JAIDS Journal of Acquired Immune Deficiency Syndromes

IntroductionBuprenorphine (BUP) is an effective treatment for opioid use disorder (OUD) that may create opportunities to expand access to preventive services for patients with OUD when implemented in the primary care setting. HIV prevention, particularly pre-exposure prophylaxis (PrEP), represents a vital service for persons with OUD due to HIV risk associated with injection drug use and condomless sex. Evaluating the existing integration of BUP treatment and HIV prevention is an important step ...

BackgroundLittle is known regarding the degree to which substance and alcohol use effects on HIV viral suppression are mediated through medication adherence. We hypothesized that the total effects of such use are mediated through adherence. MethodsWe included patients with HIV (PWH) receiving care at an urban academic HIV clinic between 2014 and 2018. Eligible patients were those prescribed antiretroviral therapy who completed both patient reported outcome (PRO) questionnaires, and had subseque...

BackgroundIn the US, transgender and gender-diverse (TGD) individuals, particularly trans feminine individuals, experience a disproportionately high burden of HIV relative to their cisgender counterparts. While engagement in the HIV Care Continuum (e.g., HIV care visits, antiretroviral (ART) prescribed, ART adherence) is essential to reduce viral load, HIV transmission, and related morbidity, the extent to which TGD people engage in one or more steps of the HIV Care Continuum at similar levels a...

BackgroundState AIDS Drug Assistance Programs (ADAPs) provide HIV medication access for people with HIV (PWH) with low incomes in the United States (US). We quantified the proportion of viral suppression (VS) that is from ADAP clients for 2015-2022. MethodsFor 2015-2022, we obtained viral load (VL) test results and VS data from publicly available, jurisdiction-level data on ADAP clients and PWH. We report descriptive statistics including the proportion of PWH with a VL who had VS and were suppo...

Substance use remains a robust predictor of HIV infection, as well as a serious impediment to progress across the HIV care continuum for people living with HIV. As such, the careful design and implementation of interventions uniquely tailored to target substance use and HIV care behaviors remain paramount. A necessary step in these efforts is to understand the extent to which HIV care interventions have been efficacious in helping people who use substances progress across the HIV care continuum....

HIV treatment can suppress viral load and prevent transmission between sex partners, a strategy known as treatment as prevention (TasP). TasP is key for ending the HIV epidemic, and it is important to understand its adoption among priority populations. We examined the TasP adoption cascade using cross-sectional survey data from 1443 U.S. men and transgender, gender-nonconforming, and nonbinary individuals who reported having sex with men. Most participants (82.4%; n = 1189/1443) reported prior a...

BackgroundMen who have sex with men (MSM) who experience sexual violence are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV infection. Associations between sexual violence and PrEP discussion or PrEP use among MSM are not well-understood. MethodsNational HIV Behavioral Surveillance used venue-based sampling methods to recruit and interview MSM in 23 U.S. urban areas in 2017. We estimated the prevalence of sexual violence and examined associations betwe...

ObjectivesPeople living with HIV (PLWH) frequently experience gastrointestinal symptoms linked to dysbiosis, impaired mucosal barrier integrity, and persistent immune activation. Cannabis is widely used for symptom management by PLWH, but its effects on the gut microbiome are unclear. MethodsWe conducted a cross-sectional analysis of 63 PLWH (mean age 59.4 years; 71.4% Black or Hispanic) enrolled in the Marijuana Associated Planning and Long-term Effects study and its microbiome substudy. Parti...

ObjectiveThe COVID-19 pandemic has profoundly impacted mental health worldwide, particularly among vulnerable populations such as people living with HIV (PLWH). However, large-scale, real-world data on mental health care utilization and associated factors among PLWH remain limited. This study leveraged electronic health records (EHR) and Basics survey data from the All of Us program to explore mental health care utilization and associated factors among PLWH during the COVID-19 pandemic. Methods...

Objective(s)To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. MethodsCounty-level HIV testing data from CDCs National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obt...

BackgroundEngagement in HIV care significantly improves health outcomes and life expectancy. However, socioeconomic challenges often impeder consistent care. Virtual care offers a potential solution by enhancing timely access to HIV services and addressing these barriers. ObjectivesWe aimed to examine the association between socioeconomic factors and the use of virtual care among people living with HIV (PLHIV) in a clinical cohort in Ontario, Canada. MethodsWe analysed 2022 data from the Ontar...

ObjectiveCOVID-19 and related disruptions led to a significant drop in HIV diagnoses in the US in 2020. Recent analyses found 18% fewer diagnoses than expected among persons with HIV (PWH) acquiring infection in 2019 or earlier, suggesting that the drop in diagnoses cannot be attributed solely to decreased transmission. This analysis evaluates the progress made towards closing the 2020 diagnosis deficit in 2021. MethodsWe apply modified versions of previously developed methods analyzing 2021 di...

ImportanceEstimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. ObjectiveTo project the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the US through 2030. DesignAgent-based simulation model SettingHIV clinics in the United States in the recent past (2020) and near future (2030) ParticipantsIn 2020, 674,531 PWH were using ART; 9% were men and 4% wome...

ObjectivesTo define the incidence of clinically-detected COVID-19 in people with HIV (PWH) in the US and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. DesignObservational study within the CFAR Network of Integrated Clinical Systems cohort in 7 cities during 2020. MethodsWe calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest C...

BackgroundRapid Start results in persons with HIV (PWH) initiating antiretroviral therapy (ART) in less than seven days. Benefits associated with Rapid Start include linkage to medical care and starting ART on the same day as diagnosis. These PWH were better retained in medical care and likely to achieve virologic suppression, in a shorter time, than those who did not have access to Rapid Start. Despite recommendations to initiate ART less than seven days after diagnosis, slow uptake of Rapid St...

BackgroundSARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggests that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection. MethodsLeveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020 and April 2...

ObjectiveMost patients severely affected by COVID-19 have been elderly and patients with underlying chronic disease such as diabetes, cardiovascular disease, or respiratory disease. People living with HIV (PLHIV) may have greater risk of contracting or developing severe COVID-19 due to the underlying HIV infection or higher prevalence of comorbidities. DesignThis is a cohort study, including PLHIV diagnosed, hospitalized, or requiring intensive services for COVID-19. MethodsData sources includ...

Alcohol-serving venues are high-risk sites for HIV transmission in East Africa. Understanding how venue characteristics influence HIV screening outcomes may help to target venue-based outreach. In eight rural communities in Kenya and Uganda, we mapped all alcohol-serving venues (N=530) and invited owners to participate in a cluster-randomized trial to promote biomedical HIV prevention uptake: 527 (99%) owners agreed to participate. We distributed cards recruiting adults ( [≥] 18 years) for fr...

BackgroundThe evidence for an increased incidence of sexually transmitted infections (STIs) among patients utilizing HIV pre-exposure prophylaxis (PrEP) has been inconsistent. We assessed the risk of incident STI while on PrEP compared to periods off PrEP among military service members starting PrEP. MethodsIncidence rates of chlamydia, gonorrhea, syphilis, hepatitis C virus, and HIV were determined among military service members without HIV prescribed daily oral tenofovir disoproxil fumarate a...

In 2019 the Trump administration instituted a federal regulation (hereinafter the Policy) requiring that Title X family planning clinics have financial and physical separation of abortion services from other health services and prohibited abortion referrals. In response, 32% (1,280) of Title X funded sites left the program nationally. Our analysis connects public data from Title X Family Planning Reports (2016-2021) and CDC surveillance reports (2016-2021), to examine the Policys impact on: 1) H...