 05-30-2014
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Prior to the introduction of highly active antiretroviral therapy (HAART), active tuberculosis (TB) was a major contributor to HIV-related morbidity and mortality in Canada and other low-incidence regions. We performed this study to examine TB incidence, clinical manifestations and screening uptake in HIV-infected TB patients during the era of HAART therapy.
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Antiretroviral drug costs and prescription patterns in British Columbia, Canada: 1996-2011.
Med Care
PUBLISHED: 05-23-2014
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Treatment options and therapeutic guidelines have evolved substantially since highly active antiretroviral treatment (HAART) became the standard of HIV care in 1996. We conducted the present population-based analysis to characterize the determinants of direct costs of HAART over time in British Columbia, Canada.
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Phylogenetic clustering of hepatitis C virus among people who inject drugs in Vancouver, Canada.
Hepatology
PUBLISHED: 05-19-2014
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Little is known about factors associated with hepatitis C virus (HCV) transmission among people who inject drugs (PWID). Phylogenetic clustering and associated factors were evaluated among PWID in Vancouver, Canada. Data were derived from the Vancouver Injection Drug Users Study. Participants who were HCV antibody-positive at enrolment and those with HCV antibody seroconversion during follow-up (1996 to 2012) were tested for HCV RNA and sequenced (Core-E2 region). Phylogenetic trees were inferred using maximum likelihood analysis and clusters were identified using ClusterPicker (90% bootstrap threshold, 0.05 genetic distance threshold). Factors associated with clustering were assessed using logistic regression. Among 655 eligible participants, HCV genotype prevalence was: G1a: 48% (n?=?313), G1b: 6% (n?=?41), G2a: 3% (n?=?20), G2b: 7% (n?=?46), G3a: 33% (n?=?213), G4a: <1% (n?=?4), G6a: 1% (n?=?8), G6e: <1% (n?=?1), and unclassifiable: 1% (n?=?9). The mean age was 36 years, 162 (25%) were female, and 164 (25%) were HIV+. Among 501 participants with HCV G1a and G3a, 31% (n?=?156) were in a pair/cluster. Factors independently associated with phylogenetic clustering included: age <40 (versus age ?40, adjusted odds ratio [AOR]?=?1.64; 95% confidence interval [CI] 1.03, 2.63), human immunodeficiency virus (HIV) infection (AOR?=?1.82; 95% CI 1.18, 2.81), HCV seroconversion (AOR?=?3.05; 95% CI 1.40, 6.66), and recent syringe borrowing (AOR 1.59; 95% CI 1.07, 2.36).
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[Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients].
Rev Bras Ter Intensiva
PUBLISHED: 04-29-2014
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To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit.
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The determinants of poor respiratory health status in adults living with human immunodeficiency virus infection.
AIDS Patient Care STDS
PUBLISHED: 04-17-2014
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The increased longevity afforded by combination antiretroviral therapy in developed countries has led to an increased concern regarding senescence-related diseases in patients with human immunodeficiency virus (HIV) infection. Previous epidemiologic analyses have demonstrated an increased risk of chronic obstructive pulmonary disease, as well as a significant burden of respiratory symptoms in HIV-infected patients. We performed the St. George's Respiratory Questionnaire (SGRQ) in 199 HIV-positive men, and determined the predominant factors contributing to poor respiratory-related health status. In univariate analyses, worse SGRQ scores were associated with respiratory-related variables such as greater smoking pack-year history (p=0.028), lower forced expiratory volume in 1 second (FEV1) (p<0.001), and worse emphysema severity as quantified by computed tomographic imaging (p=0.017). In addition, HIV-specific variables, such as a history of plasma viral load >100,000 copies/mL (p=0.043), lower nadir CD4 cell count (p=0.040), and current CD4 cell count ?350 cells/?L (p=0.005), as well as elevated levels of inflammatory markers, specifically plasma interleukin (IL)-6 (p=0.002) and alpha-1 antitrypsin (p=0.005) were also associated with worse SGRQ scores. In a multiple regression model, FEV1, current CD4 count ?350 cells/?L, and IL-6 levels remained significant contributors to reduced respiratory-related health status. HIV disease activity as measured by HIV-related immunosuppression in conjunction with the triggering of key inflammatory pathways may be important determinants of worse respiratory health status among HIV-infected individuals. Limitations of this analysis include the absence of available echocardiograms, diffusion capacity and lung volume testing, and an all-male cohort due to the demographics of the clinic population.
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Temporal trends in the discontinuation of first-line antiretroviral therapy.
J. Antimicrob. Chemother.
PUBLISHED: 04-15-2014
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The aim of this study was to describe the rates and predictors of discontinuing first-line antiretroviral therapy in the different eras of treatment over a nearly 20 year period initiated in British Columbia between 1992 and 2010.
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The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users.
Addiction
PUBLISHED: 04-08-2014
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To determine the relationship between methadone maintenance therapy (MMT) and hepatitis C (HCV) seroconversion among illicit drug users.
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Cohort Profile: HAART Observational Medical Evaluation and Research (HOMER) cohort.
Int J Epidemiol
PUBLISHED: 03-19-2014
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Since 1986, antiretroviral therapy (ART) has been available free of charge to individuals living with HIV in British Columbia (BC), Canada, through the BC Centre of Excellence in HIV/AIDS (BC-CfE) Drug Treatment Program (DTP). The Highly Active Antiretroviral Therapy (HAART) Observational Medical Evaluation and Research (HOMER) cohort was established in 1996 to maintain a prospective record of clinical measurements and medication profiles of a subset of DTP participants initiating HAART in BC. This unique cohort provides a comprehensive data source to investigate mortality, prognostic factors and treatment response among people living with HIV in BC from the inception of HAART. Currently over 5000 individuals are enrolled in the HOMER cohort. Data captured include socio-demographic characteristics (e.g. sex, age, ethnicity, health authority), clinical variables (e.g. CD4 cell count, plasma HIV viral load, AIDS-defining illness, hepatitis C co-infection, mortality) and treatment variables (e.g. HAART regimens, date of treatment initiation, treatment interruptions, adherence data, resistance testing). Research findings from the HOMER cohort have featured in numerous high-impact peer-reviewed journals. The HOMER cohort collaborates with other HIV cohorts on both national and international scales to answer complex HIV-specific research questions, and welcomes input from external investigators regarding potential research proposals or future collaborations. For further information please contact the principal investigator, Dr Robert Hogg (robert_hogg@sfu.ca).
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Declining incidence of hepatitis C virus infection among people who inject drugs in a Canadian setting, 1996-2012.
PLoS ONE
PUBLISHED: 01-01-2014
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People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection. Trends in HCV incidence and associated risk factors among PWID recruited between 1996 and 2012 in Vancouver, Canada were evaluated.
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Comparing the efficacy of efavirenz and boosted lopinavir using viremia copy-years.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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HIV-1 plasma viral load during treatment can be highly variable. Thus, there is the need to find a measure of cumulative viremia that can be used to assess both the short- and long-term efficacy of highly active antiretroviral therapy (HAART). Here, we validate a measure of cumulative viremia to evaluate HAART efficacy.
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Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).
PLoS ONE
PUBLISHED: 01-01-2014
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We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women.
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Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting.
PLoS ONE
PUBLISHED: 01-01-2014
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There has been renewed call for the global expansion of highly active antiretroviral therapy (HAART) under the framework of HIV treatment as prevention (TasP). However, population-level sustainability of this strategy has not been characterized.
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Intergenerational Sex as a Risk Factor for HIV Among Young Men Who Have Sex with Men: A Scoping Review.
Curr HIV/AIDS Rep
PUBLISHED: 11-26-2013
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An emerging body of evidence suggests that intergenerational sexual partnerships may increase risk of HIV acquisition among young men who have sex with men (YMSM). However, no studies have comprehensively evaluated literature in this area. We applied a scoping review methodology to explore the relationships between age mixing, HIV risk behavior, and HIV seroconversion among YMSM. This study identified several individual, micro-, and meso-system factors influencing HIV risk among YMSM in the context of intergenerational relationships: childhood maltreatment, coming of age and sexual identity, and substance use (individual-level factors); family and social support, partner characteristics, intimate partner violence, connectedness to gay community (micro-system factors); and race/ethnicity, economic disparity, and use of the Internet (meso-system factors). These thematic groups can be used to frame future research on the role of age-discrepant relationships on HIV risk among YMSM, and to enhance public health HIV education and prevention strategies targeting this vulnerable population.
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HIV-1 disease progression during highly active antiretroviral therapy: an application using population-level data in British Columbia: 1996-2011.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 10-19-2013
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Accurately estimating rates of disease progression is of central importance in developing mathematical models used to project outcomes and guide resource allocation decisions. Our objective was to specify a multivariate regression model to estimate changes in disease progression among individuals on highly active antiretroviral treatment in British Columbia, Canada, 1996-2011.
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The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study.
Lancet Infect Dis
PUBLISHED: 09-27-2013
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The cascade of HIV care has become a focal point for implementation efforts to maximise the individual and public health benefits of antiretroviral therapy. We aimed to characterise longitudinal changes in engagement with the cascade of HIV care in British Columbia, Canada, from 1996 to 2011.
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Evaluation of treatment tolerability, satisfaction and laboratory parameters in HIV+ patients switching from ritonavir capsule to tablet formulation.
Curr. HIV Res.
PUBLISHED: 09-07-2013
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This study evaluated treatment satisfaction, gastrointestinal tolerability, depressive symptoms and alterations in laboratory parameters before and after switching from ritonavir capsule to tablet formulation.
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Potential Impact of the US Presidents Emergency Plan for AIDS Relief on the Tuberculosis/HIV Coepidemic in Selected Sub-Saharan African Countries.
J. Infect. Dis.
PUBLISHED: 08-02-2013
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Background.?There are limited data measuring the impact of expanded human immunodeficiency virus (HIV) prevention activities on the tuberculosis epidemic at the country level. Here, we characterized the potential impact of the US Presidents Emergency Plan for AIDS Relief (PEPFAR) on the tuberculosis epidemic in sub-Saharan Africa. Methods.?We selected 12 focus countries (countries receiving the greatest US government investments) and 29 nonfocus countries (controls). We used tuberculosis incidence and mortality rates and relative risks to compare time periods before and after PEPFARs inception, and a tuberculosis/HIV indicator to calculate the rate of change in tuberculosis incidence relative to the HIV prevalence. Results.?Comparing the periods before and after PEPFARs implementation, both tuberculosis incidence and mortality rates have diminished significantly and to a higher degree in focus countries. The relative risk for developing tuberculosis, comparing those with and without HIV, was 22.5 for control and 20.0 for focus countries. In most focus countries, the tuberculosis epidemic is slowing down despite some regions still experiencing an increase in HIV prevalence. Conclusions.?This ecological study showed that PEPFAR had a more consistent and substantial effect on HIV and tuberculosis in focus countries, highlighting the likely link between high levels of HIV investment and broader effects on related diseases such as tuberculosis.
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Examining the evidence on the causal effect of HAART on transmission of HIV using the Bradford Hill criteria.
AIDS
PUBLISHED: 08-02-2013
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In recent years, evidence has accumulated regarding the ability of HAART to prevent HIV transmission. Early supportive evidence was derived from observational, ecological and population-based studies. More recently, a randomized clinical trial showed that immediate use of HAART led to a 96% decrease in HIV transmission events within HIV serodiscordant heterosexual couples. However, the generalizability of the effect of HAART, and the population-level impact on HIV transmission continues to generate substantial debate. We, therefore, conducted a review of the evidence regarding the preventive effect of HAART on HIV transmission within the context of the Bradford Hill criteria for causality. Taken together, we find the accumulated evidence supporting HIV treatment as prevention meets each of the Bradford Hill criteria for causality. We conclude that the opportunity cost of inaction while waiting for additional evidence on the generalizability of effect in other risk groups is too high. Efforts should be redoubled to mobilize the financial capital and political will to optimize implementation of HIV Treatment as Prevention strategies on a wide scale.
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The effect of history of injection drug use and alcoholism on HIV disease progression.
AIDS Care
PUBLISHED: 06-14-2013
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The effectiveness of highly active antiretroviral therapy (HAART) in preventing disease progression can be negatively influenced by the high prevalence of substance use among patients. Here, we quantify the effect of history of injection drug use and alcoholism on virologic and immunologic response to HAART. Clinical and survey data, collected at the start of HAART and at the interview date, were based on the study Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) in British Columbia, Canada. Substance use was a three-level categorical variable, combining information on history of alcohol dependence and of injection drug use, defined as: no history of alcohol and injection drug use; history of alcohol or injection drug use; and history of both alcohol and injection drug use. Virologic response (pVL) was defined by ?2 log10 copy/mL drop in a viral load. Immunologic response was defined as an increase in CD4 cell count percent of ?100%. We used cumulative logit modeling for ordinal responses to address our objective. Of the 537 HIV-infected patients, 112 (21%) were characterized as having a history of both alcohol and injection drug use, 173 (32%) were nonadherent (<95%), 196 (36%) had a CD4(+)/pVL(+) (Best) response, 180 (34%) a CD4(+)/pVL(-) or a CD4(-) /pVL(+) (Incomplete) response, and 161 (30%) a CD4(-) /pVL(-) (Worst) response. For individuals with history of both alcohol and injection drug use, the estimated probability of non-adherence was 0.61, and (0.15, 0.25, 0.60) of Best, Incomplete and Worse responses, respectively. Screening and detection of substance dependence will identify individuals at high-risk for nonadherence and ideally prevent their HIV disease from progressing to advanced stages where HIV disease can become difficult to manage.
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Characterizing durations of heroin abstinence in the California Civil Addict Program: results from a 33-year observational cohort study.
Am. J. Epidemiol.
PUBLISHED: 02-27-2013
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In accordance with the chronic disease model of opioid dependence, cessation is often observed as a longitudinal process rather than a discrete endpoint. We aimed to characterize and identify predictors of periods of heroin abstinence in the natural history of recovery from opioid dependence. Data were collected on participants from California who were enrolled in the Civil Addict Program from 1962 onward by use of a natural history interview. Multivariate regression using proportional hazards frailty models was applied to identify independent predictors and correlates of repeated abstinence episode durations. Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year. Multivariate analysis revealed several important findings. First, demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. However, employment and lower drug use severity predicted longer episodes. Second, abstinence durations were longer following sustained treatment versus incarceration. Third, individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes. Finally, abstinence episodes initiated >10 and ?20 years after first use lasted longer than others. Public policy facilitating engagement of opioid-dependent individuals in maintenance-oriented drug treatment and employment is recommended to achieve and sustain opioid abstinence.
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Application and validation of case-finding algorithms for identifying individuals with human immunodeficiency virus from administrative data in British Columbia, Canada.
PLoS ONE
PUBLISHED: 01-28-2013
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To define a population-level cohort of individuals infected with the human immunodeficiency virus (HIV) in the province of British Columbia from available registries and administrative datasets using a validated case-finding algorithm.
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Hepatitis C virus treatment for prevention among people who inject drugs: Modeling treatment scale-up in the age of direct-acting antivirals.
Hepatology
PUBLISHED: 01-10-2013
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Substantial reductions in hepatitis C virus (HCV) prevalence among people who inject drugs (PWID) cannot be achieved by harm reduction interventions such as needle exchange and opiate substitution therapy (OST) alone. Current HCV treatment is arduous and uptake is low, but new highly effective and tolerable interferon-free direct-acting antiviral (DAA) treatments could facilitate increased uptake. We projected the potential impact of DAA treatments on PWID HCV prevalence in three settings. A dynamic HCV transmission model was parameterized to three chronic HCV prevalence settings: Edinburgh, UK (25%); Melbourne, Australia (50%); and Vancouver, Canada (65%). Using realistic scenarios of future DAAs (90% sustained viral response, 12 weeks duration, available 2015), we projected the treatment rates required to reduce chronic HCV prevalence by half or three-quarters within 15 years. Current HCV treatment rates may have a minimal impact on prevalence in Melbourne and Vancouver (<2% relative reductions) but could reduce prevalence by 26% in 15 years in Edinburgh. Prevalence could halve within 15 years with treatment scale-up to 15, 40, or 76 per 1,000 PWID annually in Edinburgh, Melbourne, or Vancouver, respectively (2-, 13-, and 15-fold increases, respectively). Scale-up to 22, 54, or 98 per 1,000 PWID annually could reduce prevalence by three-quarters within 15 years. Less impact occurs with delayed scale-up, higher baseline prevalence, or shorter average injecting duration. Results are insensitive to risk heterogeneity or restricting treatment to PWID on OST. At existing HCV drug costs, halving chronic prevalence would require annual treatment budgets of US $3.2 million in Edinburgh and approximately $50 million in Melbourne and Vancouver. Conclusion: Interferon-free DAAs could enable increased HCV treatment uptake among PWID, which could have a major preventative impact. However, treatment costs may limit scale-up, and should be addressed. (Hepatology 2013).
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Modelling the impact of antiretroviral therapy on the epidemic of HIV.
Curr. HIV Res.
PUBLISHED: 07-03-2011
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Thirty years after HIV first appeared it has killed close to 30 million people but transmission continues unchecked. In 2009, an estimated 1.8 million lives were lost and 2.6 million more people were infected with HIV [1]. To cut transmission, many social, behavioural and biomedical interventions have been developed, tested and tried but have had little impact on the epidemic in most countries. One substantial success has been the development of combination antiretroviral therapy (ART) that reduces viral load and restores immune function. This raises the possibility of using ART not only to treat people but also to prevent new HIV infections. Here we consider the impact of ART on the transmission of HIV and show how it could help to control the epidemic. Much needs to be known and understood concerning the impact of early treatment with ART on the prognosis for individual patients and on transmission. We review the current literature on factors associated with modelling treatment for prevention and illustrate the potential impact using existing models. We focus on generalized epidemics in sub- Saharan Africa, with an emphasis on South Africa, where transmission is mainly heterosexual and which account for an estimated 17% of all people living with HIV. We also make reference to epidemics among men who have sex with men and injection drug users where appropriate. We discuss ways in which using treatment as prevention can be taken forward knowing that this can only be the beginning of what must become an inclusive dialogue among all of those concerned to stop acquired immune deficiency syndrome (AIDS).
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Trends in reported AIDS defining illnesses (ADIs) among participants in a universal antiretroviral therapy program: an observational study.
AIDS Res Ther
PUBLISHED: 04-29-2011
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We examined trends in AIDS-defining illnesses (ADIs) among individuals receiving highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada to determine whether declines in ADIs could be contributing to previously observed improvements in life-expectancy among HAART patients in BC since 1996.
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Expanded highly active antiretroviral therapy coverage among HIV-positive drug users to improve individual and public health outcomes.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 11-04-2010
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Highly active antiretroviral therapy (HAART) represents the single most significant advance in the fight against HIV/AIDS. The vast majority of patients treated with HAART will experience long-term remission of HIV disease. HAART does not cure HIV of course, but it changes the disease into a chronic and manageable condition. Use of HAART is associated with decreased HIV/AIDS-related morbidity, fewer opportunistic infections, and reduced mortality. Evidence has also shown that HAART can reduce HIV transmission. This is most clearly illustrated in studies of vertical or mother-to-child HIV transmission, in which use of HAART by the infected mother has virtually eliminated HIV transmission to her infant. Research has further shown that HAART use among heterosexual discordant couples in Africa was associated with a 92% reduction in HIV transmission. Until recently, the use of HAART among drug-using populations has remained controversial. However, HAART has now been shown to produce similar survival benefit when individuals with and without history of drug use were compared. This article discusses the need for an expansion in the provision of HAART to those in medical need, including drug users, to curb the devastating toll of the HIV pandemic. Such an effort should be done with the full promotion of human rights, including the need to respect each patients privacy and autonomy. Public health programs to intensify HAART use should be carried out within a comprehensive "combination prevention" framework. Such an approach for drug users would emphasize drug addiction treatment, HIV prevention including HIV testing and counseling and behavioral risk reduction interventions, and the removal of structural barriers to treat HIV-infected drug users and retain them in care.
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Risk of viral failure declines with duration of suppression on highly active antiretroviral therapy irrespective of adherence level.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 09-15-2010
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To model the effect of adherence and duration of viral suppression on the risk of viral rebound.
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Epidemiology of antiretroviral multiclass resistance.
Am. J. Epidemiol.
PUBLISHED: 07-28-2010
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Given the recent evolution of therapeutic trends, the frequency and determinants of multiclass-resistant HIV infection in the modern combination highly active antiretroviral therapy (HAART) era are less well understood. In this study, the authors characterize the epidemiology of antiretroviral multiclass resistance among HAART-naïve patients enrolled in a province-wide HAART distribution program in British Columbia, Canada. HAART and resistance testing are free to eligible individuals in British Columbia. This study was based on patients who initiated naïve on HAART and were followed during January 1, 2000-June 30, 2007. Explanatory logistic and survival models were built to identify those factors most influential in the emergence of multiclass resistance. Among the 1,820 individuals in our study, 833 (46%) were tested for antiretroviral resistance at least once during their follow-up. Multiclass resistance was observed in 142 individuals (n = 833; 17%) during a median follow-up of 14 months (interquartile range, 3-34 months) (incidence rate, 0.8 cases/1,000 person-months). The authors found that initial nonnucleoside reverse transcriptase inhibitor-based HAART was the main determinant of multiclass resistance. Given that these inhibitors are still widely used, priority should be given to make resistance testing and viral load monitoring a standard part of human immunodeficiency virus care to maximize the long-term efficacy and efficiency of HAART.
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Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study.
Lancet
PUBLISHED: 07-16-2010
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Results of cohort studies and mathematical models have suggested that increased coverage with highly active antiretroviral therapy (HAART) could reduce HIV transmission. We aimed to estimate the association between plasma HIV-1 viral load, HAART coverage, and number of new cases of HIV in the population of a Canadian province.
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Expanding access to HAART: a cost-effective approach for treating and preventing HIV.
AIDS
PUBLISHED: 07-01-2010
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HIV continues to present a substantial global health burden. Given the high direct medical costs associated with the disease, prevention of new transmission is an important element in limiting economic burden. In addition to providing therapeutic benefit, treatment with HAART has potential to prevent transmission of HIV. The objective in this study was to perform an economic evaluation of the incremental net benefit associated with an intervention to expand treatment with HAART in British Columbia, Canada.
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Prevalence of bone mineral density abnormalities and related risk factors in an ambulatory HIV clinic population.
J Clin Densitom
PUBLISHED: 05-28-2010
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Bone mineral density (BMD) abnormalities are observed frequently among human immunodeficiency virus (HIV)-infected patients. Risk factors for reduced BMD in the setting of HIV have been previously studied, but detailed antiretroviral treatment history is often not available. A cross-sectional observational study was conducted between 2005 and 2007 among unselected HIV-infected adults attending an ambulatory urban HIV clinic. Dual-energy X-ray absorptiometry (DXA) scans of lumbar spine and femoral neck, full laboratory profile, detailed questionnaire, and antiretroviral history were obtained. Univariate and multivariate logistic regression analyses were performed to investigate factors associated with BMD below the expected range for age. Two hundred ninety patients completed the study: 80% Caucasians, 89% males, with median age of 49 yr. Low BMD as assessed by Z-score was present in 19.7% of the patients. By multivariate analysis, only lower body mass index (BMI) was an independent risk factor for low BMD. Cumulative exposure to protease inhibitors, non-nucleosides, and individual nucleoside and nucleotide analogs were not independently associated with low BMD. In conclusion, a 19.7% prevalence of abnormal BMD by DXA scan was identified in an unselected group of HIV-infected adults. Lower BMI was independently associated with low BMD. No correlation was found between abnormal BMD and cumulative exposure to any antiretroviral agents.
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Expanding HAART treatment to all currently eligible individuals under the 2008 IAS-USA Guidelines in British Columbia, Canada.
PLoS ONE
PUBLISHED: 05-07-2010
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In 2008, the IAS-USA published the revised guidelines for the use of HAART in adults substantially increasing the number of individuals eligible for HAART. The epidemic in British Columbia (BC) is mainly among men who have sex with men and those with injection drug use. Here, we explored the potential impact of different HAART coverage scenarios, based on the new guidelines, on the HIV-related incidence, morbidity and mortality in BC, Canada.
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Factors behind HIV testing practices among Canadian Aboriginal peoples living off-reserve.
AIDS Care
PUBLISHED: 04-15-2010
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The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15-44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and "good" or "fair/poor" self-rated health increased the odds of HIV testing. Completion of high-school education, rural residency, and less frequent alcohol and cigarette consumption decreased the odds of HIV testing. A number of differences emerged when the sample was analyzed by gender, most notably females who self-reported "good" or "fair/poor" health status were more likely to have had an HIV test, yet males with comparable health status were less likely to have had an HIV test. Additionally, frequent alcohol consumption and less than high-school education was associated with an increased odds of HIV testing among males, but not females. Furthermore, while younger age was associated with an increased odds of having an HIV test in the overall model, this was particularly relevant for females aged 15-24. These outcomes provide evidence of the need for improved HIV testing strategies to reach greater numbers of Aboriginal peoples living off-reserve. They also echo the long-standing call for culturally appropriate HIV-related programming while drawing new attention to the importance of gender and age, two factors that are often generalized under the rubric of culturally relevant or appropriate program development.
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Regional and temporal trends in migration among people living with HIV/AIDS in British Columbia, 1993-2005.
Can J Public Health
PUBLISHED: 04-07-2010
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To examine regional and temporal trends in migration among patients receiving HIV treatment in British Columbia (BC).
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Regional and temporal changes in HIV-related mortality in British Columbia, 1987-2006.
Can J Public Health
PUBLISHED: 01-07-2010
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HIV-related mortality has been declining in Canada; however, little is known about regional differences in HIV-related mortality. The objective of this study was to characterize regional changes in HIV-related mortality from 1987-2006 in British Columbia (BC).
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Safety and efficacy of once-daily nevirapine dosing: a multicohort study.
Antivir. Ther. (Lond.)
PUBLISHED: 11-18-2009
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Nevirapine (NVP) is often prescribed once daily in clinical practice in combination with a once daily nucleoside backbone. We investigated the relationship of NVP dosing with safety and efficacy.
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The association between food insecurity and mortality among HIV-infected individuals on HAART.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 08-14-2009
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Food insecurity is increasingly recognized as a barrier to optimal treatment outcomes, but there is little data on this issue. We assessed associations between food insecurity and mortality among HIV-infected antiretroviral therapy-treated individuals in Vancouver, British Columbia, and whether body max index (BMI) modified associations.
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Effect of baseline CD4 cell counts on the clinical significance of short-term immunologic response to antiretroviral therapy in individuals with virologic suppression.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 08-12-2009
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Achieving virologic suppression is a clear therapeutic goal for patients receiving combination antiretroviral therapy (cART). However, the effects of immunologic responses, whether measured as CD4 count changes from baseline or CD4 counts at follow-up, in patients with virologic suppression, have not been clearly established.
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Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis.
Lancet Infect Dis
PUBLISHED: 06-27-2009
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Antiretroviral-therapy rollout in resource-poor countries is often associated with limited, if any, HIV-RNA monitoring. The effect of variable monitoring on the emergence of resistance after therapy with commonly used drug combinations was assessed by systematic review of studies reporting resistance in patients infected with HIV with a CD4 count of fewer than 200 cells per muL treated with two nucleoside analogues (including a thymidine analogue) and a non-nucleoside reverse transcriptase inhibitor. 8376 patients from eight cohorts and two prospective studies were analysed. Resistance at virological failure to non-nucleoside reverse transcriptase inhibitors at 48 weeks was 88.3% (95% CI 82.2-92.9) in infrequently monitored patients, compared with 61.0% (48.9-72.2) in frequently monitored patients (p<0.001). Lamivudine resistance was 80.5% (72.9-86.8) and 40.3% (29.1-52.2) in infrequently and frequently monitored patients, respectively (p<0.001); the prevalence of at least one thymidine analogue mutation was 27.8% (21.2-35.2) and 12.1% (5.9-21.4), respectively (p<0.001). Genotypic resistance at 48 weeks to lamivudine, nucleoside reverse transcriptase inhibitors (thymidine analogue mutations), and non-nucleoside reverse transcriptase inhibitors appears substantially higher in less frequently monitored patients. This Review highlights the need for cheap point-of-care viral-load tests to identify early viral failures and limit the emergence of resistance.
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Does ratification of human-rights treaties have effects on population health?
Lancet
PUBLISHED: 06-09-2009
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Human-rights treaties indicate a countrys commitment to human rights. Here, we assess whether ratification of human-rights treaties is associated with improved health and social indicators. Data for health (including HIV prevalence, and maternal, infant, and child [<5 years] mortalities) and social indicators (child labour, human development index, sex gap, and corruption index), gathered from 170 countries, showed no consistent associations between ratification of human-rights treaties and health or social outcomes. Established market economy states had consistently improved health compared with less wealthy settings, but this was not associated with treaty ratification. The status of treaty ratification alone is not a good indicator of the realisation of the right to health. We suggest the need for stringent requirements for ratification of treaties, improved accountability mechanisms to monitor compliance of states with treaty obligations, and financial assistance to support the realisation of the right to health.
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Hospitalizations sensitive to primary care as an evaluation indicator for the Family Health Strategy.
Rev Saude Publica
PUBLISHED: 06-02-2009
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To identify variables associated with hospitalizations sensitive to primary care.
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The WHOMENs scale (Womens HAART Optimism Monitoring and EvaluatioN Scale v.1) and the association with fertility intentions and sexual behaviours among HIV-positive women in Uganda.
AIDS Behav
PUBLISHED: 03-18-2009
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The objective of this study was to develop a reliable HAART optimism scale among HIV-positive women in Uganda and to test the scales validity against measures of fertility intentions, sexual activity, and unprotected sexual intercourse. We used cross-sectional survey data of 540 women (18-50 years) attending Mbarara Universitys HIV clinic in Uganda. Women were asked how much they agreed or disagreed with 23 statements about HAART. Data were subjected to a principal components and factor analyses. Subsequently, we tested the association between the scale and fertility intentions and sexual behaviour using Wilcoxon rank sum test. Factor analysis yielded three factors, one of which was an eight-item HAART optimism scale with moderately high internal consistency (alpha = 0.70). Women who reported that they intended to have (more) children had significantly higher HAART optimism scores (median = 13.5 [IQR: 12-16]) than women who did not intend to have (more) children (median = 10.5 [IQR: 8-12]; P < 0.0001). Similarly, women who were sexually active and who reported practicing unprotected sexual intercourse had significantly higher HAART optimism scores than women who were sexually abstinent or who practiced protected sexual intercourse. Our reliable and valid scale, termed the Womens HAART Optimism Monitoring and EvaluatioN scale (WHOMENs scale), may be valuable to broader studies investigating the role of HAART optimism on reproductive intentions and sexual behaviours of HIV-positive women in high HIV prevalence settings.
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HIV/AIDS in Vancouver, British Columbia: a growing epidemic.
Harm Reduct J
PUBLISHED: 03-05-2009
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The prevalence of HIV in Vancouver, British Columbia was subject to two distinct periods of rapid increase. The first occurred in the 1980s due to high incidence among men who have sex with men (MSM), and the second occurred in the 1990s due to high incidence among injection drug users (IDU). The purpose of this study was to estimate and model the trends in HIV prevalence in Vancouver from 1980 to 2006. HIV prevalence data were entered into the UNAIDS/WHO Estimation and Projection Package (EPP) where prevalence trends were estimated by fitting an epidemiological model to the data. Epidemic curves were fit for IDU, MSM, street-based female sex trade workers (FSW), and the general population. Using EPP, these curves were then aggregated to produce a model of Vancouvers overall HIV prevalence. Of the 505 000 people over the age of 15 that reside in Vancouver, 6108 (ranging from 4979 to 7237) were living with HIV in the year 2006, giving an overall prevalence of 1.21 percent (ranging from 0.99 to 1.43 percent). The subgroups of IDU and MSM account for the greatest proportion of HIV infections. Our model estimates that the prevalence of HIV in Vancouver is greater than one percent, roughly 6 times higher than Canadas national prevalence. These results suggest that HIV infection is having a relatively large impact in Vancouver and that evidence-based prevention and harm reduction strategies should be expanded.
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Increased reporting of detectable plasma HIV-1 RNA levels at the critical threshold of 50 copies per milliliter with the Taqman assay in comparison to the Amplicor assay.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 02-28-2009
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To investigate the application of the new COBAS Ampliprep Taqman HIV-1 assay in comparison with the COBAS HIV-1 Ampliprep AMPLICOR MONITOR ultrasensitive assay version 1.5, with a particular focus on the most clinically relevant region near the lower limit of quantification.
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The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 02-19-2009
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To characterize the impact of longitudinal adherence on survival in drug-naive individuals starting currently recommended highly active antiretroviral therapy (HAART) regimens.
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Association between HIV-1 RNA level and CD4 cell count among untreated HIV-infected individuals.
Am J Public Health
PUBLISHED: 02-12-2009
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We examined the significance of plasma HIV-1 RNA levels (or viral load alone) in predicting CD4 cell decline in untreated HIV-infected individuals.
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Lopinavir/ritonavir pharmacokinetics in a substitution of high-dose soft-gelatin capsule to tablet formulation.
J Clin Pharmacol
PUBLISHED: 01-31-2009
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Guidelines recommend that when soft-gelatin capsules of lopinavir/ritonavir are co-administered with CYP3A4-inducing agents, doses should be increased to 4 capsules (533 mg/133 mg) twice daily. No evidence is available to guide dosing of lopinavir/ritonavir in tablet formulation in this setting. A single-center study is conducted to compare the pharmacokinetics of high-dose lopinavir/ritonavir in 34 patients on stable HAART regimens including 4 soft-gelatin capsules twice daily who then switch to 3 tablets (600 mg/150 mg) twice daily. Median C(min) on soft-gelatin capsule and tablets is 4700 ng/mL (interquartile range [IQR] 2310, 6000 ng/mL) and 5640 ng/mL (IQR 4290, 8080 ng/mL), respectively, for those on inducing agents (n = 17). For patients not on inducing agents (n = 17), median C(min) on soft-gelatin capsule and tablets is 5170 ng/mL (IQR 3640, 6210 ng/mL) and 5640 ng/mL (IQR 4290, 8080 ng/mL), respectively. Among treatment-experienced patients on lopinavir/ritonavir capsules 533/133 mg twice daily, a switch to tablets 600/150 mg twice daily produces comparable pharmacokinetics, regardless of whether they receive concomitant CYP3A4-inducing antiretroviral agents.
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Migration adversely affects antiretroviral adherence in a population-based cohort of HIV/AIDS patients.
Soc Sci Med
PUBLISHED: 01-20-2009
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Migration among persons with HIV/AIDS is common; however, it is not clear how migration relates to antiretroviral adherence, a key determinant of treatment efficacy. Therefore, our objective was to determine the scale of regional migration and its association with adherence patterns over time among HIV-infected individuals in British Columbia (BC), Canada. Participants initiated HAART in August 1996-November 2004, and were followed until November 2005. Adherence was defined as the number of days worth of antiretrovirals dispensed divided by the number of days of follow-up (expressed as a percentage), and considered a binary time-dependent outcome: non-adherence (less than 95%) versus adherence (95% or more). Migration was calculated as the cumulative number of times a patients residential address changed during the course of treatment, and treated as a time-dependent variable. Non-linear mixed-effects models were used to estimate the association between migration and adherence over time. All analyses were adjusted for relevant fixed and time-dependent variables. A total of 2421 participants were followed during the study period. Descriptive analysis demonstrated high stability in adherence over time, with more than 55% of patients moving at least once during the course of their treatment. We observed that those individuals migrating at least 3 times were 1.79 times more likely to be in the non-adherence group than individuals who did not migrate. Our results demonstrate that migration in BC is not homogeneous across subpopulations. These results suggest that proactive strategies are needed to ensure that antiretroviral therapy remains available on a continued basis to highly migrant populations.
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Epidemiology of treatment failure: a focus on recent trends.
Curr Opin HIV AIDS
PUBLISHED: 01-14-2009
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As antiretroviral therapy has been refined with the development of more potent agents and simpler regimens, fewer individuals experience treatment failure. This review will highlight recent trends in treatment failure and virologic resistance in the developed world and resource-limited settings.
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Orphanhood predicts delayed access to care in Ugandan children.
Pediatr. Infect. Dis. J.
PUBLISHED: 01-10-2009
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We aimed to determine patient characteristics, treatment challenges, and adherence outcomes according to orphanhood status in a prospective cohort of 101 HIV+ children in rural Uganda. Orphans were older at antiretroviral initiation (P = 0.0008) and more likely to be WHO stage-4 (P = 0.03) than nonorphans. More attention to improving access to antiretrovirals in pediatric populations, especially orphans, is needed.
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Expanded Highly Active Antiretroviral Therapy Coverage - A Powerful Strategy to Curb Progression to AIDS, Death and New Infections.
Eur Infect Dis
PUBLISHED: 01-01-2009
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Sustained combination of HIV prevention strategies is essential to curb the spread of the HIV/AIDS epidemic. The use of highly active antiretroviral therapy (HAART) decreases morbidity and mortality, as well as HIV transmission, among treated individuals. The concept of treatment as prevention is dependent on HAARTs ability to sustain HIV-1 RNA virological suppression at the individual and population levels, and has been demonstrated in studies evaluating transmission in mother-to-child, sero-discordant couples and large treated populations. The worldwide expansion of maximally effective antiretroviral drug regimens has been coupled with concerns regarding the magnitude of the financial investment required. However, HAARTs compounding effect on reduced morbidity, mortality and transmission makes the expansion of HAART coverage highly cost-averting. Building on a mathematical model that evaluated the impact of expanded HAART access on viral load in a Canadian setting, we demonstrate that an investment of CA$249 million over the lifetime of treated individuals would result in a net gain of CA$2.1 billion over 30 years. This provides a powerful economic incentive to rapidly scale up HAART access worldwide.
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Disparities in the burden of HIV/AIDS in Canada.
PLoS ONE
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We aimed to characterize changes in patterns of new HIV diagnoses, HIV-related mortality, and HAART use in Canada from 1995 to 2008.
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Cost-Effectiveness of Antiretroviral Therapy for Multidrug-Resistant HIV: Past, Present, and Future.
AIDS Res Treat
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In the early years of the highly active antiretroviral therapy (HAART) era, HIV with resistance to two or more agents in different antiretroviral classes posed a significant clinical challenge. Multidrug-resistant (MDR) HIV was an important cause of treatment failure, morbidity, and mortality. Treatment options at the time were limited; multiple drug regimens with or without enfuvirtide were used with some success but proved to be difficult to sustain for reasons of tolerability, toxicity, and cost. Starting in 2006, data began to emerge supporting the use of new drugs from the original antiretroviral classes (tipranavir, darunavir, and etravirine) and drugs from new classes (raltegravir and maraviroc) for the treatment of MDR HIV. Their availability has enabled patients with MDR HIV to achieve full and durable viral suppression with more compact and cost-effective regimens including at least two and often three fully active agents. The emergence of drug-resistant HIV is expected to continue to become less frequent in the future, driven by improvements in the convenience, tolerability, efficacy, and durability of first-line HAART regimens. To continue this trend, the optimal rollout of HAART in both rich and resource-limited settings will require careful planning and strategic use of antiretroviral drugs and monitoring technologies.
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Development and validation of a composite programmatic assessment tool for HIV therapy.
PLoS ONE
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We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality.
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Technical and regulatory shortcomings of the TaqMan version 1 HIV viral load assay.
PLoS ONE
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The lower limit of detection of the original Roche Amplicor HIV plasma viral load (pVL) assay (50 copies/mL) has defined HIV treatment success. The Amplicor assay, however, has been replaced by the Roche TaqMan assay(s). Changes to the limits of detection and calibration have not been validated for clinical utility. Sudden increases in the number of patients with detectable pVL have been reported following the introduction of the TaqMan version 1 assay.
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Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada.
PLoS ONE
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To establish the reliability and validity of a shortened (10-item) depression scale used among HIV-positive patients enrolled in the Drug Treatment Program in British Columbia, Canada.
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Clinical Features, Treatment, and Outcome of HIV-Associated Immune Thrombocytopenia in the HAART Era.
Adv Hematol
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The characteristics of HIV-associated ITP were documented prior to the HAART era, and the optimal treatment beyond HAART is unknown. We performed a review of patients with HIV-associated ITP and at least one platelet count <20 × 10(9)/L since January 1996. Of 5290 patients in the BC Centre for Excellence in HIV/AIDS database, 31 (0.6%) had an ITP diagnosis and platelet count <20 × 10(9)/L. Initial ITP treatment included IVIG, n = 12; steroids, n = 10; anti-RhD, n = 8; HAART, n = 3. Sixteen patients achieved response and nine patients achieved complete response according to the International Working Group criteria. Median time to response was 14 days. Platelet response was not significantly associated with treatment received, but complete response was lower in patients with a history of injection drug use. Complications of ITP treatment occurred in two patients and there were four unrelated deaths. At a median followup of 48 months, 22 patients (71%) required secondary ITP treatment. This is to our knowledge the largest series of severe HIV-associated ITP reported in the HAART era. Although most patients achieved a safe platelet count with primary ITP treatment, nearly all required retreatment for ITP recurrence. New approaches to the treatment of severe ITP in this population are needed.
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Incidence, predictors and significance of severe toxicity in patients with human immunodeficiency virus-associated Hodgkin lymphoma.
Leuk. Lymphoma
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The incidence of Hodgkin lymphoma (HL) is rising among individuals infected with human immunodeficiency virus (HIV). Standard treatment regimens include vinblastine, which is known to cause neurotoxicity (NT) and is metabolized by cytochrome 3A4 (CYP3A4). This is inhibited by protease inhibitors (PIs), possibly increasing vinblastine exposure. There is little information on how interactions affect clinical outcome. A retrospective review of 32 patients with HIV-HL receiving chemotherapy with curative intent was performed to identify the frequency and risk factors for NT, hematologic toxicity (HT) and lung toxicity (LT). Treatment was: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) in 90%, MOPP/ABV (mechlorethamine, vincristine, procarbazine, prednisone/doxorubicin, bleomycin, vinblastine) in 10% and HAART (highly active anti-retroviral therapy) in 63%. Seventeen potential risk factors and 18 individual anti-retroviral (ARV) agents were examined, and only ritonavir or lopinavir use was found to have a significant association with toxicity. Grade 3-4 NT occurred in five patients, grade 3-4 HT in 17, infectious complications in 10 and bleomycin LT in three. Ritonavir and lopinavir use was associated with grade 3-4 NT (p = 0.03 and p = 0.01, respectively), and ritonavir with any HT (p = 0.04). Patients with HIV-HL experienced an increased incidence of NT and possibly HT. The use of ritonavir or lopinavir was associated with NT, suggesting a clinically significant interaction with vinblastine. Prospective pharmacokinetic studies to devise a rational dosing strategy for vinblastine in patients receiving ritonavir/lopinavir are warranted.
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Factors predictive of 30-day postoperative mortality in HIV/AIDS patients in the era of highly active antiretroviral therapy.
Ann. Surg.
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Factors that predict HIV (human immunodeficiency virus)/AIDS patient postoperative mortality have remained poorly defined.
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Assessing the effectiveness of antiretroviral regimens in cohort studies involving HIV-positive injection drug users.
AIDS
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We compared the effectiveness of different highly active antiretroviral therapy (HAART) regimens considering, separately, history of injection drug use (IDU) (yes/no). DESIGN, METHODS: A total of 1163 HIV-infected patients initiated HAART between 1 January 2000 and 28 February 2009 in British Columbia, Canada, and were followed until 28 February 2010. HAART effectiveness was measured by the ability to achieve viral suppression below 50 copies/ml at 6 months. We compared HAART regimens containing efavirenz and boosted atazanavir. We developed logistic regression models using different techniques to control for potential confounders.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.