Progress against HIV thwarted by patients' unmet needs
In a groundbreaking study published last year, scientists reported that effective treatment with HIV medications not only restores health and prolongs life in many HIV-infected patients, but also curtails transmission to sexual partners up to ninety-seven percent. However, a new study by UCSF scientists shows that lack of basic living needs severely undercuts these advances in impoverished men.
The new research builds on a 2010 finding by the Centers for Disease Control and Prevention showing that poverty is the single biggest factor linked to HIV infection in heterosexuals living in inner-city neighborhoods.
In the new study published in the April 25 issue of PLoS ONE, UCSF researchers found that for HIV-infected homeless and unstably housed individuals, a failure to address unmet subsistence needs such as housing, food, clothing and hygiene, undermines these very real individual and public health benefits of HIV medication delivery.
"In this study, we followed a group of homeless and unstably housed HIV-infected people living in San Francisco and found that only about a fifth of those for whom antiretroviral therapy was medically indicated were actually on the medications. More importantly, while viral load was one of the most important predictors of overall health, we found that an inability to meet basic subsistence needs had an even larger influence on health status in this population," said the study's principal investigator, Elise Riley, PhD, Associate Professor in the UCSF HIV/AIDS Division at San Francisco General Hospital and Trauma Center.
"This study shows that a simple focus on providing medications will neither effectively treat nor end HIV in inner cities. A person's ability to get needed care and take medications becomes less of a priority when they don't have food or a place to sleep. If we could improve opportunities for people to meet their basic subsistence needs, in tandem with providing antiretroviral therapy, we could improve patients' health and better realize the potential gains to public health," added Riley.
For six years, the researchers followed a group of 288 HIV-infected men who were recruited from homeless shelters, free meal programs and single room occupancy (SRO) hotels that primarily serve individuals with very low or no income. Twenty percent had reported being homeless recently. Over one-third of participants reported current symptoms of chronic illness.
At the study onset, participants had an average of 349 CD4 T-cells (the immune cells targeted and killed by HIV), which is not much higher than the cutoff of 200 often used to diagnose AIDS. While current treatment guidelines in the City and County of San Francisco indicate treatment upon HIV diagnosis, the policy active during the study period specified that individuals with less than 350 CD4 T-cells should start antiretroviral medications.
Results indicating that subsistence needs are the strongest predictor of overall health status among homeless men were consistent with findings from a recent homeless women's study conducted by the same group and published earlier this year in the American Journal of Epidemiology.
"Previous cost effectiveness studies show that homelessness is more expensive to society than the cost of housing. This is due to situations that are strongly linked to homelessness like emergency room use and incarceration. Our study suggests that the social barriers inherent in poverty are also likely to continue fueling the American HIV epidemic, which may further add to societal costs," concluded Riley.
More information: The study, funded by the National Institutes of Health, is online in PLoS ONE: www.plosone.org/ar… pone.0035207
Journal reference: American Journal of Epidemiology
Provided by University of California, San Francisco
- HIV rate in SF could be cut sharply with expanded treatment, study predicts Apr 13, 2011 | not rated yet | 0
- Researchers urge integrating TB into HIV care Jul 22, 2008 | not rated yet | 0
- Striking shift seen among newly HIV-infected men regarding partners Dec 05, 2007 | not rated yet | 0
- Study finds HIV-infected men at risk for spreading HIV despite taking HAART Mar 27, 2012 | not rated yet | 0
- Many with HIV start care too late May 28, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
HIV & AIDS 26 minutes ago | not rated yet | 0 |
Detection of HIV antibodies is used to diagnose HIV infection and monitor trials of experimental HIV/AIDS vaccines. New, more sensitive detection systems being developed use microspheres to capture HIV antibodies ...
HIV & AIDS 16 hours ago | 5 / 5 (1) | 0
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Intern ...
HIV & AIDS May 22, 2013 | not rated yet | 0
Canadian health authorities lifted Wednesday what was effectively a ban on gay men giving blood, announcing new rules making men who have not had sex with men in the past five years eligible.
HIV & AIDS May 22, 2013 | not rated yet | 1
How can healthy people who hear voices help schizophrenics? Finding the answer for this is at the centre of research conducted at the University of Bergen.
18 minutes ago | 3 / 5 (1) | 0
Researchers from London's Kingston University have begun a two-year study which could help prolong the lives of people with colorectal tumours.
8 minutes ago | not rated yet | 0
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
1 minute ago | not rated yet | 0
(Medical Xpress)—Research by Stanford scholar Emma Seppala at the Center for Compassion and Altruism Research and Education found that post-traumatic stress disorder decreased in veterans who participated ...
28 minutes ago | not rated yet | 0
The individualisation of drug treatments to support patients to self-manage their conditions is a concept that sits at the heart of policy, but a recent study in BMJ Open shows that there is no concrete defini ...
18 minutes ago | not rated yet | 0
(Medical Xpress)—UCD researchers led by Conway Fellow, Professor David Brayden in UCD School of Veterinary Medicine have successfully reduced inflammation in the swollen arthritic knees of a murine model using a novel nanoparticle.
48 minutes ago | not rated yet | 0