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- Andersen, Megan H., et al.
(författare)
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Medically assisted reproduction for people living with HIV in Europe : A cross-country exploratory policy comparison.
- 2022
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Ingår i: HIV Medicine. - : Wiley. - 1468-1293 .- 1464-2662. ; 23:8, s. 859-867
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Tidskriftsartikel (refereegranskat)abstract
- To explore the availability and accessibility of medically assisted reproduction (MAR) for people living with HIV in Europe, including the feasibility of cross-border care. Methods: We used a polymorphous engagement approach, primarily based on digital and email-based interviews with representatives of national HIV organizations, clinical researchers (infectious disease and/or infertility specialists), European and national professional societies (fertility and/or infectious disease), national regulatory authorities and individual clinics in 14 countries in the WHO European region. The research design and results were also informed by two surveys and a review of the secondary literature, news articles and clinic websites. Results: Although MAR is possible for people living with HIV in 12 out of the 14 countries mapped, accessing services can be challenging for logistical or financial reasons. People living with HIV also face barriers to MAR independent of their HIV status, such as limitations on single women and same-sex couples accessing services. Cross-border care is available for most patients who are self-financing but is limited for publicly funded patients. Conclusions: Even when MAR is available to and accessible for people living with HIV, there may still be barriers to treatment. Further research on patient experiences is needed to understand these discrepancies between availability and accessibility on paper and in practice.
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- Le, L. T., et al.
(författare)
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Correlation between CD4/CD8 ratio and neurocognitive performance during early HIV infection
- 2023
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Ingår i: Hiv Medicine. - : Wiley. - 1464-2662 .- 1468-1293. ; 24:4, s. 442-452
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Tidskriftsartikel (refereegranskat)abstract
- Introduction CD4/CD8 ratio is a marker of immune activation in HIV infection and has been associated with neurocognitive performance during chronic infection, but little is known about the early phases. The aim of this study was to examine the relationship between blood CD4/CD8 ratio and central nervous system endpoints in primary HIV infection (PHI) before and after antiretroviral treatment (ART). Methods This was a retrospective analysis of the Primary Infection Stage CNS Events Study (PISCES) cohort. We longitudinally assessed blood and cerebrospinal fluid (CSF) markers of inflammation, immune activation and neuronal injury, and neuropsychological testing performance (NPZ4, an average of three motor and one processing speed tests, and a summarized total score, NPZ11, including also executive function, learning and memory) in ART-naive participants enrolled during PHI. Spearman correlation and linear mixed models assessed the relationships between the trajectory of CD4/CD8 ratio over time and neurocognitive performance, blood and CSF markers of immune activation and neuronal injury. Results In all, 109 PHI participants were enrolled. The mean CD4/CD8 ratio decreased with longer time from infection to starting treatment (p < 0.001). Every unit increase in NPZ4 score was independently associated with a 0.15 increase in CD4/CD8 ratio (95% CI: 0.002-0.29; p = 0.047), whereas no correlation was found between CD4/CD8 ratio and NPZ11. Among the cognitive domains, only a change in processing speed was correlated with CD4/CD8 ratio over time (p = 0.03). The trajectory of the CD4/CD8 ratio was negatively correlated with change in CSF neurofilament light chain (p = 0.04). Conclusions The trajectory of CD4/CD8 ratio was independently associated with motor/psychomotor speed performance, suggesting that immune activation is involved in brain injury during the early stages of the infection.
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- Lindh, Maria, et al.
(författare)
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Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study
- 2024
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Ingår i: HIV MEDICINE. - 1464-2662 .- 1468-1293. ; 25:5, s. 540-553
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs).Methods: The study included people living with HIV (PLWH) aged >= 18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011-2018 were collected. Associations between variables and HIV RNA >= 50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size.Results: The study included 38% (n = 2981) women. Women were more likely to have HIV RNA >= 50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10-1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79-3.17) and men (RR 1.84, 95% CI: 1.40-2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10-2.02).Conclusions: This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.
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- Moller, I. K., et al.
(författare)
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COVID-19 hospitalization outcomes in adults by HIV status; a nation-wide register-based study
- 2023
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Ingår i: Hiv Medicine. - : John Wiley & Sons. - 1464-2662 .- 1468-1293. ; 24:10, s. 1045-1055
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess the outcome of patients hospitalized with COVID-19 by HIV status and risk factors for severe COVID-19 in people living with HIV (PWH), we performed a nationwide cohort study using register data. Methods: All people aged >= 18 years hospitalized with a primary COVID-19 diagnosis (U07.1 or U07.2) in Sweden between February 2020 and October 2021 were included. The primary outcome was severe COVID-19 [intensive care unit (ICU) admission or 90-day mortality]. Secondary outcomes were days in hospital and ICU, complications in hospital, and risk factors for severe COVID-19 in PWH. Regression analyses were performed to assess severe COVID-19 by HIV status and risk factors. Results: Data from 64 815 hospitalized patients were collected, of whom 121 were PWH (0.18%). PWH were younger (p < 0.001), and larger proportions were men (p = 0.014) and migrants (p < 0.001). Almost all PWH had undetectable HIV-RNA (93%) and high CD4 T-cell counts (median = 560 cells/mu L, interquartile range: 376-780). In an unadjusted model, PWH had statistically significant lower odds of severe COVID-19 compared with patients without HIV [odds ratio (OR) = 0.6, 95% confidence interval (CI): 0.34-0.94], but there was no significant difference after adjusting for age and comorbidity (adjusted OR = 0.7, 95% CI: 0.43-1.26). A statistically significant lower proportion of PWH (8%, 95% CI: 5-15%) died within 90 days compared with those without HIV (16%, 95% CI: 15-16%, p = 0.024). There was no statistically significant difference in days in hospital and complications during the hospital stay between PWH and patients without HIV. Conclusions: In this nationwide study including well-treated PWH, HIV was not a risk factor in hospitalized patients for developing severe COVID-19.
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