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Althoff KN, Stewart C, Humes E, Gerace L, Boyd C, Gebo K, Justice AC, Hyle EP, Coburn SB, Lang R, Silverberg MJ, Horberg MA, Lima VD, Gill MJ, Karris M, Rebeiro PF, Thorne J, Rich AJ, Crane H, Kitahata M, Rubtsova A, Wong C, Leng S, Marconi VC, D’Souza G, Kim HN, Napravnik S, McGinnis K, Kirk GD, Sterling TR, Moore RD, Kasaie P. The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study. PLoS Med 2024; 21:e1004325. [PMID: 38215160 PMCID: PMC10833859 DOI: 10.1371/journal.pmed.1004325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2024] [Accepted: 11/22/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the United States (US) through 2030. METHODS AND FINDINGS Using the PEARL model-an agent-based simulation of PWH who have initiated ART in the US-the prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV) were forecasted through 2030. Simulations were informed by the US CDC HIV surveillance data of new HIV diagnosis and the longitudinal North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data on risk of comorbidities from 2009 to 2017. The simulated population represented 15 subgroups of PWH including Hispanic, non-Hispanic White (White), and non-Hispanic Black/African American (Black/AA) men who have sex with men (MSM), men and women with history of injection drug use and heterosexual men and women. Simulations were replicated for 200 runs and forecasted outcomes are presented as median values (95% uncertainty ranges are presented in the Supporting information). In 2020, PEARL forecasted a median population of 670,000 individuals receiving ART in the US, of whom 9% men and 4% women with history of injection drug use, 60% MSM, 8% heterosexual men, and 19% heterosexual women. Additionally, 44% were Black/AA, 32% White, and 23% Hispanic. Along with a gradual rise in population size of PWH receiving ART-reaching 908,000 individuals by 2030-PEARL forecasted a surge in prevalence of most comorbidities to 2030. Depression and/or anxiety was high and increased from 60% in 2020 to 64% in 2030. Hypertension decreased while dyslipidemia, diabetes, CKD, and MI increased. There was little change in prevalence of cancer and ESLD. The forecasted multimorbidity among PWH receiving ART increased from 63% in 2020 to 70% in 2030. There was heterogeneity in trends across subgroups. Among Black women with history of injection drug use in 2030 (oldest demographic subgroup with median age of 66 year), dyslipidemia, CKD, hypertension, diabetes, anxiety, and depression were most prevalent, with 92% experiencing multimorbidity. Among Black MSM in 2030 (youngest demographic subgroup with median age of 42 year), depression and CKD were highly prevalent, with 57% experiencing multimorbidity. These results are limited by the assumption that trends in new HIV diagnoses, mortality, and comorbidity risk observed in 2009 to 2017 will persist through 2030; influences occurring outside this period are not accounted for in the forecasts. CONCLUSIONS The PEARL forecasts suggest a continued rise in comorbidity and multimorbidity prevalence to 2030, marked by heterogeneities across race/ethnicity, gender, and HIV acquisition risk subgroups. HIV clinicians must stay current on the ever-changing comorbidities-specific guidelines to provide guideline-recommended care. HIV clinical directors should ensure linkages to subspecialty care within the clinic or by referral. HIV policy decision-makers must allocate resources and support extended clinical capacity to meet the healthcare needs of people aging with HIV.
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Affiliation(s)
- Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cameron Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lucas Gerace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cynthia Boyd
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Amy C. Justice
- Yale Schools of Medicine and Public Health, New Haven, Connecticut, United States of America
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Emily P. Hyle
- Harvard Medical School and the Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Boston, Massachusetts, United States of America
| | - Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA and Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, United States of America
| | - Viviane D. Lima
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Maile Karris
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Peter F. Rebeiro
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Jennifer Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Mari Kitahata
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Anna Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Cherise Wong
- Division of Worldwide Research and Development, Pfizer Inc., New York City, New York, United States of America
| | - Sean Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Vincent C. Marconi
- Division of Infectious Disease, Emory School of Medicine, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hyang Nina Kim
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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2
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Kasaie P, Stewart C, Humes E, Gerace L, Hyle EP, Zalla LC, Rebeiro PF, Silverberg MJ, Rubtsova AA, Rich AJ, Gebo K, Lesko CR, Fojo AT, Lang R, Edwards JK, Althoff KN. Impact of subgroup-specific heterogeneities and dynamic changes in mortality rates on forecasted population size, deaths, and age distribution of persons receiving antiretroviral treatment in the United States: a computer simulation study. Ann Epidemiol 2023; 87:S1047-2797(23)00171-0. [PMID: 37741499 PMCID: PMC10841391 DOI: 10.1016/j.annepidem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE Model-based forecasts of population size, deaths, and age distribution of people with HIV (PWH) are helpful for public health and clinical services planning but are influenced by subgroup-specific heterogeneities and changes in mortality rates. METHODS Using an agent-based simulation of PWH in the United States, we examined the impact of distinct approaches to parametrizing mortality rates on forecasted epidemiology of PWH on antiretroviral treatment (ART). We first estimated mortality rates among (1) all PWH, (2) sex-specific, (3) sex-and-race/ethnicity-specific, and (4) sex-race/ethnicity-and-HIV-acquisition-risk-specific subgroups. We then assessed each scenario by (1) allowing unrestricted reductions in age-specific mortality rates over time and (2) restricting the mortality rates among PWH to subgroup-specific mortality thresholds from the general population. RESULTS Among the eight scenarios examined, those lacking subgroup-specific heterogeneities and those allowing unrestricted reductions in future mortality rates forecasted the lowest number of deaths among all PWH and 9 of the 15 subgroups through 2030. The forecasted overall number and age distribution of people with a history of injection drug use were sensitive to inclusion of subgroup-specific mortality rates. CONCLUSIONS Our results underscore the potential risk of underestimating future deaths by models lacking subgroup-specific heterogeneities in mortality rates, and those allowing unrestricted reductions in future mortality rates.
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Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Cameron Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lucas Gerace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital; Division of Infectious Diseases, Massachusetts General Hospital, Boston; Harvard Medical School, Boston
| | - Lauren C Zalla
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter F Rebeiro
- Department of Medicine & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Anna A Rubtsova
- Emory University Rollins School of Public Health, Department of Behavioral, Social, and Health Education Sciences, Atlanta, GA
| | - Ashleigh J Rich
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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3
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Yeh HH, Peltz-Rauchman C, Johnson CC, Pawloski PA, Chesla D, Waring SC, Stevens AB, Epstein M, Joseph C, Miller-Matero LR, Gui H, Tang A, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Loperena R, Mayo K, Mockrin S, Ohno-Machado L, Schully S, Ramirez AH, Qian J, Ahmedani BK. Examining sociodemographic correlates of opioid use, misuse, and use disorders in the All of Us Research Program. PLoS One 2023; 18:e0290416. [PMID: 37594966 PMCID: PMC10437856 DOI: 10.1371/journal.pone.0290416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The All of Us Research Program enrolls diverse US participants which provide a unique opportunity to better understand the problem of opioid use. This study aims to estimate the prevalence of opioid use and its association with sociodemographic characteristics from survey data and electronic health record (EHR). METHODS A total of 214,206 participants were included in this study who competed survey modules and shared EHR data. Adjusted logistic regressions were used to explore the associations between sociodemographic characteristics and opioid use. RESULTS The lifetime prevalence of street opioids was 4%, and the nonmedical use of prescription opioids was 9%. Men had higher odds of lifetime opioid use (aOR: 1.4 to 3.1) but reduced odds of current nonmedical use of prescription opioids (aOR: 0.6). Participants from other racial and ethnic groups were at reduced odds of lifetime use (aOR: 0.2 to 0.9) but increased odds of current use (aOR: 1.9 to 9.9) compared with non-Hispanic White participants. Foreign-born participants were at reduced risks of opioid use and diagnosed with opioid use disorders (OUD) compared with US-born participants (aOR: 0.36 to 0.67). Men, Younger, White, and US-born participants are more likely to have OUD. CONCLUSIONS All of Us research data can be used as an indicator of national trends for monitoring the prevalence of receiving prescription opioids, diagnosis of OUD, and non-medical use of opioids in the US. The program employs a longitudinal design for routinely collecting health-related data including EHR data, that will contribute to the literature by providing important clinical information related to opioids over time. Additionally, this data will enhance the estimates of the prevalence of OUD among diverse populations, including groups that are underrepresented in the national survey data.
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Affiliation(s)
- Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, United States of America
| | - Cathryn Peltz-Rauchman
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States of America
| | - Christine C. Johnson
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States of America
| | - Pamala A. Pawloski
- HealthPartners Institute, Bloomington, Minnesota, United States of America
| | - David Chesla
- Office of Research and Education, Spectrum Health, Grand Rapids, Michigan, United States of America
| | - Stephen C. Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, Minnesota, United States of America
| | - Alan B. Stevens
- Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas, United States of America
| | - Mara Epstein
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States of America
| | - Lisa R. Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, United States of America
- Behavioral Health Services, Henry Ford Health, Detroit, Michigan, United States of America
| | - Hongsheng Gui
- Behavioral Health Services, Henry Ford Health, Detroit, Michigan, United States of America
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, United States of America
| | - Eric Boerwinkle
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Mine Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Cheryl R. Clark
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, New York, United States of America
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Roxana Loperena
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kelsey Mayo
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Stephen Mockrin
- All of Us Research Program, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, UCSD Health, La Jolla, California, United States of America
| | - Sheri Schully
- All of Us Research Program, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Andrea H. Ramirez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jun Qian
- Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Brian K. Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, United States of America
- Behavioral Health Services, Henry Ford Health, Detroit, Michigan, United States of America
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Jetsupphasuk M, Hudgens MG, Lu H, Cole SR, Edwards JK, Adimora AA, Althoff KN, Silverberg MJ, Rebeiro PF, Lima VD, Marconi VC, Sterling TR, Horberg MA, Gill MJ, Kitahata MM, Moore RD, Lang R, Gebo K, Rabkin C, Eron JJ. Optimizing Treatment for Human Immunodeficiency Virus to Improve Clinical Outcomes Using Precision Medicine. Am J Epidemiol 2023; 192:1341-1349. [PMID: 36922393 PMCID: PMC10666965 DOI: 10.1093/aje/kwad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/03/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
In first-line antiretroviral therapy (ART) for human immunodeficiency virus (HIV) treatment, some subgroups of patients may respond better to an efavirenz-based regimen than an integrase strand transfer inhibitor (InSTI)-based regimen, or vice versa, due to patient characteristics modifying treatment effects. Using data based on nearly 16,000 patients from the North American AIDS Cohort Collaboration on Research and Design from 2009-2016, statistical methods for precision medicine were employed to estimate an optimal treatment rule that minimizes the 5-year risk of the composite outcome of acquired immune deficiency syndrome (AIDS)-defining illnesses, serious non-AIDS events, and all-cause mortality. The treatment rules considered were functions that recommend either an efavirenz- or InSTI-based regimen conditional on baseline patient characteristics such as demographic information, laboratory results, and health history. The estimated 5-year risk under the estimated optimal treatment rule was 10.0% (95% confidence interval (CI): 8.6, 11.3), corresponding to an absolute risk reduction of 2.3% (95% CI: 0.9, 3.8) when compared with recommending an efavirenz-based regimen for all patients and 2.6% (95% CI: 1.0, 4.2) when compared with recommending an InSTI-based regimen for all. Tailoring ART to individual patient characteristics may reduce 5-year risk of the composite outcome compared with assigning all patients the same drug regimen.
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Affiliation(s)
- Michael Jetsupphasuk
- Correspondence to Michael Jetsupphasuk, Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599 (e-mail: )
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Mitjà O, Alemany A, Marks M, Lezama Mora JI, Rodríguez-Aldama JC, Torres Silva MS, Corral Herrera EA, Crabtree-Ramirez B, Blanco JL, Girometti N, Mazzotta V, Hazra A, Silva M, Montenegro-Idrogo JJ, Gebo K, Ghosn J, Peña Vázquez MF, Matos Prado E, Unigwe U, Villar-García J, Wald-Dickler N, Zucker J, Paredes R, Calmy A, Waters L, Galvan-Casas C, Walmsley S, Orkin CM. Mpox in people with advanced HIV infection: a global case series. Lancet 2023; 401:939-949. [PMID: 36828001 DOI: 10.1016/s0140-6736(23)00273-8] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND People living with HIV have accounted for 38-50% of those affected in the 2022 multicountry mpox outbreak. Most reported cases were in people who had high CD4 cell counts and similar outcomes to those without HIV. Emerging data suggest worse clinical outcomes and higher mortality in people with more advanced HIV. We describe the clinical characteristics and outcomes of mpox in a cohort of people with HIV and low CD4 cell counts (CD4 <350 cells per mm3). METHODS A network of clinicians from 19 countries provided data of confirmed mpox cases between May 11, 2022, and Jan 18, 2023, in people with HIV infection. Contributing centres completed deidentified structured case report sheets to include variables of interest relevant to people living with HIV and to capture more severe outcomes. We restricted this series to include only adults older than 18 years living with HIV and with a CD4 cell count of less than 350 cells per mm3 or, in settings where a CD4 count was not always routinely available, an HIV infection clinically classified as US Centers for Disease Control and Prevention stage C. We describe their clinical presentation, complications, and causes of death. Analyses were descriptive. FINDINGS We included data of 382 cases: 367 cisgender men, four cisgender women, and ten transgender women. The median age of individuals included was 35 (IQR 30-43) years. At mpox diagnosis, 349 (91%) individuals were known to be living with HIV; 228 (65%) of 349 adherent to antiretroviral therapy (ART); 32 (8%) of 382 had a concurrent opportunistic illness. The median CD4 cell count was 211 (IQR 117-291) cells per mm3, with 85 (22%) individuals with CD4 cell counts of less than 100 cells per mm3 and 94 (25%) with 100-200 cells per mm3. Overall, 193 (51%) of 382 had undetectable viral load. Severe complications were more common in people with a CD4 cell count of less than 100 cells per mm3 than in those with more than 300 cells per mm3, including necrotising skin lesions (54% vs 7%), lung involvement (29% vs 0%) occasionally with nodules, and secondary infections and sepsis (44% vs 9%). Overall, 107 (28%) of 382 were hospitalised, of whom 27 (25%) died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. Among people with CD4 counts of less than 200 cells per mm3, more deaths occurred in those with high HIV viral load. An immune reconstitution inflammatory syndrome to mpox was suspected in 21 (25%) of 85 people initiated or re-initiated on ART, of whom 12 (57%) of 21 died. 62 (16%) of 382 received tecovirimat and seven (2%) received cidofovir or brincidofovir. Three individuals had laboratory confirmation of tecovirimat resistance. INTERPRETATION A severe necrotising form of mpox in the context of advanced immunosuppression appears to behave like an AIDS-defining condition, with a high prevalence of fulminant dermatological and systemic manifestations and death. FUNDING None.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Andrea Alemany
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, and Division of Infection and Immunity, University College London Hospitals, London, UK
| | | | | | | | - Ever Arturo Corral Herrera
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - Brenda Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, México City, México
| | - José Luis Blanco
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona University, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Institut d'Investigacions Mèdiques August Pi i Sunyer, Barcelona, Spain
| | - Nicolo Girometti
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valentina Mazzotta
- National Institute for Infectious Disease, Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Macarena Silva
- Infectious Diseases Department, Hospital San Borja Arriarán, Santiago de Chile, Chile
| | - Juan José Montenegro-Idrogo
- Infectious Diseases Department, Hospital Nacional Dos de Mayo, Lima, Perú; Centro de Investigaciones Tecnológicas Biomédicas y Medioambientales, Lima, Perú
| | - Kelly Gebo
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jade Ghosn
- Department of Infectious Diseases, Assistance Publique-Hôpitaux de Paris Nord, Bichat University Hospital, Paris, France; Centre of Research in Epidemiology and Statistics, Université Paris Cité, INSERM UMR 1137 IAME, Paris, France
| | | | - Eduardo Matos Prado
- Infectious Diseases Department, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Uche Unigwe
- Infectious Disease Unit Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Judit Villar-García
- Infectious Disease Unit, Hospital del Mar, Barcelona, Spain; Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Infectious Diseases and Antibiotic Therapy Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Noah Wald-Dickler
- Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Roger Paredes
- Infectious Disease Department, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Laura Waters
- Central and North West London NHS Trust, London, UK
| | - Cristina Galvan-Casas
- Skin Neglected Tropical diseases and Sexually Transmitted Infections section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain; Dermatology Department, Hospital Universitario de Móstoles, Madrid, Spain
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, Canada
| | - Chloe M Orkin
- Blizard Institute and SHARE Collaborative, Queen Mary University of London, London, UK; Department of Infection and Immunity, Barts Health NHS Trust, London, UK.
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6
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Naeim A, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Elena MC, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Karen L, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton RJ, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan DJ. Transfusing Convalescent Plasma as Post-Exposure Prophylaxis Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Double-Blinded, Phase 2 Randomized, Controlled Trial. Clin Infect Dis 2023; 76:e477-e486. [PMID: 35579509 PMCID: PMC9129191 DOI: 10.1093/cid/ciac372] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/18/2022] [Accepted: 05/10/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320 by Euroimmun ELISA) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed coronavirus disease 2019 (COVID-19) in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was new SARS-CoV-2 infection. RESULTS In total, 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for screening SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) positivity. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs 25.2 days; P = .49) and COVID-19 (26.3 vs 25.9 days; P = .35) was similar for both groups. CONCLUSIONS Administration of high-titer CCP as post-exposure prophylaxis, although appearing safe, did not prevent SARS-CoV-2 infection. CLINICAL TRIALS REGISTRATION NCT04323800.
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Affiliation(s)
| | | | | | | | - Bryan Lau
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | - Edward Cachay
- Department of Medicine, Division of Infectious Diseases
| | - Seble G. Kassaye
- Division of Infectious Diseases/Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - James H. Paxton
- Department of Emergency Medicine Wayne State University, Detroit, Michigan, USA
| | - Jonathan Gerber
- Department of Medicine, Division of Hematology and Oncology, University of Massachusetts Chan Medical School, Worchester, Massachusetts, USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, Rhode Island, USA
| | - Arash Naeim
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith Currier
- Department of Medicine, Division of Infectious Diseases, University of California, Los Angeles, Los Angeles, California, USA
| | - Bela Patel
- Department of Medicine, Division Critical Care Medicine, University of Texas Health, Houston, Texas, USA
| | - Elizabeth S. Allen
- Department of Pathology, University of California, San Diego, San Diego, California, USA
| | - Shweta Anjan
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Sheriza Baksh
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | | | | | - Valerie Cluzet
- Vassar Brothers Medical Center, Nuvance Health, Poughkeepsie, New York, USA
| | | | | | - Stephan Ehrhardt
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | - Donald Forthal
- Department of Medicine, Division of Infectious Diseases, University of California, Irvine, Irvine, California, USA
| | - Yuriko Fukuta
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas Gniadek
- Department of Pathology, Northshore University Health System, Evanston, Illinois, USA
| | | | - Moises A. Huaman
- Department of Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas A. Jabs
- Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Sabra Klein
- Department of Molecular Microbiology and Immunology
| | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Han-Sol Park
- Department of Molecular Microbiology and Immunology
| | | | - Joann Petrini
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - William Rausch
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA
| | - David M. Shade
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Catherine Sutcliffe
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Mosaic Consulting Ltd., Israel
| | | | | | - Martin Zand
- Department of Medicine, University of Rochester, Rochester, New York, USA
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7
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Randal FT, Lozano P, Qi S, Maene C, Shah S, Mo Y, Ratsimbazafy F, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Loperena R, Mayo K, Mockrin S, Ohno-Machado L, Schully S, Ramirez AH, Aschebrook-Kilfoy B, Ahsan H, Lam H, Kim KE. Achieving a Representative Sample of Asian Americans in Biomedical Research Through Community-Based Approaches: Comparing Demographic Data in the All of Us Research Program With the American Community Survey. J Transcult Nurs 2023; 34:59-67. [PMID: 36398985 DOI: 10.1177/10436596221130796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Underrepresented persons are often not included in biomedical research. It is unknown if the general Asian American population is being represented in All of Us. The purpose of this study was to compare the Asian demographic data in the All of Us cohort with the Asian nationally representative data from the American Community Survey. METHOD Demographic characteristics and health literacy of Asians in All of Us were examined. Findings were qualitatively compared with the Asian data in the 2019 American Community Survey 1-year estimate. RESULTS Compared with the national composition of Asians, less All of Us participants were born outside the United States (64% vs 79%), were younger, and had higher levels of education (76% vs 52%). Over 60% of All of Us participants reported high levels of health literacy. CONCLUSION This study had implications for the development of strategies that ensure diverse populations are represented in biomedical research.
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Affiliation(s)
| | | | - Siya Qi
- Asian Health Coalition, Chicago, IL, USA
| | | | | | - Yicklun Mo
- Asian Health Coalition, Chicago, IL, USA
| | | | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, USA
| | | | | | | | - Kelly Gebo
- Johns Hopkins University School of Medicine, Bethesda, MD, USA
| | | | - Kelsey Mayo
- Vanderbilt University Medical Center, Nashville, TN, USA
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8
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Kandathil AJ, Benner SE, Bloch EM, Shrestha R, Ajayi O, Zhu X, Caturegli PP, Shoham S, Sullivan D, Gebo K, Quinn TC, Casadevall A, Hanley D, Pekosz A, Redd AD, Balagopal A, Tobian AAR. Absence of pathogenic viruses in COVID-19 convalescent plasma. Transfusion 2023; 63:23-29. [PMID: 36268708 PMCID: PMC9840666 DOI: 10.1111/trf.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is important to maintain the safety of blood products by avoiding the transfusion of units with known and novel viral pathogens. It is unknown whether COVID-19 convalescent plasma (CCP) may contain pathogenic viruses (either newly acquired or reactivated) that are not routinely screened for by blood centers. METHODS The DNA virome was characterized in potential CCP donors (n = 30) using viral genome specific PCR primers to identify DNA plasma virome members of the Herpesviridae [Epstein Barr Virus (EBV), cytomegalovirus (CMV), human herpesvirus 6A/B, human herpesvirus 7] and Anelloviridae [Torque teno viruses (TTV), Torque teno mini viruses (TTMV), and Torque teno midi viruses (TTMDV)] families. In addition, the RNA plasma virome was characterized using unbiased metagenomic sequencing. Sequencing was done on a HiSeq2500 using high output mode with a read length of 2X100 bp. The sequencing reads were taxonomically classified using Kraken2. CMV and EBV seroprevalence were evaluated using a chemiluminescent immunoassay. RESULTS TTV and TTMDV were detected in 12 (40%) and 4 (13%) of the 30 study participants, respectively; TTMDV was always associated with infection with TTV. We did not observe TTMV DNAemia. Despite CMV and EBV seroprevalences of 33.3% and 93.3%, respectively, we did not detect Herpesviridae DNA among the study participants. Metagenomic sequencing did not reveal any human RNA viruses in CCP, including no evidence of circulating SARS-CoV-2. DISCUSSION There was no evidence of pathogenic viruses, whether newly acquired or reactivated, in CCP despite the presence of non-pathogenic Anelloviridae. These results confirm the growing safety data supporting CCP.
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Affiliation(s)
- Abraham J Kandathil
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah E Benner
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Ajayi
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrizio P Caturegli
- Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shmuel Shoham
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Sullivan
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas C Quinn
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew D Redd
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Ashwin Balagopal
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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9
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Coburn SB, Lang R, Zhang J, Palella FJ, Horberg MA, Castillo-Mancilla J, Gebo K, Galaviz KI, Gill MJ, Silverberg MJ, Hulgan T, Elion RA, Justice AC, Moore RD, Althoff KN. Statins Utilization in Adults With HIV: The Treatment Gap and Predictors of Statin Initiation. J Acquir Immune Defic Syndr 2022; 91:469-478. [PMID: 36053091 PMCID: PMC9649872 DOI: 10.1097/qai.0000000000003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We characterized trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from 2001 to 2017 and identified predictors of statin initiation between 2014 and 2017. SETTING PWH participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) enrolled in 12 US cohorts collecting data on statin eligibility criteria/prescriptions from 2001 to 2017. METHODS We determined the annual proportion eligible for statins, initiating statins, and median waiting time (from statin eligibility to initiation). Eligibility was defined using ATP III guidelines (2001-2013) and ACC/AHA guidelines (2014-2017). We assessed initiation predictors in 2014-2017 among statin-eligible PWH using Poisson regression, estimating adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). RESULTS Among 16,409 PWH, 7386 (45%) met statin eligibility criteria per guidelines (2001-2017). From 2001 to 2013, statin eligibility ranged from 22% to 25%. Initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. Median waiting time to initiation among those we observed declined over time. Per 10-year increase in age, initiation increased 46% (aPR 1.46, 95% CI: 1.29 to 1.67). Per 1-year increase in calendar year from 2014 to 2017, there was a 41% increase in the likelihood of statin initiation (aPR 1.41, 95% CI: 1.25 to 1.58). CONCLUSIONS There is a substantial statin treatment gap, amplified by the 2013 ACC/AHA guidelines. Measures are warranted to clarify reasons we observe this gap, and if necessary, increase statin use consistent with guidelines including efforts to help providers identify appropriate candidates.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
- Cumming School of Medicine, University of Calgary,
Calgary, Alberta, Canada
| | - Jinbing Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
| | - Frank Joseph Palella
- Division of Infectious Diseases, Northwestern University
Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Jose Castillo-Mancilla
- Division of Infectious Disease, School of Medicine,
University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly Gebo
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Karla I. Galaviz
- Department of Applied Health Science, Indiana University
School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary,
Canada
| | | | - Todd Hulgan
- Department of Medicine, Division of Infectious Diseases,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard A. Elion
- Department of Medicine, George Washington University
School of Medicine and Health Sciences, Washington, DC, USA
| | - Amy C. Justice
- Yale University Schools of Medicine and Public Health
and the Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - Richard D. Moore
- School of Medicine, Johns Hopkins University, Baltimore,
Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, Maryland, USA
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10
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Nagar SD, Pemu P, Qian J, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Loperena R, Mayo K, Mockrin S, Ohno-Machado L, Ramirez AH, Schully S, Able A, Green A, Zuchner S, Jordan IK, Meller R, Sanders LL, Mosby H, Olorundare EI, McCaslin A, Anderson C, Pearson A, Igwe KC, Silva K, Daugett G, McCray J, Prude M, Franklin C, Zuchner S, Carrasquillo O, Isasi R, McCauley JL, Melo JG, Riccio AK, Whitehead P, Guzman P, Gladfelter C, Velez R, Saporta M, Apagüeño B, Abreu L, Shenkman B, Hogan B, Handberg E, Hensley J, White S, Roth-Manning B, Mendoza T, Loiacono A, Weinbrenner D, Enani M, Nouina A, Zwick ME, Rosser TC, Quyyumi AA, Johnson TM, Martin GS, Alonso A, Thompson TAK, Deshpande N, Johnston HR, Ahmed H, Husbands L, Jordan IK, Meller R. Investigation of hypertension and type 2 diabetes as risk factors for dementia in the All of Us cohort. Sci Rep 2022; 12:19797. [PMID: 36396674 PMCID: PMC9672061 DOI: 10.1038/s41598-022-23353-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
The World Health Organization recently defined hypertension and type 2 diabetes (T2D) as modifiable comorbidities leading to dementia and Alzheimer's disease. In the United States (US), hypertension and T2D are health disparities, with higher prevalence seen for Black and Hispanic minority groups compared to the majority White population. We hypothesized that elevated prevalence of hypertension and T2D risk factors in Black and Hispanic groups may be associated with dementia disparities. We interrogated this hypothesis using a cross-sectional analysis of participant data from the All of Us (AoU) Research Program, a large observational cohort study of US residents. The specific objectives of our study were: (1) to compare the prevalence of dementia, hypertension, and T2D in the AoU cohort to previously reported prevalence values for the US population, (2) to investigate the association of hypertension, T2D, and race/ethnicity with dementia, and (3) to investigate whether race/ethnicity modify the association of hypertension and T2D with dementia. AoU participants were recruited from 2018 to 2019 as part of the initial project cohort (R2019Q4R3). Participants aged 40-80 with electronic health records and demographic data (age, sex, race, and ethnicity) were included for analysis, yielding a final cohort of 125,637 individuals. AoU participants show similar prevalence of hypertension (32.1%) and T2D (13.9%) compared to the US population (32.0% and 10.5%, respectively); however, the prevalence of dementia for AoU participants (0.44%) is an order of magnitude lower than seen for the US population (5%). AoU participants with dementia show a higher prevalence of hypertension (81.6% vs. 31.9%) and T2D (45.9% vs. 11.4%) compared to non-dementia participants. Dominance analysis of a multivariable logistic regression model with dementia as the outcome shows that hypertension, age, and T2D have the strongest associations with dementia. Hispanic was the only race/ethnicity group that showed a significant association with dementia, and the association of sex with dementia was non-significant. The association of T2D with dementia is likely explained by concurrent hypertension, since > 90% of participants with T2D also had hypertension. Black race and Hispanic ethnicity interact with hypertension, but not T2D, to increase the odds of dementia. This study underscores the utility of the AoU participant cohort to study disease prevalence and risk factors. We do notice a lower participation of aged minorities and participants with dementia, revealing an opportunity for targeted engagement. Our results indicate that targeting hypertension should be a priority for risk factor modifications to reduce dementia incidence.
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Affiliation(s)
| | - Priscilla Pemu
- Morehouse School of Medicine, Atlanta, USA.,University of Miami, Coral Gables, USA
| | - Jun Qian
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Eric Boerwinkle
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,The University of Texas Health Science Center at Houston, Houston, USA
| | - Mine Cicek
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Mayo Clinic, Rochester, USA
| | - Cheryl R Clark
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Brigham and Women's Hospital, Boston, USA
| | - Elizabeth Cohn
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Hunter College, New York, USA
| | - Kelly Gebo
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Johns Hopkins University, Baltimore, USA
| | - Roxana Loperena
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Kelsey Mayo
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Stephen Mockrin
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,National Institutes of Health, Bethesda, USA
| | - Lucila Ohno-Machado
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,University of California, San Diego, USA
| | - Andrea H Ramirez
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Sheri Schully
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Ashley Able
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA.,Vanderbilt University Medical Center, Nashville, USA
| | - Ashley Green
- All of Us Demonstration Projects Subcommittee, National Institutes of Health, Bethesda, USA
| | - Stephan Zuchner
- Vanderbilt University Medical Center, Nashville, USA.,University of Miami, Coral Gables, USA
| | | | | | - Robert Meller
- Morehouse School of Medicine, Atlanta, USA. .,University of Miami, Coral Gables, USA.
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11
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Aschebrook-Kilfoy B, Zakin P, Craver A, Shah S, Kibriya MG, Stepniak E, Ramirez A, Clark C, Cohn E, Ohno-Machado L, Cicek M, Boerwinkle E, Schully SD, Mockrin S, Gebo K, Mayo K, Ratsimbazafy F, Sanders A, Shah RC, Argos M, Ho J, Kim K, Daviglus M, Greenland P, Ahsan H. An Overview of Cancer in the First 315,000 All of Us Participants. PLoS One 2022; 17:e0272522. [PMID: 36048778 PMCID: PMC9436122 DOI: 10.1371/journal.pone.0272522] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The NIH All of Us Research Program will have the scale and scope to enable research for a wide range of diseases, including cancer. The program’s focus on diversity and inclusion promises a better understanding of the unequal burden of cancer. Preliminary cancer ascertainment in the All of Us cohort from two data sources (self-reported versus electronic health records (EHR)) is considered. Materials and methods This work was performed on data collected from the All of Us Research Program’s 315,297 enrolled participants to date using the Researcher Workbench, where approved researchers can access and analyze All of Us data on cancer and other diseases. Cancer case ascertainment was performed using data from EHR and self-reported surveys across key factors. Distribution of cancer types and concordance of data sources by cancer site and demographics is analyzed. Results and discussion Data collected from 315,297 participants resulted in 13,298 cancer cases detected in the survey (in 89,261 participants), 23,520 cancer cases detected in the EHR (in 203,813 participants), and 7,123 cancer cases detected across both sources (in 62,497 participants). Key differences in survey completion by race/ethnicity impacted the makeup of cohorts when compared to cancer in the EHR and national NCI SEER data. Conclusions This study provides key insight into cancer detection in the All of Us Research Program and points to the existing strengths and limitations of All of Us as a platform for cancer research now and in the future.
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Affiliation(s)
- Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States of America
- * E-mail:
| | - Paul Zakin
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Andrew Craver
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Sameep Shah
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Muhammad G. Kibriya
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Elizabeth Stepniak
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
| | - Andrea Ramirez
- Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Cheryl Clark
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth Cohn
- Hunter College City University of New York, New York, New York, United States of America
| | - Lucila Ohno-Machado
- University of California San Diego Health, La Jolla, California, United States of America
| | - Mine Cicek
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Eric Boerwinkle
- The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Sheri D. Schully
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen Mockrin
- National Institutes of Health, Leidos, Inc, Frederick, Maryland, United States of America
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Bethesda, Maryland, United States of America
| | - Kelsey Mayo
- National Institutes of Health, Bethesda, Maryland, United States of America
| | | | - Alan Sanders
- Northshore University Health System, Evanston, Illinois, United States of America
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Maria Argos
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Joyce Ho
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Karen Kim
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Martha Daviglus
- Institute for Minority Health Research, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, United States of America
- Institute for Population and Precision Health, University of Chicago, Chicago, Illinois, United States of America
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States of America
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Ramirez AH, Sulieman L, Schlueter DJ, Halvorson A, Qian J, Ratsimbazafy F, Loperena R, Mayo K, Basford M, Deflaux N, Muthuraman KN, Natarajan K, Kho A, Xu H, Wilkins C, Anton-Culver H, Boerwinkle E, Cicek M, Clark CR, Cohn E, Ohno-Machado L, Schully SD, Ahmedani BK, Argos M, Cronin RM, O’Donnell C, Fouad M, Goldstein DB, Greenland P, Hebbring SJ, Karlson EW, Khatri P, Korf B, Smoller JW, Sodeke S, Wilbanks J, Hentges J, Mockrin S, Lunt C, Devaney SA, Gebo K, Denny JC, Carroll RJ, Glazer D, Harris PA, Hripcsak G, Philippakis A, Roden DM, Ahmedani B, Cole Johnson CD, Ahsan H, Antoine-LaVigne D, Singleton G, Anton-Culver H, Topol E, Baca-Motes K, Steinhubl S, Wade J, Begale M, Jain P, Sutherland S, Lewis B, Korf B, Behringer M, Gharavi AG, Goldstein DB, Hripcsak G, Bier L, Boerwinkle E, Brilliant MH, Murali N, Hebbring SJ, Farrar-Edwards D, Burnside E, Drezner MK, Taylor A, Channamsetty V, Montalvo W, Sharma Y, Chinea C, Jenks N, Cicek M, Thibodeau S, Holmes BW, Schlueter E, Collier E, Winkler J, Corcoran J, D’Addezio N, Daviglus M, Winn R, Wilkins C, Roden D, Denny J, Doheny K, Nickerson D, Eichler E, Jarvik G, Funk G, Philippakis A, Rehm H, Lennon N, Kathiresan S, Gabriel S, Gibbs R, Gil Rico EM, Glazer D, Grand J, Greenland P, Harris P, Shenkman E, Hogan WR, Igho-Pemu P, Pollan C, Jorge M, Okun S, Karlson EW, Smoller J, Murphy SN, Ross ME, Kaushal R, Winford E, Wallace F, Khatri P, Kheterpal V, Ojo A, Moreno FA, Kron I, Peterson R, Menon U, Lattimore PW, Leviner N, Obedin-Maliver J, Lunn M, Malik-Gagnon L, Mangravite L, Marallo A, Marroquin O, Visweswaran S, Reis S, Marshall G, McGovern P, Mignucci D, Moore J, Munoz F, Talavera G, O'Connor GT, O'Donnell C, Ohno-Machado L, Orr G, Randal F, Theodorou AA, Reiman E, Roxas-Murray M, Stark L, Tepp R, Zhou A, Topper S, Trousdale R, Tsao P, Weidman L, Weiss ST, Wellis D, Whittle J, Wilson A, Zuchner S, Zwick ME. The All of Us Research Program: Data quality, utility, and diversity. Patterns 2022; 3:100570. [PMID: 36033590 PMCID: PMC9403360 DOI: 10.1016/j.patter.2022.100570] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 03/30/2022] [Accepted: 07/14/2022] [Indexed: 11/05/2022]
Abstract
The All of Us Research Program seeks to engage at least one million diverse participants to advance precision medicine and improve human health. We describe here the cloud-based Researcher Workbench that uses a data passport model to democratize access to analytical tools and participant information including survey, physical measurement, and electronic health record (EHR) data. We also present validation study findings for several common complex diseases to demonstrate use of this novel platform in 315,000 participants, 78% of whom are from groups historically underrepresented in biomedical research, including 49% self-reporting non-White races. Replication findings include medication usage pattern differences by race in depression and type 2 diabetes, validation of known cancer associations with smoking, and calculation of cardiovascular risk scores by reported race effects. The cloud-based Researcher Workbench represents an important advance in enabling secure access for a broad range of researchers to this large resource and analytical tools. The All of Us Research Program has released data for over 315,000 participants Demonstration projects support the utility and validity of the All of Us dataset The cloud-based Researcher Workbench provides secure, low-cost compute power
The engagement of participants in the research process and broad availability of data to diverse researchers are essential elements in building precision medicine equitably available for all. The NIH has established the ambitious All of Us Research Program to build one of the most diverse health databases in history with tools to support research to improve human health. Here, we present the initial launch of the Researcher Workbench with data types including surveys, physical measurements, and electronic health record data with validation studies to support researcher use of this novel platform. Broad access for researchers to data like these is a critical step in returning value to participants seeking to support the advancement of precision medicine and improved health for all.
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El-Nahal W, Grader-Beck T, Gebo K, Holmes E, Herne K, Moore R, Thompson D, Berry S. Designing an electronic medical record alert to identify hospitalised patients with HIV: successes and challenges. BMJ Health Care Inform 2022; 29:bmjhci-2021-100521. [PMID: 35705318 PMCID: PMC9204398 DOI: 10.1136/bmjhci-2021-100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/11/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Electronic medical record (EMR) tools can identify specific populations among hospitalised patients, allowing targeted interventions to improve care quality and safety. We created an EMR alert using readily available data elements to identify hospitalised people with HIV (PWH) to facilitate a quality improvement study intended to address two quality/safety concerns (connecting hospitalised PWH to outpatient HIV care and reducing medication errors). Here, we describe the design and implementation of the alert and analyse its accuracy of identifying PWH. Methods The EMR alert was designed to trigger for at least one of four criteria: (1) an HIV ICD-10-CM code in a problem list, (2) HIV antiretroviral medication(s) on medication lists, (3) an HIV-1 RNA assay ordered or (4) a positive HIV-antibody result. We used manual chart reviews and an EMR database search to determine the sensitivity and positive predictive value (PPV) of the overall alert and its individual criteria. Results Over a 24-month period, the alert functioned as intended, notifying an intervention team and a data abstraction team about admissions of PWH. Manual review of 1634 hospitalisations identified 18 PWH hospitalisations, all captured by the alert (sensitivity 100%, 95% CI 82.4% to 100.0%). Over the 24 months, the alert triggered for 1191 hospitalisations. Of these, 1004 were PWH hospitalisations, PPV=84.3% (95% CI 82.2% to 86.4%). Using fewer criteria (eg, using only ICD-10-CM codes) identified fewer PWH but increased PPV. Conclusion An EMR alert effectively identified hospitalised PWH for a quality improvement intervention. Similar alerts might be adapted as tools to facilitate interventions for other chronic diseases.
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Affiliation(s)
- Walid El-Nahal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas Grader-Beck
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Holmes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Kayla Herne
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Thompson
- Department of Anesthesiology and Critical Care Medicine, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen Berry
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Lee JS, Humes E, Hogan BC, Justice AC, Klein M, Gebo K, John Gill M, Silverberg MJ, Rebeiro P, Horberg M, Karris M, Rabkin C, Moore RD, Althoff KN. Observed CD4 counts at entry into HIV care and at antiretroviral therapy prescription by age in the USA, 2004-18: a cohort study. Lancet HIV 2022; 9 Suppl 1:S2. [PMID: 35304844 DOI: 10.1016/s2352-3018(22)00067-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Adults aged 50 years or older comprise a majority of people with HIV in the USA. Our objective was to describe observed differences by age in CD4 count at entry into HIV care, timing of antiretroviral therapy (ART) prescription, and CD4 count at time of ART prescription before (2004-11) and during (2012-18) the current era of universal treatment. METHODS For this descriptive study, we calculated median (IQR) CD4 count at entry into care, days from entry into care to ART prescription, and CD4 count at time of ART prescription among patients enrolled in US-based clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD; see appendix). We excluded participants with no CD4 count recorded at entry into care, medical records that suggested previous ART use, or previous AIDS diagnosis. All calculations were stratified by age (≥50 and 18-50 years) and calendar year. FINDINGS Of 35 293 ART-naive adult participants entering care between Jan 1, 2004 and Dec 31, 2018, 5794 (16%) were women and 29 499 (84%) were men; 15817 (45%) were Black, 11566 (33%) were White, 5538 (16%) were Hispanic (any race), 737 (2%) were Asian or Pacific Islander, 152 (0.4%) were Indigenous, and 98 (0.3%) were multiracial. Median age at entry into care was 39 years (IQR 29-49); 8004 (23%) were aged 50 years or older. Of 29 141 participants initially prescribed ART, 7274 (25%) were aged 50 years or older. From 2004 to 2018, median CD4 count at entry into care increased from 228 cells per µL (IQR 80-422) to 295 cells per µL (134-489) among adults aged 50 years and older, and from 297 cells per µL (119-480) to 378 cells per µL (202-564) among adults younger than 50 years. Median days from entry into care to ART prescription declined from 56 (IQR 17-658) to 6 (0-15) among adults older than 50 years, and from 61 (17-509) to 6 (0-16) among adults younger than 50 years. Median CD4 count at time of ART prescription increased from 139 cells per µL (IQR 59-257) to 311 cells per µL (137-504) among adults aged 50 years or older, and from 166 cells per µL (49-287) to 377 cells per µL (198-564) among adults younger than 50 years. INTERPRETATION Before the release of universal treatment guidelines by the US Department of Health and Human Services in 2012, median time to ART prescription was already falling, leading to increases in median CD4 count at ART prescription for both age groups; both measures continued to improve in the treat-all era. However, median CD4 counts, both at entry into care and at ART prescription, among adults aged 50 years and older were lower than those of adults younger than 50 years throughout the study period. Furthermore, even into the treat-all era, over half of adults aged 50 years and older entered care with CD4 counts of less than 350 cells per µL, potentially because of factors including immunosenescence, delayed HIV diagnosis, and late presentation to care. Given that age-related immunological changes might not be fully avoidable, targeted strategies for increasing HIV risk awareness, routine testing, and immediate linkage to HIV care at diagnosis are particularly essential for this population. FUNDING US National Institutes of Health grant U01AI069918.
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Affiliation(s)
- Jennifer S Lee
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Elizabeth Humes
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brenna C Hogan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT, USA; Yale University School of Public Health, New Haven, CT, USA; VA Connecticut Health System West Haven Campus, West Haven, CT, USA
| | - Marina Klein
- McGill University Health Centre, Montréal, QC, Canada
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M John Gill
- Southern Alberta HIV Program, Calgary, AB, Canada
| | | | | | | | - Maile Karris
- University of California, San Diego, San Diego, CA, USA
| | | | - Richard D Moore
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Keri N Althoff
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Shoham S, Bloch EM, Casadevall A, Hanley D, Lau B, Gebo K, Cachay E, Kassaye SG, Paxton JH, Gerber J, Levine AC, Currier J, Patel B, Allen ES, Anjan S, Appel L, Baksh S, Blair PW, Bowen A, Broderick P, Caputo CA, Cluzet V, Cordisco ME, Cruser D, Ehrhardt S, Forthal D, Fukuta Y, Gawad AL, Gniadek T, Hammel J, Huaman MA, Jabs DA, Jedlicka A, Karlen N, Klein S, Laeyendecker O, Lane K, McBee N, Meisenberg B, Merlo C, Mosnaim G, Park HS, Pekosz A, Petrini J, Rausch W, Shade DM, Shapiro JR, Singleton JR, Sutcliffe C, Thomas DL, Yarava A, Zand M, Zenilman JM, Tobian AA, Sullivan D. Randomized controlled trial transfusing convalescent plasma as post-exposure prophylaxis against SARS-CoV-2 infection. medRxiv 2021:2021.12.13.21267611. [PMID: 34931202 PMCID: PMC8687473 DOI: 10.1101/2021.12.13.21267611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The efficacy of SARS-CoV-2 convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. We hypothesized that CCP might prevent infection when administered before symptoms or laboratory evidence of infection. METHODS This double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed COVID-19 in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was development of SARS-CoV-2 infection. RESULTS 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for SARS-CoV-2 RT-PCR positivity at screening. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. There were 28 adverse events in CCP and 58 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs. 25.2 days; p=0.49) and COVID-19 (26.3 vs. 25.9 days; p=0.35) were similar for both groups. CONCLUSION In this trial, which enrolled persons with recent exposure to a person with confirmed COVID-19, high titer CCP as post-exposure prophylaxis appeared safe, but did not prevent SARS-CoV-2 infection. TRIAL REGISTRATION Clinicaltrial.gov number NCT04323800 .
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El-Nahal W, Berry S, Psoter K, Gebo K. 444. County-level COVID-19 Case Fatality Rate in Medicaid Expansion States Compared to Non-Expansion States. Open Forum Infect Dis 2021. [PMCID: PMC8690743 DOI: 10.1093/ofid/ofab466.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Medicaid expansion has been adopted by 38 states and the District of Columbia,1,2 contributing to lower rates of uninsured individuals in the US.3 During the COVID-19 pandemic, Medicaid enrollment offset employer-based insurance losses precipitated by the recession.4 The aim of this study was to evaluate whether Medicaid expansion may have impacted COVID-19 mortality. Methods We conducted an ecologic study that included all US counties in the 50 states and District of Columbia. County-specific Medicaid expansion status was based on whether expansion was adopted within the state. COVID-19 cases and deaths for each county were obtained from the Centers of Disease Control (CDC). Unadjusted and multivariable negative binomial regression with robust standard errors to account for clustering of counties within each state were used to evaluate the association of COVID-19 case fatality rate and Medicaid expansion status. Adjusted models included the addition of four sets of county-level covariates thought to influence the association of Medicaid status and COVID-19 fatality rate: demographics, comorbidities, economic indicators, and physician density. These analyses were then performed in subgroups of counties defined by urbanicity (metro, suburban or rural) and quartiles of poverty rates. Incidence Rate Ratios (IRR) and 95% confidence intervals (CI) are reported. Results A total of 1,814 Medicaid expansion and 1,328 non-expansion counties were included in the analysis. Crude case fatality rates were 2.1% (non-expansion) and 1.8% (expansion). Medicaid expansion was not associated with a significantly lower COVID-19 case fatality rate in either the unadjusted (IRR: 0.86; 95% CI: 0.74, 1.01) or fully adjusted (IRR: 1.02; 95% CI: 0.90, 1.16) models. In adjusted models, Medicaid expansion status was also not associated with differences in COVID-19 case fatality rate when counties were stratified by either urbanicity or percent of individuals living below the poverty line. ![]()
Conclusion In this county-level analysis, Medicaid expansion status was not associated with a significant difference in county-level COVID-19-related case fatality rates among people of all ages. Future individual-level studies are needed to better characterize the effect of Medicaid on COVID-19 mortality. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Walid El-Nahal
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Berry
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin Psoter
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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El-Nahal W, Shen N, Lesko C, Fojo A, Lau B, Keruly J, Manabe YC, Jones J, Moore R, Gebo K, Chander G. 48. Time Between Viral Loads for Suppressed and Non-Suppressed People with HIV During the COVID-19 Pandemic Compared to Pre-Pandemic. Open Forum Infect Dis 2021. [PMCID: PMC8643955 DOI: 10.1093/ofid/ofab466.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background During the COVID-19 pandemic, patients at the John G. Bartlett Specialty practice experienced disruptions in viral load (VL) monitoring due to 1) conversion to telemedicine visits and 2) closure of the onsite lab from March 16-July 13, 2021. We described the impact of the pandemic on VL monitoring. Methods We measured time from all index VLs collected during 3 periods: January 1, 2019 to March 15, 2020 (pre-pandemic); March 16 to July 12, 2020 (pandemic, closed onsite lab); and July 13 to December 31, 2020 (pandemic, open onsite lab) until a subsequent VL, 1 year after the index VL, or administrative censoring on December 31, 2020, whichever came first. We classified follow-up time according to these periods (treating period as a time-varying variable). We report hazard ratios (HRs) and 95% Confidence Intervals (CI) from a Cox proportional hazards model comparing the hazard of a VL during the pandemic periods to the pre-pandemic period, stratified by whether the index VL was suppressed (≤200 copies/mL). We tested for interactions between patient characteristics (age, sex at birth, race, ethnicity, and recent substance use) and period, to investigate differential effects of the pandemic on delayed VL. Results After 7,760 suppressed VL measurements, median times to subsequent VL during the pre-pandemic, pandemic (closed lab) and pandemic (open lab) periods, were 4.6 (HR=1.0), 8.9 (HR=0.34, CI:0.30, 0.37), and 5.8 (HR=0.73, CI:0.68,0.78) months respectively. After 1,025 non-suppressed VL measurements, median times to subsequent VL were 2.0 (HR=1.0), 3.9 (HR=0.57, CI:0.42,0.79), and 2.1 (HR=0.92, CI:0.76,1.10) months respectively. Time to subsequent VL after an index suppressed VL was less affected by the pandemic for patients who are white; had private insurance; or had no recent cocaine or heroin use. The effect of the pandemic on time to subsequent VL after a non-suppressed index VL did not significantly differ across patient characteristics. ![]()
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Conclusion Onsite lab closure disrupted VL collection for all groups. Once the onsite lab opened, the pandemic period was still associated with a delay among suppressed patients, but not non-suppressed patients. Further studies are needed to investigate if these delays are associated with lapses in viral suppression. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Walid El-Nahal
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nicola Shen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine Lesko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anthony Fojo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne Keruly
- The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joyce Jones
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Heaney CD, Pisanic N, Randad PR, Kruczynski K, Howard T, Zhu X, Littlefield K, Patel EU, Shrestha R, Laeyendecker O, Shoham S, Sullivan D, Gebo K, Hanley D, Redd AD, Quinn TC, Casadevall A, Zenilman JM, Pekosz A, Bloch EM, Tobian AAR. Comparative performance of multiplex salivary and commercially available serologic assays to detect SARS-CoV-2 IgG and neutralization titers. J Clin Virol 2021; 145:104997. [PMID: 34695724 PMCID: PMC8502080 DOI: 10.1016/j.jcv.2021.104997] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/16/2021] [Accepted: 10/03/2021] [Indexed: 02/01/2023]
Abstract
Oral fluid (hereafter saliva) offers a non-invasive sampling method for detection of SARS-CoV-2 antibodies. However, data comparing performance of salivary tests against commercially-available serologic and neutralizing antibody (nAb) assays are lacking. This study compared the performance of a laboratory-developed multiplex salivary SARS-CoV-2 IgG assay targeting antibodies to nucleocapsid (N), receptor binding domain (RBD) and spike (S) antigens to three commercially-available SARS-CoV-2 serologic enzyme immunoassays (EIAs) (Ortho Vitros, Euroimmun, and BioRad) and nAb. Paired saliva and plasma samples were collected from 101 eligible COVID-19 convalescent plasma (CCP) donors >14 days since PCR+ confirmed diagnosis. Concordance was evaluated using positive (PPA) and negative (NPA) percent agreement, and Cohen's kappa coefficient. The range between salivary and plasma EIAs for SARS-CoV-2-specific N was PPA: 54.4-92.1% and NPA: 69.2-91.7%, for RBD was PPA: 89.9-100% and NPA: 50.0-84.6%, and for S was PPA: 50.6-96.6% and NPA: 50.0-100%. Compared to a plasma nAb assay, the multiplex salivary assay PPA ranged from 62.3% (N) and 98.6% (RBD) and NPA ranged from 18.8% (RBD) to 96.9% (S). Combinations of N, RBD, and S and a summary algorithmic index of all three (N/RBD/S) in saliva produced ranges of PPA: 87.6-98.9% and NPA: 50-91.7% with the three EIAs and ranges of PPA: 88.4-98.6% and NPA: 21.9-34.4% with the nAb assay. A multiplex salivary SARS-CoV-2 IgG assay demonstrated variable, but comparable performance to three commercially-available plasma EIAs and a nAb assay, and may be a viable alternative to assist in monitoring population-based seroprevalence and vaccine antibody response.
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Affiliation(s)
- Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Pranay R Randad
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Tyrone Howard
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kirsten Littlefield
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Thomas C Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Zenilman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room W7033B Baltimore, MD, 21205 USA; Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baxter SL, Saseendrakumar BR, Paul P, Kim J, Bonomi L, Kuo TT, Loperena R, Ratsimbazafy F, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Mayo K, Mockrin S, Schully SD, Ramirez A, Ohno-Machado L. Predictive Analytics for Glaucoma Using Data From the All of Us Research Program. Am J Ophthalmol 2021; 227:74-86. [PMID: 33497675 PMCID: PMC8184631 DOI: 10.1016/j.ajo.2021.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To (1) use All of Us (AoU) data to validate a previously published single-center model predicting the need for surgery among individuals with glaucoma, (2) train new models using AoU data, and (3) share insights regarding this novel data source for ophthalmic research. DESIGN Development and evaluation of machine learning models. METHODS Electronic health record data were extracted from AoU for 1,231 adults diagnosed with primary open-angle glaucoma. The single-center model was applied to AoU data for external validation. AoU data were then used to train new models for predicting the need for glaucoma surgery using multivariable logistic regression, artificial neural networks, and random forests. Five-fold cross-validation was performed. Model performance was evaluated based on area under the receiver operating characteristic curve (AUC), accuracy, precision, and recall. RESULTS The mean (standard deviation) age of the AoU cohort was 69.1 (10.5) years, with 57.3% women and 33.5% black, significantly exceeding representation in the single-center cohort (P = .04 and P < .001, respectively). Of 1,231 participants, 286 (23.2%) needed glaucoma surgery. When applying the single-center model to AoU data, accuracy was 0.69 and AUC was only 0.49. Using AoU data to train new models resulted in superior performance: AUCs ranged from 0.80 (logistic regression) to 0.99 (random forests). CONCLUSIONS Models trained with national AoU data achieved superior performance compared with using single-center data. Although AoU does not currently include ophthalmic imaging, it offers several strengths over similar big-data sources such as claims data. AoU is a promising new data source for ophthalmic research.
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Affiliation(s)
- Sally L Baxter
- From the Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, (S.L.B., B.R.S.), La Jolla, California; UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California.
| | - Bharanidharan Radha Saseendrakumar
- From the Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, (S.L.B., B.R.S.), La Jolla, California; UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Paulina Paul
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Jihoon Kim
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Luca Bonomi
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Roxana Loperena
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Francis Ratsimbazafy
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Eric Boerwinkle
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas (E.B.)
| | - Mine Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (M.C.)
| | - Cheryl R Clark
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (C.R.C.)
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, Hunter College City University of New York, New York, New York (E.C.)
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, Maryland
| | - Kelsey Mayo
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Stephen Mockrin
- Life Sciences Division, Leidos, Inc, Frederick, (S.M.), Maryland
| | - Sheri D Schully
- All of Us Research Program, National Institutes of Health, Bethesda (K.M., S.S.), Bethesda, Maryland
| | - Andrea Ramirez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (A.R.)
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California; Division of Health Services Research and Development, Veterans Affairs San Diego Healthcare System, La Jolla, California (L.O.-M.), USA
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20
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Chandler PD, Clark CR, Zhou G, Noel NL, Achilike C, Mendez L, Ramirez AH, Loperena-Cortes R, Mayo K, Cohn E, Ohno-Machado L, Boerwinkle E, Cicek M, Qian J, Schully S, Ratsimbazafy F, Mockrin S, Gebo K, Dedier JJ, Murphy SN, Smoller JW, Karlson EW. Hypertension prevalence in the All of Us Research Program among groups traditionally underrepresented in medical research. Sci Rep 2021; 11:12849. [PMID: 34158555 PMCID: PMC8219813 DOI: 10.1038/s41598-021-92143-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/04/2021] [Indexed: 11/18/2022] Open
Abstract
The All of Us Research Program was designed to enable broad-based precision medicine research in a cohort of unprecedented scale and diversity. Hypertension (HTN) is a major public health concern. The validity of HTN data and definition of hypertension cases in the All of Us (AoU) Research Program for use in rule-based algorithms is unknown. In this cross-sectional, population-based study, we compare HTN prevalence in the AoU Research Program to HTN prevalence in the 2015-2016 National Health and Nutrition Examination Survey (NHANES). We used AoU baseline data from patient (age ≥ 18) measurements (PM), surveys, and electronic health record (EHR) blood pressure measurements. We retrospectively examined the prevalence of HTN in the EHR cohort using Systemized Nomenclature of Medicine (SNOMED) codes and blood pressure medications recorded in the EHR. We defined HTN as the participant having at least 2 HTN diagnosis/billing codes on separate dates in the EHR data AND at least one HTN medication. We calculated an age-standardized HTN prevalence according to the age distribution of the U.S. Census, using 3 groups (18-39, 40-59, and ≥ 60). Among the 185,770 participants enrolled in the AoU Cohort (mean age at enrollment = 51.2 years) available in a Researcher Workbench as of October 2019, EHR data was available for at least one SNOMED code from 112,805 participants, medications for 104,230 participants, and 103,490 participants had both medication and SNOMED data. The total number of persons with SNOMED codes on at least two distinct dates and at least one antihypertensive medication was 33,310 for a crude prevalence of HTN of 32.2%. AoU age-adjusted HTN prevalence was 27.9% using 3 groups compared to 29.6% in NHANES. The AoU cohort is a growing source of diverse longitudinal data to study hypertension nationwide and develop precision rule-based algorithms for use in hypertension treatment and prevention research. The prevalence of hypertension in this cohort is similar to that in prior population-based surveys.
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Affiliation(s)
- Paulette D Chandler
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Cheryl R Clark
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Guohai Zhou
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Nyia L Noel
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Confidence Achilike
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Lizette Mendez
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Kelsey Mayo
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Eric Boerwinkle
- University of Texas Health Science Center School of Public Health, Houston, TX, USA
| | | | - Jun Qian
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Kelly Gebo
- Johns Hopkins University, Baltimore, MD, USA
| | - Julien J Dedier
- Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Science and Computing, Mass General Brigham, Boston, MA, USA
| | - Jordan W Smoller
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth W Karlson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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21
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Heaney CD, Pisanic N, Randad PR, Kruczynski K, Howard T, Zhu X, Littlefield K, Patel EU, Shrestha R, Laeyendecker O, Shoham S, Sullivan D, Gebo K, Hanley D, Redd AD, Quinn TC, Casadevall A, Zenilman JM, Pekosz A, Bloch EM, Tobian AAR. Comparative performance of multiplex salivary and commercially available serologic assays to detect SARS-CoV-2 IgG and neutralization titers. medRxiv 2021:2021.01.28.21250717. [PMID: 33532806 PMCID: PMC7852272 DOI: 10.1101/2021.01.28.21250717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Oral fluid (hereafter saliva) offers a non-invasive sampling method for the detection of SARS-CoV-2 antibodies. However, data comparing performance of salivary tests against commercially-available serologic and neutralizing antibody (nAb) assays are lacking. This study compared the performance of a multiplex salivary SARS-CoV-2 IgG assay targeting antibodies to nucleocapsid (N), receptor binding domain (RBD) and spike (S) antigens to three commercially-available SARS-CoV-2 serology enzyme immunoassays (EIAs) (Ortho Vitros, Euroimmun, and BioRad) and nAb. Paired saliva and plasma samples were collected from 101 eligible COVID-19 convalescent plasma (CCP) donors >14 days since PCR+ confirmed diagnosis. Concordance was evaluated using positive (PPA) and negative (NPA) percent agreement, overall percent agreement (PA), and Cohen kappa coefficient. The range between salivary and plasma EIAs for SARS-CoV-2-specific N was PPA: 54.4-92.1% and NPA: 69.2-91.7%, for RBD was PPA: 89.9-100% and NPA: 50.0-84.6%, and for S was PPA: 50.6-96.6% and NPA: 50.0-100%. Compared to a plasma nAb assay, the multiplex salivary assay PPA ranged from 62.3% (N) and 98.6% (RBD) and NPA ranged from 18.8% (RBD) to 96.9% (S). Combinations of N, RBD, and S and a summary algorithmic index of all three (N/RBD/S) in saliva produced ranges of PPA: 87.6-98.9% and NPA: 50-91.7% with the three EIAs and ranges of PPA: 88.4-98.6% and NPA: 21.9-34.4% with the nAb assay. A multiplex salivary SARS-CoV-2 IgG assay demonstrated comparable performance to three commercially-available plasma EIAs and a nAb assay, and may be a viable alternative to assist in screening CCP donors and monitoring population-based seroprevalence and vaccine antibody response.
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Affiliation(s)
- Christopher D. Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Pranay R. Randad
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kate Kruczynski
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tyrone Howard
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kirsten Littlefield
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U. Patel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruchee Shrestha
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Sullivan
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Hanley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D. Redd
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Thomas C. Quinn
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore MD
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M. Zenilman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Pekosz
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Evan M. Bloch
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A. R. Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Zhang J, Haines C, Watson A, Hart A, Jane Platt M, Pardoll D, Cosgrove SE, Cosgrove SE, Gebo K, Sears C. 2845. Oral Antibiotic Use and Risk of Colorectal Cancer in the UK, 1989–2012: A Matched Case–Control Study. Open Forum Infect Dis 2019. [PMCID: PMC6809407 DOI: 10.1093/ofid/ofz359.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Microbiome dysbiosis predisposes to colorectal cancer (CRC), but a population-based study of oral antibiotic exposure and CRC risk is lacking. Methods A matched case–control study (incident CRC cases and up to 5 matched controls) was conducted in the Clinical Practice Research Datalink (CPRD; 1989–2012). The CRPD is validated as 92% and 99% sensitive and specific for CRC detection (98% PPV). Antibiotic exposure [categorical and continuous terms (spline)] was investigated for risk pattern, stratified by tumor location, using conditional logistic regression and adjusting for known confounders. Results In total, 28,980 CRC cases and 137,077 controls were identified. Oral antibiotic use increased risk of colon cancer in a dose-dependent fashion (Ptrend < 0.001), but effects differed by anatomic location. Colon cancer risk was greatest in the proximal colon and with antibiotics with anti-anaerobic activity (Figure 1). In contrast, an inverse association was detected between antibiotic use and rectal cancers (Ptrend = 0.003), particularly with length of antibiotic exposure >60 days (adjusted odds ratio [AOR], 0.85, 95% CI 0.79–0.93) when compared with no antibiotic exposure. Nonlinearity models showed significantly increased colon cancer risk after minimal antibiotic use, but decreased rectum cancer risk with cumulative use of over 30 days (Figure 2). Penicillins, particularly ampicillin/amoxicillin, increased risk of colon cancer (AOR,1.09, [1.05–1.13]) whereas tetracyclines reduced risk for rectal cancer (AOR, 0.90, [0.84–0.97]). Significant interactions were detected between antibiotic use and tumor location (colon vs. rectum, Pinteraction < 0.001). The antibiotic-cancer association was found for antibiotic exposure occurring >10 years before diagnosis (AOR, 1.17, [1.06–1.31]). Conclusion We conclude that oral antibiotic use associates with increased colon cancer risk, particularly in the right colon, but a reduced risk for rectal cancer. This effect heterogeneity suggests unabsorbed antibiotics impact gut microbiota in the right colon to enhance carcinogenesis whereas antibiotic anti-inflammatory or anti-proliferative actions may yield an inverse effect on carcinogenesis in the rectum. ![]()
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Disclosures Sara E. Cosgrove, MD, MS, Basilea: Consultant; Theravance: Consultant.
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Affiliation(s)
- Jiajia Zhang
- Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Alastair Watson
- Norwich Medical School, University of East Anglia, Norwich, England, UK
| | - Andrew Hart
- Norwich Medical School, Norwich, England, UK
| | | | | | - Sara E Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara E Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly Gebo
- Johns Hopkins University, Baltimore, Maryland
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23
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Neilan AM, Lu F, Gebo K, Diaz-Reyez R, Huang M, Parker R, Karalius B, Patel K, Voss C, Ciaranello A, Agwu A. 2520. Resource utilization in adolescents and young adults with HIV in the HIV Research Network. Open Forum Infect Dis 2019. [PMCID: PMC6810850 DOI: 10.1093/ofid/ofz360.2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Adolescents and young adults (AYA) with HIV experience worse health outcomes than adults with HIV in the United States. Little is known about AYA patterns of utilization of costly healthcare resources. Methods We estimated utilization of outpatient, emergency department (ED), and inpatient care among 13–30 year-olds from 2006–2015. We stratified outpatient visits, ED visits and inpatient days per person-year (PY) by transmission mode (perinatal (PHIVY), non-perinatal (NPHIVY), age (13–17, 18–23, 24–30 years), CD4 strata (< 200, 200–499, ≥ 500 cells/µL) and presence or absence of viral load (VL) suppression (<, ≥ 400 copies/mL[c/mL]) combined with antiretroviral (ARV) use. We also quantified outpatient, ED, and inpatient care associated with specific AIDS-defining conditions. Results Among 4,450 AYA (PHIVY: 15%; NPHIVY: 85%), mean (SD) follow-up was 2.8 years (2.5) [PHIVY: 4.2 years (3.1); NPHIVY: 2.5 years (2.3)]. Mean age was 21.4 years (PHIVY: 16.9 years; NPHIVY: 22.3 years) and female sex was 28% (PHIVY: 52%; NPHIVY: 23%). Among PHIVY, most person-time (PT) was spent between ages 13–23 years (13–17 years: 43%; 18–23 years: 45%), CD4 ≥ 500/µL (61%), and VL < 400 c/mL (69%). Among NPHIVY, most PT was spent between ages 24 and 30 years (56%), CD4 ≥ 500/µL (54%), and VL < 400 c/mL (66%). PT spent while prescribed ARVs and VL ≥ 400 c/mL was 30% (PHIVY) and 24% (NPHIVY). For both PHIVY and NPHIVY, outpatient visit rates were higher at younger ages (13–17 years and 18–23 years), lower CD4 (< 200, 200–499/µL), and among those prescribed ARVs (Figure 1). Rates of ED visits and inpatient days were higher during PT spent at older ages (18–23 years, 24–30 years), lower CD4 (< 200, 200–499/µL), and VL ≥ 400 c/mL (Figures 2 and 3). Overall, utilization was higher among PHIVY than NPHIVY (outpatient: 12.1 vs. 6.0/PY; ED: 0.4 vs. 0.3/PY; inpatient: 1.5 vs. 0.8/PY). The overall rate of AIDS-defining conditions was 4.5/100 PY (Figure 4). Conclusion Among AYA with HIV, more ED visits and inpatient days were observed during time spent at older ages, lower CD4 counts, and VL ≥ 400 c/mL. While AIDS-defining conditions were rare, associated resource utilization was substantial. Interventions to improve retention in care, virologic suppression, and immune response may improve outcomes, and thus decrease costly resource utilization, for AYA with HIV as they transition to adulthood. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Anne M Neilan
- Massachusetts General Hospital, Boston, Massachusetts
| | - Frances Lu
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kelly Gebo
- Johns Hopkins University, Baltimore, Maryland
| | | | - Mingshu Huang
- Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Parker
- Massachusetts General Hospital, Boston, Massachusetts
| | - Brad Karalius
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Cindy Voss
- Johns Hopkins University, Baltimore, Maryland
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24
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Rusley JC, Monroe A, Matson P, Gebo KA, Nonyane BAS, Minkovitz CS, Agwu A, Emerson M, Moore R, Rutstein R, Aberg J, Nijhawan A, Boswell S, Sanders R, Edelstein H, Baranoski A, Allen S, Beil R, Felsen U, Urbina A, Korthuis PT, Akbar M, Gaur A, Somboonwit C, Valenti W, Mathews WC, Hellinger F, Fleishman J, Fraser I, Mills R, Malitz F, Keruly J, Gebo K, Voss C, Collins C, Diaz-Reyes R. Discontinuity in Medicaid Coverage Among Young Adults with HIV. AIDS Patient Care STDS 2019; 33:89-92. [PMID: 30844306 DOI: 10.1089/apc.2018.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jack C. Rusley
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Monroe
- Division of General Internal Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pamela Matson
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly A. Gebo
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Cynthia S. Minkovitz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark Emerson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Moore
- Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judith Aberg
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ank Nijhawan
- Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Stephen Boswell
- Fenway Health and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Renata Sanders
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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25
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Fleming J, Berry S, Somboonwit C, Nijhawan AE, Moore R, Gebo K. 585. Hospitalization Rates and Diagnoses Vary by Age Group Among Persons with HIV (PWH) in 2014–2015. Open Forum Infect Dis 2018. [PMCID: PMC6253033 DOI: 10.1093/ofid/ofy210.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Effective antiretroviral therapy has increased survival in persons with HIV (PWH). Over 45% of PWH are now over 50 years old, and comorbidities of aging are becoming more prevalent. The objective of this study was to evaluate hospitalization rates and causes for hospitalization among PWH in longitudinal HIV care by age. Methods Hospitalization rates and diagnoses were determined in PWH receiving longitudinal care at 13 sites in the HIV Research Network between 2014 and 2015. Using AHRQ Clinical Classification Software, we divided inpatient ICD9 discharge diagnoses into diagnostic categories. Multivariate negative binomial regression was performed to assess for factors associated with overall hospitalization and for each diagnostic category. Results The sample included 20,608 patients, 73% male, 46% black, 21% Hispanic, 47% MSM, and 12% IDU. Median age was 48 yo [range 18–89] of which 32% were 50–59 yo, 12% were ≥ 60 yo. 75% had CD4 ≥ 350, 81% had HIV-1 RNA < 50 copies. 20% had private insurance, 36% Medicaid, 10% Medicare, and 5% were uninsured. All cause hospitalization rate for 2014–2015 was 201/1000 person-years (PY). Non-AIDS defining infection (non-ADI) was the leading cause for admission (47/1,000 PY), followed by cardiovascular disease (CVD) (22/1,000 PY), psychiatric (14/1,000 PY), endocrine (14/1,000 PY) and ADI (13/1,000 PY). In multivariate analysis, the incidence rate ratio (IRR) for all-cause hospitalization increased by age group (18–29 yo reference): 30–39 yo IRR 1.05 (95% CI 0.88, 1.26), 40–49 yo IRR 1.28 (1.08, 1.51), 50–59 yo IRR 1.43 (1.22, 1.69), and 60 yo or greater IRR 1.97 (1.64, 2.37). Hospitalization rates increased significantly by age group for CV, GU, pulmonary, endocrine, and oncology diagnostic categories. Rates did not differ by age for non-ADI infection, GI and mental health diagnostic categories. Conclusion The hospitalization rates for noncommunicable diseases (NCDs) increase as PWH age. There is an increase CV hospitalizations among older PWH. ADI accounted for fewer hospitalizations than many chronic diseases. Our results suggest that HIV experts, primary care providers and other specialists may need to work together to optimize the care of older PWH. ![]()
Disclosures A. E. Nijhawan, Gilead: Consultant, Research support.
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Affiliation(s)
| | - Stephen Berry
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Richard Moore
- Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chow J, Nijhawan A, Raifman J, Gebo K, Moore R, Berry S. 1906. Hospitalization Rates Among Persons With HIV Who Gained Medicaid or Private Insurance in 2014. Open Forum Infect Dis 2018. [PMCID: PMC6253629 DOI: 10.1093/ofid/ofy210.1562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The Ryan White Program (RWP), which provides safety net outpatient healthcare coverage to thousands of low-income persons with HIV (PWH), does not pay for inpatient care. Many PWH who relied on RWP transitioned to either Medicaid or private insurance (private) with the Affordable Care Act in 2014. It is unknown whether such transitions affected hospitalization rates. Methods We included patients from three HIV Research Network sites (two in Medicaid expansion states, one in a nonexpansion state) who relied solely on RWP in 2013. Patients either stayed in RWP through 2015, or changed to Medicaid or private in 2014. 2015 hospitalization rate ratios were modeled using negative binomial regression, adjusting for demographics, CD4 count, HIV viral load (VL), clinic site, and number of 2013 hospitalizations. Results Our sample of 1,634 patients was 73% male, 46% Black, 36% Hispanic; median age was 45 years (IQR 37,52) and median CD4 count 526 cells/μL (356, 716); 85% had a VL ≤400 copies/mL. Ninety-five patients were hospitalized in 2015. Unadjusted hospitalization rates (per 100 person years) were 8.4, 21.3, and 7.4 in 2013 and 6.3, 20.2, and 3.7 in 2015 for those who remained in RWP, switched to Medicaid, or switched to private, respectively. Switching to Medicaid or private was not associated with 2015 hospitalization rates (IRR 1.26 (95% CI 0.71–2.23) and 0.48 (0.18–1.28), table). Older age, CD4 <200, VL >400, and number of 2013 hospitalizations were associated with higher rates. Conclusion Among PWH relying on RWP in 2013, changing to either Medicaid or private insurance was not associated with a change in hospitalization rate. Among PWH, gaining inpatient coverage does not appear to increase inpatient utilization. Disclosures A. Nijhawan, Gilead: Consultant, Research support.
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Affiliation(s)
- Jeremy Chow
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Ank Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Julia Raifman
- Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Moore
- Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Berry
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Shiels MS, Althoff KN, Pfeiffer RM, Achenbach CJ, Abraham AG, Castilho J, Cescon A, D'Souza G, Dubrow R, Eron JJ, Gebo K, John Gill M, Goedert JJ, Grover S, Hessol NA, Justice A, Kitahata M, Mayor A, Moore RD, Napravnik S, Novak RM, Thorne JE, Silverberg MJ, Engels EA. HIV Infection, Immunosuppression, and Age at Diagnosis of Non-AIDS-Defining Cancers. Clin Infect Dis 2017; 64:468-475. [PMID: 27940936 DOI: 10.1093/cid/ciw764] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/02/2016] [Indexed: 01/07/2023] Open
Abstract
Background It is unclear whether immunosuppression leads to younger ages at cancer diagnosis among people living with human immunodeficiency virus (PLWH). A previous study found that most cancers are not diagnosed at a younger age in people with AIDS, with the exception of anal and lung cancers. This study extends prior work to include all PLWH and examines associations between AIDS, CD4 count, and age at cancer diagnosis. Methods We compared the median age at cancer diagnosis between PLWH in the North American AIDS Cohort Collaboration on Research and Design and the general population using data from the Surveillance, Epidemiology and End Results Program. We used statistical weights to adjust for population differences. We also compared median age at cancer diagnosis by AIDS status and CD4 count. Results After adjusting for population differences, younger ages at diagnosis (P < .05) were observed for PLWH compared with the general population for lung (difference in medians = 4 years), anal (difference = 4), oral cavity/pharynx (difference = 2), and kidney cancers (difference = 2) and myeloma (difference = 4). Among PLWH, having an AIDS-defining event was associated with a younger age at myeloma diagnosis (difference = 4; P = .01), and CD4 count <200 cells/µL (vs ≥500) was associated with a younger age at lung cancer diagnosis (difference = 4; P = .006). Conclusions Among PLWH, most cancers are not diagnosed at younger ages. However, this study strengthens evidence that lung cancer, anal cancer, and myeloma are diagnosed at modestly younger ages, and also shows younger ages at diagnosis of oral cavity/pharynx and kidney cancers, possibly reflecting accelerated cancer progression, etiologic heterogeneity, or risk factor exposure in PLWH.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Chad J Achenbach
- Department of Medicine, Division of Infectious Diseases, Center for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jessica Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Angela Cescon
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert Dubrow
- Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Nancy A Hessol
- School of Pharmacy, University of California, San Francisco, USA
| | - Amy Justice
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mari Kitahata
- Center for AIDS Research, University of Washington, Seattle, USA
| | - Angel Mayor
- School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Richard M Novak
- Division of Infectious Diseases, University of Illinois College of Medicine, Chicago, USA
| | - Jennifer E Thorne
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Griffith D, Farmer C, Rutstein R, Mathews WC, Beil R, Korthuis PT, Berry S, Nijhawan AE, Gaur A, Gebo K, Agwu A, Network HIVR. Uptake and Virologic Outcomes of 1-Pill versus Multipill Antiretroviral Therapy Among Treatment-Naive Nonperinatally HIV-Infected Youth (2006–2014). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David Griffith
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles Farmer
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Stephen Berry
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ank E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Aditya Gaur
- St Jude's Children's Research Hospital, Memphis, TN
| | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison Agwu
- Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
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29
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Buchacz K, Lau B, Jing Y, Bosch R, Abraham AG, Gill MJ, Silverberg MJ, Goedert JJ, Sterling TR, Althoff KN, Martin JN, Burkholder G, Gandhi N, Samji H, Patel P, Rachlis A, Thorne JE, Napravnik S, Henry K, Mayor A, Gebo K, Gange SJ, Moore RD, Brooks JT. Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000-2010. J Infect Dis 2016; 214:862-72. [PMID: 27559122 PMCID: PMC4996145 DOI: 10.1093/infdis/jiw085] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/24/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are few recent data on the rates of AIDS-defining opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in care in the United States and Canada. METHODS We studied HIV-infected participants in 16 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) during 2000-2010. After excluding 16 737 (21%) with any AIDS-defining clinical events documented before NA-ACCORD enrollment, we analyzed incident OIs among the remaining 63 541 persons, most of whom received antiretroviral therapy during the observation. We calculated incidence rates per 100 person-years of observation (hereafter, "person-years") with 95% confidence intervals (CIs) for the first occurrence of any OI and select individual OIs during 2000-2003, 2004-2007, and 2008-2010. RESULTS A total of 63 541 persons contributed 261 573 person-years, of whom 5836 (9%) developed at least 1 OI. The incidence rate of any first OI decreased over the 3 observation periods, with 3.0 cases, 2.4 cases, and 1.5 cases per 100 person-years of observation during 2000-2003, 2004-2007, and 2008-2010, respectively (Ptrend<.001); the rates of most individual OIs decreased as well. During 2008-2010, the leading OIs included Pneumocystis jiroveci pneumonia, esophageal candidiasis, and disseminated Mycobacterium avium complex or Mycobacterium kansasii infection. CONCLUSIONS For HIV-infected persons in care during 2000-2010, rates of first OI were relatively low and generally declined over this time.
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Affiliation(s)
- Kate Buchacz
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryan Lau
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Hasina Samji
- Johns Hopkins University, Baltimore, Maryland British Columbia Centre for Excellence in HIV/AIDS, Vancouver
| | - Pragna Patel
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Keith Henry
- Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Kelly Gebo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | - John T Brooks
- Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lee L, Yehia BR, Gaur AH, Rutstein R, Gebo K, Keruly JC, Moore RD, Nijhawan AE, Agwu AL. The Impact of Youth-Friendly Structures of Care on Retention Among HIV-Infected Youth. AIDS Patient Care STDS 2016; 30:170-7. [PMID: 26983056 DOI: 10.1089/apc.2015.0263] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Limited data exist on how structures of care impact retention among youth living with HIV (YLHIV). We describe the availability of youth-friendly structures of care within HIV Research Network (HIVRN) clinics and examine their association with retention in HIV care. Data from 680 15- to 24-year-old YLHIV receiving care at 7 adult and 5 pediatric clinics in 2011 were included in the analysis. The primary outcome was retention in care, defined as completing ≥2 primary HIV care visits ≥90 days apart in a 12-month period. Sites were surveyed to assess the availability of clinic structures defined a priori as 'youth-friendly'. Univariate and multivariable logistic regression models assessed structures associated with retention in care. Among 680 YLHIV, 85% were retained. Nearly half (48%) of the 680 YLHIV attended clinics with youth-friendly waiting areas, 36% attended clinics with evening hours, 73% attended clinics with adolescent health-trained providers, 87% could email or text message providers, and 73% could schedule a routine appointment within 2 weeks. Adjusting for demographic and clinical factors, YLHIV were more likely to be retained in care at clinics with a youth-friendly waiting area (AOR 2.47, 95% CI [1.11-5.52]), evening clinic hours (AOR 1.94; 95% CI [1.13-3.33]), and providers with adolescent health training (AOR 1.98; 95% CI [1.01-3.86]). Youth-friendly structures of care impact retention in care among YLHIV. Further investigations are needed to determine how to effectively implement youth-friendly strategies across clinical settings where YLHIV receive care.
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Affiliation(s)
- Lana Lee
- Divisions of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Baligh R. Yehia
- Department of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly Gebo
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeanne C. Keruly
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Richard D. Moore
- Divisions of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ank E. Nijhawan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allison L. Agwu
- Divisions of Adult and Pediatric Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Althoff KN, Rebeiro P, Brooks JT, Buchacz K, Gebo K, Martin J, Hogg R, Thorne JE, Klein M, Gill MJ, Sterling TR, Yehia B, Silverberg MJ, Crane H, Justice AC, Gange SJ, Moore R, Kitahata MM, Horberg MA. Disparities in the quality of HIV care when using US Department of Health and Human Services indicators. Clin Infect Dis 2014; 58:1185-9. [PMID: 24463281 DOI: 10.1093/cid/ciu044] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We estimated US Department of Health and Human Services (DHHS)-approved human immunodeficiency virus (HIV) indicators. Among patients, 71% were retained in care, 82% were prescribed treatment, and 78% had HIV RNA ≤200 copies/mL; younger adults, women, blacks, and injection drug users had poorer outcomes. Interventions are needed to reduce retention- and treatment-related disparities.
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Agwu AL, Fleishman JA, Rutstein R, Korthuis PT, Gebo K. Changes in Advanced Immunosuppression and Detectable HIV Viremia Among Perinatally HIV-Infected Youth in the Multisite United States HIV Research Network. J Pediatric Infect Dis Soc 2013; 2:215-23. [PMID: 26619475 DOI: 10.1093/jpids/pit008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/31/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Due to successful antiretroviral therapy (ART), perinatally human immunodeficiency virus (PHIV)-infected children are reaching adolescence and young adulthood. Adolescence is characterized by factors (eg, increased risk-taking) that may hamper management. We examined PHIV-infected youth in a multisite US cohort, assessing factors associated with changes in advanced immunosuppression and detectable viremia over time. METHODS We conducted a retrospective study of 521 PHIV-infected youth, 12 years and older, followed at 16 HIV clinics in the HIV Research Network between 2002 and 2010. We assessed demographic and clinical factors associated with CD4 <200 cells/mm(3) and viral load ≥2.60 log10 HIV-1 RNA copies/mL using multivariable logistic regression. RESULTS Between 2002 and 2010, the median age of PHIV-infected youth in care increased from 14 to 18 years. The proportion prescribed ART increased from 67.4% to 84%, with virologic suppression increasing from 35.5% to 63.0% (P trend < .01). Older age, Black and Hispanic race/ethnicity, and increasing viremia were independently associated with CD4 <200 cells/mm(3). Older age, Black race and Hispanic ethnicity were independently associated with higher likelihood of detectable viremia, whereas more recent year of evaluation and being prescribed ART were associated with a lower likelihood. CONCLUSIONS The proportion of PHIV-infected youth on ART has increased. Rates of viremia and advanced immunosuppression have decreased in recent years, but both rates are higher for older PHIV-infected youth. Factors associated with advanced immunosuppression and viremia offer the chance to define strategies to optimize outcomes.
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Affiliation(s)
- Allison L Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, and Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, and
| | - John A Fleishman
- Center for Financing, Access, and Cost Trends, Agency for Health Care Research and Quality, Rockville, Maryland
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania; and Departments of
| | - P Todd Korthuis
- Internal Medicine Public Health and Preventive Medicine, Oregon Health and Science University, Portland
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, and
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Oboho I, Gebo K, Moore R, Ghanem KG. P2.069* Factors Associated with Biologic False Positive Rapid Plasma Reagin (RPR) Serologies in HIV-1-Infected Persons. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abraham AG, Lau B, Deeks S, Moore RD, Zhang J, Eron J, Harrigan R, Gill MJ, Kitahata M, Klein M, Napravnik S, Rachlis A, Rodriguez B, Rourke S, Benson C, Bosch R, Collier A, Gebo K, Goedert J, Hogg R, Horberg M, Jacobson L, Justice A, Kirk G, Martin J, McKaig R, Silverberg M, Sterling T, Thorne J, Willig J, Gange SJ. Missing data on the estimation of the prevalence of accumulated human immunodeficiency virus drug resistance in patients treated with antiretroviral drugs in north america. Am J Epidemiol 2011; 174:727-35. [PMID: 21813792 DOI: 10.1093/aje/kwr141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Determination of the prevalence of accumulated antiretroviral drug resistance among persons infected with human immunodeficiency virus (HIV) is complicated by the lack of routine measurement in clinical care. By using data from 8 clinic-based cohorts from the North American AIDS Cohort Collaboration on Research and Design, drug-resistance mutations from those with genotype tests were determined and scored using the Genotypic Resistance Interpretation Algorithm developed at Stanford University. For each year from 2000 through 2005, the prevalence was calculated using data from the tested subset, assumptions that incorporated clinical knowledge, and multiple imputation methods to yield a complete data set. A total of 9,289 patients contributed data to the analysis; 3,959 had at least 1 viral load above 1,000 copies/mL, of whom 2,962 (75%) had undergone at least 1 genotype test. Using these methods, the authors estimated that the prevalence of accumulated resistance to 2 or more antiretroviral drug classes had increased from 14% in 2000 to 17% in 2005 (P < 0.001). In contrast, the prevalence of resistance in the tested subset declined from 57% to 36% for 2 or more classes. The authors' use of clinical knowledge and multiple imputation methods revealed trends in HIV drug resistance among patients in care that were markedly different from those observed using only data from patients who had undergone genotype tests.
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Affiliation(s)
- Alison G Abraham
- Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street,Suite E7640, Baltimore, MD 21205, USA.
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D'Souza G, Jing Y, Strickler H, Silverberg M, Engels E, Bosch R, Brooks JT, Dubrow R, Eron J, Gebo K, Gill MJ, Hogg B, Kitahata M, Klein M, Moore R, Rourke S, Abraham AG. Cervical cancer epidemiology among HIV-infected women in North America. Infect Agent Cancer 2010. [PMCID: PMC3002751 DOI: 10.1186/1750-9378-5-s1-a9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hill AM, Gebo K, Hemmett L, Löthgren M, Allegri G, Smets E. Predicting direct costs of HIV care during the first year of darunavir-based highly active antiretroviral therapy using CD4 cell counts: evidence from POWER. Pharmacoeconomics 2010; 28 Suppl 1:169-181. [PMID: 21182350 DOI: 10.2165/11587510-000000000-00000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Given the association between CD4 cell counts and HIV-related morbidity/mortality, new antiretroviral therapies could potentially lower the direct costs of HIV care by raising CD4 cell counts. OBJECTIVES To predict the effects of the ritonavir-boosted, HIV protease inhibitor (PI) darunavir on the direct costs of care, while accounting for CD4 cell counts, during the first year of therapy in highly treatment-experienced, HIV-infected adults in different healthcare settings. METHODS The mean annual per-patient cost of darunavir/ritonavir (DRV/r) and control PI-based highly active antiretroviral therapy (HAART) was calculated from the proportional use of antiretroviral agents in the DRV/r and control PI arms of the pooled POWER 1 and 2 trials, applying drug-acquisition costs for five healthcare settings. Non-antiretroviral-related costs by CD4 cell count, derived from non-interventional studies in the same settings, were applied to the POWER data (proportion of patients with CD4 cell counts in different strata at week 48) to estimate mean annual non-antiretroviral-related costs per patient in patients receiving DRV/r or control PI-based HAART during year 1. RESULTS Across all settings, the mean annual per-patient cost of DRV/r-based treatment was 2-19% higher than that of control PI-based therapy during the first year of therapy. By raising CD4 cell counts, however, DRV/r-based regimens were predicted to lower mean annual non-antiretroviral-related costs by 16-38% compared with control PI-based therapy. When combined, the total annual per-patient cost of HIV care during the first year of therapy was estimated to be 7% lower in the DRV/r compared with the control PI arm using US data, 8% lower using Swedish data, budget neutral using UK and Belgian data and 5% higher using Italian data. CONCLUSIONS Darunavir-based HAART may lower non-antiretroviral-related costs compared with control PI-based therapy in highly treatment-experienced, HIV-infected patients during the first year of therapy by improving patients' CD4 cell counts. These costs could partly/fully offset the increased acquisition cost of DRV/r in this patient population over the same period.
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Affiliation(s)
- Andrew M Hill
- Department of Pharmacology, University of Liverpool, Liverpool, UK and Tibotec BVBA, Mechelen, Belgium
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Chander G, Josephs J, Fleishman JA, Korthuis PT, Gaist P, Hellinger J, Gebo K. Alcohol use among HIV-infected persons in care: results of a multi-site survey. HIV Med 2008; 9:196-202. [PMID: 18366443 DOI: 10.1111/j.1468-1293.2008.00545.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to determine the prevalence of any alcohol use and hazardous alcohol consumption among HIV-infected individuals engaged in care and to identify factors associated with hazardous alcohol use. METHODS During 2003, 951 patients were interviewed at 14 HIV primary care sites in the USA. Hazardous drinking was defined as >14 drinks/week or >or=5 drinks/occasion for men and >7 drinks/week or >or=4 drinks/occasion for women. Moderate alcohol use was consumption at less than hazardous levels. We used logistic regression to identify factors associated with any alcohol use and hazardous alcohol use. RESULTS Forty per cent of the sample reported any alcohol use in the 4 weeks prior to the interview; 11% reported hazardous use. In multivariate regression, male sex [adjusted odds ratio (AOR) 1.52 (95% confidence interval, CI, 1.07-2.16)], a college education (compared to<high school) [AOR 1.87 (1.10-3.18)] and illicit drug use [AOR 2.69 (1.82-3.95)] were associated positively with any alcohol use, while CD4 nadir >or=500 cells/microL [AOR 2.65 (1.23-5.69)] and illicit drug use [AOR 2.67 (1.48-4.82)] were associated with increased odds of hazardous alcohol use (compared to moderate and none). CONCLUSIONS Alcohol use is prevalent among HIV-infected individuals and is associated with a variety of socioeconomic and demographic characteristics. Screening for alcohol use should be routine practice in HIV primary care settings.
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Affiliation(s)
- G Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Effros RB, Fletcher CV, Gebo K, Halter JB, Hazzard WR, Horne FM, Huebner RE, Janoff EN, Justice AC, Kuritzkes D, Nayfield SG, Plaeger SF, Schmader KE, Ashworth JR, Campanelli C, Clayton CP, Rada B, Woolard NF, High KP. Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clin Infect Dis 2008; 47:542-53. [PMID: 18627268 PMCID: PMC3130308 DOI: 10.1086/590150] [Citation(s) in RCA: 396] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Highly active antiretroviral treatment has resulted in dramatically increased life expectancy among patients with HIV infection who are now aging while receiving treatment and are at risk of developing chronic diseases associated with advanced age. Similarities between aging and the courses of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome suggest that HIV infection compresses the aging process, perhaps accelerating comorbidities and frailty. In a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the HIV Medical Association, the National Institute on Aging, and the National Institute on Allergy and Infectious Diseases, researchers in infectious diseases, geriatrics, immunology, and gerontology met to review what is known about HIV infection and aging, to identify research gaps, and to suggest high priority topics for future research. Answers to the questions posed are likely to help prioritize and balance strategies to slow the progression of HIV infection, to address comorbidities and drug toxicity, and to enhance understanding about both HIV infection and aging.
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Affiliation(s)
- Rita B. Effros
- David Geffen School of Medicine at the University of California, Los Angeles
| | | | - Kelly Gebo
- Johns Hopkins University School of Medicine, Baltimore
| | | | | | | | - Robin E. Huebner
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Edward N. Janoff
- Mucosal and Vaccine Research Program Colorado, University of Colorado School of Medicine, Denver
| | | | - Daniel Kuritzkes
- Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Susan F. Plaeger
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | | | | | | | | | - Beth Rada
- Infectious Diseases Society of America, Arlington, Virginia
| | - Nancy F. Woolard
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kevin P. High
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Effros R, Fletcher C, Gebo K, Halter J, Hazzard W, Horne F, Huebner R, Janoff E, Justice A, Kuritzkes D, Nayfield S, Plaeger S, Schmader K, Ashworth J, Campanelli C, Clayton C, Rada B, Woolard N, High K. Aging and Infectious Diseases: Workshop on HIV Infection and Aging: What Is Known and Future Research Directions. Clin Infect Dis 2008. [DOI: https:/doi.10.1086/590150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Hill A, Gebo K. Predicting HIV care costs using CD4 counts from clinical trials. Am J Manag Care 2007; 13:524-8. [PMID: 17803366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To predict the effects of a new antiretroviral agent on the costs of care in a US HIV care setting. METHODS Recent data on costs of patient care by CD4 count from 2 US cohorts (the HIV Research Network cohort and patients receiving primary care at the University of Alabama at Birmingham HIV clinic) were combined with CD4 count data from the POWER trials of the protease inhibitor darunavir. Patients in the POWER trials received either darunavir plus low-dose ritonavir (darunavir/r) or selected control protease inhibitors. The effects of rising CD4 counts with darunavir/r 600/100 mg twice daily on healthcare costs were predicted by using the US cohort data and published US antiretroviral drug prices. RESULTS In the POWER trials, the overall cost of antiretroviral treatment including darunavir/r was $427 (1.4%) higher than that of combination treatment including control protease inhibitors. However, this increase may be offset by lower predicted costs of HIV care, leading to predicted net savings in overall costs of HIV treatment and care of $3613 per person-year based on data from the HIV Research Network cohort and $2836 per person-year based on data from the University of Alabama cohort. The prediction of cost savings is limited to the 12-month duration of the trial. CONCLUSION By raising the CD4 count, new antiretrovirals could lower healthcare costs for HIV-infected people. This type of analysis could be used for other antiretrovirals, for a short-term assessment of overall budget impact.
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Affiliation(s)
- Andrew Hill
- Department of Pharmacology, University of Liverpool, UK, and Tibotec BVBA, Mechelen, Belgium.
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Gebo K, Wilson L. Report from Los Angeles: the 14th Conference on Retroviruses and Opportunistic Infections (CROI). Viral hepatitis co-infection in HIV. Hopkins HIV Rep 2007; 19:7-9. [PMID: 17882787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Wilson L, Gebo K. Viral hepatitis treatment and beyond: a review of CROI 2005. Hopkins HIV Rep 2005; 17:10-1, 16. [PMID: 16419312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Chaisson RE, Gebo K, Flexner C, Gallant JE, Lucas GM, Bartlett JG. Selected topics from the 9th Conference on Retroviruses and Opportunistic Infections. HIV Clin Trials 2002; 3:333-49. [PMID: 12187508 DOI: 10.1310/3dap-k96v-qpan-213l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gebo K. HIV and hepatitis C. Hopkins HIV Rep 2002; 14:5-6. [PMID: 12030211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Polydefkis M, Koenig S, Flexner C, Obah E, Gebo K, Chakrabarti S, Earl PL, Moss B, Siliciano RF. Anchor sequence-dependent endogenous processing of human immunodeficiency virus 1 envelope glycoprotein gp160 for CD4+ T cell recognition. J Exp Med 1990; 171:875-87. [PMID: 1968506 PMCID: PMC2187764 DOI: 10.1084/jem.171.3.875] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Human CD4+ T cell clones and cell lines were shown to lyse recombinant vaccinia virus-infected cells that synthesize the HIV-1 envelope glycoprotein gp160. The processing of endogenously synthesized gp160 for recognition by CD4+ T cells required that the protein, after synthesis on the rough endoplasmic reticulum and during subsequent cellular transport, remain attached to the luminal/extracellular membrane face by a hydrophobic anchor sequence.
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Affiliation(s)
- M Polydefkis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205
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