Case report: HIV-associated neurocognitive disorder & myelopathy in patient with preserved CD4, but high viral load

HIV-associated neurocognitive disorder and HIV-associated myelopathy in a patient with a preserved CD4, but high viral load-a rarely reported phenomenon: a case report and literature review. 

Ayele, B.A., Amogne, W. & Gemechu, L.

BMC Infect Dis 20, 574 (2020). https://doi.org/10.1186/s12879-020-05297-9

This case supports the current understanding regarding the persistent occurrence of HIV-associated neurocognitive disorder and HIV-associated myelopathy even decades after introduction of cART. Therefore, it’s important to screen HIV+ patients for the HAND and HAM even if they have relatively preserved immunity.

Because patient can be easily shifted to ART drugs with better CNS penetrating potential to achieve acceptable virological suppression level, to observe sound clinical improvement.

Changes to Post-Exposure Prophylaxis (PEP) Distribution

SHINE SA,  

SHINE SA will now temporarily provide a full 28-day supply of Post-exposure Prophylaxis (PEP) medication in place of the usual five-day starter pack. This measure has been put in place with the assistance of SA Health to help limit movement during the COVID-19 pandemic.

Prior to the pandemic, clients received a five-day HIV PEP starter pack and then the remaining medication after a follow-up appointment. Clients can now call SHINE SA for a telehealth appointment where our team will guide clients through the process including supply of the medications and blood tests. Follow-up care arrangements will remain in place.

What is PEP?

PEP is a four week long course of medication taken to reduce the risk of HIV infection. It needs to be initiated within 72 hours of possible contact with HIV in order to help prevent the chance of infection. Exposure can occur through unprotected sex or the sharing of needles and other injection equipment.

It’s important that PEP is accessed as soon as possible after you think you may been exposed to HIV. If you are outside of the time-frame you can still contact your local GP or SHINE SA for further assistance.

What are the most common reasons for needing PEP?

  • Sex without a condom or sex where a condom broke or slipped off, with a person who has, or might have, HIV.
  • Sharing needles or syringes with a person who has, or might have, HIV.

How can I find out more?

  • The PEP Hotline is available 24 hours a day on 1800 022 026. The Registered Nurse on the PEP hotline will help assess your needs and indicate where to access PEP near you.
  • To speak to SHINE SA about accessing PEP call 8300 5300.
  • To learn more about PEP you can visit the SAMESH website or call 7099 5300.

From: https://www.shinesa.org.au/changes-to-pep/

Coronavirus disease (COVID-19), HIV & hepatitis C: What you need to know

CATIE (Canada), 17 March 2020

  • An HIV-positive person on effective treatment is not expected to be at higher risk of becoming seriously ill with COVID-19
  • A person with untreated HIV or a low CD4+ cell count may be at higher risk of becoming seriously ill with COVID-19
  • People with HIV or hepatitis C are more likely to have other conditions that carry a greater risk of becoming seriously ill with COVID-19

 

 

“I’m never having sex with anybody ever again”: what helps PLHIV get over these feelings

nam/aidsmap, 27 January 2020

For people living with HIV, sexual adjustment after diagnosis is affected by fears of transmitting the virus and of possible rejection by sexual partners, new qualitative research shows. Healthy sexual adjustment over time is facilitated by partner acceptance; peer, community and professional support; and up-to-date knowledge of HIV transmission, including U=U.

Barriers to healthy sexual adjustment include the persistence of undue fears of transmission and rejection long after diagnosis, which may result in avoiding sex or pairing it with drugs and alcohol. Based on these findings, Dr Ben Huntingdon and colleagues at the University of Sydney propose a new model of sexual adjustment to HIV, published in the BMC Infectious Diseases journal.

Thirty participants (19 male, 11 female) out of 45 PLWH who agreed to be contacted completed the interview and questionnaire as part of the study.

Delayed linkage to HIV care among asylum seekers

Kronfli, N., Linthwaite, B., Sheehan, N. et al. Delayed linkage to HIV care among asylum seekers in Quebec, CanadaBMC Public Health 191683 (2019). https://doi.org/10.1186/s12889-019-8052-y

Abstract:

Background

Migrants represent an increasing proportion of people living with HIV in many developed countries. We aimed to describe the HIV care cascade and baseline genotypic resistance for newly diagnosed asylum seekers referred to the McGill University Health Centre (MUHC) in Montreal, Quebec, Canada.

Methods

We conducted a retrospective cohort study of patients linked to the MUHC from June 1, 2017 to October 31, 2018. We calculated the median time (days; interquartile range (IQR)) from: 1) entry into Canada to immigration medical examination (IME) (i.e. HIV screening); 2) IME to patient notification of diagnosis; 3) notification to linkage to HIV care (defined as a CD4 or viral load (VL) measure); 4) linkage to HIV care to combination antiretroviral therapy (cART) prescription; and 5) cART prescription to viral suppression (defined as a VL < 20 copies/mL). We reviewed baseline genotypes and interpreted mutations using the Stanford University HIV Drug Resistance Database. We calculated the proportion with full resistance to > 1 antiretroviral.

Results

Overall, 43% (60/139) of asylum seekers were newly diagnosed in Canada. Among these, 62% were late presenters (CD4 < 350 cells/μl), 22% presented with advanced HIV (CD4 < 200 cells/μl), and 25% with high-level viremia (VL > 100,000 copies/ml). Median time from entry to IME: 27 days [IQR:13;55]; IME to notification: 28 days [IQR:21;49]; notification to linkage: 6 days [IQR:2;19]; linkage to cART prescription: 11 days [IQR:6;17]; and cART to viral suppression: 42 days [IQR:31;88]; 45% were linked to HIV care within 30 days. One-fifth (21%) had baseline resistance to at least one antiretroviral agent; the K103 N/S mutation was the most common mutation.

Conclusions

While the majority of newly diagnosed asylum seekers were late presenters, only 45% were linked to care within 30 days. Once linked, care and viral suppression were rapid. Delays in screening and linkage to care present increased risk for onward transmission, and in the context of 21% baseline resistance, consideration of point-of-care testing and immediate referral at IME screening should be made.

SHINE SA Media Release: World AIDS Day – Every Journey Counts

World AIDS Day is marked on 1 December each year, to raise awareness across the world and in the community about the issues surrounding HIV and AIDS. It is a day to show support for people living with HIV and to commemorate loved ones who we have lost to the epidemic.

The day also aims to encourage Australians to educate themselves and others about HIV and to ensure that people living with HIV can participate fully in the life of the community, free from stigma and discrimination.

HIV still exists in Australia and can affect anyone. While there is still no vaccine or cure for HIV, there are now highly effective treatments and prevention options. People with HIV can take medications on a daily basis to maintain their HIV at an undetectable level and to keep them healthy. Today, HIV is considered a chronic but manageable condition, and people with HIV can lead long and healthy lives, with a similar life expectancy to a person who does not have HIV.

Natasha Miliotis, SHINE SA’s Chief Executive Officer said that:

“Like many other conditions, HIV can be prevented. By being informed about what HIV is and how it can be transmitted, we can take measures to look after ourselves and others.”

SHINE SA encourages people looking to test for or talk about HIV to visit one of our clinics, or contact SAMESH, a collaborative program of Thorne Harbour Health and SHINE SA.

You can show your support for people with HIV on World AIDS Day by wearing a red ribbon, the international symbol of HIV awareness and support. You can also find a World AIDS Day event near you by visiting www.worldaidsday.org.au.

To read SHINE SA’s Fact Sheet on HIV visit: www.shinesa.org.au/health-information/sexually-transmitted-infections/hiv/

For further information and media enquiries contact Tracey Hutt, Director Workforce Education and Development