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Ramirez HC, Monroe AK, Byrne M, O'Connor LF. Examining the Association Between a Modified Quan-Charlson Comorbidity Index and HIV Viral Suppression: A Cross-Sectional Analysis of DC Cohort Participants. AIDS Res Hum Retroviruses 2023; 39:662-670. [PMID: 37392022 PMCID: PMC10712358 DOI: 10.1089/aid.2022.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023] Open
Abstract
With the advancement of effective antiretroviral therapy, people with HIV live longer, and many are developing non-AIDS comorbidities. It is important to assess how comorbidities are associated with HIV-related health outcomes, such as viral suppression (VS). The aim of this study was to analyze the association between comorbidity burden, measured using a modified Quan-Charlson Comorbidity Index (QCCI), and VS (viral load result of <200 copies/mL). We hypothesized that an increase in QCCI score, indicating a higher risk for mortality, would correlate with lower likelihood of VS because of the burden of comorbidity treatment, possibly leading to worse antiretroviral adherence. Our analysis included participants from the DC Cohort Longitudinal HIV Study in Washington, DC. Eligible participants were aged ≥18 years and enrolled in the cohort as of January 1, 2018 (n = 2,471). A modified QCCI score, which weighs selected comorbidities (not including HIV/AIDS) and predicts mortality, was calculated using International Classification of Disease-9/10 codes from electronic health records. Multivariable logistic regressions were used to characterize the association between QCCI composite scores and VS. Participants were predominantly virally suppressed (89.6%), male (73.9%), non-Hispanic Black (74.7%), and between 18 and 55 years (59.3%). The median QCCI score was 1 (range = 1-12, interquartile range = 0-2), demonstrating predominately low mortality risk. We did not establish a statistically significant association between QCCI score and VS (adjusted odds ratio = 1.06, 95% confidence interval 0.96-1.17). Our findings suggest that a higher QCCI score was not associated with lower VS in this population, which may be partly due to the high retention in care among cohort participants.
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Affiliation(s)
- Hasmin C. Ramirez
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Anne K. Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Lauren F. O'Connor
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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2
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Perello R, Losada A, Chen Qin J, Supervia A, Salgado E, Smithson A, Xipell M, Inciarte A, Vallecillo G. Amphetamine-related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020. HIV Med 2023; 24:260-266. [PMID: 35945158 DOI: 10.1111/hiv.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stimulant drugs, particularly amphetamines, are more commonly implicated in drug-related deaths in people living with HIV; however, the clinical characteristics of amphetamine-related intoxication in people living with HIV are poorly described. MATERIAL AND METHODS We conducted a retrospective study in people living with HIV who were admitted for amphetamine-related intoxication to an emergency department of a teaching hospital between 2018 and 2021. Severe intoxication (SI) was arbitrarily defined as requiring admission to the emergency medical support unit and receiving medical treatment for ≥6 h. RESULTS In total, 170 male patients with a median age of 36.2 + 7.5 years were included in the study. A total of 77 (45.3%) individuals had mental disorders, and 120 (85.7%) had HIV-1 RNA suppression, with a median CD4 cell count of 696 (interquartile range 490-905). In total, 61 (37.9%) individuals were on ritonavir/cobicistat-based regimens. Presenting clinical syndromes included agitation in 60 (35.3%) subjects, anxiety in 37 (21.7%), psychosis in 27 (15.8%), chest pain in 26 (15.3%) and altered level of consciousness in 20 (11.7%). SI was observed in 48 (28.2%) individuals, 12 (7.1%) required admission to the intensive care unit, and two (1.2%) died. Altered level of consciousness (odds ratio [OR] 6.5; 95% confidence interval [CI] 2.2-18.9; p < 0.01), psychosis (OR 5.8; 95% CI 2.2-15.1; p < 0.01) and suicide attempt (OR 4.6; 95% CI 1.8-11.6; p 0.01) were associated with SI in the adjusted analysis. CONCLUSIONS Amphetamine-related intoxication causes high morbidity in people living with HIV. Healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine-related intoxication.
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Affiliation(s)
| | | | | | | | | | - Alex Smithson
- Emergency Department, Fundació Esperit Sant, Barcelona, Spain
| | - Marc Xipell
- Emergency Department, Hospital Clínic, Barcelona, Spain
| | - Alexis Inciarte
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - Gabriel Vallecillo
- Drug addiction Unit, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona, Spain
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3
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Oh GY, Brouwer ES, Abner EL, Fardo DW, Freeman PR, Delcher C, Moga DC. Predictors of chronic opioid therapy in Medicaid beneficiaries with HIV who initiated antiretroviral therapy. Sci Rep 2021; 11:15503. [PMID: 34326369 PMCID: PMC8322087 DOI: 10.1038/s41598-021-94690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
The factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002–2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with COT. In sex-stratified analyses, multiple predictors were shared between male and female beneficiaries; however, chronic obstructive pulmonary disease, liver disease, any malignancy, and antipsychotic therapy were unique to female beneficiaries. Comorbidities and polypharmacy were important predictors of COT in Medicaid beneficiaries with HIV who initiated cART.
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Affiliation(s)
- GYeon Oh
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA.,Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.,Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Emily S Brouwer
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.,Takeda Pharmaceuticals, Cambridge, MA, USA
| | - Erin L Abner
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.,Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.,Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.,Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Chris Delcher
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA.,Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Daniela C Moga
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA. .,Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA. .,Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA. .,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA.
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4
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Van Beckhoven D, Florence E, De Wit S, Wyndham-Thomas C, Sasse A, Van Oyen H, Macq J. Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort. HIV Med 2020; 21:557-566. [PMID: 32627351 PMCID: PMC7540395 DOI: 10.1111/hiv.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to study the incidence rate, predictors and outcomes of HIV care interruption (HCI) in Belgium. Methods We analysed data for adult patients with at least two HIV care records in the Belgian HIV cohort between 1 January 2007 and 31 December 2016. An HCI episode was defined as 1 year without an HIV care record. The HCI incidence rate was analysed using Poisson regression, return to HIV care using a cumulative incidence function with death as a competing risk, and viral load (VL) status upon return to HIV care using logistic regression. Results We included 16 066 patients accounting for 78 625 person‐years of follow‐up. The incidence rate of HCI was 5.3/100 person‐years [95% confidence interval (CI) 5.1–5.4/100 person‐years]. The incidence of return to HIV care after HCI was estimated at 77.5% (95% CI 75.7–79.2%). Of those who returned to care, 43.7% had a VL ≤ 200 HIV‐1 RNA copies/mL, suggesting care abroad or suboptimal care (without an HIV‐related care record) in Belgium during the HCI, and 56.3% returned without controlled VL and were therefore considered as having experienced a real gap in HIV care; they represented 2.3/100 person‐years of follow‐up. Factors individually associated with HCI were no antiretroviral therapy (ART) uptake, lower age, injecting drug use, non‐Belgian nationality, male gender, not being a man who has sex with men, a shorter time since HIV diagnosis, no high blood pressure and CD4 count < 350 cells/µL. Conclusions This study highlights the need to investigate return to care and viral status at return, to better understand HCI. Identified predictors can help health care workers to target patients at higher risk of HCI for awareness and support.
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Affiliation(s)
| | - E Florence
- Institute of Tropical Medicine, Antwerp, Belgium
| | - S De Wit
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - A Sasse
- Sciensano, Brussels, Belgium
| | - H Van Oyen
- Sciensano, Brussels, Belgium.,University of Ghent, Ghent, Belgium
| | - J Macq
- Université Catholique de Louvain, Brussels, Belgium
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5
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Kang CR, Bang JH, Cho SI. Factors Contributing to Missed Visits for Medical Care among Human Immunodeficiency Virus-Infected Adults in Seoul, Korea. J Korean Med Sci 2018; 33:e261. [PMID: 30310363 PMCID: PMC6179983 DOI: 10.3346/jkms.2018.33.e261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It is important that patients with human immunodeficiency virus (HIV) remain under medical care to improve their health and to reduce the potential for HIV transmission. We explored factors associated with missed visits for HIV medical care according to age group. METHODS Data were derived from a city-wide, cross-sectional survey of 812 HIV-infected adults in Seoul. Multiple logistic analyses were used to explore predictors of missed visits. RESULTS Of the 775 subjects, 99.3% were treated with antiretroviral therapy (ART) and 12.5% had missed a scheduled appointment for HIV medical care during the past 12 months. Compared with the group aged ≥ 50 years, the 20-34-years and 35-49-years groups were strongly associated with missed visits (adjusted odds ratio [aOR], 5.0 and 2.2, respectively). When divided by age group, lower education level (aOR, 3.0) in subjects aged 20-34 years, low income (aOR, 3.5), National Medical Aid beneficiary (aOR, 0.3), and treatment interruption due to side effects of ART (aOR, 3.4) in subjects aged 35-49 years, and National Medical Aid beneficiary (aOR, 7.1) in subjects aged ≥ 50 years were associated with missed visits. CONCLUSION In conclusion, younger age was a strong predictor of missed visits for HIV medical care. However, the risk factors differed according to age group, and the strongest predictor in each age group was related to socioeconomic status.
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Affiliation(s)
- Cho Ryok Kang
- Environmental Health Division, Seoul Metropolitan Government, Seoul, Korea
| | - Ji Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sung-Il Cho
- Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea
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6
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Okello S, Ueda P, Kanyesigye M, Byaruhanga E, Kiyimba A, Amanyire G, Kintu A, Fawzi WW, Muyindike WR, Danaei G. Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross-sectional study in Uganda. J Clin Hypertens (Greenwich) 2017; 19:1181-1191. [PMID: 28895288 DOI: 10.1111/jch.13092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 01/01/2023]
Abstract
The authors sought to describe the association between human immunodeficiency virus (HIV) and blood pressure (BP) levels, and determined the extent to which this relationship is mediated by body weight in a cross-sectional study of HIV-infected and HIV-uninfected controls matched by age, sex, and neighborhood. Mixed-effects models were fit to determine the association between HIV and BP and amount of effect of HIV on BP mediated through body mass index. Data were analyzed from 577 HIV-infected and 538 matched HIV-uninfected participants. HIV infection was associated with 3.3 mm Hg lower systolic BP (1.2-5.3 mm Hg), 1.5 mm Hg lower diastolic BP (0.2-2.9 mm Hg), 0.3 m/s lower pulse wave velocity (0.1-0.4 mm Hg), and 30% lower odds of hypertension (10%-50%). Body mass index mediated 25% of the association between HIV and systolic BP. HIV infection was inversely associated with systolic BP, diastolic BP, and pulse wave velocity. Comprehensive community-based programs to routinely screen for cardiovascular risk factors irrespective of HIV status should be operationalized in HIV-endemic countries.
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Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter Ueda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael Kanyesigye
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emmanuel Byaruhanga
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gideon Amanyire
- Makerere University Joint AIDS Program (MJAP), Mbarara, Uganda
| | - Alex Kintu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Winnie R Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Goodarz Danaei
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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7
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Crawford TN, Thornton A. Retention in Continuous Care and Sustained Viral Suppression. J Int Assoc Provid AIDS Care 2016; 16:42-47. [PMID: 27852944 DOI: 10.1177/2325957416678929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To examine the relationship between retention in continuous care and sustained viral suppression. METHODS The authors retrospectively followed 653 persons who were virally suppressed and seeking care at an infectious disease clinic in Kentucky for an average of 6 years to determine the rates of retention in medical care (≥2 visits separated by ≥3 months within a 12-month period) and sustained viral suppression (<400 copies/mL). A generalized linear mixed model was used to determine an association between retention and suppression over time. RESULTS Approximately 61% of the study population were retained in continuous care and 75% had sustained viral suppression for all patient-years. Persons retained in care were 3 times the odds of sustaining viral suppression over time ( P < .001). CONCLUSION Retention is essential to achieving and maintaining viral suppression. Strategies should be set in place that emphasize increasing the rates of retention, which in turn may increase the rates of suppression.
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Affiliation(s)
| | - Alice Thornton
- 2 College of Medicine, University of Kentucky, Lexington, KY, USA
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8
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Cook RL, Kelso NE, Brumback BA, Chen X. Analytic strategies to evaluate the association of time-varying exposures to HIV-related outcomes: Alcohol consumption as an example. Curr HIV Res 2016; 14:85-92. [PMID: 26511345 DOI: 10.2174/1570162x13666151029101919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/10/2015] [Accepted: 10/21/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND As persons with HIV are living longer, there is a growing need to investigate factors associated with chronic disease, rate of disease progression and survivorship. Many risk factors for this high-risk population change over time, such as participation in treatment, alcohol consumption and drug abuse. Longitudinal datasets are increasingly available, particularly clinical data that contain multiple observations of health exposures and outcomes over time. Several analytic options are available for assessment of longitudinal data; however, it can be challenging to choose the appropriate analytic method for specific combinations of research questions and types of data. The purpose of this review is to help researchers choose the appropriate methods to analyze longitudinal data, using alcohol consumption as an example of a time-varying exposure variable. When selecting the optimal analytic method, one must consider aspects of exposure (e.g. timing, pattern, and amount) and outcome (fixed or time-varying), while also addressing minimizing bias. In this article, we will describe several analytic approaches for longitudinal data, including developmental trajectory analysis, generalized estimating equations, and mixed effect models. For each analytic strategy, we describe appropriate situations to use the method and provide an example that demonstrates the use of the method. Clinical data related to alcohol consumption and HIV are used to illustrate these methods.
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Affiliation(s)
- Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
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9
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Castel AD, Kalmin MM, Hart RLD, Young HA, Hays H, Benator D, Kumar P, Elion R, Parenti D, Ruiz ME, Wood A, D'Angelo L, Rakhmanina N, Rana S, Bryant M, Hebou A, Fernández R, Abbott S, Peterson J, Wood K, Subramanian T, Binkley J, Happ LP, Kharfen M, Masur H, Greenberg AE. Disparities in achieving and sustaining viral suppression among a large cohort of HIV-infected persons in care - Washington, DC. AIDS Care 2016; 28:1355-64. [PMID: 27297952 DOI: 10.1080/09540121.2016.1189496] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One goal of the HIV care continuum is achieving viral suppression (VS), yet disparities in suppression exist among subpopulations of HIV-infected persons. We sought to identify disparities in both the ability to achieve and sustain VS among an urban cohort of HIV-infected persons in care. Data from HIV-infected persons enrolled at the 13 DC Cohort study clinical sites between January 2011 and June 2014 were analyzed. Univariate and multivariate logistic regression were conducted to identify factors associated with achieving VS (viral load < 200 copies/ml) at least once, and Kaplan-Meier (KM) curves and Cox proportional hazards models were used to identify factors associated with sustaining VS and time to virologic failure (VL ≥ 200 copies/ml after achievement of VS). Among the 4311 participants, 95.4% were either virally suppressed at study enrollment or able to achieve VS during the follow-up period. In multivariate analyses, achieving VS was significantly associated with age (aOR: 1.04; 95%CI: 1.03-1.06 per five-year increase) and having a higher CD4 (aOR: 1.05, 95% CI 1.04-1.06 per 100 cells/mm(3)). Patients infected through perinatal transmission were less likely to achieve VS compared to MSM patients (aOR: 0.63, 95% CI 0.51-0.79). Once achieved, most participants (74.4%) sustained VS during follow-up. Blacks and perinatally infected persons were less likely to have sustained VS in KM survival analysis (log rank chi-square p ≤ .001 for both) compared to other races and risk groups. Earlier time to failure was observed among females, Blacks, publically insured, perinatally infected, those with longer standing HIV infection, and those with diagnoses of mental health issues or depression. Among this HIV-infected cohort, most people achieved and maintained VS; however, disparities exist with regard to patient age, race, HIV transmission risk, and co-morbid conditions. Identifying populations with disparate outcomes allows for appropriate targeting of resources to improve outcomes along the care continuum.
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Affiliation(s)
- Amanda D Castel
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Mariah M Kalmin
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | | | - Heather A Young
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Harlen Hays
- b Cerner Corporation , Kansas City , MO , USA
| | - Debra Benator
- c Veterans Affairs Medical Center , Washington , DC , USA
| | - Princy Kumar
- d Division of Infectious Diseases, Georgetown University , Washington , DC , USA
| | | | - David Parenti
- f Division of Infectious Disease , George Washington Medical Faculty Associates , Washington , DC , USA
| | - Maria Elena Ruiz
- g Division of Infectious Diseases, Department of Medicine , Washington Hospital Center , Washington , DC , USA
| | - Angela Wood
- h Family and Medical Counseling Service , Washington , DC , USA
| | - Lawrence D'Angelo
- i Burgess Adolescent Clinic, Children's National Medical Center , Washington , DC , USA
| | - Natella Rakhmanina
- j Special Immunology Service Pediatric Clinic Children's National Medical Center , Washington , DC , USA
| | - Sohail Rana
- k Department of Pediatric and Child Health , Howard University Hospital , Washington , DC , USA
| | - Maya Bryant
- l Howard University Hospital Adult Infectious Disease Clinic , Washington , DC , USA
| | | | | | | | - James Peterson
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Kathy Wood
- p Cerner Corporation , Vienna , VA , USA
| | | | | | - Lindsey Powers Happ
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
| | - Michael Kharfen
- r District of Columbia Department of Health , HIV/AIDS, Hepatitis, Sexually Transmitted Diseases, Tuberculosis Administration (HAHSTA) , Washington , DC , USA
| | - Henry Masur
- s Department of Critical Care Medicine , National Institutes of Health , Bethesda , MD , USA
| | - Alan E Greenberg
- a Department of Epidemiology and Biostatistics , George Washington University Milken Institute School of Public Health , Washington , DC , USA
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10
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Silva DS, De Boni RB, Lake JE, Cardoso SW, Ribeiro S, Moreira RI, Clark JL, Veloso VG, Grinsztejn B, Luz PM. Retention in Early Care at an HIV Outpatient Clinic in Rio de Janeiro, Brazil, 2000-2013. AIDS Behav 2016; 20:1039-48. [PMID: 26525222 PMCID: PMC4840032 DOI: 10.1007/s10461-015-1235-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Retention in early HIV care has been associated with virologic suppression and improved survival, but remains understudied in Brazil. We estimated retention in early HIV care for the period 2000-2013, and identified socio-demographic and clinical factors associated with good retention in an urban cohort from Rio de Janeiro, Brazil. Antiretroviral therapy-naïve, HIV-infected persons ≥18 years old linked to care between 2000 and 2011 were included. Retention in the first 2 years post-linkage (i.e. early care) was defined by the proportion of 6-month intervals with ≥1 HIV laboratory result. "Good" retention was defined as ≥1 HIV laboratory result recorded in at least three intervals. Overall, 80 % of participants met criteria for good retention and retention significantly improved over the study period. Older age, higher education level and early antiretroviral therapy initiation were associated with good retention. Efforts to improve retention in early care in this population should target younger and less-educated HIV-infected persons.
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Affiliation(s)
- Daniel S Silva
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Jordan E Lake
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Sayonara Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Jesse L Clark
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
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11
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Abstract
BACKGROUND Retention in care is important for all HIV-infected persons and is strongly associated with initiation of antiretroviral therapy and viral suppression. However, it is unclear how retention in care and age interact to affect viral suppression. We evaluated whether the association between retention and viral suppression differed by age at entry into care. METHODS Cross-sectional analysis (2006-2010) involving 17,044 HIV-infected adults in 14 clinical cohorts across the United States and Canada. Patients contributed 1 year of data during their first full-calendar year of clinical observation. Poisson regression examined associations between retention measures [US National HIV/AIDS Strategy (NHAS), US Department of Health and Human Services (DHHS), 6-month gap, and 3-month visit constancy] and viral suppression (HIV RNA ≤200 copies/mL) by age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years or older. RESULTS Overall, 89% of patients were retained in care using the NHAS measure, 74% with the DHHS indicator, 85% did not have a 6-month gap, and 62% had visits in 3-4 quarters of the year; 54% achieved viral suppression. For each retention measure, the association with viral suppression was significant for only the younger age groups (18-29 and 30-39 years): 18-29 years [adjusted prevalence ratio (APR) = 1.33, 95% confidence interval (CI): 1.03 to 1.70]; 30-39 years (APR = 1.23, 95% CI: 1.01 to 1.49); 40-49 years (APR = 1.06, 95% CI: 0.90 to 1.22); 50-59 (APR = 0.92, 95% CI: 0.75 to 1.13); ≥60 years (APR = 0.99, 95% CI: 0.63 to 1.56) using the NHAS measure as a representative example. CONCLUSIONS These results have important implications for improving viral control among younger adults, emphasizing the crucial role retention in care plays in supporting viral suppression in this population.
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12
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Crawford TN. Examining the relationship between multiple comorbidities and retention in HIV medical care: a retrospective analysis. AIDS Care 2015; 27:892-9. [PMID: 25679403 DOI: 10.1080/09540121.2015.1009361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Retention in medical care among people living with HIV (PLWH) is a major component in properly managing the disease. As PLWH age, diagnoses of comorbid conditions become common and it may be important to understand how these conditions may impact engagement in care, in particular retention in HIV medical care. A secondary data analysis was conducted to determine the relationship between multiple comorbid conditions and retention in HIV care among patients who sought HIV care between 2003 and 2011. Retention in care was defined as having two clinic visits separated by ≥3 months within a 12-month period. Logistic regression was conducted to determine if multiple comorbid conditions were associated with optimal retention (100%) versus suboptimal retention (<100%). There were 1261 patients included in the analysis, 47% had ≥1 comorbid condition, and approximately 55%, were optimally retained in care. In the regression model, those with one comorbid condition (odds ratio [OR]: 2.47; 95% confidence interval [CI]: 1.81-3.39) and ≥2 comorbid conditions (OR: 4.08; 95% CI: 2.59-6.45) were at significantly higher odds of being optimally retained in care. The results of the study suggest that those living with both HIV and multiple comorbid conditions are better engaged in care compared to those without any comorbid conditions, and this may not present a barrier to care as suggested by other researchers. The results of this study may shed light on the development of tailored interventions to improve retention in care.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. RECENT FINDINGS Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. SUMMARY Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa.
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Yang GL, Yan J, Liu Y, Huang ZL, Long S. Retention in care and factors affecting it among people living with HIV/AIDS in Changsha City, China. Asia Pac J Public Health 2014; 27:86S-92S. [PMID: 25204803 DOI: 10.1177/1010539514548758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the retention in care and examine the factors affecting it among people living with HIV and AIDS (PLWHA) in Changsha City, China. Data on treatment, care, and their retention of all registered 822 PLWHA in Changsha Center for Disease Control and Prevention were analyzed. The retention rate had shown 58.1% among this sample. With logistic regression analysis, retention in care was significantly related to education level (senior high school vs university: odds ratio [OR] = 0.471, 95% confidence interval [CI] = 0.237-0.937), CD4 count (<50cells/mm(3) vs >500cells/mm(3): OR = 2.659, 95% CI = 1.816-28.760), and initiation of antiretroviral therapy (No vs Yes: OR = 0.362, 95% CI = 0.180-0.550). In conclusion, the intervention to improve retention in care for PLWHA in Changsha is warranted, especially for those who have lower education level, for those who have higher baseline CD4 count, and for those who have not initiated antiretroviral therapy.
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Affiliation(s)
- Guoli L Yang
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jin Yan
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yan Liu
- The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhulin L Huang
- Changsha Center for Disease Control and Prevention, Changsha, China
| | - Shuo Long
- The Third Xiangya Hospital, Central South University, Changsha, China
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Crawford TN. Poor retention in care one-year after viral suppression: a significant predictor of viral rebound. AIDS Care 2014; 26:1393-9. [DOI: 10.1080/09540121.2014.920076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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