How to Evolve the Response to the Global HIV Epidemic With New Metrics and Targets Based on Pre-Treatment CD4 Counts.

Abstract:

PURPOSE OF THE REVIEW:Early diagnosis and treatment of HIV following seroconversion improves individual and population health. Using published data on pre-treatment CD4 cell counts, we benchmarked the level of immunodeficiency at HIV diagnosis and ART initiation in the "real world" against those of the treatment and control arms of landmark controlled trials that successfully reduced HIV-related deaths (INSIGHT/START) and onward HIV transmission (HPTN 052). RECENT FINDINGS:The median CD4 count in the treatment vs. control arms of the INSIGHT/START trial and HPTN 052 were 650 vs. 408 cells/μL and 442 vs. 221 cells/μL, respectively. In the real world, recent global estimates of the median CD4 count at start of ART range from 234 to 350 cells/μL, and only 25% of those initiating ART do so early (i.e., with CD4 > 500 cells/μL). Recent global data on trends in the median CD4 count at diagnosis and ART initiation are not encouraging. We identify a critical need for new targets and metrics for persons newly diagnosed with HIV, newly enrolling in HIV care, and newly initiating ART, based on pre-treatment CD4 counts, to help increase the focus of implementation efforts on achieving earlier diagnosis, linkage to care, and ART initiation.

journal_name

Curr HIV/AIDS Rep

journal_title

Current HIV/AIDS reports

authors

Nash D,Robertson M

doi

10.1007/s11904-019-00452-7

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

304-313

issue

4

eissn

1548-3568

issn

1548-3576

pii

10.1007/s11904-019-00452-7

journal_volume

16

pub_type

杂志文章,评审
  • Monitoring antiretroviral therapy in resource-limited settings: balancing clinical care, technology, and human resources.

    abstract::Due to the rapid expansion of first-line antiretroviral therapy in resource-limited settings (RLS), increasing numbers of people are living with HIV for prolonged periods of time. Treatment programs must now decide how to balance monitoring costs necessary to maximize health benefits for those already on treatment wit...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-010-0046-4

    authors: Hosseinipour MC,Schechter M

    更新日期:2010-08-01 00:00:00

  • Human genetic variability and HIV treatment response.

    abstract::Access to potent antiretroviral medications greatly reduces morbidity and mortality due to HIV/AIDS, but drug toxicity limits treatment success in many individuals. The field of pharmacogenomics strives to understand the influence of human genetic variants in response to medications. Investigators have begun to identi...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-006-0018-x

    authors: Haas DW

    更新日期:2006-07-01 00:00:00

  • Understanding the etiology and management of HIV-associated peripheral neuropathy.

    abstract::HIV may cause several forms of peripheral neuropathy, the most common of which is distal symmetric polyneuropathy (DSP) characterized by pain and sensory deficits in a stocking-glove distribution. The pathophysiology of DSP remains largely unknown but is thought to be related both to the neurotoxicity of HIV-through i...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-014-0211-2

    authors: Stavros K,Simpson DM

    更新日期:2014-09-01 00:00:00

  • Role of immune activation in HIV pathogenesis.

    abstract::T-cell activation has long been considered a central mediator of HIV pathogenesis. High T-cell activation levels predict more rapid disease progression in untreated patients and decreased treatment-mediated CD4+ T-cell gains during antiretroviral therapy, independent of plasma HIV RNA levels, and may be the primary fe...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-007-0007-8

    authors: Hunt PW

    更新日期:2007-02-01 00:00:00

  • Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa.

    abstract::For the last three decades, sub-Saharan Africa has been the epicentre of the HIV epidemic. Some key drivers of the epidemic are specific to this region and there is an urgent need to develop context-specific strategies to reduce HIV-related burden. Implementation frameworks should endeavour to combine structural, beha...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-015-0262-z

    authors: Shanaube K,Bock P

    更新日期:2015-06-01 00:00:00

  • Factors Associated With Insulin Resistance in Adults With HIV Receiving Contemporary Antiretroviral Therapy: a Brief Update.

    abstract:PURPOSE OF REVIEW:This narrative review summarizes recent data on factors associated with insulin resistance (IR) in adults with HIV, including contemporary antiretroviral therapy (ART). RECENT FINDINGS:IR remains common in persons with HIV, even those receiving contemporary ART. Generalized and abdominal obesity and ...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-018-0399-7

    authors: Hulgan T

    更新日期:2018-06-01 00:00:00

  • Interventions for body habitus changes associated with HIV infection and its treatment.

    abstract::Lipodystrophy and its two components lipo-accumulation and lipoatropy are very common among individuals with HIV infection on treatment, especially among those who started therapy in the late 1990s and early 2000s. This review discusses the current management of these complications of HIV and its treatment. For the pu...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-007-0013-x

    authors: Tebas P

    更新日期:2007-05-01 00:00:00

  • HIV-related neurocognitive impairment in the HAART era.

    abstract::Neurocognitive impairment is common in people living with HIV and AIDS. Prior to highly active antiretroviral therapy (HAART), cognitive impairment primarily affected patients with advanced disease, and was a more rapidly progressive illness. With the use of HAART, cognitive impairment improved, along with the overall...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-009-0020-1

    authors: Robinson-Papp J,Elliott KJ,Simpson DM

    更新日期:2009-08-01 00:00:00

  • Differentiating HIV-associated nephropathy from antiretroviral drug-induced nephropathy: a clinical challenge.

    abstract::With the introduction of potent combination antiretroviral therapy (cART) into clinical practice, HIV-infected patients have garnered much benefit. However, kidney disease continues to be a potential complication in this group. Whereas HIV-associated nephropathy (HIVAN) was the major renal complication prior to cART, ...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-014-0209-9

    authors: Kumar N,Perazella MA

    更新日期:2014-09-01 00:00:00

  • Therapeutic drug monitoring: pharmacologic considerations for antiretroviral drugs.

    abstract::Therapeutic drug monitoring (TDM) is the process by which a patient's dosing regimen is guided by repeated measures of plasma drug concentrations. An enormous challenge with regard to TDM of antiretroviral drugs (ARV) is that the concentration goals can be moving targets. Well-designed prospective studies demonstratin...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-005-0020-8

    authors: Kiser JJ,Anderson PL,Gerber JG

    更新日期:2005-06-01 00:00:00

  • T-cell exhaustion in HIV infection.

    abstract::Generation of memory T cells, which mediate immunity against microbes and cancers, relies, for optimal activity, on the interactions of multiple cell types that are highly regulated through the expression of soluble factors and negative and positive receptors. Their disruption will lead to aberrant immune responses, w...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-008-0003-7

    authors: El-Far M,Halwani R,Said E,Trautmann L,Doroudchi M,Janbazian L,Fonseca S,van Grevenynghe J,Yassine-Diab B,Sékaly RP,Haddad EK

    更新日期:2008-02-01 00:00:00

  • Breaking the Glyco-Code of HIV Persistence and Immunopathogenesis.

    abstract:PURPOSE OF REVIEW:Glycoimmunology is an emerging field focused on understanding how immune responses are mediated by glycans (carbohydrates) and their interaction with glycan-binding proteins called lectins. How glycans influence immunological functions is increasingly well understood. In a parallel way, in the HIV fie...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-019-00433-w

    authors: Colomb F,Giron LB,Trbojevic-Akmacic I,Lauc G,Abdel-Mohsen M

    更新日期:2019-04-01 00:00:00

  • Realizing the potential of treatment as prevention: global ART policy and treatment coverage.

    abstract::This article reviews the antiretroviral therapy (ART) initiation criteria from published national guidelines for 94 countries (representing 86 % of global HIV burden) and compares them with the 2013 World Health Organization (WHO) ART guidelines. As of 31st of July 2014, 19 countries have adopted the WHO-recommended C...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-014-0230-z

    authors: Gupta S,Williams B,Montaner J

    更新日期:2014-12-01 00:00:00

  • Solid organ transplantation is a reality for patients with HIV infection.

    abstract::Recent policies, guidelines, and laws reflect promising preliminary outcomes among transplant recipients with HIV infection, and ethical analyses suggest that it is not justifiable to deny solid organ transplantation based solely on HIV-infection status. These studies consistently describe stable HIV disease following...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/BF02696657

    authors: Roland ME,Stock PG

    更新日期:2006-09-01 00:00:00

  • Exploring Relative Preferences for HIV Service Features Using Discrete Choice Experiments: a Synthetic Review.

    abstract:PURPOSE OF REVIEW:Aligning HIV treatment services with patient preferences can promote long-term engagement. A rising number of studies solicit such preferences using discrete choice experiments, but have not been systematically reviewed to seek generalizable insights. Using a systematic search, we identified eleven ch...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-020-00520-3

    authors: Eshun-Wilson I,Kim HY,Schwartz S,Conte M,Glidden DV,Geng EH

    更新日期:2020-10-01 00:00:00

  • Network-Based Research on Rural Opioid Use: an Overview of Methods and Lessons Learned.

    abstract:PURPOSE OF REVIEW:The purpose of this paper is to provide a thorough overview of methods used for recruitment, network data collection, and network data management in a network-based study of rural people who use drugs (PWUD) and to offer methodological recommendations for future research on rural drug use. RECENT FIN...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-018-0391-2

    authors: Young AM,Rudolph AE,Havens JR

    更新日期:2018-04-01 00:00:00

  • Factors Driving the HIV Epidemic in Southern Africa.

    abstract::The HIV pandemic has disproportionately impacted sub-Saharan Africa and Southern Africa in particular. The concurrent presence of overlapping epidemic drivers likely underpins how and why the HIV epidemic is so explosive in this region, with implications for understanding approaches to reduce transmission. In this rev...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-016-0314-z

    authors: McKinnon LR,Karim QA

    更新日期:2016-06-01 00:00:00

  • Novel interventions to prevent HIV and HCV among persons who inject drugs.

    abstract::Persons who inject drugs (PWID) are at high risk for infection with and poor outcomes from HIV and hepatitis C virus (HCV). Well-established interventions for HIV/HCV prevention among PWID include syringe access, opioid agonist maintenance treatment, and supervised injection facilities, yet these interventions remain ...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-014-0248-2

    authors: Coffin PO,Rowe C,Santos GM

    更新日期:2015-03-01 00:00:00

  • HIV/AIDS Among Female Sex Workers in China: Epidemiology and Recent Prevention Strategies.

    abstract:PURPOSE OF REVIEW:This review aims to describe the epidemiology of HIV among female sex workers (FSWs) in China over the past decade, to summarize current gaps in knowledge regarding risk factors, and to identify new directions for HIV prevention strategies. RECENT FINDINGS:We summarized national and regional levels o...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-019-00477-y

    authors: Zhang H,Hsieh E,Wang L,Liao S

    更新日期:2020-04-01 00:00:00

  • Innate Lymphoid Cells: Their Contributions to Gastrointestinal Tissue Homeostasis and HIV/SIV Disease Pathology.

    abstract:PURPOSE OF REVIEW:The discovery of innate lymphoid cells (ILCs) over the past decade has reformed principles that were once thought to be exclusive to adaptive immunity. Here, we describe ILC nomenclature and function, and provide a survey of studies examining these cells in the context of HIV/SIV infections. Particula...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-019-00439-4

    authors: Mudd JC,Brenchley JM

    更新日期:2019-06-01 00:00:00

  • Improving the self-report of HIV antiretroviral medication adherence: is the glass half full or half empty?

    abstract::Self-reports are the most widely used method for measuring antiretroviral adherence. The association between self-reports and viral loads has been repeatedly demonstrated, but this association does not address how well self-reports measure actual medication-taking behaviors. Understanding adherence self-reports requir...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章

    doi:10.1007/s11904-009-0024-x

    authors: Wilson IB,Carter AE,Berg KM

    更新日期:2009-11-01 00:00:00

  • The medical management of opioid dependence in HIV primary care settings.

    abstract::Injecting drug use is a common mode of transmission among persons with HIV/AIDS. Many HIV-infected patients meet diagnostic criteria for opioid dependence, a chronic and relapsing brain disorder. Most HIV providers, however, receive little training in substance use disorders. Opioid agonist therapy (OAT) has a stabili...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-006-0016-z

    authors: Lum PJ,Tulsky JP

    更新日期:2006-11-01 00:00:00

  • The evolving role of HIV counseling and testing in resource-limited settings: HIV prevention and linkage to expanding HIV care access.

    abstract::The role of voluntary counseling and testing (VCT)of HIV in resource-limited settings has recently broadened from primarily that of a prevention intervention to its identification as the key entry point into expanding access to life-saving antiretroviral therapy, additional HIV-specific medical care, and other support...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-004-0028-5

    authors: Liechty CA

    更新日期:2004-12-01 00:00:00

  • HIV and aging: time for a new paradigm.

    abstract::The population of patients with HIV infection achieving viral suppression on combination antiretroviral therapy is growing, aging, and experiencing a widening spectrum of non-AIDS diseases. Concurrently, AIDS-defining conditions are becoming less common and are variably associated with outcome. Nonetheless, the spectr...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章

    doi:10.1007/s11904-010-0041-9

    authors: Justice AC

    更新日期:2010-05-01 00:00:00

  • Preventing bacterial disease in the HIV-infected of sub-Saharan Africa: the role of cotrimoxazole and the pneumococcal vaccines.

    abstract::Bacterial infection is a major cause of morbidity and mortality among patients with HIV living in Africa. Broadening the scope of cotrimoxazole (CTX) prophylaxis to cover patients whose CD4 counts are above 200 cells/mm(3) has been suggested as a means of improving the control of infectious disease on the continent. C...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-007-0021-x

    authors: Spencer DC

    更新日期:2007-08-01 00:00:00

  • Vaginal microbicides: a novel approach to preventing sexual transmission of HIV.

    abstract::The AIDS epidemic continues its unrelentless expansion. According to the Joint United Nations Programme on HIV/AIDS, there are more than 40 million people living with HIV, and more than 15,000 new infections occur every day. One approach to curbing HIV is the development of topical microbicidal agents or microbicides....

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-004-0004-0

    authors: Doncel G,Mauck C

    更新日期:2004-04-01 00:00:00

  • Pathogenesis and management of lipoatrophy.

    abstract::Despite impressive decreases in mortality and morbidity, significant adverse events have surfaced as a result of combination antiretroviral therapy (ART). They include lipoatrophy, or subcutaneous fat wasting of the face, arms, buttocks, or legs, which can be associated with central fat accumulation. Although the unde...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-008-0010-8

    authors: Tungsiripat M,McComsey G

    更新日期:2008-05-01 00:00:00

  • Better Service by Doing Less: Introducing De-implementation Research in HIV.

    abstract::The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. PURPOSE OF REVIEW: To describe the state of de-implementation research in HIV and provide a rationale for e...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-020-00517-y

    authors: McKay VR,Tetteh EK,Reid MJ,Ingaiza LM

    更新日期:2020-10-01 00:00:00

  • PrEP Product Acceptability and Dual Process Decision-Making Among Men Who Have Sex with Men.

    abstract:PURPOSE OF REVIEW:Advances in short- and long-acting pre-exposure prophylaxis (PrEP) technologies have incentivized the need to understand how individuals make trade-offs and competing decisions regarding PrEP modalities. The purpose of this review was to examine how researchers have conceptualized and measured attribu...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-020-00497-z

    authors: Bauermeister JA,Downs JS,Krakower DS

    更新日期:2020-06-01 00:00:00

  • Application of Pathogen Discovery/Metagenomic Sequencing in CNS HIV.

    abstract:PURPOSE OF REVIEW:Neurological conditions associated with HIV/AIDS including central nervous system (CNS), opportunistic infections (OI), chronic conditions including HIV-associated neurocognitive disorder, and cerebrospinal fluid (CSF) viral escape remain major contributors to morbidity and mortality worldwide. CNS in...

    journal_title:Current HIV/AIDS reports

    pub_type: 杂志文章,评审

    doi:10.1007/s11904-020-00514-1

    authors: Thakur KT

    更新日期:2020-10-01 00:00:00