Kaiser Daily HIV/AIDS Report Highlights Recently Released Journal Articles
The following highlights recently released journal articles on HIV/AIDS.
- "Optimizing Resource Allocation in United States AIDS Drug Assistance Programs," Clinical Infectious Diseases: Benjamin Linas of the Harvard Center for AIDS Research, Massachusetts General Hospital and Harvard Medical School and colleagues examined if AIDS Drug Assistance Programs would be more efficient if they prioritized clients based on CD4+ T cell counts rather than operating on a standard "first-come, first-served basis." The researchers used Massachusetts ADAP administrative figures to develop a retrospective study of the state's ADAP clients from fiscal year 2003. They compared the characteristics of patients included under CD4+ T cell count-based eligibility criteria with the first-come, first-served eligibility criteria. The study found that Massachusetts ADAP -- which during FY 2003 served 3,560 clients at a cost of $10.3 million -- would have served 2,253 clients using CD4+ T cell count-based model and saved $2.7 million during the same time period. Given the same budget limitations and using the first-come, first-served eligibility, Massachusetts ADAP would have served 2,406 clients. The study also found that the first-come, first-served model would have excluded patients with a median CD4+ T cell count of 659 in favor of serving patients with a median CD4+ T cell count of 257. A CD4+ T cell count-based approach also would have served 65% of nonwhite clients, compared with 55% of whites. Researchers concluded that ADAPs with limited resources will "serve more diverse populations and patients with significantly more advanced HIV disease by using CD4[+ T] cell count-based enrollment criteria rather than a first-come, first-served approach" (Linas et al., Clinical Infectious Diseases, 10/17).
- "Association of Herpes Simplex Virus Type 2 Infection and Syphilis With Human Immunodeficiency Virus Infection Among Men Who Have Sex With Men in Peru," Journal of Infectious Diseases: Javier Lama from the Asociacion Civil Impacta Salud y Educacion and colleagues surveyed and tested for HIV 3,280 men who have sex with men in Peru and found an HIV prevalence of 13.9% in the group, a herpes simplex virus type 2 prevalence of 46.3% and a syphilis prevalence of 13.4%. The study also found that 80.5% of MSM who tested HIV-positive also tested positive for herpes, compared with 40.8% of HIV-negative MSM who tested positive for herpes. According to the researchers, self-reported sexually transmitted infections in the prior six months; prior syphilis, genital warts or genital ulcer disease; cocaine use before or during sex; history of sex work or exchange of money for sex; oral receptive sex; proctitis, an inflamation of the rectal lining; unprotected sex; and identification as "homosexual" also were found to be "significant predictors of HIV infection." The researchers recommend increasing condom distribution, routine STI testing and herpes treatment to curb HIV transmission among MSM in the country (Lama et al., Journal of Infectious Diseases, October 2006).
- "HIV Infection, Antiretroviral Therapy, and CD4 + Cell Count Distributions in African Populations," Journal of Infectious Diseases: Brian Williams of the World Health Organization's Stop TB Department and colleagues developed a mathematical model that aimed to predict the distribution of CD4+ T cell counts in HIV-positive adults across Africa using the distribution of CD4+ T cell counts in HIV-negative adults. Working under the assumption that survival is unrelated to CD4+ T cell counts before HIV seroconversion, the researchers predicted that HIV-positive Zambians with CD4+ T cell counts of 200 would have a median life expectancy of four years, 1.7 times that of HIV-positive South Africans' life expectancy of 2.3 years with the same CD4+ T cell count. According to researchers, the mathematical model "provides a way to estimate the changing distribution of CD4+ T cell counts and, hence, the changing incidence of HIV-related opportunistic infections as the epidemic matures." The researchers said that the study could "substantially improve" the development of health care services, including the need and demand for antiretroviral therapy. They also wrote that clearer data are needed to assess the study model and its theories and to fully understand the variability in CD4+ T cell counts within and among various groups (Williams et al., Journal of Infectious Diseases, 10/3).
- "Health Services Utilization for People With HIV Infection: Comparison of a Population Targeted for Outreach With the U.S. Population in Care," Medical Care: William Cunningham, a professor of medicine at the David Geffen School of Medicine at the University of California-Los Angeles, and colleagues compared survey responses of 1,286 HIV-positive people who participated in the Targeted HIV Outreach and Intervention Initiative -- conducted under the Ryan White CARE Act from 2001 through 2002 to locate "hard-to-reach" HIV-positive people in 16 sites -- with the responses of 2,267 HIV-positive people who participated in the HIV Costs and Services Utilization Study -- a group of HIV-positive people receiving medical care -- in 1998. According to the study, 59% of the participants in the outreach group were black, compared with 32% in the HCSUS group. In addition, 20% of the participants in the outreach group were Hispanic, compared with 16% in the HCSUS group (UCLA release, 10/24). In addition, 58% of participants in the outreach group were receiving antiretroviral drugs, compared with 82% in the HCSUS group, the study found. According to the researchers, participants in the outreach group largely were racial and ethnic minorities, illicit drug users and poor, and they also had less favorable health status and health care utilization characteristics than participants in the HCSUS group. "This study provides substantial evidence that the strategies needed to improve care might differ between the populations represented by the Outreach and HCSUS samples," the researchers wrote, concluding that in addition to factors such as insurance coverage, the study's findings "suggest that addressing heavy alcohol use could have a substantial impact on improving utilization for hard-to-reach HIV-positive persons" (Cunningham et al., Medical Care, November 2006).