HIV-Associated Neurocognitive Disorders (HAND) are not routinely evaluated in primary care due to lack of a screening strategy. We developed a new screening procedure to determine HAND prevalence against a standard neuropsychological (NP) test battery.
In a prospective observational study we collected complete baseline data. The screening included standard questionnaires for mood, drug and alcohol use and activities of daily living; and a newly designed 20-minute computerized CogState battery assessing 5 cognitive domains. CogState data were transformed into age-corrected z-scores. HIV+ patients with co-morbidities were not excluded to form a representative community group but excluded in HIV-group to form a local reference). Those screened with HAND, a random HIV+ with normal screen, and a random HIV- sample also completed a standard NP battery assessing eight cognitive domains. NP data were transformed into demographically-corrected T-scores. Screening and NP testing HAND used the American Academy of Neurology 2007 criteria. Participants were blinded to screening results the NP examiner was blinded to screening and HIV status.
Enrolled were 254HIV+ subjects (median age 49 years, 93% male MSM, 65% tertiary-educated, 82% on cART, median nadir CD4 270 cells/mL, 15% CDC category C); and 72 demographically matched HIV- controls. HAND screening prevalence was 28.3% (HIV-associated dementia 3.9%, mild neurocognitive impairment 14.2% and asymptomatic neurocognitive impairment (ANI) 10.2%) versus 12.5% impaired in HIV- (all ANI), (p=0.009). Of 75 who completed the standard NP, HAND prevalence in HIV+ was 51.0% by NP and 47.2% by screening (ns) The HAND screening versus NP battery sensitivity was 64% and specificity79%.
HAND prevalence ranged between 28%-51% in a well-controlled HIV+ community cohort and was significantly higher than in HIV- controls. The CogState-based screening yields HAND rate similar to those of a two-hour NP battery but has a moderate sensitivity that may be improved by developing with comprehensive demographic corrections.
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.
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.
Background: People Living with HIV (PLHIV) who are transitioning from custodial settings are at risk of experiencing treatment interruptions and loss to follow up for vital HIV care. The NSW Persons In Custody HIV Community Referral Project (PICHCRP) aims to ensure PLHIV who are transitioning from custodial settings back into the community receive seamless HIV service, care and support.