Road Map to Re-Engagement: A Visual Guide to Overcoming Individual and System Barriers to HIV Care and Treatment
In this activity, an expert discusses the factors that contribute to people living with HIV (PLWH) falling out of care, the barriers associated with different strategies for re-engaging PLWH, and individualized plans that can be used for re-engaging PLWH back into care.
Differentiated service delivery (DSD) models were able to provide comparable effectiveness in treating people with HIV as the standard of care (SoC) when it came to maintaining care and viral suppression, according to a review published in Reviews in Medical Virology.
With ART and the extended lifespan of PLWH, HIV comorbidities also include aging—most likely due to accelerated aging—as well as cardiovascular, neurocognitive disorders, lung and kidney disease, and malignancies. The broad evidence suggests that HIV with ART is associated with accentuated aging and that the age-related comorbidities occur earlier, due in part to chronic immune activation, co-infections, and possibly the effects of ART alone.
Senescence is a hallmark of aging-related diseases that is characterized by stable cell cycle arrest and chronic inflammation. Chronic HIV-1 infection predisposes patients to aging-related illnesses and is similarly marked by a senescence-like phenotype. A better understanding of the role of HIV-1 in aging will inform the development of therapeutics aimed at eliminating senescent cells that drive accelerated physiologic aging.
Systemic inflammation and the increased risk of inflamm-aging and age-associated diseases in people living with HIV on long-term suppressive antiretroviral therapy
This study evaluates the levels of systemic inflammation to better understand the risk of age-associated diseases in PLHIV on long-term suppressive ART using a large number of biomarkers of inflammation and immune activation. This study found that there is still a large amount of inflammation in those who are on ART as in those who were untreated.
A cross-sectional study assessed how effective it was for those on HIV meds to not transmit to others, along with how high the loss to follow-up was in various HIV programs. They found that there was a high loss of follow-up in HIV care programs, but it highlighted the need for intervention as well as an increase in rates of viral suppression.
A tale of two countries: all-cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada
Canada and the United Kingdom have different provisions in health care services for those living with HIV. This study follows Canadians and UK citizens with HIV who started ART between 2000 and 2012. The researchers found that there was no significant difference in mortality rates between Canadians and UK citizens who got HIV through sexual transmission and were on ART.
The article discusses some of the challenges, clinical and immunological, that elderly people living with HIV encounter. It also discusses that due to ART more people are living with HIV, which means that they live longer. It warns of various things that clinicians can keep in mind while evaluating elder patients with HIV, such as mixing medications.