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Kim J, Newcomb CW, Carbonari DM, Torgersen J, Althoff KN, Kitahata MM, Klein MB, Moore RD, Reddy KR, Silverberg MJ, Mayor AM, Horberg MA, Cachay ER, Lim JK, Gill MJ, Chew K, Sterling TR, Hull M, Seaberg EC, Kirk GD, Coburn SB, Lang R, McGinnis KA, Gebo KA, Napravnik S, Kim HN, Lo Re V. Hepatitis B care cascade among people with HIV/HBV coinfection in the North American AIDS Cohort Collaboration on Research and Design, 2012-2016. PLoS One 2023; 18:e0290889. [PMID: 37656704 PMCID: PMC10473492 DOI: 10.1371/journal.pone.0290889] [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: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
A care cascade is a critical tool for evaluating delivery of care for chronic infections across sequential stages, starting with diagnosis and ending with viral suppression. However, there have been few data describing the hepatitis B virus (HBV) care cascade among people living with HIV infection who have HBV coinfection. We conducted a cross-sectional study among people living with HIV and HBV coinfection receiving care between January 1, 2012 and December 31, 2016 within 13 United States and Canadian clinical cohorts contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). We evaluated each of the steps in this cascade, including: 1) laboratory-confirmed HBV infection, 2) tenofovir-based or entecavir-based HBV therapy prescribed, 3) HBV DNA measured during treatment, and 4) viral suppression achieved via undetectable HBV DNA. Among 3,953 persons with laboratory-confirmed HBV (median age, 50 years; 6.5% female; 43.8% were Black; 7.1% were Hispanic), 3,592 (90.9%; 95% confidence interval, 90.0-91.8%) were prescribed tenofovir-based antiretroviral therapy or entecavir along with their antiretroviral therapy regimen, 2,281 (57.7%; 95% confidence interval, 56.2-59.2%) had HBV DNA measured while on therapy, and 1,624 (41.1%; 95% confidence interval, 39.5-42.6) achieved an undetectable HBV DNA during HBV treatment. Our study identified significant gaps in measurement of HBV DNA and suppression of HBV viremia among people living with HIV and HBV coinfection in the United States and Canada. Periodic evaluation of the HBV care cascade among persons with HIV/HBV will be critical to monitoring success in completion of each step.
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Affiliation(s)
- Jessica Kim
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Craig W. Newcomb
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Dena M. Carbonari
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessie Torgersen
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Keri N. Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mari M. Kitahata
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Marina B. Klein
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Richard D. Moore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - K. Rajender Reddy
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Mid-Atlantic Permanente Medical Group, Rockville, Maryland, United States of America
| | - Edward R. Cachay
- Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Joseph K. Lim
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Chew
- Department of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Timothy R. Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Mark Hull
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric C. Seaberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sally B. Coburn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen A. McGinnis
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Kelly A. Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - H. Nina Kim
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Vincent Lo Re
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
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Muiru AN, Madden E, Scherzer R, Horberg MA, Silverberg MJ, Klein MB, Mayor AM, John Gill M, Napravnik S, Crane HM, Marconi VC, Koethe JR, Abraham AG, Althoff KN, Lucas GM, Moore RD, Shlipak MG, Estrella MM. Effect of Adopting the New Race-Free 2021 Chronic Kidney Disease Epidemiology Collaboration Estimated Glomerular Filtration Rate Creatinine Equation on Racial Differences in Kidney Disease Progression Among People With Human Immunodeficiency Virus: An Observational Study. Clin Infect Dis 2023; 76:461-468. [PMID: 36069064 PMCID: PMC10169400 DOI: 10.1093/cid/ciac731] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/24/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The impact of adopting a race-free estimated glomerular filtration rate (eGFR) creatinine (eGFRcr) equation on racial differences in chronic kidney disease (CKD) progression among people with human immunodeficiency virus (PWH) is unknown. METHODS We defined eGFR stages using the original race-adjusted Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFRcr equation and the new race-free CKD-EPI eGFRcr equation. We then estimated 5-year probabilities of transitioning from baseline kidney function to more advanced eGFR stages and examined the association of race (black vs white) with rates of CKD progression using Markov models. RESULTS With the race-adjusted eGFRcr equation, black participants (n = 31 298) had a lower risk of progressing from eGFR stage 1 to 2 (hazard ratio [HR], 0.77; 95% confidence interval [CI], .73-.82), an equal risk of progressing from stage 2 to 3 (1.00; .92-.07) and a 3-fold risk of progressing from stage 3 to 4 or 5 (3.06; 2.60-3.62), compared with white participants (n = 27 542). When we used the race-free eGFRcr equation, 16% of black participants were reclassified into a more severe eGFR stage at baseline. The reclassified black individuals had a higher prevalence of CKD risk factors than black PWH who were not reclassified. With the race-free eGFRcr equation, black participants had a higher risk of disease progression across all eGFR stages than white participants. CONCLUSIONS The original eGFRcr equation systematically masked a subgroup of black PWH who are at high-risk of CKD progression. The new race-free eGFRcr equation unmasks these individuals and may allow for earlier detection and management of CKD.
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Affiliation(s)
- Anthony N Muiru
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Erin Madden
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | | | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine,Bayamon, Puerto Rico, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Center for AIDS Research, University of Washington, Seattle, Washington, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - John R Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison G Abraham
- Department of Epidemiology, School of Public Health University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California, USA
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
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3
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Lang R, John Gill M, Coburn SB, Grossman J, Gebo KA, Horberg MA, Mayor AM, Silverberg MJ, Willig AL, Justice AC, Klein MB, Bosch RJ, Rabkin CS, Hogan B, Thorne JE, Moore RD, Althoff KN. The changing prevalence of anemia and risk factors in people with HIV in North America who have initiated ART, 2007-2017. AIDS 2023; 37:287-298. [PMID: 36541641 PMCID: PMC9782731 DOI: 10.1097/qad.0000000000003423] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To characterize the prevalence of anemia and risk factors between 2007 and 2017 for moderate/severe anemia among people with HIV (PWH) in North America who have initiated antiretroviral therapy (ART). DESIGN Observational study of participants in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). METHODS We estimated the annual prevalence between 1 January 2007 and 31 December 2017 of mild (11.0-12.9 g/dl men, 11.0-11.9 g/dl women), moderate (8.0-10.9 g/dl regardless of sex) and severe (<8.0 g/dl regardless of sex) anemia. Poisson regression models with robust variance and general estimating equations estimated crude and adjusted prevalence ratios (aPR) with 95% confidence intervals ([-]) comparing risk factors for moderate/severe vs. no/mild anemia between 2007 and 2017. RESULTS Among 73 898 PWH we observed 366 755 hemoglobin measurements following ART initiation, 37 301 (50%) had one or more measures of anemia during follow-up (mild = 17 743 [24%]; moderate = 13 383[18%]; severe = 6175 [8%]). Moderate/severe anemia was more prevalent among women, non-Hispanic Black and Hispanic PWH (vs. non-Hispanic white), those with underweight body mass index (<18.5 kg/m2) and with comorbidities and coinfections. Older age had increased prevalence of moderate/severe anemia among males and decreased prevalence among females. Prevalence of moderate/severe anemia was greater among those with lower CD4+ cell count (≤200 cells/μl) [aPR = 2.11 (2.06-2.17)] unsuppressed HIV viral load (>200 copies/ml) [aPR = 1.26 (1.23-1.29)] and within the first 6 months of ART initiation (vs. >1 year of ART) [aPR = 1.66 (1.61-1.72)]. CONCLUSION The prevalence of anemia among PWH is reduced after ART initiation but remains high. Risk factors differ by sex and include comorbidities and HIV disease severity. The persistent, substantial prevalence of anemia among PWH merits further investigation, targeted screening, and clinical interventions.
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Affiliation(s)
- Raynell Lang
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, University of Calgary School of Medicine, Calgary, Alberta, Canada
| | - M John Gill
- Department of Medicine, University of Calgary School of Medicine, Calgary, Alberta, Canada
| | - Sally B. Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Grossman
- Department of Medicine, University of Calgary School of Medicine, Calgary, Alberta, Canada
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Angel M. Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | - Amanda L. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy C. Justice
- Yale University Schools of Medicine and Public Health, New Haven CT, USA and Veterans Affairs Connecticut Healthcare System, West Haven, CT USA
| | | | | | - Charles S. Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer E. Thorne
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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4
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Zalla LC, Cole SR, Eron JJ, Adimora AA, Vines AI, Althoff KN, Silverberg MJ, Horberg MA, Marconi VC, Coburn SB, Lang R, Williams EC, Gill MJ, Gebo KA, Klein M, Sterling TR, Rebeiro PF, Mayor AM, Moore RD, Edwards JK. Association of Race and Ethnicity With Initial Prescription of Antiretroviral Therapy Among People With HIV in the US. JAMA 2023; 329:52-62. [PMID: 36594946 PMCID: PMC9856806 DOI: 10.1001/jama.2022.23617] [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: 07/01/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Importance Integrase strand transfer inhibitor (INSTI)-containing antiretroviral therapy (ART) is currently the guideline-recommended first-line treatment for HIV. Delayed prescription of INSTI-containing ART may amplify differences and inequities in health outcomes. Objectives To estimate racial and ethnic differences in the prescription of INSTI-containing ART among adults newly entering HIV care in the US and to examine variation in these differences over time in relation to changes in treatment guidelines. Design, Setting, and Participants Retrospective observational study of 42 841 adults entering HIV care from October 12, 2007, when the first INSTI was approved by the US Food and Drug Administration, to April 30, 2019, at more than 200 clinical sites contributing to the North American AIDS Cohort Collaboration on Research and Design. Exposures Combined race and ethnicity as reported in patient medical records. Main Outcomes and Measures Probability of initial prescription of ART within 1 month of care entry and probability of being prescribed INSTI-containing ART. Differences among non-Hispanic Black and Hispanic patients compared with non-Hispanic White patients were estimated by calendar year and time period in relation to changes in national guidelines on the timing of treatment initiation and recommended initial treatment regimens. Results Of 41 263 patients with information on race and ethnicity, 19 378 (47%) as non-Hispanic Black, 6798 (16%) identified as Hispanic, and 13 539 (33%) as non-Hispanic White; 36 394 patients (85%) were male, and the median age was 42 years (IQR, 30 to 51). From 2007-2015, when guidelines recommended treatment initiation based on CD4+ cell count, the probability of ART initiation within 1 month of care entry was 45% among White patients, 45% among Black patients (difference, 0% [95% CI, -1% to 1%]), and 51% among Hispanic patients (difference, 5% [95% CI, 4% to 7%]). From 2016-2019, when guidelines strongly recommended treating all patients regardless of CD4+ cell count, this probability increased to 66% among White patients, 68% among Black patients (difference, 2% [95% CI, -1% to 5%]), and 71% among Hispanic patients (difference, 5% [95% CI, 1% to 9%]). INSTIs were prescribed to 22% of White patients and only 17% of Black patients (difference, -5% [95% CI, -7% to -4%]) and 17% of Hispanic patients (difference, -5% [95% CI, -7% to -3%]) from 2009-2014, when INSTIs were approved as initial therapy but were not yet guideline recommended. Significant differences persisted for Black patients (difference, -6% [95% CI, -8% to -4%]) but not for Hispanic patients (difference, -1% [95% CI, -4% to 2%]) compared with White patients from 2014-2017, when INSTI-containing ART was a guideline-recommended option for initial therapy; differences by race and ethnicity were not statistically significant from 2017-2019, when INSTI-containing ART was the single recommended initial therapy for most people with HIV. Conclusions and Relevance Among adults entering HIV care within a large US research consortium from 2007-2019, the 1-month probability of ART prescription was not significantly different across most races and ethnicities, although Black and Hispanic patients were significantly less likely than White patients to receive INSTI-containing ART in earlier time periods but not after INSTIs became guideline-recommended initial therapy for most people with HIV. Additional research is needed to understand the underlying racial and ethnic differences and whether the differences in prescribing were associated with clinical outcomes.
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Affiliation(s)
- Lauren C Zalla
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Now with Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen R Cole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joseph J Eron
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Keri N Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Vincent C Marconi
- Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sally B Coburn
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Raynell Lang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle
- Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs, Seattle, Washington
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly A Gebo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marina Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Timothy R Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter F Rebeiro
- Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, Tennessee
- Division of Infectious Diseases, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Angel M Mayor
- Clinical Research Center, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessie K Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Lesko CR, Edwards JK, Hanna DB, Mayor AM, Silverberg MJ, Horberg M, Rebeiro PF, Moore RD, Rich AJ, McGinnis KA, Buchacz K, Crane HM, Rabkin CS, Althoff KN, Poteat TC. Longitudinal HIV care outcomes by gender identity in the United States. AIDS 2022; 36:1841-1849. [PMID: 35876653 PMCID: PMC9529804 DOI: 10.1097/qad.0000000000003339] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Describe engagement in HIV care over time after initial engagement in HIV care, by gender identity. DESIGN Observational, clinical cohort study of people with HIV engaged in routine HIV care across the United States. METHODS We followed people with HIV who linked to and engaged in clinical care (attending ≥2 visits in 12 months) in cohorts in the North American Transgender Cohort Collaboration, 2000-2018. Within strata of gender identity, we estimated the 7-year (84-month) restricted mean time spent: lost-to-clinic (stratified by pre/postantiretroviral therapy (ART) initiation); in care prior to ART initiation; on ART but not virally suppressed; virally suppressed (≤200 copies/ml); or dead (pre/post-ART initiation). RESULTS Transgender women ( N = 482/101 841) spent an average of 35.5 out of 84 months virally suppressed (this was 30.5 months for cisgender women and 34.4 months for cisgender men). After adjustment for age, race, ethnicity, history of injection drug use, cohort, and calendar year, transgender women were significantly less likely to die than cisgender people. Cisgender women spent more time in care not yet on ART, and less time on ART and virally suppressed, but were less likely to die compared with cisgender men. Other differences were not clinically meaningful. CONCLUSIONS In this sample, transgender women and cisgender people spent similar amounts of time in care and virally suppressed. Additional efforts to improve retention in care and viral suppression are needed for all people with HIV, regardless of gender identity.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Angel M Mayor
- Department of Internal Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Michael Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Peter F Rebeiro
- Division of Infectious Diseases and Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ashleigh J Rich
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kathleen A McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kate Buchacz
- HIV Research Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi M Crane
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Charles S Rabkin
- Infections and Immunoepidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tonia C Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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6
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Castilho JL, Bian A, Jenkins CA, Shepherd BE, Sigel K, Gill MJ, Kitahata MM, Silverberg MJ, Mayor AM, Coburn SB, Wiley D, Achenbach CJ, Marconi VC, Bosch RJ, Horberg MA, Rabkin CS, Napravnik S, Novak RM, Mathews WC, Thorne JE, Sun J, Althoff KN, Moore RD, Sterling TR, Sudenga SL. CD4/CD8 Ratio and Cancer Risk Among Adults With HIV. J Natl Cancer Inst 2022; 114:854-862. [PMID: 35292820 PMCID: PMC9194634 DOI: 10.1093/jnci/djac053] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 07/23/2021] [Revised: 12/10/2021] [Accepted: 03/07/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Independent of CD4 cell count, a low CD4/CD8 ratio in people with HIV (PWH) is associated with deleterious immune senescence, activation, and inflammation, which may contribute to carcinogenesis and excess cancer risk. We examined whether low CD4/CD8 ratios predicted cancer among PWH in the United States and Canada. METHODS We examined all cancer-free PWH with 1 or more CD4/CD8 values from North American AIDS Cohort Collaboration on Research and Design observational cohorts with validated cancer diagnoses between 1998 and 2016. We evaluated the association between time-lagged CD4/CD8 ratio and risk of specific cancers in multivariable, time-updated Cox proportional hazard models using restricted cubic spines. Models were adjusted for age, sex, race and ethnicity, hepatitis C virus, and time-updated CD4 cell count, HIV RNA, and history of AIDS-defining illness. RESULTS Among 83 893 PWH, there were 5628 incident cancers, including lung cancer (n = 755), Kaposi sarcoma (n = 501), non-Hodgkin lymphoma (n = 497), and anal cancer (n = 439). The median age at cohort entry was 43 years. The overall median 6-month lagged CD4/CD8 ratio was 0.52 (interquartile range = 0.30-0.82). Compared with a 6-month lagged CD4/CD8 of 0.80, a CD4/CD8 of 0.30 was associated with increased risk of any incident cancer (adjusted hazard ratio = 1.24 [95% confidence interval = 1.14 to 1.35]). The CD4/CD8 ratio was also inversely associated with non-Hodgkin lymphoma, Kaposi sarcoma, lung cancer, anal cancer, and colorectal cancer in adjusted analyses (all 2-sided P < .05). Results were similar using 12-, 18-, and 24-month lagged CD4/CD8 values. CONCLUSIONS A low CD4/CD8 ratio up to 24 months before cancer diagnosis was independently associated with increased cancer risk in PWH and may serve as a clinical biomarker.
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Affiliation(s)
- Jessica L Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cathy A Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keith Sigel
- Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mari M Kitahata
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe School of Medicine, Bayamón, PR, USA
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dorothy Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | - Ronald J Bosch
- Department of Biostatistics, T.H. Chan Harvard School of Public Health, Boston, MA, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Medical Group and Research Institute, Washington, DC, USA
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, Rockville, MD, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Richard M Novak
- Division of Infectious Diseases, Department of Medicine, University of Illinois Chicago School of Medicine, Chicago, IL, USA
| | - W Christopher Mathews
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jennifer E Thorne
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Moore
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Staci L Sudenga
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Koh MJ, Merrill MH, Koh MJ, Stuver R, Alonso CD, Foss FM, Mayor AM, Gill J, Epeldegui M, Cachay E, Thorne JE, Silverberg MJ, Horberg MA, Althoff KN, Nijhawan AE, McGinnis KA, Lee JS, Rabkin CS, Napravnik S, Li J, Castilho JL, Shen C, Jain S. Comparative outcomes for mature T-cell and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas. Blood Adv 2022; 6:1420-1431. [PMID: 35026839 PMCID: PMC8905704 DOI: 10.1182/bloodadvances.2021006208] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
There are no studies comparing the prognosis for mature T-cell lymphoma (TCL) in people with HIV (PWH) to people without HIV (PWoH) and to AIDS-defining B-cell lymphomas (A-BCLs) in the modern antiretroviral therapy era. North American AIDS Cohort Collaboration on Research and Design and Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment are cohorts that enroll patients diagnosed with HIV and TCL, respectively. In our study, 52, 64, 101, 500, and 246 PWH with histologic confirmation of TCL, primary central nervous system lymphoma, Burkitt's lymphoma, diffuse large B-cell lymphoma (DLBCL), and Hodgkin's lymphoma (HL), respectively, and 450 TCLs without HIV were eligible for analysis. At the time of TCL diagnosis, anaplastic large-cell lymphoma (ALCL) was the most common TCL subtype within PWH. Although PWH with TCL diagnosed between 1996 and 2009 experienced a low 5-year survival probability at 0.23 (95% confidence interval [CI]: 0.13, 0.41), we observed a marked improvement in their survival when diagnosed between 2010 and 2016 (0.69; 95% CI: 0.48, 1; P = .04) in contrast to TCLs among PWoH (0.45; 95% CI: 0.41, 0.51; P = .53). Similarly, PWH with ALCLs diagnosed between 1996 and 2009 were associated with a conspicuously inferior 5-year survival probability (0.17; 95% CI: 0.07, 0.42) and consistently lagged behind A-BCL subtypes such as Burkitt's (0.43; 95% CI:0.33, 0.57; P = .09) and DLBCL (0.17; 95% CI: 0.06, 0.46; P = .11) and behind HL (0.57; 95% CI: 0.50, 0.65; P < .0001). Despite a small number, those diagnosed between 2010 and 2016 experienced a remarkable improvement in survival (0.67; 95% CI: 0.3, 1) in comparison with PWoH (0.76; 95% CI: 0.66, 0.87; P = .58). Thus, our analysis confirms improved overall survival for aggressive B- and T-cell malignancies among PWH in the last decade.
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Affiliation(s)
- Min Jung Koh
- School of Medicine, Georgetown University, Washington, DC
| | | | - Min Ji Koh
- Department of Public Health, Brown University, Providence, RI
| | - Robert Stuver
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Carolyn D. Alonso
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Canada
| | | | - Edward Cachay
- University of California at San Diego, San Diego, CA
| | | | | | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ank E. Nijhawan
- UT Southwestern Medical Center, Division of Infectious Diseases, Dallas, TX
| | | | - Jennifer S. Lee
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jessica L. Castilho
- Department of Medicine, Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Changyu Shen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Biogen, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Salvia Jain
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Massachusetts General Hospital Cancer Center, Boston, MA; and
- Harvard Medical School, Boston, MA
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8
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Young J, Re VL, Kim HN, Sterling TR, Althoff KN, Gebo KA, Gill MJ, Horberg MA, Mayor AM, Moore RD, Silverberg MJ, Klein MB. Do contemporary antiretrovirals increase the risk of end-stage liver disease? Signals from patients starting therapy in the North American AIDS Cohort Collaboration on Research and Design. Pharmacoepidemiol Drug Saf 2022; 31:214-224. [PMID: 34729853 PMCID: PMC9089458 DOI: 10.1002/pds.5379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/19/2021] [Revised: 10/14/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Despite effective antiretroviral therapy, rates of end-stage liver disease (ESLD) remain high. It is not clear whether contemporary antiretrovirals contribute to the risk of ESLD. METHODS We included patients from cohorts with validated ESLD data in the North American AIDS Cohort Collaboration on Research and Design. Patients had to initiate antiretroviral therapy after 1 January 2004 with a nucleos(t)ide backbone of either abacavir/lamivudine or tenofovir/emtricitabine and a contemporary third (anchor) drug. Patients were followed until a first ESLD event, death, end of a cohort's ESLD validation period, loss to follow-up or 31 December 2015. We estimated associations between cumulative exposure to each drug and ESLD using a hierarchical Bayesian survival model with weakly informative prior distributions. RESULTS Among 10 564 patients included from 12 cohorts, 62 had an ESLD event. Of the nine anchor drugs, boosted protease inhibitors atazanavir and darunavir had the strongest signals for ESLD, with increasing hazard ratios (HR) and narrowing credible intervals (CrI), from a prior HR of 1.5 (95% CrI 0.32-7.1) per 5 year's exposure to posterior HRs respectively of 1.8 (95% CrI 0.82-3.9) and 2.0 (95% CrI 0.86-4.7). Both backbones and efavirenz showed no signal. Hepatitis C coinfection was the most important covariate risk factor (HR 4.4, 95% CrI 2.6-7.0). CONCLUSIONS While contemporary antiretrovirals pose less risk for ESLD than hepatitis coinfection, atazanavir and darunavir had a toxicity signal. We show how hierarchical Bayesian modelling can be used to detect toxicity signals in cohort event monitoring data even with complex treatments and few events.
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Affiliation(s)
- Jim Young
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal QC, Canada.,Corresponding Author: Jim Young, Research Institute of the McGill University Health Centre, 5252 boul de Maisonneuve W, #3C.23, Montréal, QC H4A 3S5 Canada. Tel. +1-514-934-1934 ext.32198,
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, USA
| | - H. Nina Kim
- Department of Medicine, University of Washington, Seattle WA, USA
| | - Timothy R. Sterling
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville TN, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary AB, Canada
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville MD, USA
| | - Angel M. Mayor
- Retrovirus Research Center, Internal Medicine Department, School of Medicine, Universidad Central del Caribe, Bayamón PR, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | - Marina B. Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Glen Site, McGill University Health Centre, Montreal QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal QC, Canada.,CIHR Canadian HIV Trials Network, Vancouver BC, Canada
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9
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Qian Y, Moore RD, Coburn SB, Davy-Mendez T, Akgün KM, McGinnis KA, Silverberg MJ, Colasanti JA, Cachay ER, Horberg MA, Rabkin CS, Jacobson JM, Gill MJ, Mayor AM, Kirk GD, Gebo KA, Nijhawan AE, Althoff KN. Association of the VACS Index With Hospitalization Among People With HIV in the NA-ACCORD. J Acquir Immune Defic Syndr 2022; 89:9-18. [PMID: 34878432 PMCID: PMC8665227 DOI: 10.1097/qai.0000000000002812] [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: 06/04/2021] [Accepted: 09/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND People with HIV (PWH) have a higher hospitalization rate than the general population. The Veterans Aging Cohort Study (VACS) Index at study entry well predicts hospitalization in PWH, but it is unknown if the time-updated parameter improves hospitalization prediction. We assessed the association of parameterizations of the VACS Index 2.0 with the 5-year risk of hospitalization. SETTING PWH ≥30 years old with at least 12 months of antiretroviral therapy (ART) use and contributing hospitalization data from 2000 to 2016 in North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Three parameterizations of the VACS Index 2.0 were assessed and categorized by quartile: (1) "baseline" measurement at study entry; (2) time-updated measurements; and (3) cumulative scores calculated using the trapezoidal rule. METHODS Discrete-time proportional hazard models estimated the crude and adjusted associations (and 95% confidence intervals [CIs]) of the VACS Index parameterizations and all-cause hospitalizations. The Akaike information criterion (AIC) assessed the model fit with each of the VACS Index parameters. RESULTS Among 7289 patients, 1537 were hospitalized. Time-updated VACS Index fitted hospitalization best with a more distinct dose-response relationship [score <43: reference; score 43-55: aHR = 1.93 (95% CI: 1.66 to 2.23); score 55-68: aHR = 3.63 (95% CI: 3.12 to 4.23); score ≥68: aHR = 9.98 (95% CI: 8.52 to 11.69)] than study entry and cumulative VACS Index after adjusting for known risk factors. CONCLUSIONS Time-updated VACS Index 2.0 had the strongest association with hospitalization and best fit to the data. Health care providers should consider using it when assessing hospitalization risk among PWH.
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Affiliation(s)
- Yuhang Qian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thibaut Davy-Mendez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Kathleen M. Akgün
- Department of Internal Medicine and General Internal Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | - Edward R. Cachay
- Division of Infectious Diseases and Global Public Health, University of California at San Diego, San Diego, CA, USA
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - Charles S. Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Jeffrey M. Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M John Gill
- Department of Medicine, University of Calgary, S Alberta HIV Clinic, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Angel M. Mayor
- Department of Medicine, Universidad Central del Caribe at Bayamón, Puerto Rico
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ank E. Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Kim HN, Newcomb CW, Carbonari DM, Roy JA, Torgersen J, Althoff KN, Kitahata MM, Reddy KR, Lim JK, Silverberg MJ, Mayor AM, Horberg MA, Cachay ER, Kirk GD, Sun J, Hull M, Gill MJ, Sterling TR, Kostman JR, Peters MG, Moore RD, Klein MB, Re VL. Risk of HCC With Hepatitis B Viremia Among HIV/HBV-Coinfected Persons in North America. Hepatology 2021; 74:1190-1202. [PMID: 33780007 PMCID: PMC8843101 DOI: 10.1002/hep.31839] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Chronic HBV is the predominant cause of HCC worldwide. Although HBV coinfection is common in HIV, the determinants of HCC in HIV/HBV coinfection are poorly characterized. We examined the predictors of HCC in a multicohort study of individuals coinfected with HIV/HBV. APPROACH AND RESULTS We included persons coinfected with HIV/HBV within 22 cohorts of the North American AIDS Cohort Collaboration on Research and Design (1995-2016). First occurrence of HCC was verified by medical record review and/or cancer registry. We used multivariable Cox regression to determine adjusted HRs (aHRs [95% CIs]) of factors assessed at cohort entry (age, sex, race, body mass index), ever during observation (heavy alcohol use, HCV), or time-updated (HIV RNA, CD4+ percentage, diabetes mellitus, HBV DNA). Among 8,354 individuals coinfected with HIV/HBV (median age, 43 years; 93% male; 52.4% non-White), 115 HCC cases were diagnosed over 65,392 person-years (incidence rate, 1.8 [95% CI, 1.5-2.1] events/1,000 person-years). Risk factors for HCC included age 40-49 years (aHR, 1.97 [1.22-3.17]), age ≥50 years (aHR, 2.55 [1.49-4.35]), HCV coinfection (aHR, 1.61 [1.07-2.40]), and heavy alcohol use (aHR, 1.52 [1.04-2.23]), while time-updated HIV RNA >500 copies/mL (aHR, 0.90 [0.56-1.43]) and time-updated CD4+ percentage <14% (aHR, 1.03 [0.56-1.90]) were not. The risk of HCC was increased with time-updated HBV DNA >200 IU/mL (aHR, 2.22 [1.42-3.47]) and was higher with each 1.0 log10 IU/mL increase in time-updated HBV DNA (aHR, 1.18 [1.05-1.34]). HBV suppression with HBV-active antiretroviral therapy (ART) for ≥1 year significantly reduced HCC risk (aHR, 0.42 [0.24-0.73]). CONCLUSION Individuals coinfected with HIV/HBV on ART with detectable HBV viremia remain at risk for HCC. To gain maximal benefit from ART for HCC prevention, sustained HBV suppression is necessary.
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Affiliation(s)
| | | | | | - Jason A. Roy
- Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA
| | | | | | | | | | | | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | | | | | - Jing Sun
- Johns Hopkins University, Baltimore, MD, USA
| | - Mark Hull
- University of British Columbia, Vancouver, Canada
| | | | | | - Jay R. Kostman
- Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA, USA
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11
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Davy-Mendez T, Napravnik S, Eron JJ, Cole SR, van Duin D, Wohl DA, Hogan BC, Althoff KN, Gebo KA, Moore RD, Silverberg MJ, Horberg MA, Gill MJ, Mathews WC, Klein MB, Colasanti JA, Sterling TR, Mayor AM, Rebeiro PF, Buchacz K, Li J, Nanditha NGA, Thorne JE, Nijhawan A, Berry SA. Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years. J Infect Dis 2021; 224:657-666. [PMID: 34398239 PMCID: PMC8366443 DOI: 10.1093/infdis/jiaa786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/24/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Persons with human immunodeficiency virus (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. METHODS In 6 US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (years 2-5) and long-term (years 6-11) suppression and lowest presuppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRRs) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest presuppression CD4 count. RESULTS The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% white. Among patients with lowest presuppression CD4 count <200 cells/μL (44%), patients with current CD4 count 200-350 vs >500 cells/μL had aIRRs of 1.44 during early suppression (95% confidence interval [CI], 1.01-2.06), and 1.67 (95% CI, 1.03-2.72) during long-term suppression. Among patients with lowest presuppression CD4 count ≥200 (56%), patients with current CD4 351-500 vs >500 cells/μL had an aIRR of 1.22 (95% CI, .93-1.60) during early suppression and 2.09 (95% CI, 1.18-3.70) during long-term suppression. CONCLUSIONS Virologically suppressed patients with lower CD4 counts experienced higher hospitalization rates and could potentially benefit from targeted clinical management strategies.
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Affiliation(s)
- Thibaut Davy-Mendez
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen R Cole
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David van Duin
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David A Wohl
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brenna C Hogan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard D Moore
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - M John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | | | - Marina B Klein
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | - Angel M Mayor
- School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA
| | - Peter F Rebeiro
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ni Gusti Ayu Nanditha
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer E Thorne
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ank Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen A Berry
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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12
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Silverberg MJ, Leyden W, Hernández-Ramírez RU, Qin L, Lin H, Justice AC, Hessol NA, Achenbach CJ, D’Souza G, Engels EA, Althoff KN, Mayor AM, Sterling TR, Kitahata MM, Bosch RJ, Saag MS, Rabkin CS, Horberg MA, Gill MJ, Grover S, Mathews WC, Li J, Crane HM, Gange SJ, Lau B, Moore RD, Dubrow R, Neugebauer RS. Timing of Antiretroviral Therapy Initiation and Risk of Cancer Among Persons Living With Human Immunodeficiency Virus. Clin Infect Dis 2021; 72:1900-1909. [PMID: 32785640 PMCID: PMC8315132 DOI: 10.1093/cid/ciaa1046] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/26/2020] [Accepted: 07/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Persons living with human immunodeficiency virus (HIV; PLWH) experience a high burden of cancer. It remains unknown which cancer types are reduced in PLWH with earlier initiation of antiretroviral therapy (ART). METHODS We evaluated AIDS-free, ART-naive PLWH during 1996-2014 from 22 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. PLWH were followed from first observed CD4 of 350-500 cells/µL (baseline) until incident cancer, death, lost-to-follow-up, or December 2014. Outcomes included 6 cancer groups and 5 individual cancers that were confirmed by chart review or cancer registry linkage. We evaluated the effect of earlier (in the first 6 months after baseline) versus deferred ART initiation on cancer risk. Marginal structural models were used with inverse probability weighting to account for time-dependent confounding and informative right-censoring, with weights informed by subject's age, sex, cohort, baseline year, race/ethnicity, HIV transmission risk, smoking, viral hepatitis, CD4, and AIDS diagnoses. RESULTS Protective results for earlier ART were found for any cancer (adjusted hazard ratio [HR] 0.57; 95% confidence interval [CI], .37-.86), AIDS-defining cancers (HR 0.23; 95% CI, .11-.49), any virus-related cancer (HR 0.30; 95% CI, .16-.54), Kaposi sarcoma (HR 0.25; 95% CI, .10-.61), and non-Hodgkin lymphoma (HR 0.22; 95% CI, .06-.73). By 15 years, there was also an observed reduced risk with earlier ART for virus-related NADCs (0.6% vs 2.3%; adjusted risk difference -1.6; 95% CI, -2.8, -.5). CONCLUSIONS Earlier ART initiation has potential to reduce the burden of virus-related cancers in PLWH but not non-AIDS-defining cancers (NADCs) without known or suspected viral etiology.
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Affiliation(s)
- Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Raúl U Hernández-Ramírez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- School of Nursing, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, New Jersey, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
- Research Service, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Ronald J Bosch
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut, USA
| | - Romain S Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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13
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Sun J, Althoff KN, Jing Y, Horberg MA, Buchacz K, Gill MJ, Justice AC, Rabkin CS, Goedert JJ, Sigel K, Cachay E, Park L, Lim JK, Kim HN, Lo Re V, Moore R, Sterling T, Peters MG, Achenbach CJ, Silverberg M, Thorne JE, Mayor AM, Crane HM, Kitahata MM, Klein M, Kirk GD. Trends in Hepatocellular Carcinoma Incidence and Risk Among Persons With HIV in the US and Canada, 1996-2015. JAMA Netw Open 2021; 4:e2037512. [PMID: 33595662 PMCID: PMC7890526 DOI: 10.1001/jamanetworkopen.2020.37512] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE People with HIV (PWH) are often coinfected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV), leading to increased risk of developing hepatocellular carcinoma (HCC), but few cohort studies have had sufficient power to describe the trends of HCC incidence and risk among PWH in the combination antiretroviral therapy (cART) era. OBJECTIVE To determine the temporal trends of HCC incidence rates (IRs) and to compare rates by risk factors among PWH in the cART era. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) study, which was conducted between 1996 and 2015. NA-ACCORD pooled individual-level data from 22 HIV clinical and interval cohorts of PWH in the US and Canada. PWH aged 18 years or older with available CD4 cell counts and HIV RNA data were enrolled. Data analyses were completed in March 2020. EXPOSURES HBV infection was defined as detection of either HBV surface antigen, HBV e antigen, or HBV DNA in serum or plasma any time during observation. HCV infection was defined by detection of anti-HCV seropositivity, HCV RNA, or detectable genotype in serum or plasma at any time under observation. MAIN OUTCOMES AND MEASURES HCC diagnoses were identified on the basis of review of medical records or cancer registry linkage. RESULTS Of 109 283 PWH with 723 441 person-years of follow-up, the median (interquartile range) age at baseline was 43 (36-51) years, 93 017 (85.1%) were male, 44 752 (40.9%) were White, 44 322 (40.6%) were Black, 21 343 (19.5%) had HCV coinfection, 6348 (5.8%) had HBV coinfection, and 2082 (1.9%) had triple infection; 451 individuals received a diagnosis of HCC by 2015. Between the early (1996-2000) and modern (2006-2015) cART eras, the crude HCC IR increased from 0.28 to 0.75 case per 1000 person-years. HCC IRs remained constant among HIV-monoinfected persons or those coinfected with HBV, but from 1996 to 2015, IRs increased among PWH coinfected with HCV (from 0.34 cases/1000 person-years in 1996 to 2.39 cases/1000 person-years in 2015) or those with triple infection (from 0.65 cases/1000 person-years in 1996 to 4.49 cases/1000 person-years in 2015). Recent HIV RNA levels greater than or equal to 500 copies/mL (IR ratio, 1.8; 95% CI, 1.4-2.4) and CD4 cell counts less than or equal to 500 cells/μL (IR ratio, 1.3; 95% CI, 1.0-1.6) were associated with higher HCC risk in the modern cART era. People who injected drugs had higher HCC risk compared with men who had sex with men (IR ratio, 2.0; 95% CI, 1.3-2.9), adjusted for HBV-HCV coinfection. CONCLUSIONS AND RELEVANCE HCC rates among PWH increased significantly over time from 1996 to 2015. PWH coinfected with viral hepatitis, those with higher HIV RNA levels or lower CD4 cell counts, and those who inject drugs had higher HCC risk.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Yuezhou Jing
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, Maryland
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy C. Justice
- Department of Medicine, Yale University, West Haven, Connecticut
| | | | | | - Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, San Diego
| | - Lesley Park
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Joseph K. Lim
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - H. Nina Kim
- Department of Medicine, University of Washington, Seattle
| | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
| | - Richard Moore
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Timothy Sterling
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marion G. Peters
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Chad J. Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Angel M. Mayor
- Retrovirus Research Center, Department of Medicine, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Heidi M. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Mari M. Kitahata
- Department of Medicine, University of Washington School of Medicine, Seattle
| | - Marina Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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14
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Hernández-Ramírez RU, Qin L, Lin H, Leyden W, Neugebauer RS, Althoff KN, Hessol NA, Achenbach CJ, Brooks JT, Gill MJ, Grover S, Horberg MA, Li J, Mathews WC, Mayor AM, Patel P, Rabkin CS, Rachlis A, Justice AC, Moore RD, Engels EA, Silverberg MJ, Dubrow R. Association of Immunosuppression and Human Immunodeficiency Virus (HIV) Viremia With Anal Cancer Risk in Persons Living With HIV in the United States and Canada. Clin Infect Dis 2021; 70:1176-1185. [PMID: 31044245 DOI: 10.1093/cid/ciz329] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/07/2019] [Accepted: 04/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV; PLWH) have a markedly elevated anal cancer risk, largely due to loss of immunoregulatory control of oncogenic human papillomavirus infection. To better understand anal cancer development and prevention, we determined whether recent, past, cumulative, or nadir/peak CD4+ T-cell count (CD4) and/or HIV-1 RNA level (HIV RNA) best predict anal cancer risk. METHODS We studied 102 777 PLWH during 1996-2014 from 21 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. Using demographics-adjusted, cohort-stratified Cox models, we assessed associations between anal cancer risk and various time-updated CD4 and HIV RNA measures, including cumulative and nadir/peak measures during prespecified moving time windows. We compared models using the Akaike information criterion. RESULTS Cumulative and nadir/peak CD4 or HIV RNA measures from approximately 8.5 to 4.5 years in the past were generally better predictors for anal cancer risk than their corresponding more recent measures. However, the best model included CD4 nadir (ie, the lowest CD4) from approximately 8.5 years to 6 months in the past (hazard ratio [HR] for <50 vs ≥500 cells/µL, 13.4; 95% confidence interval [CI], 3.5-51.0) and proportion of time CD4 <200 cells/µL from approximately 8.5 to 4.5 years in the past (a cumulative measure; HR for 100% vs 0%, 3.1; 95% CI, 1.5-6.6). CONCLUSIONS Our results are consistent with anal cancer promotion by severe, prolonged HIV-induced immunosuppression. Nadir and cumulative CD4 may represent useful markers for identifying PLWH at higher anal cancer risk.
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Affiliation(s)
- Raúl U Hernández-Ramírez
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Chad J Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John T Brooks
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M John Gill
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - Jun Li
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Angel M Mayor
- Retrovirus Research Center, Department of Medicine, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Pragna Patel
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles S Rabkin
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Anita Rachlis
- Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Ontario, Canada
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Department of Health Policy and Management, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut.,Research Service, Veterans Affairs Connecticut Healthcare System, West Haven
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric A Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | | | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public Health, Yale School of Medicine, New Haven, Connecticut
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15
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Davy-Mendez T, Napravnik S, Hogan BC, Althoff KN, Gebo KA, Moore RD, Horberg MA, Silverberg MJ, Gill MJ, Crane HM, Marconi VC, Bosch RJ, Colasanti JA, Sterling TR, Mathews WC, Mayor AM, Nanditha NGA, Buchacz K, Li J, Rebeiro PF, Thorne JE, Nijhawan A, van Duin D, Wohl DA, Eron JJ, Berry SA. Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005-2015. J Infect Dis 2020; 223:2113-2123. [PMID: 33084891 DOI: 10.1093/infdis/jiaa661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/14/2020] [Accepted: 10/15/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015. METHODS In 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL. RESULTS Among 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories. CONCLUSIONS Among PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.
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Affiliation(s)
- Thibaut Davy-Mendez
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brenna C Hogan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri N Althoff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kelly A Gebo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard D Moore
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | | | - M John Gill
- Southern Alberta HIV Clinic, Calgary, Alberta, Canada
| | - Heidi M Crane
- School of Medicine, University of Washington, Seattle, Washington, USA
| | | | - Ronald J Bosch
- T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | | | | | | | - Angel M Mayor
- School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico, USA
| | - Ni Gusti Ayu Nanditha
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Peter F Rebeiro
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jennifer E Thorne
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ank Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David van Duin
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David A Wohl
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph J Eron
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen A Berry
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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16
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Rebeiro PF, Jenkins CA, Bian A, Lake JE, Bourgi K, Moore RD, Horberg MA, Matthews WC, Silverberg MJ, Thorne J, Mayor AM, Lima VD, Palella FJ, Saag MS, Althoff KN, Gill MJ, Wong C, Klein MB, Crane HM, Marconi VC, Shepherd BE, Sterling TR, Koethe JR. Risk of Incident Diabetes Mellitus, Weight Gain, and their Relationships with Integrase Inhibitor-based Initial Antiretroviral Therapy Among Persons with HIV in the US and Canada. Clin Infect Dis 2020; 73:e2234-e2242. [PMID: 32936919 DOI: 10.1093/cid/ciaa1403] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Integrase strand transfer inhibitor (INSTI)-based combination antiretroviral therapy (cART) is associated with greater weight gain among persons with HIV, though the metabolic consequences, such as diabetes mellitus (DM), are unclear. We examined the impact of initial cART regimen and weight on incident DM in a large North American HIV cohort (NA-ACCORD). METHODS cART-naïve adults (≥18 years) initiating INSTI-, PI-, or NNRTI-based regimens from 01/2007-12/2017 who had weight measured 12 (±6) months after treatment initiation contributed time until clinical DM (HbA1c ≥6.5%, initiation of DM-specific medication, or new DM diagnosis plus DM-related medication), virologic failure, cART regimen switch, administrative close, death, or loss to follow-up. Multivariable Cox regression yielded adjusted hazard ratios (HR) and 95% confidence intervals ([-]) for incident DM by cART class. Mediation analyses, with 12-month weight as mediator, adjusted for all covariates from the primary analysis. RESULTS Among 22,884 eligible individuals, 47% started NNRTI-, 30% PI-, and 23% INSTI-based cART with median follow-up of 3.0, 2.3, and 1.6 years, respectively. Overall, 722 (3%) developed DM. Persons starting INSTIs vs. NNRTIs had incident DM risk (HR=1.17 [0.92-1.48]) similar to PI- vs. NNRTI-initiators (HR=1.27 [1.07-1.51]). This effect was most pronounced for raltegravir- (HR=1.42 [1.06-1.91]) vs. NNRTI-initiators. The INSTI-DM association was attenuated (HR=1.03 [0.71-1.49] vs. NNRTIs) when accounting for 12-month weight. CONCLUSIONS Initiating first cART regimens with INSTIs or PIs vs. NNRTIs may confer greater risk of DM, likely mediated through weight gain. Further characterization of metabolic changes after INSTI initiation and potential therapeutic interventions are needed.
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Affiliation(s)
- Peter F Rebeiro
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cathy A Jenkins
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aihua Bian
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jordan E Lake
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | | | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamón, PR, USA
| | | | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | | | | | | | - John R Koethe
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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17
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Malpica-Nieves CJ, Rivera-Aponte DE, Tejeda-Bayron FA, Mayor AM, Phanstiel O, Veh RW, Eaton MJ, Skatchkov SN. The involvement of polyamine uptake and synthesis pathways in the proliferation of neonatal astrocytes. Amino Acids 2020; 52:1169-1180. [PMID: 32816168 PMCID: PMC7908810 DOI: 10.1007/s00726-020-02881-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/24/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Polyamines (PAs), such as spermidine (SPD) and spermine (SPM), are essential to promote cell growth, survival, proliferation, and longevity. In the adult central nervous system (CNS), SPD and SPM are accumulated predominantly in healthy adult glial cells where PA synthesis is not present. To date, the accumulation and biosynthesis of PAs in developing astrocytes are not well understood. The purpose of the present study was to determine the contribution of uptake and/or synthesis of PAs using proliferation of neonatal astrocytes as an endpoint. We inhibited synthesis of PAs using α-difluoromethylornithine (DFMO; an inhibitor of the PA biosynthetic enzyme ornithine decarboxylase (ODC)) and inhibited uptake of PAs using trimer44NMe (PTI; a novel polyamine transport inhibitor). DFMO, but not PTI alone, blocked proliferation, suggesting that PA biosynthesis was present. Furthermore, exogenous administration of SPD rescued cell proliferation when PA synthesis was blocked by DFMO. When both synthesis and uptake of PAs were inhibited (DFMO + PTI), exogenous SPD no longer supported proliferation. These data indicate that neonatal astrocytes synthesize sufficient quantities of PAs de novo to support cell proliferation, but are also able to import exogenous PAs. This suggests that the PA uptake mechanism is present in both neonates as well as in adults and can support cell proliferation in neonatal astrocytes when ODC is blocked.
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Affiliation(s)
- Christian J Malpica-Nieves
- Department of Biochemistry, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA
| | - David E Rivera-Aponte
- Department of Biochemistry, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA
| | - Flavia A Tejeda-Bayron
- Department of Biochemistry, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA
| | - Angel M Mayor
- Department of Internal Medicine, Universidad Central del Caribe, Bayamón, PR, 00956, USA
| | - Otto Phanstiel
- Department of Medical Education, University of Central Florida, Orlando, FL, 32816, USA
| | - Rüdiger W Veh
- Institut für Zell- Und Neurobiologie, Charité, 10117, Berlin, Germany
| | - Misty J Eaton
- Department of Biochemistry, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA
| | - Serguei N Skatchkov
- Department of Biochemistry, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA.
- Department of Physiology, School of Medicine, Universidad Central del Caribe, P.O. Box 60327, Bayamón, PR, 00960-6032, USA.
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18
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Althoff KN, Chandran A, Zhang J, Arevalo WM, Gange SJ, Sterling TR, Gill MJ, Justice AC, Palella FJ, Rebeiro PF, Silverberg MJ, Mayor AM, Horberg MA, Thorne JE, Rabkin CS, Mathews WC, Klein MB, Humes E, Lee J, Hogg R, Moore RD. Life-Expectancy Disparities Among Adults With HIV in the United States and Canada: The Impact of a Reduction in Drug- and Alcohol-Related Deaths Using the Lives Saved Simulation Model. Am J Epidemiol 2019; 188:2097-2109. [PMID: 31602475 PMCID: PMC7036649 DOI: 10.1093/aje/kwz232] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 11/05/2018] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 12/27/2022] Open
Abstract
Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic, drug- and alcohol-related deaths might be contributing to the disparities in life expectancy. We sought to estimate life expectancy at age 20 years in key populations (and their comparison groups) in 3 time periods (2004-2007, 2008-2011, and 2012-2015) and the potential increase in expected life expectancy with a simulated 20% reduction in drug- and alcohol-related deaths using the novel Lives Saved Simulation model. Among 92,289 PLWH, life expectancy increased in all key populations and comparison groups from 2004-2007 to 2012-2015. Disparities in survival of approximately a decade persisted among black versus white men who have sex with men and people with (vs. without) a history of injection drug use. A 20% reduction in drug- and alcohol-related mortality would have the greatest life-expectancy benefit for black men who have sex with men, white women, and people with a history of injection drug use. Our findings suggest that preventing drug- and alcohol-related deaths among PLWH could narrow disparities in life expectancy among some key populations, but other causes of death must be addressed to further narrow the disparities.
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Affiliation(s)
- Keri N Althoff
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jinbing Zhang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Stephen J Gange
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy C Justice
- Department of Medicine, Yale University, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut
| | - Frank J Palella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Peter F Rebeiro
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Angel M Mayor
- Department of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Jennifer E Thorne
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elizabeth Humes
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer Lee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Robert Hogg
- Department of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for HIV/AIDS Excellence, Vancouver, British Columbia, Canada
| | - Richard D Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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19
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Rebeiro PF, Rebeiro PF, Jenkins C, Bian A, Lake J, Lake J, Bourgi K, Bourgi K, Horberg MA, Horberg MA, Moore R, Moore R, Altoff K, Klein M, Eron JJ, Eron JJ, Gill MJ, Kitahata M, Napravnik S, Silverberg M, Mayor AM, Willig A, Willig A, Floris-Moore M, Sterling T, Koethe JR, Koethe JR. LB9. The Effect of Initiating Integrase Inhibitor-based vs. Non-Nucleoside Reverse Transcriptase Inhibitor-based Antiretroviral Therapy on Progression to Diabetes among North American Persons in HIV Care. Open Forum Infect Dis 2019. [PMCID: PMC6810257 DOI: 10.1093/ofid/ofz415.2492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/30/2022] Open
Abstract
Background Integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) has been implicated in greater weight gain than other regimens among people with HIV, but there is little evidence about its role in serious clinical outcomes proximal to weight gain. We therefore examined the impact of initial ART regimen class/drug on incident diabetes mellitus (DM) in a large North American HIV cohort. Methods Treatment-naïve adults (≥18 years) initiating INSTI-, protease inhibitor (PI)-, or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART from January 2007 to December 2016 in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Individuals were followed until date of incident DM (HgA1c >6.5%, diabetes-specific medication, DM diagnosis along with diabetes-related medication, or random glucose measure ≥200 mg/dL), virologic failure, regimen core switch, cohort close (through December 2016), death date, or loss to follow-up (≥12 months with no contact before cohort close). Cox regression stratified by site and adjusting for age, sex, race, HIV transmission risk, year of ART initiation, and baseline weight, CD4+ cell count, and HIV-1 RNA yielded adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident DM by ART class and INSTI drug. Results Among 21,516 eligible ART initiators, 10,553 (49%) started NNRTIs, 6,677 (31%) PIs, and 4,286 (20%) INSTIs, with median follow-up of 3.0, 2.4, and 1.6 years, respectively. Among INSTI initiators, 21% started dolutegravir (DTG), 28% raltegravir (RAL), and 51% elvitegravir (EVG). Overall, 669 (3%) developed DM. Patients differed by all characteristics except baseline body mass index and HIV-1 RNA. Those starting INSTIs vs. NNRTIs had increased risk of incident DM (HR = 1.22; CI: 0.95–1.57) similar in magnitude as for PI vs. NNRTI initiators (HR = 1.25; CI: 1.05–1.49) (figure). Among INSTIs, starting RAL- vs. NNRTI-based ART was associated with a 50% increased risk of DM (HR = 1.50, CI: 1.11–2.03). Conclusion Initiating ART with INSTI- or PI- vs. NNRTI-based regimens may confer increased risk of incident DM, though risk is heterogeneous among INSTIs. Further research is needed to determine whether this elevated risk can be attributed to weight gain. ![]()
Disclosures Kassem Bourgi, MD, Gilead Sciences (Grant/Research Support), Joseph J. Eron, MD, Gilead Sciences (Consultant, Grant/Research Support), Janssen (Grant/Research Support), Merck (Consultant), ViiV Healthcare (Consultant, Grant/Research Support), M. John Gill, MB, ChB, MSc, Gilead (Board Member), Merck (Board Member), Viiv (Board Member), Michael Silverberg, PhD, MPH, Gilead (Grant/Research Support). Other Authors: No reported disclosures.
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Affiliation(s)
| | | | - Cathy Jenkins
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aihua Bian
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan Lake
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Jordan Lake
- University of Texas Health Science Center at Houston, Houston, Texas
| | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Kassem Bourgi
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | | | - Keri Altoff
- Johns Hopkins University, Baltimore, Maryland
| | - Marina Klein
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - M John Gill
- University of Calgary, Calgary, Alberta, Canada
| | | | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Angel M Mayor
- Universidad Central del Caribe, Carolina, Not Applicable, Puerto Rico
| | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John R Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - John R Koethe
- Vanderbilt University Medical Center, Nashville, Tennessee
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20
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Lo Re V, Newcomb CW, Carbonari DM, Roy JA, Althoff KN, Kitahata MM, Reddy KR, Lim JK, Silverberg MJ, Mayor AM, Horberg MA, Cachay ER, Kirk GD, Hull M, Gill J, Sterling TR, Kostman JR, Peters MG, Moore RD, Klein MB, Kim HN. Determinants of Liver Complications Among HIV/Hepatitis B Virus-Coinfected Patients. J Acquir Immune Defic Syndr 2019; 82:71-80. [PMID: 31107304 PMCID: PMC6692181 DOI: 10.1097/qai.0000000000002094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a leading cause of end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in HIV. Factors contributing to the high rates of liver complications among HIV/HBV-coinfected individuals remain unknown. SETTING North American AIDS Cohort Collaboration on Research and Design. METHODS We performed a retrospective cohort study among HIV/HBV-coinfected patients in 10 US and Canadian cohorts of the North American AIDS Cohort Collaboration on Research and Design that validated ESLD (ascites, spontaneous bacterial peritonitis, variceal hemorrhage, and/or hepatic encephalopathy) and HCC diagnoses from 1996 to 2010. Multivariable Cox regression was used to examine adjusted hazard ratios [aHRs with 95% confidence interval (CIs)] of liver complications (first occurrence of ESLD or HCC) associated with hypothesized determinants and with increasing durations of HIV suppression (≤500 copies/mL). RESULTS Among 3573 HIV/HBV patients with 13,790 person-years of follow-up, 111 liver complications occurred (incidence rate = 8.0 [95% CI: 6.6 to 9.7] events/1000 person-years). Rates of liver complication were increased with non-black/non-Hispanic race [aHR = 1.76 (1.13-2.74)], diabetes mellitus [aHR = 2.07 (1.20-3.57)], lower time-updated CD4 cell count [<200 cells/mm: aHR = 2.59 (1.36-4.91); 201-499 cells/mm: aHR = 1.75 (1.01-3.06) versus ≥500 cells/mm], heavy alcohol use [aHR = 1.58 (1.04-2.39)], and higher FIB-4 at start of follow-up [>3.25: aHR = 9.79 (5.73-16.74); 1.45-3.25: aHR = 3.20 (1.87-5.47) versus FIB-4 <1.45]. HIV suppression for ≥6 months was associated with lower liver complication rates compared with those with unsuppressed HIV [aHR = 0.56 (0.35-0.91)]. CONCLUSIONS Non-black/non-Hispanic race, diabetes, lower CD4 cell count, heavy alcohol use, and advanced liver fibrosis were determinants of liver complications among HIV/HBV patients. Sustained HIV suppression should be a focus for HIV/HBV-coinfected patients to reduce the risks of ESLD/HCC.
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Affiliation(s)
- Vincent Lo Re
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Craig W Newcomb
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dena M Carbonari
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jason A Roy
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Mari M Kitahata
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Rajender Reddy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph K Lim
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Angel M Mayor
- Department of Medicine, Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamon, Puerto Rico
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Edward R Cachay
- Department of Medicine, University of California, San Diego, CA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Mark Hull
- Department of Medicine, British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
| | - John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Timothy R Sterling
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV Trials, Philadelphia, PA
| | - Marion G Peters
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marina B Klein
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - H Nina Kim
- Department of Medicine, University of Washington, Seattle, WA
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21
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Hernández-Ramírez RU, Qin L, Lin H, Leyden W, Neugebauer RS, Althoff KN, Achenbach CJ, Hessol NA, D’Souza G, Gebo KA, Gill MJ, Grover S, Horberg MA, Li J, Mathews WC, Mayor AM, Park LS, Rabkin CS, Salters K, Justice AC, Moore RD, Engels EA, Silverberg MJ, Dubrow R. Association of immunosuppression and HIV viraemia with non-Hodgkin lymphoma risk overall and by subtype in people living with HIV in Canada and the USA: a multicentre cohort study. Lancet HIV 2019; 6:e240-e249. [PMID: 30826282 PMCID: PMC6531288 DOI: 10.1016/s2352-3018(18)30360-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Research is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype. METHODS We studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion. FINDINGS Of 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months; <50 cells per μL vs ≥500 cells per μL, hazard ratio [HR] 3·2, 95% CI 2·2-4·7) and average viral load during a 3-year window lagged by 6 months (a cumulative measure; ≥100 000 copies per mL vs ≤500 copies per mL, HR 9·6, 95% CI 6·5-14·0). These measures were also the key predictors of risk for diffuse large B-cell lymphoma (recent CD4 count <50 cells per μL vs ≥500 cells per μL, HR 2·4, 95% CI 1·4-4·2; average viral load ≥100 000 copies per mL vs ≤500 copies per mL, HR 7·5, 95% CI 4·5-12·7). However, recent CD4 count was the sole key predictor of risk for CNS non-Hodgkin lymphoma (<50 cells per μL vs ≥500 cells per μL, HR 426·3, 95% CI 58·1-3126·4), and proportion of time viral load was greater than 500 copies per mL during the 3-year window (a cumulative measure) was the sole key predictor for Burkitt lymphoma (100% vs 0%, HR 41·1, 95% CI 9·1-186·6). INTERPRETATION Both recent immunosuppression and prolonged HIV viraemia have important independent roles in the development of non-Hodgkin lymphoma, with likely subtype heterogeneity. Early and sustained antiretroviral therapy to decrease HIV replication, dampen B-cell activation, and restore overall immune function is crucial for preventing non-Hodgkin lymphoma. FUNDING National Institutes of Health, Centers for Disease Control and Prevention, US Agency for Healthcare Research and Quality, US Health Resources and Services Administration, Canadian Institutes of Health Research, Ontario Ministry of Health and Long Term Care, and the Government of Alberta.
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Affiliation(s)
- Raúl U. Hernández-Ramírez
- Corresponding author: Raúl U.
Hernández-Ramírez, Department of Biostatistics, Yale School of
Public Health, New Haven, CT 06520-8034, USA
| | - Li Qin
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA
| | - Haiqun Lin
- Department of Biostatistics, Yale School of Public Health, Yale
School of Medicine, New Haven, CT, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California,
Oakland, CA, USA
| | | | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Chad J. Achenbach
- Division of Infectious Diseases, Northwestern University Feinberg
School of Medicine, Chicago, IL, USA
| | - Nancy A. Hessol
- Department of Clinical Pharmacy, University of California, San
Francisco, San Francisco, CA, USA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg
School of Public Health, Baltimore, MD, USA
| | - Kelly A. Gebo
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Alberta,
Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania
Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente
Mid-Atlantic States, Rockville, MD, USA
| | - Jun Li
- Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe School
of Medicine, Bayamon, Puerto Rico
| | - Lesley S. Park
- Stanford Center for Population Health Sciences, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Charles S. Rabkin
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | - Kate Salters
- Epidemiology and Population Health, British Columbia Centre for
Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, New
Haven, CT, USA,Department of Health Policy and Management, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA,Research Service, Veterans Affairs Connecticut Healthcare System,
West Haven, CT, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, Rockville, MD,
USA
| | | | - Robert Dubrow
- Department of Environmental Health Sciences, Yale School of Public
Health, Yale School of Medicine, New Haven, CT, USA
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22
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Althoff KN, Wong C, Hogan B, Desir F, You B, Humes E, Zhang J, Jing Y, Modur S, Lee JS, Freeman A, Kitahata M, Van Rompaey S, Mathews WC, Horberg MA, Silverberg MJ, Mayor AM, Salters K, Moore RD, Gange SJ. Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data. Ann Epidemiol 2019; 33:54-63. [PMID: 31005552 DOI: 10.1016/j.annepidem.2019.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/19/2018] [Revised: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Use of electronic health records (EHRs) in health research may lead to the false assumption of complete event ascertainment. We estimated "observation windows" (OWs), defined as periods within which the assumption of complete ascertainment of events is more likely to hold, as a quality control approach to reducing the likelihood of this false assumption. We demonstrated the impact of OWs on estimating the rates of type II diabetes mellitus (diabetes) from HIV clinical cohorts. METHODS Data contributed by 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence as a case study. Procedures included (1) gathering cohort-level data; (2) visualizing and summarizing gaps in observations; (3) systematically establishing start and stop dates during which the assumption of complete ascertainment of diabetes events was reasonable; and (4) visualizing the diabetes OWs relative to the cohort open and close dates to identify immortal person-time. We estimated diabetes occurrence event rates and 95% confidence intervals in the most recent decade that data were available (January 1, 2007, to December 31, 2016). RESULTS The number of diabetes events decreased by 17% with the use of the diabetes OWs; immortal person-time was removed decreasing total person-years by 23%. Consequently, the diabetes rate increased from 1.23 (95% confidence interval [1.20, 1.25]) per 100 person-years to 1.32 [1.29, 1.35] per 100 person-years with the use of diabetes OWs. CONCLUSIONS As the use of EHR-curated data for event-driven health research continues to expand, OWs have utility as a quality control approach to complete event ascertainment, helping to improve accuracy of estimates by removing immortal person-time when ascertainment is incomplete.
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Affiliation(s)
| | | | | | | | - Bin You
- Johns Hopkins University, Baltimore, MD
| | | | | | | | | | | | | | | | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
| | | | - Angel M Mayor
- Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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23
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Desir FA, Lesko CR, Moore RD, Horberg MA, Wong C, Crane HM, Silverberg M, Thorne JE, Rachlis B, Rabkin C, Mayor AM, Mathews WC, Althoff KN. One Size Fits (n)One: The Influence of Sex, Age, and Sexual Human Immunodeficiency Virus (HIV) Acquisition Risk on Racial/Ethnic Disparities in the HIV Care Continuum in the United States. Clin Infect Dis 2019; 68:795-802. [PMID: 30169624 PMCID: PMC6376102 DOI: 10.1093/cid/ciy556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 03/06/2018] [Accepted: 07/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood. METHODS We estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014. RESULTS Among women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites. CONCLUSIONS Racial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.
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Affiliation(s)
- Fidel A Desir
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
| | - Michael A Horberg
- Division of Research, Kaiser Permanente Mid-Atlantic Research Group, Rockville, Maryland
| | - Cherise Wong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Heidi M Crane
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | | | - Jennifer E Thorne
- Division of Ocular Immunology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland
| | - Beth Rachlis
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Charles Rabkin
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Angel M Mayor
- Department of Internal Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico
| | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
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24
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Althoff KN, Gebo KA, Moore RD, Boyd CM, Justice AC, Wong C, Lucas GM, Klein MB, Kitahata MM, Crane H, Silverberg MJ, Gill MJ, Mathews WC, Dubrow R, Horberg MA, Rabkin CS, Klein DB, Lo Re V, Sterling TR, Desir FA, Lichtenstein K, Willig J, Rachlis AR, Kirk GD, Anastos K, Palella FJ, Thorne JE, Eron J, Jacobson LP, Napravnik S, Achenbach C, Mayor AM, Patel P, Buchacz K, Jing Y, Gange SJ. Contributions of traditional and HIV-related risk factors on non-AIDS-defining cancer, myocardial infarction, and end-stage liver and renal diseases in adults with HIV in the USA and Canada: a collaboration of cohort studies. Lancet HIV 2019; 6:e93-e104. [PMID: 30683625 DOI: 10.1016/s2352-3018(18)30295-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/03/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Adults with HIV have an increased burden of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease. The objective of this study was to estimate the population attributable fractions (PAFs) of preventable or modifiable HIV-related and traditional risk factors for non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes. METHODS We included participants receiving care in academic and community-based outpatient HIV clinical cohorts in the USA and Canada from Jan 1, 2000, to Dec 31, 2014, who contributed to the North American AIDS Cohort Collaboration on Research and Design and who had validated non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, or end-stage renal disease outcomes. Traditional risk factors were tobacco smoking, hypertension, elevated total cholesterol, type 2 diabetes, renal impairment (stage 4 chronic kidney disease), and hepatitis C virus and hepatitis B virus infections. HIV-related risk factors were low CD4 count (<200 cells per μL), detectable plasma HIV RNA (>400 copies per mL), and history of a clinical AIDS diagnosis. PAFs and 95% CIs were estimated to quantify the proportion of outcomes that could be avoided if the risk factor was prevented. FINDINGS In each of the study populations for the four outcomes (1405 of 61 500 had non-AIDS-defining cancer, 347 of 29 515 had myocardial infarctions, 387 of 35 044 had end-stage liver disease events, and 255 of 35 620 had end-stage renal disease events), about 17% were older than 50 years at study entry, about 50% were non-white, and about 80% were men. Preventing smoking would avoid 24% (95% CI 13-35) of these cancers and 37% (7-66) of the myocardial infarctions. Preventing elevated total cholesterol and hypertension would avoid the greatest proportion of myocardial infarctions: 44% (30-58) for cholesterol and 42% (28-56) for hypertension. For liver disease, the PAF was greatest for hepatitis C infection (33%; 95% CI 17-48). For renal disease, the PAF was greatest for hypertension (39%; 26-51) followed by elevated total cholesterol (22%; 13-31), detectable HIV RNA (19; 9-31), and low CD4 cell count (13%; 4-21). INTERPRETATION The substantial proportion of non-AIDS-defining cancers, myocardial infarction, end-stage liver disease, and end-stage renal disease outcomes that could be prevented with interventions on traditional risk factors elevates the importance of screening for these risk factors, improving the effectiveness of prevention (or modification) of these risk factors, and creating sustainable care models to implement such interventions during the decades of life of adults living with HIV who are receiving care. FUNDING National Institutes of Health, US Centers for Disease Control and Prevention, the US Agency for Healthcare Research and Quality, the US Health Resources and Services Administration, the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long Term Care, and the Government of Alberta.
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Affiliation(s)
- Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Kelly A Gebo
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Richard D Moore
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amy C Justice
- Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Cherise Wong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory M Lucas
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA
| | | | | | | | | | - Fidel A Desir
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Anita R Rachlis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jennifer E Thorne
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph Eron
- University of North Carolina, Chapel Hill, NC, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Pragna Patel
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yuezhou Jing
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Lancaster KE, Hetrick A, Jaquet A, Adedimeji A, Atwoli L, Colby DJ, Mayor AM, Parcesepe A, Syvertsen J. Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities. J Virus Erad 2018; 4:26-32. [PMID: 30515311 PMCID: PMC6248849] [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] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
As universal testing and treatment for HIV, or 'treat all', expands across sub-Saharan Africa (SSA), substance use will likely have a negative impact on the success of scale-up efforts for antiretroviral treatment (ART). Overwhelming evidence highlights the negative impact of substance use on HIV care and treatment outcomes. Yet, as many countries in SSA expand ART, evidence of the extent of substance use, and its impact in the region, is more limited. Stigma, and the psychoactive effects of substance use, are barriers to seeking HIV treatment and adhering to ART regimens for persons with heavy alcohol use or substance use. As a result, we identified several implementation and operations research priorities and metrics for monitoring the impact of substance use and Treat All. Identifying barriers and facilitators to the integration of the prevention and treatment of substance use with HIV care, and assessing effects on HIV outcomes, through longitudinal studies are priorities that will determine the impacts of substance use on 'treat all' in SSA. Future research must use existing infrastructure, including large networks of HIV clinics, to enhance our understanding of the implementation and service delivery of substance use screening, referral and treatment. These networks will also inform robust and standardised substance use estimates and interventions within the 'treat all' era in SSA.
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Affiliation(s)
- Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, Ohio State University,
Columbus, OH,
USA
| | - Angela Hetrick
- Division of Epidemiology, College of Public Health, Ohio State University,
Columbus, OH,
USA
| | | | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine,
Bronx, NY,
USA
| | | | - Donn J Colby
- SEARCH, Thai Red Cross AIDS Research Center,
Bangkok,
Thailand
| | - Angel M Mayor
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, Bayamón,
Puerto Rico
| | - Angela Parcesepe
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health,
Chapel Hill, NC,
USA
| | - Jennifer Syvertsen
- Department of Anthropology, University of California,
Riverside, CA,
USA
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Lancaster KE, Hetrick A, Jaquet A, Adedimeji A, Atwoli L, Colby DJ, Mayor AM, Parcesepe A, Syvertsen J. Substance use and universal access to HIV testing and treatment in sub-Saharan Africa: implications and research priorities. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30342-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Wong C, Gange SJ, Buchacz K, Moore RD, Justice AC, Horberg MA, Gill MJ, Koethe JR, Rebeiro PF, Silverberg MJ, Palella FJ, Patel P, Kitahata MM, Crane HM, Abraham AG, Samji H, Napravnik S, Ahmed T, Thorne JE, Bosch RJ, Mayor AM, Althoff KN. First Occurrence of Diabetes, Chronic Kidney Disease, and Hypertension Among North American HIV-Infected Adults, 2000-2013. Clin Infect Dis 2017; 64:459-467. [PMID: 28172581 DOI: 10.1093/cid/ciw804] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/29/2016] [Indexed: 11/14/2022] Open
Abstract
Background There remains concern regarding the occurrence of noncommunicable diseases (NCDs) among individuals aging with human immunodeficiency virus (HIV), but few studies have described whether disparities between demographic subgroups are present among individuals on antiretroviral therapy (ART) with access to care. Methods We assessed the first documented occurrence of type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and treated hypertension (HTN) by age, sex, and race within the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). HIV-infected adults (≥18 years) who initiated ART were observed for first NCD occurrence between 1 January 2000 and 31 December 2013. Cumulative incidences as of age 70 were estimated accounting for the competing risk of death; Poisson regression was used to compare rates of NCD occurrence by demographic subgroup. Results We included >50000 persons with >250000 person-years of follow-up. Median follow-up was 4.7 (interquartile range, 2.4–8.1) years. Rates of first occurrence (per 100 person-years) were 1.2 for DM, 0.6 for CKD, and 2.6 for HTN. Relative to non-black women, the cumulative incidences were increased in black women (68% vs 51% for HTN, 52% vs 41% for DM, and 38% vs 35% for CKD; all P < .001); this disparity was also found among men (73% vs 60% for HTN, 44% vs 34% for DM, and 30% vs 25% for CKD; all P < .001). Conclusions Racial disparities in the occurrence of DM, CKD, and HTN emphasize the need for prevention and treatment options for these HIV populations receiving care in North America.
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Affiliation(s)
- Cherise Wong
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen J Gange
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kate Buchacz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard D Moore
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | | | | | | | - Michael J Silverberg
- Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Pragna Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Alison G Abraham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hasina Samji
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Tareq Ahmed
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jennifer E Thorne
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Angel M Mayor
- Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Judd A, Zangerle R, Touloumi G, Warszawski J, Meyer L, Dabis F, Mary Krause M, Ghosn J, Leport C, Wittkop L, Reiss P, Wit F, Prins M, Bucher H, Gibb D, Fätkenheuer G, Julia DA, Obel N, Thorne C, Mocroft A, Kirk O, Stephan C, Pérez-Hoyos S, Hamouda O, Bartmeyer B, Chkhartishvili N, Noguera-Julian A, Antinori A, d’Arminio Monforte A, Brockmeyer N, Prieto L, Rojo Conejo P, Soriano-Arandes A, Battegay M, Kouyos R, Mussini C, Tookey P, Casabona J, Miró JM, Castagna A, Konopnick D, Goetghebuer T, Sönnerborg A, Quiros-Roldan E, Sabin C, Teira R, Garrido M, Haerry D, de Wit S, Miró JM, Costagliola D, d’Arminio-Monforte A, Castagna A, del Amo J, Mocroft A, Raben D, Chêne G, Judd A, Pablo Rojo C, Barger D, Schwimmer C, Termote M, Wittkop L, Campbell M, Frederiksen CM, Friis-Møller N, Kjaer J, Raben D, Salbøl Brandt R, Berenguer J, Bohlius J, Bouteloup V, Bucher H, Cozzi-Lepri A, Dabis F, d’Arminio Monforte A, Davies MA, del Amo J, Dorrucci M, Dunn D, Egger M, Furrer H, Grabar S, Guiguet M, Judd A, Kirk O, Lambotte O, Leroy V, Lodi S, Matheron S, Meyer L, Miro JM, Mocroft A, Monge S, Nakagawa F, Paredes R, Phillips A, Puoti M, Rohner E, Schomaker M, Smit C, Sterne J, Thiebaut R, Thorne C, Torti C, van der Valk M, Wittkop L, Tanser F, Vinikoor M, Macete E, Wood R, Stinson K, Garone D, Fatti G, Giddy J, Malisita K, Eley B, Fritz C, Hobbins M, Kamenova K, Fox M, Prozesky H, Technau K, Sawry S, Benson CA, Bosch RJ, Kirk GD, Boswell S, Mayer KH, Grasso C, Hogg RS, Richard Harrigan P, Montaner JSG, Yip B, Zhu J, Salters K, Gabler K, Buchacz K, Brooks JT, Gebo KA, Moore RD, Moore RD, Rodriguez B, Horberg MA, Silverberg MJ, Thorne JE, Rabkin C, Margolick JB, Jacobson LP, D’Souza G, Klein MB, Rourke SB, Rachlis AR, Cupido P, Hunter-Mellado RF, Mayor AM, John Gill M, Deeks SG, Martin JN, Patel P, Brooks JT, Saag MS, Mugavero MJ, Willig J, Eron JJ, Napravnik S, Kitahata MM, Crane HM, Drozd DR, Sterling TR, Haas D, Rebeiro P, Turner M, Bebawy S, Rogers B, Justice AC, Dubrow R, Fiellin D, Gange SJ, Anastos K, Moore RD, Saag MS, Gange SJ, Kitahata MM, Althoff KN, Horberg MA, Klein MB, McKaig RG, Freeman AM, Moore RD, Freeman AM, Lent C, Kitahata MM, Van Rompaey SE, Crane HM, Drozd DR, Morton L, McReynolds J, Lober WB, Gange SJ, Althoff KN, Abraham AG, Lau B, Zhang J, Jing J, Modur S, Wong C, Hogan B, Desir F, Liu B, You B, Cahn P, Cesar C, Fink V, Sued O, Dell’Isola E, Perez H, Valiente J, Yamamoto C, Grinsztejn B, Veloso V, Luz P, de Boni R, Cardoso Wagner S, Friedman R, Moreira R, Pinto J, Ferreira F, Maia M, Célia de Menezes Succi R, Maria Machado D, de Fátima Barbosa Gouvêa A, Wolff M, Cortes C, Fernanda Rodriguez M, Allendes G, William Pape J, Rouzier V, Marcelin A, Perodin C, Tulio Luque M, Padgett D, Sierra Madero J, Crabtree Ramirez B, Belaunzaran P, Caro Vega Y, Gotuzzo E, Mejia F, Carriquiry G, McGowan CC, Shepherd BE, Sterling T, Jayathilake K, Person AK, Rebeiro PF, Giganti M, Castilho J, Duda SN, Maruri F, Vansell H, Ly PS, Khol V, Zhang FJ, Zhao HX, Han N, Lee MP, Li PCK, Lam W, Chan YT, Kumarasamy N, Saghayam S, Ezhilarasi C, Pujari S, Joshi K, Gaikwad S, Chitalikar A, Merati TP, Wirawan DN, Yuliana F, Yunihastuti E, Imran D, Widhani A, Tanuma J, Oka S, Nishijima T, Na S, Choi JY, Kim JM, Sim BLH, Gani YM, David R, Kamarulzaman A, Syed Omar SF, Ponnampalavanar S, Azwa I, Ditangco R, Uy E, Bantique R, Wong WW, Ku WW, Wu PC, Ng OT, Lim PL, Lee LS, Ohnmar PS, Avihingsanon A, Gatechompol S, Phanuphak P, Phadungphon C, Kiertiburanakul S, Sungkanuparph S, Chumla L, Sanmeema N, Chaiwarith R, Sirisanthana T, Kotarathititum W, Praparattanapan J, Kantipong P, Kambua P, Ratanasuwan W, Sriondee R, Nguyen KV, Bui HV, Nguyen DTH, Nguyen DT, Cuong DD, An NV, Luan NT, Sohn AH, Ross JL, Petersen B, Cooper DA, Law MG, Jiamsakul A, Boettiger DC, Ellis D, Bloch M, Agrawal S, Vincent T, Allen D, Smith D, Rankin A, Baker D, Templeton DJ, O’Connor CC, Thackeray O, Jackson E, McCallum K, Ryder N, Sweeney G, Cooper D, Carr A, Macrae K, Hesse K, Finlayson R, Gupta S, Langton-Lockton J, Shakeshaft J, Brown K, Idle S, Arvela N, Varma R, Lu H, Couldwell D, Eswarappa S, Smith DE, Furner V, Smith D, Cabrera G, Fernando S, Cogle A, Lawrence C, Mulhall B, Boyd M, Law M, Petoumenos K, Puhr R, Huang R, Han A, Gunathilake M, Payne R, O’Sullivan M, Croydon A, Russell D, Cashman C, Roberts C, Sowden D, Taing K, Marshall P, Orth D, Youds D, Rowling D, Latch N, Warzywoda E, Dickson B, Donohue W, Moore R, Edwards S, Boyd S, Roth NJ, Lau H, Read T, Silvers J, Zeng W, Hoy J, Watson K, Bryant M, Price S, Woolley I, Giles M, Korman T, Williams J, Nolan D, Allen A, Guelfi G, Mills G, Wharry C, Raymond N, Bargh K, Templeton D, Giles M, Brown K, Hoy J. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study. Clin Infect Dis 2017; 65:1316-1326. [PMID: 28531260 PMCID: PMC5850623 DOI: 10.1093/cid/cix480] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/19/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. METHODS We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). RESULTS We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were <50 cells/µL, the KS risk was halved in South Africa (aHR, 0.53; 95% CI, .17-1.63) but reduced by ≥95% in other regions. CONCLUSIONS Despite important ART-related declines in KS incidence, men and women in South Africa and men who have sex with men remain at increased KS risk, likely due to high human herpesvirus 8 coinfection rates. Early ART initiation and maintenance of high CD4 cell counts are essential to further reducing KS incidence worldwide, but additional measures might be needed, especially in Southern Africa.
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Engels EA, Yanik EL, Wheeler W, Gill MJ, Shiels MS, Dubrow R, Althoff KN, Silverberg MJ, Brooks JT, Kitahata MM, Goedert JJ, Grover S, Mayor AM, Moore RD, Park LS, Rachlis A, Sigel K, Sterling TR, Thorne JE, Pfeiffer RM. Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America. Clin Infect Dis 2017; 65:636-643. [PMID: 29017269 PMCID: PMC5849088 DOI: 10.1093/cid/cix392] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [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: 01/25/2017] [Accepted: 04/25/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts. METHODS We evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load. RESULTS There were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts <100 cells/mm3. PAFs for NADCs increased during 1995-2009, reaching 10.1% in 2006-2009. CONCLUSIONS Approximately 10% of deaths in PWHIV prescribed ART during 1995-2009 were attributable to cancer, but this fraction increased over time. A large proportion of cancer-attributable deaths were associated with non-Hodgkin lymphoma, lung cancer, and liver cancer. Deaths due to NADCs will likely grow in importance as AIDS mortality declines and PWHIV age.
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Affiliation(s)
| | | | | | | | | | - Robert Dubrow
- Yale School of Public Health, New Haven, Connecticut
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - John T Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | - Anita Rachlis
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Keith Sigel
- Icahn School of Medicine at Mount Sinai, New York
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Muzaale AD, Althoff KN, Sperati CJ, Abraham AG, Kucirka LM, Massie AB, Kitahata MM, Horberg MA, Justice AC, Fischer MJ, Silverberg MJ, Butt AA, Boswell SL, Rachlis AR, Mayor AM, Gill MJ, Eron JJ, Napravnik S, Drozd DR, Martin JN, Bosch RJ, Durand C, Locke JE, Moore RD, Lucas GM, Segev DL. Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors. Am J Transplant 2017; 17:1823-1832. [PMID: 28497525 PMCID: PMC5489376 DOI: 10.1111/ajt.14235] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 06/02/2016] [Revised: 12/28/2016] [Accepted: 01/29/2017] [Indexed: 01/25/2023]
Abstract
New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load <400 copies/mL, and CD4+ count ≥500 cells/μL, the 9-year cumulative incidence of ESRD was higher than that of their HIV-negative peers, yet still low: 2.5 versus 1.1 per 10 000 among white women, 3.0 versus 1.3 per 10 000 among white men, 13.2 versus 3.6 per 10 000 among black women, and 15.8 versus 4.4 per 10 000 among black men. HIV-positive individuals with no comorbidities and well-controlled disease may be considered low-risk kidney donor candidates.
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Affiliation(s)
- Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Keri N Althoff
- Departament of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - C John Sperati
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alison G Abraham
- Departament of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Lauren M Kucirka
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Departament of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Departament of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Mari M Kitahata
- University of Washington Center for AIDS Research, Seattle, WA
| | | | - Amy C Justice
- Veterans Affairs Connecticut Healthcare System, West Haven, CT
| | | | | | - Adeel A Butt
- Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar, and Weill Cornell Medical College, Doha, Qatar and New York, USA
| | | | - Anita R Rachlis
- Sunnybrook Health Sciences Centre, Infectious Diseases Division, Toronto, Ontario
| | | | - M John Gill
- Southern Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, HIV Clinic Cohort
| | - Sonia Napravnik
- University of North Carolina, Chapel Hill, HIV Clinic Cohort
| | | | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Ronald J Bosch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christine Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jayme E Locke
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD,Departament of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Tossas-Milligan KY, Hunter-Mellado RF, Mayor AM, Fernández-Santos DM, Dworkin MS. Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico. P R Health Sci J 2016; 35:113-121. [PMID: 27232874] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. METHODS Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. RESULTS From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. CONCLUSION These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.
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Affiliation(s)
- Katherine Y Tossas-Milligan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
| | - Robert F Hunter-Mellado
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Diana M Fernández-Santos
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Mark S Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
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Mayor AM, Santiago-Rodriguez EJ, Rios-Olivares E, Tortolero-Luna G, Hunter-Mellado RF. Malignancies Trends in a Hispanic Cohort of HIV Persons in Puerto Rico before and after cART. Int J Cancer Res 2016; 12:92-100. [PMID: 27695577 PMCID: PMC5042344 DOI: 10.3923/ijcr.2016.92.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The study describes the cancer trends in a Puerto Rican Hispanic HIV/AIDS cohort for three different time periods as defined by the availability of combination antiretroviral therapy (cART) in the Island: pre (1992-1995), early (1996-2002, and recent (2003-2009). METHODS AIDS and non-AIDS related malignancies risk, standardized incidence rate and one year mortality was evaluated in the cohort before and after cART. RESULTS Of the 281 malignancies found in 265 persons; 72% were in men, 38% in injecting drug users and 42.3% were AIDS related cancers. AIDS related cancer standardized incidence rates decreased significantly in the cART eras; however, Kaposi's sarcoma and invasive cervical carcinoma incidence remained significantly higher in the cohort when compare to the general population. On the contrary, non-AIDS related cancer standardized incidence rates increased significantly in the cART eras, specifically those of the oral/cavity/pharynx, liver, anus, vaginal, and Hodgkin's and non-Hodgkin's Lymphomas. Around 50% of the persons with cancers were reported dead within the first year of their diagnoses without a significant variation during the cART eras. CONCLUSION The higher incidence of Kaposi's sarcoma, invasive cervical carcinoma and non-AIDS related malignancies and their high mortality in the cART eras is suggestive of the role of oncogenic viruses, environmental agents, risky lifestyle behaviors and inadequate cancer prevention efforts that contribute and accelerate the risk of malignant transformation in these subjects. Aggressive intervention in the form of vaccines, risky practice reduction, early screening, early treatment and adequate risk reduction education needs to be incremented in this vulnerable population.
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Affiliation(s)
- Angel M Mayor
- Universidad Central del Caribe, School of Medicine, Bayamón, Puerto Rico
| | | | - Eddy Rios-Olivares
- Universidad Central del Caribe, School of Medicine, Bayamón, Puerto Rico
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Koethe JR, Jenkins CA, Lau B, Shepherd BE, Justice AC, Tate JP, Buchacz K, Napravnik S, Mayor AM, Horberg MA, Blashill AJ, Willig A, Wester CW, Silverberg MJ, Gill J, Thorne JE, Klein M, Eron JJ, Kitahata MM, Sterling TR, Moore RD. Rising Obesity Prevalence and Weight Gain Among Adults Starting Antiretroviral Therapy in the United States and Canada. AIDS Res Hum Retroviruses 2016; 32:50-8. [PMID: 26352511 DOI: 10.1089/aid.2015.0147] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The proportion of overweight and obese adults in the United States and Canada has increased over the past decade, but temporal trends in body mass index (BMI) and weight gain on antiretroviral therapy (ART) among HIV-infected adults have not been well characterized. We conducted a cohort study comparing HIV-infected adults in the North America AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to United States National Health and Nutrition Examination Survey (NHANES) controls matched by sex, race, and age over the period 1998 to 2010. Multivariable linear regression assessed the relationship between BMI and year of ART initiation, adjusting for sex, race, age, and baseline CD4(+) count. Temporal trends in weight on ART were assessed using a generalized least-squares model further adjusted for HIV-1 RNA and first ART regimen class. A total of 14,084 patients from 17 cohorts contributed data; 83% were male, 57% were nonwhite, and the median age was 40 years. Median BMI at ART initiation increased from 23.8 to 24.8 kg/m(2) between 1998 and 2010 in NA-ACCORD, but the percentage of those obese (BMI ≥30 kg/m(2)) at ART initiation increased from 9% to 18%. After 3 years of ART, 22% of individuals with a normal BMI (18.5-24.9 kg/m(2)) at baseline had become overweight (BMI 25.0-29.9 kg/m(2)), and 18% of those overweight at baseline had become obese. HIV-infected white women had a higher BMI after 3 years of ART as compared to age-matched white women in NHANES (p = 0.02), while no difference in BMI after 3 years of ART was observed for HIV-infected men or non-white women compared to controls. The high prevalence of obesity we observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future.
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Affiliation(s)
- John R. Koethe
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Bryan Lau
- Johns Hopkins University, Baltimore, Maryland
| | | | - Amy C. Justice
- Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Janet P. Tate
- Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John Gill
- Alberta HIV Clinic, Sheldon M. Chumir Health Centre, Calgary, Alberta, Canada
| | | | - Marina Klein
- McGill University Health Center, Montreal, Quebec, Canada
| | - Joseph J. Eron
- University of North Carolina, Chapel Hill, North Carolina
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Fernandez-Santos DM, Miranda-Diaz C, Figueroa-Cosme WI, Ramon RO, Mayor AM, Rios-Olivares E, Hunter-Mellado RF. Impact of ASUMA Intervention on HIV Risk Behaviors among Puerto Rican Adolescents. Int J Environ Res Public Health 2015; 13:ijerph13010060. [PMID: 26703684 PMCID: PMC4730451 DOI: 10.3390/ijerph13010060] [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] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 12/03/2015] [Accepted: 12/18/2015] [Indexed: 11/16/2022]
Abstract
The purpose of this manuscript is to assess and compare HIV risk behaviors among early adolescents after a three-year pilot study. A total of 135 public and private junior high schools students completed the intervention protocol. A self-administered questionnaire was given at baseline and at the end of the third year (fourth measure). Descriptive and inferential analyses were performed using SPSS 20.0. About 60% of the students were 14 years old at the fourth measure. The proportion of students that did not report at least one HIV risk behavior at baseline and those that reported any risk behavior at the fourth measure was lower in the intervention group (45.0%) than in the control group (54.5%). The proportion of students that reported at least one HIV risk behavior at baseline and those that did not report any HIV risk behavior at the fourth measure was higher in the intervention group than in the control group (33.3% vs. 8.3%). The proportion of students engaging in HIV risk behaviors was higher in the control group than in the intervention group at the fourth measure, suggesting that A Supportive Model for HIV Risk Reduction in Early Adolescence (ASUMA) intervention might be a promising initiative to reduce adolescents' engagement in HIV risk behaviors.
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Affiliation(s)
- Diana M Fernandez-Santos
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Christine Miranda-Diaz
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Wanda I Figueroa-Cosme
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Raul O Ramon
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Angel M Mayor
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Eddy Rios-Olivares
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
| | - Robert F Hunter-Mellado
- Internal Medicine Department, Universidad Central del Caribe, School of Medicine, PO BOX 60327, Bayamon 00960-6032, Puerto Rico.
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Tossas-Milligan KY, Hunter-Mellado RF, Mayor AM, Fernández-Santos DM, Dworkin MS. Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico. P R Health Sci J 2015; 34:148-54. [PMID: 26356739 PMCID: PMC4776320] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. METHODS Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. RESULTS From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. CONCLUSION These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.
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Affiliation(s)
- Katherine Y Tossas-Milligan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
| | - Robert F Hunter-Mellado
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Diana M Fernández-Santos
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamón, PR
| | - Mark S Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, 1603 W. Taylor Street, M/C 923, Chicago, IL
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Abraham AG, Althoff KN, Jing Y, Estrella MM, Kitahata MM, Wester CW, Bosch RJ, Crane H, Eron J, Gill MJ, Horberg MA, Justice AC, Klein M, Mayor AM, Moore RD, Palella FJ, Parikh CR, Silverberg MJ, Golub ET, Jacobson LP, Napravnik S, Lucas GM. End-stage renal disease among HIV-infected adults in North America. Clin Infect Dis 2014; 60:941-9. [PMID: 25409471 DOI: 10.1093/cid/ciu919] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [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: 12/20/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-infected adults, particularly those of black race, are at high-risk for end-stage renal disease (ESRD), but contributing factors are evolving. We hypothesized that improvements in HIV treatment have led to declines in risk of ESRD, particularly among HIV-infected blacks. METHODS Using data from the North American AIDS Cohort Collaboration for Research and Design from January 2000 to December 2009, we validated 286 incident ESRD cases using abstracted medical evidence of dialysis (lasting >6 months) or renal transplant. A total of 38 354 HIV-infected adults aged 18-80 years contributed 159 825 person-years (PYs). Age- and sex-standardized incidence ratios (SIRs) were estimated by race. Poisson regression was used to identify predictors of ESRD. RESULTS HIV-infected ESRD cases were more likely to be of black race, have diabetes mellitus or hypertension, inject drugs, and/or have a prior AIDS-defining illness. The overall SIR was 3.2 (95% confidence interval [CI], 2.8-3.6) but was significantly higher among black patients (4.5 [95% CI, 3.9-5.2]). ESRD incidence declined from 532 to 303 per 100 000 PYs and 138 to 34 per 100 000 PYs over the time period for blacks and nonblacks, respectively, coincident with notable increases in both the prevalence of viral suppression and the prevalence of ESRD risk factors including diabetes mellitus, hypertension, and hepatitis C virus coinfection. CONCLUSIONS The risk of ESRD remains high among HIV-infected individuals in care but is declining with improvements in virologic suppression. HIV-infected black persons continue to comprise the majority of cases, as a result of higher viral loads, comorbidities, and genetic susceptibility.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Michael A Horberg
- Mid-Atlantic Kaiser Permanente Research Institute, Rockville, Maryland
| | - Amy C Justice
- Veterans Affairs Healthcare System, West Haven, Connecticut Yale University, New Haven, Connecticut
| | | | - Angel M Mayor
- Universidad Central del Caribe, Bayamon, Puerto Rico
| | - Richard D Moore
- Johns Hopkins Bloomberg School of Public Health Johns Hopkins School of Medicine, Baltimore, Maryland
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Maldonado-Martínez G, Fernández-Santos DM, Ríos-Olivares E, Mayor AM, Hunter-Mellado RF. HIV/AIDS in the Puerto Rican elderly: immunological changes between gender and body mass index. J Health Care Poor Underserved 2014; 24:94-105. [PMID: 24241264 DOI: 10.1353/hpu.2014.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Human immunodeficiency virus (HIV) in the elderly population has serious repercussions. The elderly are underdiagnosed for HIV and the costs associated with their late-stage care represent a financial burden to the public health system. The purpose is to analyze various profiles among a cohort of elderly patients with HIV/AIDS. METHODS This is a baseline cohort 60 years or older seen in the Retrovirus Research Center between January 2000 to December 2011. We present the profiles of our cohort stratified by gender and body mass index viewed as a covariate of interest. RESULTS A total of 266 people (68% males and 32% females) seen at the Center were older than 60 years of age. Males were significantly more often overweight (p<.05). Females were significantly more underweight with chronic conditions (p<.05). Women had higher CD4 count and lower HIV viral loads (p<.05). Underweight elderly males were more heavily affected with the burden of HIV infection compared with women.
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Ríos G, Estrada M, Mayor AM, Vilá LM. Factors associated with tender point count in Puerto Ricans with fibromyalgia syndrome. P R Health Sci J 2014; 33:112-116. [PMID: 25244879 PMCID: PMC4366115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine the factors associated with fibromyalgia syndrome (FMS) tender point count (TPC) in a group of Hispanic patients from Puerto Rico. METHODS A cross-sectional study was performed in 144 FMS patients as determined using American College of Rheumatology [ACR] classification). Sociodemographic features, clinical manifestations, comorbidities, and pharmacologic agents were determined during the study visit. Tender points were assessed as described in the ACR classification for FMS. A t-test and one-way ANOVA test were used to examine the relationships between continuous, dichotomous, and nominal variables. RESULTS The mean (standard deviation, [SD]) age of the FMS patients in this study was 50.2 (9.9) years; 95.1% were females. The mean (SD) TPC was 15.0 (4.7). Dysmenorrhea, the sicca syndrome, subjective swelling, increased urinary frequency, shortness of breath, headache, constipation, paresthesia, cognitive dysfunction, arthralgia, tiredness, morning stiffness, depression, and anxiety were associated with higher TPC. No associations were seen between socio-demographic features and FMS pharmacologic therapies. CONCLUSION In this group of Puerto Ricans with FMS, TPC was associated with several FMS symptoms and comorbidities. This study suggests that TPC may be a simple and effective tool for assessing disease severity in FMS patients.
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Santiago-Rodríguez EJ, Mayor AM, Fernández-Santos DM, Ruiz-Candelaria Y, Hunter-Mellado RF. Anemia in a cohort of HIV-infected Hispanics: prevalence, associated factors and impact on one-year mortality. BMC Res Notes 2014; 7:439. [PMID: 25005803 PMCID: PMC4099091 DOI: 10.1186/1756-0500-7-439] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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] [Received: 03/25/2014] [Accepted: 06/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anemia occurs frequently in HIV-infected patients and has been associated with an increased risk of death in this population. For Hispanic subjects, information describing this blood disorder during HIV is scarce. Therefore, the present study examined data from a cohort of HIV-positive Hispanics to determine the prevalence of anemia, identify its associated factors, and evaluate its relationship with one-year mortality. METHODS This study included 1,486 patients who enrolled between January, 2000 and December, 2010 in an HIV-cohort in Bayamón, Puerto Rico. Data were collected through personal interviews and medical record abstractions. To determine the factors independently associated with anemia, a multivariable logistic regression model was used. Kaplan-Meier and Cox proportional hazards models were also performed to estimate survival time and to predict death risk. RESULTS The prevalence of anemia at enrollment was 41.5%. Factors independently associated with increased odds of anemia were: unemployment (OR = 2.02; 95% CI 1.45-2.79), CD4 count <200 cells/μL (OR = 2.66; 95% CI 1.94-3.66), HIV viral load ≥100,000 copies/mL (OR = 1.94; 95% CI 1.36-2.78), white blood cell count <4,000 cells/μL (OR = 2.42; 95% CI 1.78-3.28) and having clinical AIDS (OR = 2.39; 95% CI 1.39-4.09). Overweight (OR = 0.43; 95% CI 0.32-0.59) and obese (OR = 0.44; 95% CI 0.29-0.67) BMI's were independently associated with reduced odds of anemia. Survival differed significantly by anemia status (log-rank test: p < 0.001). One-year mortality estimates were: 30.8%, 23.3%, 8.4% and 2.5%, for patients with severe, moderate, mild and no anemia, respectively. Having anemia at baseline was independently associated with an increased one-year mortality risk (severe anemia: HR = 9.06; 95% CI: 4.16-19.72; moderate anemia: HR = 6.51; 95% CI: 3.25-13.06; mild anemia: HR = 2.53; 95% CI: 1.35-4.74). CONCLUSIONS A high prevalence of anemia at enrollment was observed in this cohort of HIV-infected Hispanics. Unemployment and several adverse prognostic features of HIV infection were independently associated with this blood disorder. Anemia resulted to be the strongest predictor of one-year mortality, evidencing a dose-response effect. Further investigations are needed to evaluate whether recovering from anemia is associated with longer survival, and to identify the types of anemia affecting this particular group of HIV patients.
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Affiliation(s)
| | | | | | | | - Robert F Hunter-Mellado
- Retrovirus Research Center, Universidad Central del Caribe School of Medicine, 00960-6032 Bayamón, Puerto Rico.
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Font YM, Castro-Santana LE, Nieves-Plaza M, Maldonado M, Mayor AM, Vilá LM. Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus. Clin Rheumatol 2014; 33:995-1000. [PMID: 24522480 DOI: 10.1007/s10067-013-2474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 12/20/2013] [Indexed: 12/26/2022]
Abstract
The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.
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Affiliation(s)
- Yvonne M Font
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
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Mayor AM, Fernández DM, Colón HM, Thomas JC, Miranda C, Hunter-Mellado RF. Hepatitis-C multimedia prevention program in poor Hispanic HIV-infected injecting drug users: six months after intervention. J Health Care Poor Underserved 2013; 24:29-37. [PMID: 24241258 PMCID: PMC4071764 DOI: 10.1353/hpu.2014.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injection drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 low-income Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices, and HIV/HCV co-infection synergisms was observed in the group six months post-intervention. CONCLUSION Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations.
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Mayor AM, Fernandez DM, Rios-Oliveras E, Zavala D, Hunter-Mellado RF. P3.319 Malignancies Surveillance in a Hispanic HIV/AIDS Cohort Before and After HAART. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0772] [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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Fernandez-Santos DM, Mayor AM, Santiago E, Rios-Olivares E, Hunter-Mellado RF. P3.049 HIV/AIDS in a Puerto Rican Women Population: Psychosocial, Risk Behavior and Lifestyles. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0509] [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: 11/03/2022]
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Nieves-Plaza M, Castro-Santana LE, Font YM, Mayor AM, Vilá LM. Association of hand or knee osteoarthritis with diabetes mellitus in a population of Hispanics from Puerto Rico. J Clin Rheumatol 2013; 19:1-6. [PMID: 23319016 DOI: 10.1097/rhu.0b013e31827cd578] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although a higher prevalence of osteoarthritis (OA) has been reported among diabetes mellitus (DM) patients, inconsistencies and limitations of observational studies have precluded a conclusive association. OBJECTIVE The objective of this study was to evaluate the association of hand or knee OA with DM in a population of Hispanics from Puerto Rico. METHODS A cross-sectional study was performed in 202 subjects (100 adult DM patients as per the National Diabetes Data Group Classification and 102 nondiabetic subjects). Osteoarthritis of hand and knee was ascertained using the American College of Rheumatology classification criteria. Sociodemographic characteristics, health-related behaviors, comorbidities, pharmacotherapy, and DM clinical manifestations were determined. Multivariable logistic regression was used to evaluate the association of DM with hand or knee OA and to evaluate factors associated with hand or knee OA among DM patients. RESULTS The mean (SD) age for DM patients was 51.6 (13.1) years; 64.0% were females. The mean (SD) DM duration was 11.0 (10.4) years. The prevalence of OA in patients with DM and nondiabetic subjects was 49.0% and 26.5%, respectively (P < 0.01). In the multivariable analysis, patients with DM had 2.18 the odds of having OA when compared with nondiabetic subjects (95% confidence interval [CI], 1.12-4.24). In a subanalysis among DM patients, female patients were more likely to have hand or knee OA (odds ratio [95% CI], 5.06 [1.66-15.66]), whereas patients who did not use insulin alone for DM therapy were more likely to have OA (odds ratio [95% CI], 4.44 [1.22-16.12]). CONCLUSIONS In this population of Hispanics from Puerto Rico, DM patients were more likely to have OA of hands or knees than were nondiabetic subjects. This association was retained in multivariable models accounting for established risk factors for OA. Among DM patients, females were at greater risk for OA, whereas the use of insulin was negatively associated.
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Affiliation(s)
- Mariely Nieves-Plaza
- Puerto Rico Clinical & Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Santiago-Casas Y, González-Rivera T, Castro-Santana L, Ríos G, Martínez D, Rodríguez V, González-Alcover R, Mayor AM, Vilá LM. Impact of managed care health insurance system for indigent patients with rheumatoid arthritis in Puerto Rico. Clin Rheumatol 2013; 32:763-9. [PMID: 23314687 DOI: 10.1007/s10067-013-2167-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/09/2012] [Revised: 12/21/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the clinical outcome among indigent patients with rheumatoid arthritis (RA) in Puerto Rico receiving their healthcare in a managed care system, as compared with non-indigent patients treated in fee-for-service settings. A cross-sectional study was conducted in 214 Puerto Ricans with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative clinical manifestations, disease activity (per disease activity score 28), comorbid conditions, functional status (per Health Assessment Questionnaire), and pharmacologic profile were determined. Data were examined using uni- and multivariable (logistic regression) analyses. The mean (standard deviation (SD)) age of the study population was 56.6 (13.5) years; 180 (84.1 %) were women. The mean (SD) disease duration was 10.8 (9.6) years. Sixty-seven patients were treated in the managed care setting, and 147 patients received their healthcare in fee-for-service settings. In the multivariable analyses, RA patients treated in the managed care setting had more joint deformities, extra-articular manifestations, arterial hypertension, type 2 diabetes mellitus, cardiovascular events, fibromyalgia syndrome, and poorer functional status while having a lower exposure to biological agents than those treated in fee-for-service settings. Efforts should be undertaken to curtail the gap of health disparities among these Hispanic patients in order to improve their long-term outcomes.
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Affiliation(s)
- Yesenia Santiago-Casas
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, 00936-5067 San Juan, Puerto Rico
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Mayor AM, Fernández Santos DM, Dworkin MS, Ríos-Olivares E, Hunter-Mellado RF. Toxoplasmic encephalitis in an AIDS cohort at Puerto Rico before and after highly active antiretroviral therapy (HAART). Am J Trop Med Hyg 2011; 84:838-41. [PMID: 21540399 DOI: 10.4269/ajtmh.2011.10-0718] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) significantly reduced the toxoplasmic encephalitis (TE) incidence in acquired immunodeficiency syndrome (AIDS) patients. The TE incidence and mortality were evaluated in an AIDS cohort followed in Puerto Rico before, during, and after HAART implementation in the Island. Of the 2,431 AIDS studied patients 10.9% had TE diagnosis, with an incidence density that decreased from 5.9/100 person-years to 1.1/100 person-years after HAART. Cox proportional hazard analysis showed substantial mortality reduction among TE cases who received HAART. No mortality reduction was seen in those cases who received TE prophylaxis. Although this study shows a TE incidence and mortality reduction in the AIDS cohort after HAART, the incidence was higher than those reported in the United States AIDS patients. Poor TE prophylaxis compliance might explain the lack of impact of this intervention. Strengthening the diagnostic and opportune TE diagnosis and prompt initiation of HAART in susceptible patients is important to control this opportunistic infection.
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Affiliation(s)
- Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Bayamon, Puerto Rico.
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Miranda C, Fernandez DM, Ramon RO, Velázquez M, Mayor AM, Hunter-Mellado RF. Changes in the socio-demographics, risk behaviors, clinical and immunological profile of a cohort of the Puerto Rican population living with HIV: an update of the Retrovirus Research Center (1992-2008). Bol Asoc Med P R 2010; 102:45-51. [PMID: 23875520 PMCID: PMC3725647] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We describe the changes in the socio demographic, risk behavior, immunological and clinical trends profiles of a cohort HIV patients followed at the Retrovirus Research Center, at baseline and study periods interval by periods intervals: 1992-1997, 1998-2003, and 2004-2008. METHODS This is a cross-sectional study of a longitudinal cohort comprised of 4016 HIV/AIDS patients admitted to the RRC since January 1992. Data collected include socio-demographic variables; risk related variables; psychological variables; and clinical variable by periods of study. RESULTS. The most common AIDS defining conditions observed in patients were: Pneumocistis Cariini pneumonia (PCP), toxoplasmosis of brain (TP), and wasting syndrome (WS). Chronic conditions are more prevalent than AIDS-defining conditions in the cohort of patients. CONCLUSIONS Understanding the socio demographic, HIV risk behavior profile; and the immunological and clinical trends among HIV patients is critical for redesigning services and programs oriented in HIV patient care.
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Affiliation(s)
- Christine Miranda
- Retrovirus Research Center and the Internal Medicine Department, Universidad Central del Caribe, School of Medicine, Call Box 60-327, Bayamon, PR 00960-6032.
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Ríos G, Mayor AM. Clinical and sociodemographic features of Puerto Ricans with systemic sclerosis. Ethn Dis 2010; 20:S1-189. [PMID: 20521412] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Systemic sclerosis is an autoimmune disease of unknown etiology characterized by fibrotic changes in the skin, blood vessels, and various internal organs. The disease has a wide spectrum of presentation and a variable clinical course that includes limited skin involvement to life-threatening disease. Clinical manifestations and disease severity differs among ethnic groups. The objective of this study is to describe the clinical and sociodemographic features of patients with well-characterized systemic sclerosis from Puerto Rico. METHODS A structured questionnaire was completed for each patient to gather information about demographic factors, clinical manifestations, laboratory findings, diagnostic studies, and pharmacologic treatments. RESULTS Of the 24 patients with systemic sclerosis, 96% were females, 83% had Raynaud's phenomenon, 67% had gastrointestinal involvement, 63% had skin hypopigmentation, 50% had digital pitting scars, 46% had arterial hypertension, 11% had pulmonary hypertension, and 4.8% had renal involvement. The overall median modified Rodnan skin score was 24.5 (inter-quartile range 16.0-31.3). Pulmonary function tests resulted in abnormal in 60% of 14 patients, of which 57% had restrictive lung disease (FVC < 70%) and 42.9% had decreased diffusion capacity. Serologically, 66.7% were positive for antinuclear antibody and 62.5% were positive for anti-centromere. CONCLUSIONS In this study, the predominant clinical features of Puerto Ricans with systemic sclerosis were gastrointestinal involvement, Raynaud's phenomenon, digital pitting scars, and lung disease. Patients had a moderate severity of skin disease. The presence of renal involvement and pulmonary hypertension were low in our group. No significant differences were found between systemic sclerosis disease subsets.
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Affiliation(s)
- Grissel Ríos
- Division of Rheumatology Office 824; MCS University of Puerto Rico, P.O. Box 365067, San Juan.
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Mayor AM, Dworkin M, Quesada L, Ríos-Olivares E, Hunter-Mellado RF. The morbidity and mortality associated with kidney disease in an HIV-infected cohort in Puerto Rico. Ethn Dis 2010; 20:S1-167. [PMID: 20521408 PMCID: PMC3551344] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Nephropathy in HIV-infected patients has been associated with progression to AIDS and death. The virus, several comorbid conditions and certain medications may contribute to the development and progression of kidney disease. METHODS This study analyzed data collected from HIV-infected persons enrolled in a HIV registry in Puerto Rico during January 1998 through September 2006. Demographic factors, clinical manifestations, laboratory findings at enrollment, and antiretroviral therapy (ART) prescriptions were compared between patients with and without kidney disease. Death status and cause of death by December 2006 were also evaluated and compared. RESULTS The study included 1,283 subjects, 69.0% male, 39.7% injecting drug users, 19.5% hepatitis C infected, 6.5% with diabetes mellitus (DM-2), 11.6% had hypertension (HTN) and 9.0% had kidney disease. Patients with kidney disease had significantly higher (P < .05) HIV viral load mean (273,499 vs. 202,858 copies/mL), CD4 T-cell count < 200 (57.0% vs. 44.4%), underweight (22.9% vs. 10.9%), DM-2 (13.9% vs. 5.8%), HTN (27.8% vs 10.0%) and mortality (15.9 vs 5.7 deaths per 100 years of follow-up) than those without it. Cox proportional hazard analysis showed that patients with kidney disease had a higher mortality risk (2.1) after controlling for age, sex, HIV risk factor, ART prescription in the last year and HIV disease duration. CONCLUSIONS This study demonstrated a substantial disparity in mortality for Puerto Rican HIV-infected patients with nephropathy. Kidney disease preventive strategies that include aggressive control of HIV-infection and chronic medical conditions, such as hypertension and diabetes, are recommend as an approach to reduce this health disparity.
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Affiliation(s)
- Angel M Mayor
- Retrovirus Research Center, Internal Medicine Department, School of Medicine, Universidad Central del Caribe, Puerto Rico.
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Santiago-Casas Y, González-Rivera TC, Castro-Santana LE, Ríos G, Martínez D, Rodríguez VE, González-Alcover R, Mayor AM, Vilá LM. Impact of age on clinical manifestations and outcome in Puerto Ricans with rheumatoid arthritis. Ethn Dis 2010; 20:S1-195. [PMID: 20521413 PMCID: PMC3569061] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Disease expression and outcomes in rheumatoid arthritis (RA) vary among different ethnic groups. There are limited data on the impact of age on disease severity and outcomes among Hispanics. Thus, we determined the demographic characteristics, clinical manifestations, comorbidities, pharmacologic profile, and functional status among Puerto Ricans with RA of different age groups. METHODS A cross-sectional study was conducted in 214 Puerto Rican patients with RA (per American College of Rheumatology classification criteria). Demographic features, health-related behaviors, cumulative RA manifestations, treatment profiles, disease activity (Disease Activity Score 28), comorbid conditions, and functional status (Health Assessment Questionnaire) were determined at study visit. Three age groups were studied: <40, 40-59, and > or =60 years. Data were examined using univariable and multivariable (logistic regression) analyses. RESULTS The mean (SD) age of the study population was 56.5 (13.6) years with a mean disease duration (SD) of 10.8 (9.7) years; 180 patients (84.1%) were women. In the multivariable analyses, patients aged > or =60 years were more likely to have joint deformities, extra-articular manifestations, and comorbidities such as dyslipidemia, arterial hypertension, diabetes mellitus, vascular events, osteoarthritis, low back pain, and osteoporosis. In addition, older patients used corticosteroids more frequently. No differences were found for the use of disease-modifying anti-rheumatic drugs or biologic agents. CONCLUSIONS Puerto Rican RA patients aged > or =60 years present a severe type of disease having more joint damage, extra-articular manifestations, and comorbidities than younger patients. These disparities must be considered when establishing effective therapy for older RA patients.
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Affiliation(s)
- Yesenia Santiago-Casas
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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