Suchergebnisse

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

IntroductionTranslation of the evidence regarding the protective role of highly active antiretroviral therapy (HAART) on HIV sexual transmission rates into sexual behaviour patterns of HIV‐infected subjects remains largely unexplored. This study aims to describe frequency of self‐reported condom use among women living with HIV in Italy and to investigate the variables associated with inconsistent condom use (ICU).MethodsDIDI (Donne con Infezione Da HIV) is an Italian multicentre study based on a questionnaire survey performed during November 2010 and February 2011. Women‐reported frequency of condom use was dichotomized in "always" versus "at times"/"never" (ICU).ResultsAmong 343 women, prevalence of ICU was 44.3%. Women declared a stable partnership with an HIV‐negative (38%) and with an HIV‐positive person (43%), or an occasional sexual partner (19%). Among the 194 women engaged in a stable HIV‐negative or an occasional partnership, 51% reported fear of infecting the partner. Nonetheless, 43% did not disclose HIV‐positive status. Less than 5% of women used contraceptive methods other than condoms. At multivariable analysis, variables associated with ICU in the subgroup of women with a stable HIV‐negative or an occasional HIV‐unknown partner were: having an occasional partner (AOR 3.51, 95% confidence interval [CI] 1.44–8.54, p=0.005), and reporting fear of infecting the sexual partner (AOR 3.20, 95% CI 1.43–7.16, p=0.004). Current use of HAART together with virological control in plasma level did not predict ICU after adjusting for demographic, behavioural and HIV‐related factors. With regard to socio‐demographic factors, lower education was the only variable significantly associated with ICU in the multivariate analysis (AOR 2.27, 95% CI 1.07–4.82, p=0.03). No association was found between high adherence to HAART and ICU after adjusting for potential confounders (AOR 0.89, 95% CI 0.39–2.01, p=0.78).ConclusionsCurrently in Italy, the use of HAART with undetectable HIV RNA in plasma as well as antiretroviral adherence is not associated with a specific condom use pattern in women living with HIV and engaged with a sero‐discordant or an HIV‐unknown partner. This might suggest that the awareness of the protective role of antiretroviral treatment on HIV sexual transmission is still limited among HIV‐infected persons, at least in this country.

IntroductionHIV‐positive patients receiving combination antiretroviral therapy (cART) frequently experience metabolic complications such as dyslipidemia and insulin resistance, as well as lipodystrophy, increasing the risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Rates of DM and other glucose‐associated disorders among HIV‐positive patients have been reported to range between 2 and 14%, and in an ageing HIV‐positive population, the prevalence of DM is expected to continue to increase. This study aims to develop a model to predict the short‐term (six‐month) risk of DM in HIV‐positive populations and to compare the existing models developed in the general population.MethodsAll patients recruited to the Data Collection on Adverse events of Anti‐HIV Drugs (D:A:D) study with follow‐up data, without prior DM, myocardial infarction or other CVD events and with a complete DM risk factor profile were included. Conventional risk factors identified in the general population as well as key HIV‐related factors were assessed using Poisson‐regression methods. Expected probabilities of DM events were also determined based on the Framingham Offspring Study DM equation. The D:A:D and Framingham equations were then assessed using an internal‐external validation process; area under the receiver operating characteristic (AUROC) curve and predicted DM events were determined.ResultsOf 33,308 patients, 16,632 (50%) patients were included, with 376 cases of new onset DM during 89,469 person‐years (PY). Factors predictive of DM included higher glucose, body mass index (BMI) and triglyceride levels, and older age. Among HIV‐related factors, recent CD4 counts of<200 cells/µL and lipodystrophy were predictive of new onset DM. The mean performance of the D:A:D and Framingham equations yielded AUROC of 0.894 (95% CI: 0.849, 0.940) and 0.877 (95% CI: 0.823, 0.932), respectively. The Framingham equation over‐predicted DM events compared to D:A:D for lower glucose and lower triglycerides, and for BMI levels below 25 kg/m2.ConclusionsThe D:A:D equation performed well in predicting the short‐term onset of DM in the validation dataset and for specific subgroups provided better estimates of DM risk than the Framingham.