Entry into care and clinician management of acute HIV infection in New York City.
New York City Department of Health and Mental Hygiene , Long Island City, New York.AIDS patient care and STDs (Impact Factor: 3.5). 03/2012; 26(3):129-31. DOI: 10.1089/apc.2011.0380
Article: The aging HIV population[Show abstract] [Hide abstract]
ABSTRACT: As we move into the fourth decade of the HIV epidemic, this illness, once considered nearly always fatal, is now viewed as a chronic disease in most industrialized nations, due to advances in treatment. Patients with HIV are growing older and the number of infected patients over the age of 50 years is growing steadily. With this shift in demographics, the medical field is turning its attention toward the need to both care for older patients whose disease is long-standing, and identify newly infected older patients. It is increasingly apparent that older HIV-infected patients are vulnerable to a variety of non-AIDS-related conditions and the interplay of aging and HIV occurs in multiple ways. Identifying older patients at risk, the importance of getting patients into care and the impact of aging on the course of the infection are discussed as are common comorbidities such as cardiovascular disease, chronic kidney disease and neurocognitive decline. Recommendations for the evaluation of an older HIV-infected patient are outlined, recognizing that optimizing comprehensive, multidisciplinary care is essential.Clinical Practice 03/2014; 11(2):221-231. DOI:10.2217/cpr.13.90
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ABSTRACT: Purpose of review: Acute and early HIV (AHI) is a pivotal time during HIV infection, yet there remain major shortfalls in diagnosis, linkage to care, and antiretroviral therapy (ART) initiation during AHI. We introduce an AHI-specific cascade, review recent evidence pertaining to the unique challenges of AHI, and discuss strategies for improving individual and public health outcomes. Recent findings: Presentation during AHI is common. Expanding use of fourth-generation testing and pooled nucleic acid amplification testing has led to improved AHI detection in resource-wealthy settings. Technologies capable of AHI diagnosis are rare in resource-limited settings; further development of point-of-care devices and utilization of targeted screening is needed. Rapid ART initiation during AHI limits reservoir seeding, preserves immunity, and prevents transmission. Reporting of AHI cascade outcomes is limited, but new evidence suggests that impressive rates of diagnosis, linkage to care, rapid ART initiation, and viral suppression can be achieved. Summary: With advancements in AHI diagnostics and strong evidence for the therapeutic and prevention benefits of ART initiated during AHI, improving AHI cascade outcomes is both crucial and feasible. HIV guidelines should recommend diagnostic algorithms capable of detecting AHI and prescribe rapid, universal ART initiation during AHI.Current opinion in HIV and AIDS 09/2015; 10(6). DOI:10.1097/COH.0000000000000193 · 4.68 Impact Factor
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