Christine Potkul

Patients with HIV have a high likelihood of developing depression related to their diagnosis, according to the results of a recent study. Uncertain what actions to take, many of these patients do not seek medical care and go without proper therapy.

, examined the association between the length of time a patient remains depressed and care outcomes among 5927 HIV-positive adult patients. Participants took multiple depressive severity assessments that were translated into a measurement of percent of days with depression. The results showed that patients spend a median of 14% of their days with depression.

According to the study, each 25% increase in the amount of days spent with depression resulted in an 8% increase in the risk of missed appointments, a 5% increase in the risk of treatment failure, and a 19% increase in mortality. Patients experiencing depression for the duration of the follow-up period had a 37% greater risk of missing appointments, a 23% increased risk of treatment failure, and a mortality rate 2 times higher than patients who never spent time depressed.

These study findings show that patients with HIV who develop depression are more susceptible to worse health outcomes than their counterparts without depression. Health care providers need to accurately identify depression in these patients through regular screenings and provide them with an individualized treatment that works for them.

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Patients with HIV have a high likelihood of developing depression related to their diagnosis, according to a recent study, and many of these individuals do not seek medical care.


Patients With HIV at Higher Risk for Developing Depression

Routine HIV screening tests are preventive measures recommended by the CDC for all patients aged 13 to 64 years. Provider-initiated

test offers are an important strategy for increasing HIV screening among heterosexual populations, but improvement is needed, according to a study published in the CDC’s

By offering this service, health care providers remind patients of the importance of HIV testing, especially among heterosexual populations at an increased risk for acquiring the infection. To obtain more information about the prevalence and predictors of provider-initiated HIV test offers in this patient population, the National HIV Behavioral Surveillance (NHBS) used data from Virginia.

The NHBS recruited heterosexual, cis-gendered individuals aged 18 to 60 years, who have an increased risk for acquiring HIV attributed to heterosexual activity and are of low-income status. Patients must not have used injection drugs or had male-to-male sexual contact in the previous 12 months before interviews.

Patients who completed the face-to-face NHBS interviews, but did not meet all criteria were excluded from the study, leaving 333 respondents. To examine the association between HIV test offers and demographic and behavioral characteristics, researchers used univariable log-binomial regression models. All the analysis variables were self-reported by respondents.

According to the findings in this study, 58% of respondents reported not receiving an HIV test offer from their health care provider compared with 42% who did. Among the individuals who did report an HIV test offer, 71% of patients underwent HIV testing during the 12 months following the interview, while only 16% of patients not offered the HIV test went for screenings during that period.

HIV test offer prevalence was lower among patients uninsured than among those with health insurance (PR = 0.78; 95% Cl = 0.59-1.03). The prevalence of HIV test offers in patients aged 31 to 40 years (PR = 1.24; 95% Cl = 0.89-1.72) was higher compared with patients aged 51 to 60 years (PR = 0.71; 95% Cl = 0.49-1.01).

HIV test offer prevalence was lower among men than women (prevalence ratio [PR] = 0.67; 95% cl = 0.50-0.89). Researchers found the relationship between gender and HIV test offer significant (aPR = 0.72; 95% Cl = 0.53-0.97).

When potential confounders were adjusted for in this relationship, prevalence of HIV test offers remained significantly lower in men than in women (aPR = 0.69; 95% Cl = 0.51-0.93). The likelihood of females receiving more HIV test offers could be attributed to their participation in family planning services, fewer sex partners, and more frequent seeking of health care and routine health screens than male patients.

Health care providers who offer HIV tests will encourage patients to integrate preventive HIV screenings into their health care routines. If providers implement this strategy, heterosexual adults at increased risk for acquiring the infection, especially males, will be more inclined to undergo repeat HIV screening.

Karen D, Tina C, Anne R, et al. Prevalence and Predictors of Provider-Initiated HIV Test Offers Among Heterosexual Persons at Increased Risk for Acquiring HIV Infection-Virginia 2016. MMWR Morb Mortal Wkly Rep. 2018; 67(25);714-717.

Routine HIV screening tests are preventive measures recommended by the CDC for all patients aged 13 to 64 years.

Provider-Initiated HIV Test Offers: Important Strategy, Yet Underused

The US Food and Drug Administration (FDA) has granted the US Department of Defense (DoD) an emergency use authorization (EUA) of freeze-dried plasma product (FDP) that is made in France.

Known as French FDP, or Pathogen-Reduced Leukocyte Freeze-Dried Plasma, the product is manufactured by the Centre de Transfusion Sanguine des Armees, and has eliminated a typically long thawing period and made plasma rapidly available for use at the point of injury.

Plasma is typically frozen within 24 hours following donation, to preserve clotting factors. When the frozen plasma is needed, it must be placed in a water bath at 30 to 37 C in an FDA-cleared device. The long thawing period is impractical when treating hemorrhage or coagulopathy in US military personnel during an emergency involving agents of military combat.

The FDA has partnered with the DoD and the Center for Biologics Evaluation and Research (CBER) to see the delivery of safe and effective products to those protecting the nation. An initial work plan was created to address DoD’s medical needs. In this new plan, the FDA will facilitate the development and availability of specific products regulated by the CBER, determined to be important to the health of military service members by the DoD.

In a statement, FDA Commissioner, Scott Gottlieb, MD, explained. “The FDA remains deeply committed to implementing an enduring pathway to ensure that these potentially life-saving medical products are made available in the most expeditious, safe and effective manner possible.”

A Pennsylvania-based company is also developing a freeze-dried plasma product.

FDA takes action to support American Military personnel by granting an authorization for freeze-drived plasma product to enable broader access while the agency works toward approval of the product [news release]. FDA’s website.

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm612893.htm

American Red Cross. Blood Components: How can one donation help multiple people? American Red Cross Website.

https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html

The US Food and Drug Administration (FDA) has granted the US Department of Defense (DoD) an emergency use authorization (EUA) of freeze-dried plasma product (FDP) that is made in France.


Military Personnel Authorized to Receive Freeze-Dried Blood

tedious process that requires careful consideration of every item

packed, especially, when medications are needed. Each country has developed their own distinct guidelines

for those with chronic or serious health conditions.

are permitted to bring with them, and where they can acquire their medication

If travelers violate another country’s rules, they

may face consequences that could present serious setbacks to their health or impose penalti

s for drug trafficking. The CDC is encouraging individuals to be aware of these varying regulations prior to traveling

avoid such consequences. Clinicians can help by counseling patients who are planning vacations or other trips.

When packing, medications should be kept separated from oth

that medications can be easily located, and accessed

. TSA has a specific list of medical supplies that they allow on the plane, so it is important to look at that beforehand. For example, TSA states that diabetes-related supplies, equipment, and medications are allowed

through checkpoint after they have been screened or inspected.

The CDC also recommends bringing a small surplus of medicines in case of delays, and to make sure the containers have their original labels. Travelers should have a copy of all prescriptions in their possession

leave another copy at home with family or relative

. For controlled substances, such as marijuana, and injectable medicines, a note on letterhead stationary from the prescribing doctor should accompany.

A travel health medicine specialist or health care provider should be contacted to obtain

discussions on how to adjust medication schedules when facing time zone changes and the best way to store medicines. Also, be sure to make an appointment, weeks in advance, to get

There is a high likelihood that certain medications will not be accessible for purchase in a different country.

In addition, counterfeit drugs are a major problem amongs

t many developing countries, according to the CDC. Patients should stay

alert, and buy only medicines in original packaging, from a licensed pharmacy.

What the United States may consider common prescriptions, or available over-the-counter drugs, may be illegal somewhere else. Travelers should be

to prevent issues, and to ease the entire traveling process. They should c

country and utilize the International Narcotics Control Board to verify that medicines are permittable.

. It’s important to continue proper management of health issues while in a different country without letting

serious health conditions or chronic diseases get in the way of exciting, new experiences

Traveling Abroad with Medicine. CDC website. https://www.cdc.gov/features/travel-medicine/index.html. Updated July 2, 2018. Accessed July 6, 2018.

Travel preparation can be a tedious process that requires careful consideration of every item being packed, especially, when medications are needed. 

Christine Potkul

Articles

Patients With HIV at Higher Risk for Developing Depression

Provider-Initiated HIV Test Offers: Important Strategy, Yet Underused

Military Personnel Authorized to Receive Freeze-Dried Blood

Traveling With Medication Takes Preparation