Methods: The study population comprised patients picking up fixed dose combinations of: tenofovir-emtricitabine, abacavir-lamivudine or tenofovir-emtricitabine-efavirenz on ≥2 occasions from 2010-12. ART were prescribed by one of 8 general practitioners working at 1 high and 1 low caseload clinic near the Alfred. ART adherence was estimated using the medication possession ratio (MPR) calculated by dividing the days ART dispensed by the number of days from first to last pick-up. Median MPR at the 2 sites were compared by Wilcoxon Rank-Sum test and the relative risk for low adherence by site was established.
Results: 472 patients met inclusion criteria with 455/472 (96.4%) attended the high caseload clinic that is <1 kilometre from the Alfred and 5 kilometres from MSHC. 397/472 (84.1%) picked up from MSHC and 75/472 (15.9%) from the Alfred. Median (Q1-Q3) MPR was 99.2% (93.1%-102.6%) at MSHC and 97.9% (86.1%-102.5%) at the Alfred (p=0.12). There were increased risks for low adherence when picking up at the Alfred when defined as <95% adherence by MPR (RR 1.38; 95% CI 1.01-1.88, p=.05). Conclusion: The overwhelming majority of individuals pick-up ART at MSHC where there are no co-pays despite regular HIV care close to the Alfred. ART co-payment is associated with worse adherence as measured by the MPR. More detailed studies exploring associations between ART cost and adherence outcomes are warranted.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
In recent years there has been a widespread uptake of smartphones with internet access and location services and the development of mobile ‘apps’ for gay men to meet each other. We reviewed data collected in the Sydney and Melbourne Gay Community Periodic Surveys (GCPS) to identify which men were relying on mobile and internet methods to meet each other and whether these methods were associated with different risk practices.