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Topics, Trends & Updates
July 2015

Topics, Trends & Updates is a new monthly update from the NYSDOH AIDS Institute HIV Clinical Guidelines Program. Delivered on the first Thursday of each month, TTU will highlight the program's developments and important news. 

Updated NYS Adult ART Guidelines
NYS now recommends that all patients 
with confirmed HIV infection, regardless 
of CD4 count, be offered ART. 
This update confirms NYS support of treatment as a strategy for prevention. 
 
Table 5 provides updated monitoring recommendations. This update confirms NYS support of regular monitoring of HIV RNA as the most accurate and meaningful measure
of effective ART. 

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What We're Reading

 

HIV Status and the Risk of Ischemic Stroke Among Men

Chris Hoffmann, MD, MPH, June 27, 2015

 

Early in the ART era, an increase in heart attacks and stroke was reported in individuals with HIV infection, but it's not clear that those being treated with modern ART regimens are still at an increased risk for such diseases of aging. A recent study from the VA Veterans Aging Cohort Study-Virtual Cohort (Jason Sico, et al. Neurology 2015; 84: 1933-1940) assessed for an association between ischemic stroke and HIV among 25,434 HIV-infected and 51,401 matched non-HIV-infected male veterans, with follow-up from 1998 to 2009. They reported a 17% higher risk for ischemic stroke among those with HIV after controlling for other important risk factors. However, the increased risk could be entirely attributed to the 55% of HIV-infected veterans with a viral load >500 copies/mL (the high number of HIV-infected veterans with an elevated viral load presumably reflects the ART initiation guidelines and less tolerable regimens in use during the earlier years of the observation period). Among those with an undetectable viral load, there was no difference in ischemic stroke when compared with non-HIV-infected veterans. Factors other than HIV infection, such as older age, African American race, uncontrolled hypertension, atrial fibrillation, HCV infection, tobacco abuse, obesity, and renal disease were all associated with increased risk for ischemic stroke. This study reinforces the importance of an undetectable viral load for patients with HIV infection, and it also highlights the need to keep our patients healthy with basic primary care to control blood pressure, diabetes, and obesity, and assist with smoking cessation. (Read abstract on PubMed)

 

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HIV Clinical Guidelines Program 
New York State Department of Health AIDS Institute
In collaboration with JHU School of Medicine, Division of Infectious Diseases
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