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Newswise — DALLAS – Jan. 8, 2020 – Providing multidisciplinary team consults for HIV patients while they are hospitalized to help address social and medical barriers reduces future infection rates and boosts participation in follow-up care, results from a study on how to reengage patients show.

A multidisciplinary inpatient team of HIV medical specialists, HIV case managers, and transitional care nurses assigned to help patients overcome care gaps improved viral suppression rates by 30 percent and increased engagement in care after discharge by 30 percent compared with those without interventions (for whom viral suppression increased 7 percent and engagement 11 percent), researchers at UT Southwestern Medical Center report in the journal AIDS Care.

Ank Nijhawan, M.D., M.P.H., associate professor of internal medicine, and of population and data sciences

“As we focus on national initiatives to Ending the HIV Epidemic: A Plan for America, it is important to remember that many people living with HIV continue to struggle with staying engaged in care – particularly youth, minorities, and people who live in the South. Solutions to this problem require a collaborative and adaptable approach,” says clinical researcher Ank Nijhawan, M.D., M.P.H., an associate professor of internal medicine, and of population and data sciences at UT Southwestern. “Our multidisciplinary approach of matching the type and intensity of intervention to the level of need resulted in significant improvement in the outcomes of patients with HIV.”

Fewer than half of people living with HIV receive consistent, ongoing medical care, while vulnerable populations such as African Americans, Hispanics, and uninsured patients are at an even higher risk of disengagement and uncontrolled HIV infection, researchers say.

In this study, the UT Southwestern infectious disease researchers reviewed electronic health records for 1,056 people living with HIV in the Parkland Health and Hospital System between September 2013 and December 2015 – a year prior to and after the multidisciplinary intervention team launched its program. The intervention program initiated in October 2014. Hospitalized patients with HIV received one of the following: (a) an HIV medical consultation (as requested by primary treatment team), (b) an HIV medical consultation plus transitional care nursing (based on readmission risk), or (c) no specialized intervention beyond care coordination from the HIV case manager. Of the patients who were studied, 68 percent were male, 55 percent were African American, 23 percent were Hispanic, 77 percent were single, and 38 percent had AIDs.

In addition, 85 percent who were seen by the transitional care nurse reported at least one barrier to continuity of care – most commonly mental health and substance use disorders – and more than a third (39 percent) reported three or more such barriers. Many had poor engagement in outpatient HIV care and low virologic suppression rates.

The success of the team’s multidisciplinary approach reinforced the importance not just of specialized medical care, but also the critical role of social determinants of health such as transportation, housing instability, and substance use disorders, the researchers say.

The study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), and the Agency for Healthcare Research and Quality (AHRQ). The multidisciplinary teams were partially funded through a Centers for Medicare and Medicaid Services (CMS) 1115 waiver program. Other study authors include Mitu Bhattatiry, Matthieu Chansard, Song Zhang, Ph.D., and Ethan Halm, M.D., M.P.H., MBA, all of UT Southwestern. No conflicts of interest were reported.

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A team of plastic surgeons from Georgetown University Medical Center found that when a man opted to undergo facial plastic surgery, he was generally perceived as more attractive, trustworthy, and likable by others post-procedure.

“The tendency to judge facial appearance is likely rooted in evolution, as studies suggest evaluating a person based on appearance is linked to survival — our animal instinct tells us to avoid those who are ill-willed and we know from previous research that personality traits are drawn from an individual’s neutral expressions,” said senior investigator and board certified Facial Plastic & Reconstructive surgeon, Michael J. Reilly, MD, an associate professor of otolaryngology at Georgetown’s School of Medicine. 

This study, published in JAMA Facial Plastic Surgery, did not focus solely on perceptions of gender — a man being perceived as more masculine, say — as a similar 2015 study on facial plastic surgery effects on women did.

“Taken together, our findings suggest that both men and women undergoing facial cosmetic surgery can experience not only improved perception of attractiveness, but other positive changes in society’s perception of their persona,” Reilly said.

Reilly and his colleagues set out to determine if society really does prefer men with square jaws, chiseled cheekbones, and more prominent chins. To do so, they used before-and-after pictures from facial plastic surgery procedures done on 24 men who had one or more of the following surgeries: upper eyelid lift (upper blepharoplasty), reduction of lower eyelids (lower blepharoplasty), face-lift, brow-lift, neck-lift, nose reshaping (rhinoplasty), and/or a chin implant.

The team designed six surveys, and each included eight photographs — four photos of a patient before surgery, and four after. No survey contained both photos of a single patient.

More than 150 participants (mostly between the ages of 25-34, white, and with a college degree) took the surveys without any knowledge of the study’s intent. Via the surveys, they were asked to rate their perception of each patient’s aggressiveness, extroversion, likeability, risk-seeking, sociability, trustworthiness, as well as attractiveness and masculinity.

The researchers then built a model to assess the participants’ perceptions of men who had undergone specific plastic surgery procedures. They found that specific personality and appearance perceptions were linked to specific facial procedures with chin augmentation being the only procedure that did not have an effect on perceived personality traits or attractiveness. 

Upper eyelid augmentation increased a man’s likeability and trustworthiness. Lower eyelid augmentation decreased perceived risk-taking. A brow lift improved perception of extroversion and risk-taking. A face-life increased one’s likability and trustworthiness. A neck-lift increased perceived extroversion and masculinity. And a nose job improved attractiveness.

“It is really interesting that different anatomic areas of the face have varying degrees of contribution to overall personality perception,” Reilly said. “And it is also noteworthy that the study did not find a significant change in masculinity. Just one procedure, a neck-lift, was found to enhance that trait.”

Reilly said that these findings suggest that the current “menu of cosmetic procedures for men” are not as gender-enhancing as they may be for women. In a similar study conducted on 30 female patients, increased femininity was significant post-procedure.

“Cicero described the face as the ‘mirror of the soul,’ meaning that a person’s physical appearance is the personal characteristic most obvious and accessible to others in social interaction — so it’s not surprising that subtle changes in neutral facial appearances are powerful enough to alter judgments of personality,” Reilly said.

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TOKYO

A new medication for treatment of the Human Immunodeficiency Virus (HIV) was placed on sale in Japan from April. But the government has been slow to approve other effective methods for dealing with HIV that have achieved favorable results in foreign countries.

To learn more about the current status of HIV/AIDS in Japan, Nikkan Gendai (June 28) met with Dr Shinichi Oka, director-general of AIDS Clinical Center at the International Medical Center of Japan in Tsukuba, Ibaraki Prefecture.

HIV carriers whose conditions go undiagnosed or untreated may eventually develop one or more of 23 afflictions, such as malignant lymphoma and others to which carriers are most vulnerable.

“What’s important is to begin a regimen of treatment before AIDS develops,” Oka is quoted as saying. “With the right treatment and support, people living with HIV can enjoy normal lives.”

Once a drug regimen is initiated, within three to six months the volume of HIV in the blood is reduced to “untraceable” levels. Use of a condom during sex is generally considered sufficient to prevent infecting one’s partner. Likewise the statistical likelihood of a pregnant female HIV carrier receiving treatment to transmit the HIV to her fetus is below 1%.

“There’s no chance of the virus developing resistance,” says Oka. “As in the past, missing one dosage won’t result in a problem. Moreover development is progressing with new drugs that will only need to be administered by injection once a month, or every other month.”

“In the case of Japan, some 30% of patient infections are diagnosed after the appearance of full-blown AIDS,” Oka points out. “There are certain areas where this phenomenon occurs more common than others. Over the past decade, the situation in Japan related to AIDS has not changed, and the number of new cases reported remains the same as before.”

The methodology for reducing the number of new cases is clear. The first step calls for early diagnosis of HIV and initiating a full treatment regimen. In Japan for some reason, this appears to be a high hurdle.

A free, anonymous blood test can only be conducted at public health offices, but people make various excuses for not going, such as “I can’t make the time.” (The offices are closed on weekends.) Or, “If people find out, I’ll be in trouble.” Or, “There’s a chance I’ll run into someone I know at the public health office.” And so on.

In many foreign countries, a number of test options are available such as diagnosis by mail using a saliva test kit — something that has yet to receive government approval in Japan.

Also available overseas is Truvada, a PrEP (an acronym for preexposure prophylaxis) prescribed to high-risk individuals. This has been strongly promoted by the World Health Organization and already approved in over 40 countries. But not Japan. If purchased out-of-pocket (without insurance coverage), a daily PrEP dosage costs about 3,800 yen; individuals who want it can purchase generic varieties online from overseas and it can enter the country legally as a “personal import.” But physicians are reluctant to recommend drugs that have yet to be approved and the average person cannot easily come by useful information.

“In many African countries with a serious AIDS problem, the number of cases has been reduced by half from the peak,” says Oka, who added. “In some parts of the U.S., Australia and Europe, where preventative medication is available, new cases have been drastically reduced.”

Japan, meanwhile, continues to cling inflexibly to two strategies: “Get a test at the public health office” and “Use a condom.” The data on new cases indicate that reliance on these is ineffective in reducing the contagion.

At the very least, Nikkan Gendai concludes, Japan should approve the simple and inexpensive saliva test and adopt the strategy of making preventative drugs available to high-risk individuals with multiple sex partners.

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