Objective: Black individuals in the United States are disproportionately affected by HIV and experience disparities in antiretroviral therapy (ART) adherence. This study examined components of the Health Belief Model (HBM) and related psychosocial factors as predictors of ART adherence across multiple adherence measures. Methods: Participants were 91 Black adults with HIV recruited from a federally qualified health center (FQHC) and enrolled in a single-arm text messaging-based adherence support intervention. ART adherence was assessed using three measures: (1) a continuous adherence measure, (2) a visual analog scale (VAS), and (3) daily text message-reported responses. Selected HBM constructs (perceived benefits, perceived severity, perceived barriers, and self-efficacy) and related psychosocial factors (supports and beliefs) were examined as predictors of these three adherence outcomes. Linear mixed-effects models assessed associations between psychosocial predictors and longitudinal adherence outcomes. Results: The sample was primarily comprised of men and older individuals, most of whom had disclosed their HIV status to others. In multivariable models including all predictors, greater self-efficacy was associated with higher adherence on both the continuous adherence measure (β = .18, t = 2.11, p = .04) and VAS (β = .21, t = 2.54, p = .01), but not the daily text message responses. Greater perceived barriers were associated with lower adherence on the continuous adherence measure and VAS (p’s <.001) and showed a trend toward lower text message responses (t = –0.79, p = .06). Greater support for adherence was marginally associated with higher VAS scores (t = 1.95, p = .06). Other psychosocial predictors were not significantly associated with adherence outcomes. Conclusions: In this older cohort of Black adults receiving HIV care, self-efficacy and perceived barriers emerged as the most salient correlates of retrospective self-reported ART adherence. Findings support the potential value of interventions that strengthen self-efficacy and reduce perceived adherence challenges.
As people with HIV (PWH) age with improved antiretroviral therapy (ART), understanding health outcomes in cohabiting couples whether seroconcordant or serodiscordant has become increasingly important for comprehensive HIV care. This study investigated viral load suppression rates, hypertension, and diabetes prevalence among HIV-infected individuals in seroconcordant and serodiscordant cohabiting relationships and identified demographic and clinical factors associated with these outcomes. This hospital-based study analyzed 247 adults (>18 years) with HIV, comprising 176 individuals from seroconcordant couples and 71 HIV-infected individuals from serodiscordant couples. Participants' mean age was 47.59 ± 10.61 years, with a mean ART duration of 13.29 ± 5.43 years. The overall viral suppression rate was 97.6%, while hypertension prevalence was 9.3% and diabetes prevalence was 2.8%. Enhanced adherence counselling (EAC) for prior virologic failure was provided for 6.5% of participants. Concordance status did not significantly affect viral suppression (p = 0.7) or hypertension prevalence (p=0.8). However, seroconcordant couples had significantly longer ART duration (14.02 vs 11.24 years, p<0.001), while serodiscordant couples had longer cohabitation duration (20.83 vs 17.99 years, p=0.033). Despite excellent overall suppression, participants on second-line ART regimens had 93% lower odds of viral suppression compared to first-line recipients [adjusted odds ratio (aOR)=0.07, 95% confidence interval (CI): 0.01–0.76, p=0.028]. Those with a history of EAC had similarly reduced suppression odds of viral suppression (aOR=0.11, 95% CI: 0.01–0.94, p=0.044). Male sex and higher body mass index were independent predictors (aOR=3.13, 95% CI: 1.15–9.09, p=0.025 and aOR=1.12, 95% CI: 1.02–1.23, p=0.014, respectively). These findings underscore that partner HIV status does not influence clinical outcomes but highlight important needs for sustained adherence support in patients with complex treatment histories and targeted cardiovascular risk management in the ageing population of PWH.
Case Summary: This case highlights a rare and diagnostically challenging presentation of liver failure from Autoimmune Hepatitis (AIH) in a 35-year-old male with Human Immunodeficiency Virus (HIV). The patient, initially on antiretroviral therapy (ART) and tuberculosis prophylaxis, presented with a one-month history of abdominal pain, jaundice, acholic stool, tea-colored urine, and nausea. Initial workup suggested obstructive jaundice due to choledocholithiasis and acute calculous cholecystitis, managed by endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. However, the patient’s jaundice and liver enzyme abnormalities persisted postoperatively, prompting further investigation. Subsequent testing revealed positive anti-smooth muscle antibodies (ASMA) and liver biopsy showed chronic portal and lobular inflammation with cholestasis, confirming the diagnosis of Autoimmune Hepatitis. Common causes of liver dysfunction in HIV such as viral hepatitis and drug-induced liver injury (DILI) were ruled out. Immunosuppressive therapy with Prednisone and Mycophenolate Mofetil stabilized liver function transaminases, but did not normalize bilirubin levels, necessitating a cycle of DPMAS (Double Plasma Molecular Adsorption System), which effectively reduced bilirubin and ammonia levels. This case underscores the clinical complexity of diagnosing AIH in immunocompromised patients, especially when structural and infectious causes coexist. The successful use of conventional immunosuppression and DPMAS in this context suggests the need for future studies on their safety and efficacy in HIV-positive patients.
Background: Adolescents and young adults living with HIV often face adherence challenges due to psychosocial, developmental, and structural barriers. This study examined whether the mode of HIV transmission—vertical vs. horizontal—impacts adherence or viral suppression in youth receiving long-acting cabotegravir–rilpivirine within a specialty pharmacy-supported pediatric/adolescent HIV outpatient clinic. Methods: A retrospective, cohort analysis was conducted on patients aged 13–23 who received at least six bimonthly cabotegravir-rilpivirine injections from October 1, 2022, to October 1, 2024. Patients were classified by transmission mode and monitored for adherence and viral load. Adherence was defined as receiving each injection within ±7 days of the 56-day treatment interval. Patients who switched to monthly dosing, changed therapy due to drug interactions, or became pregnant were excluded. Results: A total of 45 patients met inclusion criteria (14 vertically acquired, 31 horizontally acquired). Adherence was 100% in the vertical group and 99% in the horizontal group (p = 0.31). All patients established and/or maintained viral suppression (HIV-1 RNA <200 copies/mL). However, mean viral load differed significantly: 128.1 copies/mL in the vertical group vs. 1.8 copies/mL in the horizontal group (p = 0.01), despite both being within suppressed ranges. Conclusions: High adherence and virologic suppression were observed in both groups, with no clinical difference in transmission mode. Specialty pharmacy care may play a critical role in supporting long-acting injectable antiretroviral therapy (LAI – ART) success in youth living with HIV.
Background: People living with HIV (PLWH) are more likely to experience chronic pain, trauma, and analgesic use than their HIV-negative counterparts. This complex chronic pain profile can have subsequent physical, mental, and psychological sequela. Despite this, a tool to rapidly screen at risk patients and refer to specialized care has not been established. The purpose of this scoping review is to identify current screening tools for chronic pain, trauma, and opioid use to guide design of our comprehensive HOPE (HIV, Opioids and Pain Experience) screening tool. Methods: A systematic search was conducted using a combination of controlled vocabulary and natural language keywords across four electronic databases to identify relevant peer-reviewed studies. Data extraction from eligible studies was then performed to summarize and organize findings according to the topic of the outcome measurement tool. Results: A total of 10,573 abstracts were identified, 1,167 full-text articles reviewed, and 39 included for final data extraction. Among these articles, 31 screeners were identified for pain assessment, 8 for detecting opioid misuse, and 7 for trauma evaluation. Discussion and conclusions: This study revealed tools for screening of chronic pain, trauma and opioid use described in the literature that can be used in the creation of an innovative screening tool for all the above in an HIV clinical context. All extracted tools demonstrated good validity and reliability, indicating their potential for inclusion in the development of a multidimensional screener for complex chronic pain among PLWH.
