By American Academy of HIV Medicine Chief Medical Officer
Carolyn Chu, MD, MSc, AAHIVS
Featured Literature #1:

Leistikow PT, Patel V, Nouryan C, Cervia JS.  Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review.  J Investig Med.  2022 Dec 8; jim-2021-002056.  doi: 10.1136/jim-2021-002056.  Online ahead of print. 

This systematic review and qualitative analysis, undertaken July 2019, aimed to compare rates of HIV testing acceptance and linkage to care for adolescents and young adults across various delivery models: emergency department (ED), primary care/inpatient setting, community-based program, or STI/family planning clinics.  59 studies from North America, Africa, Asia, Australia, and Europe were identified for data review and analysis.  In the North American context, the greatest acceptance of testing occurred in ED settings (77.7%), while in other regions acceptance was highest in primary care/hospital settings (93.3%).  Review of ED-based studies found a significant association by testing strategy, with opt-in approaches resulting in a higher acceptance rate compared to opt-out (82% vs. 75%).  Overall, highest linkage to care rates were reported for ED-based testing, followed by primary care/hospital settings.  However, when only North American studies were examined, primary care/hospital settings had the lowest linkage to care rates (38.8%) compared to ED-based testing (93.5%), STI/family planning clinics (81.4%), and community-based programs (69.9%).

Author’s Commentary:

This review is a timely one, given the recent release of the updated National HIV/AIDS Strategy for the United States (2022-2025).  Youth compose 21% of new HIV diagnoses in the U.S., however are the least likely of any age group to remain in care and have a suppressed viral load.  Trends over the last decade indicate decreases in the percentage of sexually active high school students who used condoms during last intercourse, and less than 10% reported STI screening within the past year.  Findings from this analysis may help inform how to design and implement youth-centered and culturally informed HIV screening/testing and linkage services which are likely to result in high rates of testing acceptance and engagement in care.      

Featured Literature: #2

Siddiqui J, Samuel SK, Hayward B, et. al.  HIV-associated wasting prevalence in the era of modern antiretroviral therapy.  AIDS.  2022 Jan 1; 36(1): 127-135.  doi: 10.1097/QAD. 0000000000003096.  PMID: 34628440. 

Authors analyzed medical and pharmacy claims to assess prevalence and comorbidity burden of HIV-associated wasting (HIVAW), utilizing information from the IBM MarketScan Commercial, Medicare Supplemental and Multi-State Medicaid Research Databases.  PWH with evidence of HIVAW were identified by proxy based on a previously developed algorithm specific to claims data; patients were excluded if they had any malignancy diagnosis claim.  Estimated HIVAW cumulative prevalence (July 2012 to March 2019) was 18.3%.  The proportions of PWH with ART claims were similar in the HIVAW and non-HIVAW cohorts, however the proportion with one or more diagnosis claims of an opportunistic infection or HIV/AIDS-related condition was 64.2% in the HIVAW cohort vs. 38.6% in the non-HIVAW cohort.  A significantly higher percentage of the HIVAW cohort were on Medicaid (86.7% vs 63.8%).  The most prevalent co-occurring conditions in the HIVAW cohort were dyslipidemia (48.5%), depressive disorders (46.1%), and chronic pulmonary disease (45.1%); mean Charlson Comorbidity Index score was 3.6 vs. 2.0. 

Author’s Commentary:

Few, if any, studies have described prevalence estimates of HIVAW in the contemporary treatment era—this analysis of over 42,500 PWH found that over ~6yrs, 18.5% of insured PWH receiving medical care met the definition of HIVAW (~3% annual prevalence).  Investigators observed that HIVAW was most strongly associated with Medicaid coverage and hospitalizations, but not ART use, affirming that HIVAW continues to occur even among people on HIV treatment.  Because of its multi-factorial nature and overlap with prevalent conditions in an aging population of PWH, HIVAW may not necessarily be the leading consideration when evaluating patients experiencing weight loss/body mass changes, decreased physical endurance and overall level of function.  Nevertheless, authors highlight these data suggest the need to monitor for unintentional weight loss in PWH … [and further] evaluate the risk of HIVAW by comorbidities and payer type.     

The author has no conflicts of interest to disclose.

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