Direct-Acting Antiviral Initiation Among People With Hepatitis C Virus (HCV) and HIV on Antiretroviral Therapy in the United States and Canada: Factors Driving the HCV Treatment Gap.

Background: People with human immunodeficiency virus (HIV; PWH) are at increased risk of hepatitis C virus (HCV) coinfection and experiencing negative clinical outcomes. We evaluated direct-acting antiviral (DAA) initiation among PWH with HCV to identify factors associated with initiation.

Methods: US and Canadian PWH ≥18 years with a detectable HCV RNA in the North American AIDS Cohort Collaboration on Research and Design were followed up from the latest of first detectable HCV viremia, antiretroviral therapy initiation, enrollment date, or 1 January 2014 until the first of DAA prescription, clearance of HCV viremia, loss to follow-up, death, or 31 December 2021.

Clinical predictors and incidence of Kaposi sarcoma among males with HIV in the Treat-all era in the United States and Canada.

Background: Stagnating declines in Kaposi sarcoma (KS) among men with HIV (MWH) following Treat-All policies necessitate evaluating changes in clinical drivers of KS. We examined clinical factors and their associations with KS rates among MWH in North America.

Methods: Among MWH in the North American AIDS Cohort Collaboration on Research and Design, we estimated annual KS rates (per 100,000 person-years [PY]) by viral suppression (<200 copies/mL), CD4 count (<500 vs.

Alcohol use disorder, but not current alcohol use is associated with falls among people with HIV in care.

Background: Current understanding of associations between alcohol use and falls among people with HIV (PWH) is limited due to few and inconsistent studies. Given the prevalence of heavy episodic alcohol use reported among PWH, this remains an important question.

Methods: Alcohol use was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and self-reported alcohol use treatment and/or diagnosis of alcohol use disorder (collectively AUD) among PWH at 8 CFAR Network of Integrated Clinical Systems (CNICS) sites from 2021-2024.

Impact of Depressive Symptom Severity on Stroke Risk in a US Cohort of People with HIV.

Background: Depression is a common psychiatric condition and an independent stroke risk factor among people with HIV (PWH). The impacts of depressive symptom severity on stroke are not clear in PWH.

Methods: We studied adult PWH in clinical care at five CNICS sites with ≥1 assessment for depressive symptoms (PHQ-9) from 2010-2022.

Retention in HIV Care Still Matters: A Longitudinal Multisite Analysis.

Introduction: Retention in care has recently been de-emphasized as a key national HIV health metric, and its relevance in the era of more effective antiretroviral therapy (ART) regimens remains unclear. We assessed the relationship between retention in care and sustained viral suppression (SVS) over a 2-year period for newly established and previously established people with HIV (PWH).

Methods: We analyzed data from seven Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites using modified Poisson regression with generalized estimating equations.

Patterns in Mental Health Symptoms, Substance Use, and Viral Suppression in People with HIV: A Clustering Analysis.

Mental health conditions and substance use are prevalent among people with HIV (PWH), are correlated with one another, and associate with viral non-suppression independently; their joint association with viral non-suppression may be under-studied because of data sparsity. We conducted a machine learning-based clustering analysis to characterize groups of patient-reported mental health symptoms and substance use based on their relationship with HIV viral suppression. Participants in the Johns Hopkins HIV Clinical Cohort reported symptoms of depression, anxiety, and post-traumatic stress, and recent use of alcohol, cocaine, amphetamine, non-prescribed opioids, and cannabis (2013-2023).

Superinfection with intact HIV-1 results in conditional replication of defective proviruses and nonsuppressible viremia in people living with HIV-1.

During replication of some RNA viruses, defective particles can spontaneously arise and interfere with wild-type (WT) virus replication. Recently, engineered versions of these defective interfering particles (DIPs) have been proposed as an HIV-1 therapeutic. However, DIPs have yet to be reported in people with HIV-1 (PWH).

Changes in the prevalence of non-AIDS conditions among hospitalized persons with HIV in the United States and Canada, 2008-2018.

Background: Hospitalization causes among persons with HIV (PWH) have shifted to non-AIDS conditions, but the complete disease profile of hospitalized PWH has not been well described. To inform hospitalization and readmission prevention efforts, we examined non-AIDS disease prevalence among PWH hospitalized in four US and one Canadian cohorts.

Methods: Among PWH with ≥1 hospitalization from 2008 to 2018, we used log-binomial regression with generalized estimating equations to estimate trends in the annual prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease stage ≥3 (CKD), and multimorbidity (≥2 and ≥3 conditions), defined using longitudinal diagnosis, medication, and laboratory data.

The Association of Anemia on Non-AIDS-Defining Cancer and Subsequent Survival Among People With HIV After Antiretroviral Initiation.

Background: The association of anemia as a predictive and prognostic indicator of non-AIDS-defining cancer (NADC) among people with HIV (PWH) remains unknown. We evaluated the presence of anemia and its severity as a predictor of NADC and 5-year all-cause survival after an NADC diagnosis among PWH who had initiated antiretroviral therapy.

Setting: North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

Impact of Depression and HIV Symptoms on Glycemic Outcomes among Patients with HIV and Type 2 Diabetes: A Clinical Cohort Study.

Type 2 diabetes (T2DM) and depressive symptoms frequently co-occur among people with HIV (PWH). Depression may impact diabetes management in PWH. This study evaluated the prevalence of concurrent T2DM and depression among PWH and the impact of depression and HIV symptoms on glycemic outcomes (hemoglobin A1c [A1c], blood glucose [BG]) among people with both HIV and T2DM.

Prevalence and Correlates of Hepatitis C Viremia Among People With Human Immunodeficiency Virus in the Direct-Acting Antiviral Era.

Background: National US data on the burden and risks for hepatitis C virus (HCV) infection in people with human immunodeficiency virus (HIV) during the direct-acting antiviral (DAA) era are limited. These data are important to understand current progress and guide future efforts toward HCV microelimination.

Methods: We evaluated (1) HCV prevalence (2011-2013, 2014-2017, 2018-2022) using a serial cross-sectional design and (2) correlates for HCV viremia (2018-2022) in adult people with HIV (PWH) within the Centers for AIDS Research Network of Integrated Clinic Systems (CNICS) cohort using multivariable adjusted relative risk regression.

Brief Report: Protease Inhibitors Versus Nonnucleoside Reverse Transcriptase Inhibitors and the Risk of Cancer Among People With HIV.

Background: The effect of initial antiretroviral therapy (ART) class on cancer risk in people with HIV (PWH) remains unclear.

Setting: Cohort study of 36,322 PWH enrolled (1996-2014) in the North American AIDS Cohort Collaboration on Research and Design.

Methods: We followed individuals from ART initiation (protease inhibitor [PI]-, non-nucleoside reverse transcriptase inhibitor [NNRTI]-, or integrase strand transfer inhibitor [INSTI]-based) until incident cancer, death, loss-to-follow-up, 12/31/2014, 85 months (intention-to-treat analyses [ITT]), or 30 months (per-protocol [PP] analyses).

Severity and Number of Substances Used are Independently Associated with Antiretroviral Therapy Adherence Over Time among People with HIV in the Current Treatment Era.

Substance use is associated with decreased antiretroviral therapy (ART) adherence among people with HIV (PWH). Adherence plays a significant role in mediating the negative effects of substance use on HIV suppression and is a principal modifiable patient-level factor in improving HIV suppression and reducing ART drug resistance. Understanding substance use and ART adherence, particularly with rapidly changing substance use epidemiology and ART regimens, is vital to improving HIV care.

The impact of Medicaid expansion under the Affordable Care Act on HIV care continuum outcomes across the United States.

HIV care continuum outcome disparities by health insurance status have been noted among people with HIV (PWH). We therefore examined associations between state Medicaid expansion and HIV outcomes in the United States. Adults (≥18 years) with ≥1 visit in NA-ACCORD clinical cohorts from 2012-2017 contributed person-time annually between first and final visit or death; in each calendar year, clinical retention was ≥2 completed visits > 90 days apart, antiretroviral therapy (ART) receipt was receipt of ≥3 antiretroviral agents, and viral suppression was last measured HIV-1 RNA < 200 copies/mL.

Cohort profile update: the Johns Hopkins HIV clinical cohort, 1989-2023.

The Johns Hopkins HIV Clinical Cohort, established in 1989, links comprehensive, longitudinal clinical data for adults with HIV receiving care in the Johns Hopkins John G. Bartlett Specialty Practice in Baltimore, Maryland, USA, to aid in understanding HIV care and treatment outcomes. Data include demographics, laboratory results, inpatient and outpatient visit information and clinical diagnoses, and prescribed and dispensed medications abstracted from medical records.

Smoking and Type 1 Versus Type 2 Myocardial Infarction Among People With HIV in the United States: Results from the Center for AIDS Research Network Integrated Clinical Systems Cohort.

Smoking is a myocardial infarction (MI) risk factor among people with HIV (PWH). Questions persist regarding the role of smoking behaviors and measurements (e.g.

Internalized HIV stigma and viral suppression: examining the mediating and moderating roles of substance use and social support.

Objective: The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects.

Design: Longitudinal observational clinical cohort of patients in HIV care in the US.Methods: Data from the CFAR Network for Integrated Clinical Systems (2016-2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence.