HIV-infected persons in the U.S. are increasingly overweight and obese with rates of weight excess similar to the general population. Weight excess in the HIV-infected population is often associated with other medical conditions such as hypertension and high cholesterol, and clinicians should consider including weight management programs as part of routine HIV care.¹ Josephine DiLena is a Registered Dietitian practicing at the François-Xavier Bagnoud (FXB) Center Clinic at The University Hospital in Newark, New Jersey. For seven years she has been caring for HIV-infected men, women and children, offering them nutritional guidance to enhance antiretroviral treatment (ART) and other therapies. Over the years, she has witnessed the changes in weight loss and gain among ART users, so we asked her to share what she believes to be most important for HIV providers to keep in mind when discussing nutrition with their patients.
From the Ryan White All-Grantee Meeting to the International AIDS Conference to the in+care Campaign, from case conferencing to the water cooler, the “treatment cascade” seemed to have everyone, everywhere talking. The numbers were even explored right here on ShareSpot, too! So what can we do to get these hard to reach HIV patients into—or back into—care and treatment?
Among the 1.1 million Americans living with HIV infection in the United States, only 25% are virally suppressed. Depicted as the “treatment cascade,” individuals must navigate a series of steps starting with HIV testing and diagnosis, initial linkage to medical care among those who test positive and subsequent retention in care followed by antiretroviral therapy (ART) receipt and adherence to ultimately achieve viral suppression (Figure 1).
The intersection of opioid abuse, particularly injection drug use, and HIV is well documented and has been since the early days of the epidemic. A newer trend, however, has been nonmedical pain medication abuse.
Receipt of prescription opioids to treat pain is not uncommon, particularly as HIV disease is associated with acute and chronic pain syndromes. Today, thanks to recent legislation, physicians can prescribe buprenorphine to address such opioid abuse.
An increasingly diverse population continues to challenge the American health care system as it struggles to deliver quality health care to all. One consequence of this is increased health disparities and inequities, particularly within racial and ethnic minority communities.
In November of 2011, The François-Xavier Bagnoud Center of the School of Nursing at The University of Medicine and Dentistry of New Jersey, (FXBC/UMDNJ) was awarded a cooperative agreement from the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) to develop a national training and technical assistance resource center to assist Ryan White HIV/AIDS Program grantees in understanding, developing and successfully applying to become recognized patient centered medical homes (PCMH).
They partnered with the University of San Francisco, Department of Family and Community Medicine, Center for Excellence in Primary Care (UCSF/CEPC) to form the HIV Medical Homes Resource Center (HIV-MHRC). We asked Co-Prinicpal Investigators Andrea Norberg, MS, RN and Carolyn Burr, EdD, RN, and Program Manager Denise Anderson-Carr, MPH, RD, to tell us a little more about their progress, vision and next steps for the HIV-MHRC in year two.
How can we, as practitioners, prevent HIV infection from occurring? Recently [October 2011] I had the opportunity to hear Dr. Michael Saag from the University of Alabama at Birmingham present during the Infectious Diseases Society of America (IDSA) Annual conference in Boston on “30 Years of HIV/AIDS – Where We Have Been and Where Are We Going.” This wonderful historical review included a brief discussion of HIV prevention measures and focused on recent microbicides and pre-exposure prophylaxis data. His presentation caused me to reflect on past recommendations from the CDC, NIH, and HIVMA/IDSA in 2003 regarding the incorporation of HIV prevention into the medical care of persons living with HIV. This strategy involves obtaining a sexual history, identifying risky behaviors that may increase their risk of STD infection, and screening sexually active HIV-positive individuals for sexually transmissible infections at least annually (or more frequently if their risk is significant) as part of their ongoing clinical management. We understand that an individual's untreated STD infection(s) increases their chance of acquiring HIV, and conversely, an HIV-positive individual with an ulcerative or inflammatory STD is more likely to transmit HIV in genital secretions or direct sexual contact.
What are some ways to get MSM into medical care? This is a frequently asked question and one with a very complicated answer. Researchers, community advocates, and medical providers have made serious inroads into identifying and understanding the barriers to accessing medical care for MSM. One key barrier that is often noted anecdotally and in literature relates to providing culturally competent care.
How can mapping the HIV epidemic help healthcare providers talk to patients about getting tested?
An estimated one in five individuals living with HIV in the United States don’t know they are infected, according to the Centers for Disease Control and Prevention (CDC). CDC recommends routine HIV screening among persons aged 13-64, but many individuals, due to the lingering stigma around the disease, are hesitant to talk about HIV with their doctors or to ask to be tested. Healthcare providers often do not test patients because they perceive that the patients do not fit a risk profile or because the providers are not comfortable assessing and discussing HIV risk behaviors.