New Law in Los Angeles – Adult Movie Actor’s Required To Wear Condoms

Actors making pornographic movies in Los Angeles will be required to use condoms while filming, under a new law signed by the city mayor.

The new regulation has been welcomed by health officials but pornography industry leaders say it could force them to abandon the city.

LA’s San Fernando Valley is considered the capital of the multibillion-dollar US adult film industry.

Correspondents say it is not yet clear how the new law will be enforced.

The LA-based Aids Healthcare Foundation welcomed the move saying it was crucial in protecting adult film actors from HIV and other sexually transmitted diseases.

The foundation, which has campaigned for the measure for six years, said it would now seek similar condom requirement elsewhere in the US.

“The city of Los Angeles has done the right thing. They’ve done the right thing for the performers,” said foundation president Michael Weinstein.

He said his group would also be vigilant in keeping track of where porn producers might move to.

Several of the industry’s biggest adult filmmakers have said they might consider moving just outside city boundaries.

They insist that adult films featuring condoms are not as popular and that some actors prefer not to use them.

The new law was signed by Los Angeles Mayor Antonio Villaraigosa on Monday.

The city council has now asked the police, city attorney’s office and workplace safety officials to figure out how they enforce the rule, the Los Angeles Times reports.

Industry experts estimate as many as 90% of all pornographic films produced in the US are made in Los Angeles.

Last year, pornographic film productions across the US were temporarily shut down after an adult film performer tested positive for HIV – the virus that causes Aids.

Above article via BBC News

Our message is clear!

Condoms provide the best protection from HIV and other sexually transmitted infections.  HIV stands for human immunodeficiency virus. It was identified in the early 1980s and it belongs to a group of viruses called retroviruses.

Normally, the body’s immune system would fight off an infection, but HIV prevents the body’s immune system from working properly. HIV infects key cells in the body’s natural defences called CD4 cells, which co-ordinate the body’s response to infection. Many CD4 cells are destroyed by being infected, and some stop working as they should.

Although HIV can’t be cured, it can be treated. Modern HIV treatment means that many people with HIV are living long, healthy lives and can look forward to a near-normal lifespan.

AIDS
If HIV isn’t treated, the gradual weakening of the immune system leaves the body vulnerable to serious infections and cancers which it would normally be able to fight off. These are called ‘opportunistic infections’ because they take the opportunity of the body’s weakened immunity to take hold.

If someone with HIV develops certain opportunistic infections, they are diagnosed as having AIDS. The term ‘AIDS’ stands for acquired immune deficiency syndrome. People diagnosed as having AIDS can become unwell with a range of different illnesses, depending on the specific opportunistic infections they develop. This is why AIDS is not considered a disease, but a syndrome – a collection of different symptoms and illnesses, all caused by the same virus, HIV.

Most people who have HIV have not had an AIDS diagnosis. Also, if someone develops an AIDS-defining illness this doesn’t mean that they are on a one-way path to illness and death. Thanks to HIV treatment, many people who were once diagnosed as having AIDS are now living long and healthy lives.

Have you ever had a HIV test?

If you’re interested in having a HIV test, we offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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The virtual elimination of mother-to-child transmission of HIV

With the right programs and financing, the UN and its partners have said that, by 2015, virtually no HIV-positive mother will have to pass along HIV to her newborn — an exciting goal that can be achieved in just a few short years.

But Prevention of Mother-To-Child Transmission (PMTCT) can be a confusing process.  PMTCT isn’t exactly an acronym that rolls off your tongue, and the process by which transmission is prevented is a bit complicated, requiring different paths of treatment and follow-up tailored to the mother and child.

Fortunately, UNAIDS have made a great infographic that details the steps required along the way to ensure that a baby can be born HIV-negative. It works a little like a “choose your own adventure” story — except with far more important, real-world consequences. Try following a few different paths through the infographic, keeping an eye out for the percentages built into the circles. The smaller the percentage, the more the baby is likely to be born HIV-free — a happy ending, indeed!

Source: UNAIDS (Outlook 30, 2011 Report).

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Bangkok International Symposium on HIV Medicine 2012

The HIV Netherlands Australia Thailand Research Collaboration holds an International Bangkok Symposium on HIV Medicine in January every year and it starts again for 2012 tomorrow. At the Queen Sirikit National Convention Centre.

The key objective of the annual Bangkok International Symposium on HIV Medicine is to provide health care workers and members of the HIV-infected and affected community from Thailand and all over the world with a comprehensive review of the management of HIV infection and opportunistic infections, efforts to improve access to therapy as well as the latest updates on research into HIV treatments and vaccines.

The symposium also aims to stimulate debate through a series of panel discussions on issues such as access to care and the cost of ARV in developing countries. In the last 5 years, over 3,000 participants from Asia Pacific, Europe and the America have attended the symposium.

An expert faculty of speakers from Thailand, Asia, Australia, Europe and USA presents a comprehensive review of current HIV management. World class international and local speakers present plenary sessions and facilitate interactive workshops.

Key reasons people attend the Symposium

• The Symposium is a premier medical-scientific conference in HIV and related diseases in South East Asia.
• People will hear about the latest advances in HIV research and treatment from leading local and international figures.
• People will gain recognition for Continuing Medical Education (CME) and Continuing Nursing Education (CNE) and Continuing Pharmaceutical Education (CPE).
• People will have an opportunity to network with colleagues from across South East Asia and all over the world.

The symposium hopes that delegates not only receive knowledge in HIV management through the trainings, but also a warm welcome from Thai people.

Full details on the Symposium are available at: http://www.hivnat.org/symposium/15th/home

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HIV treatment integrated into general health care delivers ‘equal or better’ results in MSF programmes

Outcomes for people taking antiretroviral treatment in Médecins sans Frontières’ (MSF) integrated general healthcare programmes were as good or better than those in vertical HIV programmes, researchers report in a nine-country study published the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

While those in integrated programmes may have started ART at a more advanced disease stage, the risk of death was similar to those in vertical programmes but loss to follow-up was less (aHR 1.02; 95% CI: 0.83-1.24 and aHR 0.71; 95% CI: 0.61-0.83, respectively) among patients followed for up to 30 months.

The authors say this analysis of retrospective observational cohort data from 17 programmes (seven vertical and 10 integrated) on ART delivery and care “validates the programme design of integration and its associated benefits.”

The success of scale-up of access to ART in resource-poor settings with outcomes matching those of resource-rich settings has been achieved primarily through large-scale vertical treatment programmes, notably in urban areas.

However, resource demands make vertical programmes neither feasible nor appropriate in rural settings or in areas of low HIV prevalence with other competing health issues.

The authors suggest programmes integrating HIV care into other health activities offer a possible feasible alternative model using HIV resources and staff to provide both HIV and non-HIV services.

Benefits include:

• Improved access to HIV care in areas where vertical programmes are not feasible.
• Retention in care made easier since services are both closer to the patient and spread across disciplines.
• Strengthened health programmes as HIV often brings additional resources including clinical training, improved laboratory services and procurement supply systems.
• HIV treated as any other illness may reduce stigma.
• Same staff able to treat many different conditions in the same place.
• Improved programme cohesiveness.

Yet, the advantages that integration brings may mean sacrificing the quality of care that dedicated services and specialised staff provide in vertical programmes. With this in mind the authors chose to compare outcomes of patients treated with ART in MSF’s integrated and vertical HIV programmes.

Vertical programmes were defined as specifically designed to treat HIV in a population. Integrated programmes were defined as providing comprehensive health care within which HIV was included as part of general healthcare services.

Although programmes differed in their degree of integration into general health services, all testing and treatment protocols, adherence counselling and patient follow-up, data collection and monitoring, laboratory protocols and drug supply and procurement were standardised across all MSF programmes; and out-of-programme training and advisory staff were the same. Drugs and materials were supplied through MSF but the programmes were integrated into Ministry of Health facilities.

The authors used Cox regression to determine the link between death and programme design, adjusting for potential confounders including gender, and at baseline: age, body mass index, clinical WHO stage, tuberculosis; programme age at the patient’s start of ART (providing ART for 12 months or more or less than 12 months) and setting (rural or urban).

Ninety per cent (15876) of the 17,561 adults who started ART in the 17 programmes were treated in the vertical programmes with the remaining 10% (1685) in the integrated programmes. Eighty-eight per cent (15,403) had at least six months of follow-up for inclusion in the 12-month treatment outcome analysis. 14,523 had complete data for inclusion in the Cox regression.

Median time on ART for all patients was 12.7 months (IQR: 4.5-24.0) and 6.8 months (IQR: 2.3-15.0) for vertical and integrated programmes, respectively.

Before adjusting for possible confounders, estimates showed a higher proportion of deaths in integrated programmes, 11.9% compared to 7.9%. The authors suggest this is explained because patients were more clinically immunosuppressed at baseline (a higher proportion at WHO clinical stage 4).

This is in keeping with other findings. Patients targeted in integrated programme often present for care when they are already sick. In contrast, the authors note, to vertical programmes that do large-scale community counselling and testing so attracting more asymptomatic patients.

After adjusting for other factors the Cox proportional hazards model showed the risks of death were similar in both programmes, with clinical WHO stage at the start of ART the most significant influence (aHR 1.99, 95% CI: 1.74-2.29). And, the risk of loss-to-follow-up was 29% less in integrated than in vertical programmes.

Reasons include, the authors suggest, integrated services allow for better treatment of co-existing illnesses, including tuberculosis; lower patient numbers mean more individualised care and follow-up; easier access with services closer to the patient; and normalisation of HIV reduces stigma.

The authors note these findings are comparable to other published studies. They cite the ART-LINC cohort of 18 programmes in low-income settings in Africa, Asia and Latin Americas. Combined death and loss to follow-up rates were 21%, 19% and 24% for ART-LINC, MSF vertical and integrated programmes, respectively.

The greater the programme experience, the more protective it was against death (aHR 0.77, 95% CI: 0.66-0.89).

However, risk of loss to follow-up was greater in more experienced programmes (aHR 3.33, 95% CI: 2.92-3.79). The authors suggest as programmes grow in size less time is spent on patient selection, preparation and counselling for ART adherence.

Not surprisingly, the risk was even greater among patients treated in rural settings (aHR 3.82, 95% CI: 3.49-4.20) because of travel distances and limited travel options, note the authors.

Limitations include: the Cox hazards model, because of the body mass index variable, did not follow the assumption of proportional hazards, so potentially reducing its power.

Vertical programmes were larger and predominantly in urban centres so may have had an unmeasured effect on outcomes.

The range of programmes from different countries over a number of years supports the generalizability of the findings yet data quality, in spite of a standardised database, may have varied.

Sensitivity analyses, however, did not change the main findings.

The authors conclude “In a time of intense debate regarding the merits of specific funding to HIV services, our data provide evidence in these settings [rural and relatively low prevalence) that resources dedicated to HIV through integrated programmes can benefit the individual patient, and as previously described can also strengthen the health system as a whole.”

Original Article by Carole Leach-Lemens at NAM

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Charities criticise London ‘failing’ HIV prevention programme

Charities have criticised the way HIV services in London are commissioned following the release of a report which highlights “significant management failings” and a “lack of strategy”.

The report said there was "an urgent need to address HIV prevention in London"

The Pan London HIV Prevention Programme (PLHPP) Needs Assessment report highlights “failings” of the pan London HIV commissioning group, which spends £2.3m a year.

HIV treatment in London costs £500m with almost 30,000 people accessing care and that number rising by 5% annually.  The PLHPP provides prevention work targeting gay men and African communities and treatment information for people with HIV.

HIV prevention charity African Health Policy Network (AHPN) chief Francis Kaikumba said he was “shocked, annoyed and heads need to roll” in light of the report.  Meanwhile, Caspar Thomson, director of the National Aids Manual, which provides information on HIV and Aids, said: “The whole process is moving too slowly. There’s an urgent need to address HIV prevention in London.”

But Mark Creelman, director of strategy at Inner North West London Primary Care Trusts (INWL PCTs), which leads the pan London HIV commissioning group, said: “We are working to ensure the programme has the right leadership and the right governance in place to be as effective as possible.”
‘Crisis level’

The needs assessment report was prepared by the INWL PCTs on behalf of the Pan London HIV commissioning group and will be used to guide future commissioning intentions.

It identified “significant failings with the management of the programme” and said “providers have fallen far short of their activity targets”.

HIV IN LONDON

•     Almost 30,000 people with HIV accessing care in London
•     About 26% of Londoners affected with HIV remain undiagnosed
•     People diagnosed with HIV rising by 5% annually
•     46% of those diagnosed in London are men who have sex with men
•     Black Africans make up 5.5% of London population but 32% of those newly diagnosed with HIV
•     Treatment costs are £500m per year.

Failings identified by the report included “a lack of clarity over leadership” and “inconsistent direction from commissioners”.  The programme “appears to have evolved over time without any explicit strategic direction”, the report said.

Mr Thomson responded to the report saying: “Over the course of the years of the programme, I think the strategic direction was lost.”

Mr Kaikumba said: “HIV prevention work in London is at an all-time crisis level. Where is the accountability? Why has there been a lack of leadership?” he asked.

“Heads need to roll in terms of what the PLHPP is going to do about it.”

But Mr Creelman said: “The basis for the needs assessment was to give us a more strategic direction.

“Across commissioning and providers, we have a joint responsibility to ensure we’re spending taxpayers’ money effectively.”  Francis Kaikumba, head of the AHPN AHPN chief Francis Kaikumba says the proportion of money going towards Black Africans is “poor”

The report highlights the need for an “urgent” exercise “to inform commissioning intentions”.  Another report, entitled PLHPP Final Evaluation Report, published last February, showed of 17 projects commissioned, only two “merited continued commissioning”.

A total of 11 were said to “merit no further investment” while four needed “fundamental restructuring”.  Nevertheless, these projects all continue to receive funding through the programme, nearly a year after the report was published.

Mr Thomson stressed the need for urgent action, saying: “Organisations are under threat because of the delays and if some of them go a huge amount of knowledge and expertise will be lost.”

But Mr Creelman said: “The needs assessment is very much the start of the process.  We understand the urgency but we wanted to make absolutely sure within the evidence that has been collected, that organisations look at the needs assessment.”

Contributors to the report now have until 6 February to comment further, before new commissioning intentions are “developed”.

The needs assessment report also highlighted that the PLHPP spends £320,000 per year on the black African community, compared with £1.3m on “men who have sex with men”.

“Spend targeted at the black African population appears disproportionately low” the report said.

Mr Kaikumba said: “The amount of money that goes towards Black African work is ridiculous – it’s really poor.  We’re shocked and annoyed how few pennies are being spent to support black Africans with HIV,” he said.

But Mr Creelman said: “The needs assessment supports that Black African work is much better served by being done at a local level.  Lots of PCTs have Black African HIV prevention programmes and those programmes were set up to address their local needs.”

Mr Kaikumba said the report showed: “We’re spending such a tiny amount on prevention.”  Can we get away with spending so little?” he asked.

But Mr Creelman stressed: “This is a programme within a wider prevention portfolio. The local PCTs also fund localised services”.  Meanwhile, with 26% of Londoners affected with HIV remaining undiagnosed, there appear to be no plans to reduce the amount spent on HIV prevention.

“Chief executives are absolutely committed to not taking any money out of prevention in this programme,” Mr Creelman said.

Original Article By Andy Dangerfield at BBC News

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Video Tip of the Day: Check Your Meds!

When Gwenn and Shawn went to pick up Shawn’s HIV medications, they made a video update in the car that was intended to be a joke of sorts about how long it can take to pick up meds.

Then when they got home, they made another video about what they discovered about the medication that wasn’t so funny.  Check out the videos, particularly the second one below. If you don’t like Vlogs– then here’s a spoiler: one of the drugs was in the wrong pill bottle and that’s why it’s very important for anyone who takes medication to know what their pills look like, and what they are called.

New anti-HIV drugs were licensed in the European Union in 2011.  The National AIDS Trust have updated their antiretroviral drugs chart. A copy can be found from this link.

Via Poz.com Blogs and NAM’s Resources

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Portrayal of HIV in the media & The Leveson Inquiry

The Prime Minister announced a two-part inquiry investigating the role of the press and police in the phone-hacking scandal, on 13 July 2011.

Lord Justice Leveson was appointed as Chairman of the Inquiry.  The first part will examine the culture, practices and ethics of the media. In particular, Lord Justice Leveson will examine the relationship of the press with the public, police and politicians.  He is assisted by a panel of six independent assessors with expertise in key issues being considered by the Inquiry.

The Inquiry will make recommendations on the future of press regulation and governance consistent with maintaining freedom of the press and ensuring the highest ethical and professional standards.

Lord Justice Leveson opened the hearings on Monday 14 November 2011, saying: “The press provides an essential check on all aspects of public life. That is why any failure within the media affects all of us. At the heart of this Inquiry, therefore, may be one simple question: who guards the guardians?”

A major concern for people living with HIV in the UK and the organisations that support them is the number of articles in the media that sensationalise and stigmatise HIV and unfairly represent individuals living with the virus.

Stories in the media can have a positive effect in increasing people’s awareness of HIV and what it means to live with HIV. However media reports about HIV are often stigmatising or inaccurate. Many stories contribute to a culture of blame about HIV transmission, focusing on so-called irresponsible sexual activity, use judgmental language and stereotype people living with HIV.

Improving the media’s coverage of HIV issues is vital to tackle discrimination experienced by people living with HIV, improve people’s knowledge and help prevent the spread of the virus.

Portrayal of HIV in the media

There are very few public figures who are open about their HIV status, and currently no established characters living with HIV in mainstream soaps or television dramas.   NAT are calling for proactive initiatives to portray realistic HIV stories in the media, with the BBC and Channel 4 taking the lead as part of their statutory duty to promote disability equality.

As well as in the media, NAT would like to see greater, and supportive, visibility for people living with HIV both in cultural representation and public life.

NAT recently made a submission to the Leveson Inquiry, which is examining the culture, practices and ethics of the media, and made the case for the need to tackle the frequent inaccuracies still written about HIV in the press and the use of stigmatising and prejudicial language.  You can read NAT’s submission to the Leveson Inquiry here.

Guidelines on Reporting HIV

NAT and the National Union of Journalists have jointly produced Guidelines on Reporting HIV to help journalists make sure that the articles that they write are not misleading and do not encourage negative perceptions about HIV.

You can read what NAT is saying to editors and journalists to improve reporting on HIV here.

Press Gang

Press Gang is an online group of people living with HIV who are interested in challenging stigmatising coverage in the media and making their voices heard. The National AIDS Trust keep Press Gang members informed of any stigmatising or inaccurate coverage and give them advice on how to challenge it.

Every day they scan many newspapers online and check other media for mentions of HIV and AIDS. Any articles that are identified as stigmatising or inaccurate are sent to Press Gang members via email as a ‘stigma alert’.

Members are then encouraged to write a letter to the editor or add a comment online pointing out why this article is stigmatising or inaccurate and informing readers about the realities of living with HIVin the UK.

If you’re living with HIV and are interested in challenging stigma in the media then you can find out more about find out more about joining ‘Press Gang’ here.

What’s in the news?

NAT scans the media in the UK and worldwide daily for stories relating to HIV and produces a summary of the main stories of the week, with online links to the original article. You can read the latest news here.  Where they identify inaccurate reporting of HIV, they always challenge it.

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Mr Gay UK Vows to Donate Winnings to HIV Charity

The recently crowned winner of Mr. Gay UK has vowed to give some of his prize money to a prominent HIV/Aids charity in an attempt to raise more awareness about the disease.

Samuel Kneen, 22, a hairdresser from Cardiff, says he will give some of his £2,000 winnings to the Terrance Higgins Trust after seeing a close friend suffer from HIV, saying he feels strongly about supporting the cause.

He told Wales Online: “I paid off a little bit of debt and I said that I’d donate some money to Terrence Higgins Trust,” he said.

“I told them when I entered the contest that I know somebody who has got HIV and I want to support him. It is something I feel strongly about,” he said.

As well as the donation, he also hopes to play a part in raising general awareness of the issue. “I walked around Cardiff on World Aids Day last year and the shops didn’t know what I was talking about when I was asking if they had any ribbons for sale. I’d like to make a difference if I can, and help people know more about it,” he added.

Kneen also won a trip to Morocco as part of the prize and he has the chance to enter the Mr. Gay Europe competition, but he already feels proud of his achievement. “I was excited because I won,” he said. “But it was more the fact that I felt proud of myself that I had accomplished something. That was the biggest reward,”

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Following HIV Treatment Guidelines Results In Better Outcomes

Results from a recent study of HIV-positive adults in Switzerland show that following United States antiretroviral therapy treatment guidelines when deciding on initial therapy regimens results in a greater likelihood of successfully suppressing HIV.

The researchers also found that the vast majority of patients receive regimens that conform to guideline recommendations.

The authors stated that their results validate the recommendations in current guidelines as well as the utility of the guides in helping clinicians decide on initial regimens to prescribe.

“Our results suggest that, in the context of constant increase in the number of therapeutic options and knowledge on specific drug-related side-effects and interactions, the release of updated treatment recommendations as well as the promotion of their use are important to guarantee the best possible care of HIV infected patients,” wrote the study authors.

The United States Department of Health and Human Services releases treatment guidelines on when to start antiretroviral therapy and which initial combination regimens to use for previously untreated (treatment-naïve) people with HIV.

The guidelines contain preferred treatment regimens as well as alternative and acceptable regimens. Preferred regimens are recommended as the best treatment regimens for most people starting antiretroviral therapy.

The guidelines are intended for use by HIV care practitioners when treating HIV-positive adults and adolescents in the U.S. The most recent set of guidelines were released in October 2011 (see this).

According to the study authors, the U.S. guidelines are also used to determine initial treatment regimens for people with HIV in Switzerland, which no longer issues its own guidelines.

In this study, the researchers sought to determine how often the guidelines are followed by clinicians in Switzerland when prescribing antiretroviral regimens. They also attempted to determine whether following the guidelines led to better treatment outcomes, such as higher CD4 (white blood cell) counts or greater probability of successfully achieving an undetectable viral load (amount of virus in the blood).

The study included 4,189 previously untreated patients from seven different clinical sites in Switzerland. All patients began antiretroviral therapy between August 1998 and December 2007. Approximately two-thirds (68 percent) of the study participants were male, and three-quarters (75 percent) were Caucasian. About 42 percent of participants were between the ages of 31 and 40 when they started therapy.

Results showed that 73 percent of the study participants were prescribed one of the preferred first-line regimens as their initial antiretroviral therapy treatment. Five percent of participants were prescribed a regimen that violated the recommendations in the guideline. The definition of a violation regimen included regimens that consisted of fewer than three antiretroviral drugs or had three drugs but included a nucleoside reverse transcriptase inhibitor (NRTI) regimen base, or backbone, that was not recommended.

The most common type of regimen guideline violation was prescribing a non-recommended NRTI backbone (34 percent of violations).

Results also showed that participants who were prescribed a violation regimen were about half as likely to successfully achieve undetectable viral loads within a year after starting treatment. CD4 cell count increases were similar between the groups after one year, with an average increase of 185 cells per microliter in the group taking a recommended regimen, versus 152 cells per microliter in those on violation regimens.

Within the first year of treatment, 34 percent of patients on violation regimens switched to a different regimen, versus 25 percent of patients on recommended regimens.

Women and highly educated patients were more likely to receive violation regimens, as were participants who started the study with CD4 counts above 350 cells per microliter. The study authors speculated that these patients may negotiate more with their clinicians over which antiretrovirals to take.

Participants with high viral loads (between 10,000 and 100,000 copies per milliliter) were less likely to receive a violation regimen.

For more information, please see the study in PLoS One.

Original Article by Courtney McQueen via Aidsbeacon.com

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Big Increase In Repeat Pregnancy Rates In HIV-Positive Women In UK & Ireland

Rates of repeat pregnancies among HIV-positive women in the UK and Ireland have increased substantially since 1997, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

In 2009 over a third of all pregnancies involved women who had at least one other pregnancy. Younger age and geographic region of origin were associated with having a subsequent pregnancy.

“A substantial and increasing proportion of pregnancies in diagnosed HIV-infected women are occurring in those who have already received HIV-related care in one or more previous pregnancy,” comment the authors. “The main demographic characteristics independently associated with repeat pregnancies were younger age…and being born in Middle or Western Africa.”

A large proportion of HIV-positive women are of childbearing age. However, mother-to-child transmission can be prevented in most cases with appropriate antiretroviral treatment and care. This low risk of transmission combined with the excellent prognosis provided by modern antiretroviral treatment means that HIV-positive women in resource-rich countries can realistically consider childbearing.

In the UK and Ireland the number of pregnancies in HIV-positive women has increased significantly over the last decade. A significant proportion of these women have experienced at least one other pregnancy while receiving HIV care. Given their often complex medical, obstetric and social needs, the care of this group of women can be complex.

Despite this, little is currently known about the demographics and health status of HIV-positive women who experience repeat pregnancies.

Therefore investigators from the National Study of HIV in Pregnancy and Childhood examined 20 years of data obtained from pregnant HIV-positive women in the UK and Ireland. Data from 1990 and 2009 were included in the study.

The investigators’ aims were to characterise the pattern and rate of repeat pregnancies and to establish the demographic and clinical characteristics of HIV-positive women with two or more recorded pregnancies.

A total of 14096 pregnancies were recorded in HIV-positive women during the study period. Just over a quarter (2737; 26%) were repeat pregnancies. This figure included 2117 women who had two pregnancies, 475 with three pregnancies and 145 with four or more pregnancies.

Outcomes were recorded for 13,355 pregnancies. In all, 11,915 (89%) resulted in a live birth, 121 (1%) in a still birth and 10% in either miscarriage or termination.

Both the number and proportion of repeat pregnancies increased significantly. There were 158 recorded pregnancies in 1997, and 32 (20%) were repeat pregnancies. By 2009, the total number of pregnancies had increased to 1465, with 565 (37%) being repeat pregnancies.

Further analysis of the 2009 figures showed that 28% were second pregnancies, 7% were third and 3% were fourth or subsequent pregnancies.

“The increase in repeat pregnancies over the last two decades is likely to reflect a combination of factors including the accumulation of diagnosed HIV-infected women who have already had pregnancy,” suggest the investigators. “Major improvements in quality of life and AIDS-free survival of people living with HIV, and substantial reductions in the risk of mother-to-child-transmission are also likely to have had an impact.”

Overall, the rate of repeat pregnancies was 6.7 per 100 woman-years.

The median interval between first and second deliveries was 2.7 years, with an interval of 2.3 years between second and third deliveries, with the same interval between third and fourth deliveries.

Analysis of the factors associated with repeat pregnancy was restricted to women who received care after 2000. A total of 11,426 pregnancies in 8661 women were therefore included. Just over a quarter (26%) were repeat pregnancies.

The probability of a repeat pregnancy declined significantly with increasing age (p < 0.001).

Women born in central African countries and West Africa were more likely to experience sequential pregnancies than women born in other regions.

“This pattern is likely to reflect a complex range of cultural, behavioural and migratory factors such as fertility patterns in women’s countries of origin and the demographics of women who migrate from different regions,” write the researchers.

There was no robust evidence that either CD4 cell count or health were associated with repeat pregnancies.

“The number of diagnosed HIV-infected women in the UK and Ireland having more than one pregnancy has increased substantially and is likely to continue to grow,” conclude the authors.

They stress the importance of understanding the characteristics of these repeat pregnancies. “Variations in the probability of repeat pregnancies, according to demographic characteristics, are important considerations when planning the reproductive health services and HIV care for people living with HIV.”

Original Article via Michael Carter at NAM

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