by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
July 21, 2020
Below are 3 studies from this conference. Each address very different HIV-related issues but all have clinical relevance to our respective practices and patients.
As persons with HIV continue to have an increased life expectancy, it remains imperative that currently recommended ART regimens remain both effective and safe in aging patients. This study is a pooled analysis from four clinical trials (GS 1844, 1878, 4030 and 4449) that included 140 virally suppressed adults > 65 years old who were switched to bictegravir/FTC/TAF. The primary endpoint was HIV-1 RNA<50 copies/mL at week 48. The median age was 68 years and 14% were female. Baseline co-morbidities included CVD 24%, DM 22%, and HTN 55%. At week 48, 92% had viral loads <50 copies/mL, although no participants had confirmed virologic failure. The most common adverse events (AEs) were nasopharyngitis and arthralgia (7% each). Eleven subjects had a drug-related Grade 1 or 2 AE, but there were no Grade 3-4 AEs. Four subjects had AEs that led to discontinuation of B/F/TAF. There were non-significant changes in lipids and a median weight gain of only 1 kg. These data support the use of B/FTC/TAF in adults > 65 years of age.
HIV prevalence among persons incarcerated in U.S. federal and state prisons is three to five times higher than the national prevalence. The CDC recommends that all correctional-based clinics offer opt-out HIV screening, provide HIV education to inmates, and provide medication and linkage to medical services to the inmate upon release. This study was a review of all Bureau of Prison (BOP) and department of corrections’ (DOC) medical guidelines to assess variations in prison HIV policies. Guidelines were reviewed: 1) HIV testing, 2) HIV education, 3) linkage to care, and 4) post-discharge ART. Seventy-one percent mandate provision of HIV education, only 33% provide opt-out testing. Only 26% mandate provision of ART and linkage to community services upon discharge. Five states (LA, MD, PA, TN, D.C.) mandate the provision of all four of the CDC recommended HIV services, while eight (FL, HI, NY, ND, OR, RI, SD, UT) do not provide any of these services. The majority of state DOC do not have HIV polices consistent with CDC guidance. This is a missed opportunity that must be corrected in order to meet the HIV and health needs of this high-risk population during and after incarceration.
The author has no conflicts of interest to disclose.
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