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Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
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Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
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Broder K, Geller RL, Del Rio C, Bhamidipati D. A rare case of Pneumocystis jirovecii and cytomegalovirus coinfection in the small bowel. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Infection with Pneumocystis jirovecii remains a common cause of pneumonia in patients with Acquired Immune Deficiency Syndrome (AIDS). Extrapulmonary manifestations, however, are exceedingly rare. We describe a rare case of coinfection of the small bowel by Pneumocystis jirovecii and cytomegalovirus (CMV).
Methods/Case Report
A 48-year-old female with a history of HIV/AIDS, remote history of Pneumocystis jirovecii pneumonia, and previous non-compliance with HAART, presented to the emergency department with right lower quadrant abdominal pain, fever, and chills for 1 week. Her recent medical history included a hospital admission 1 month prior for community-acquired pneumonia with CD4 count and viral load of 12 cells/mcl and >680,000 copies/mL, respectively; upon discharge she restarted HAART. When she presented to the emergency department in our case, she demonstrated leukocytosis (14.3 K/mcl), tachycardia (131 bpm), and hypotension (87/58 mmHg). An abdominal CT scan showed free air with concern for perforated viscus and multi-station lymphadenopathy with gastrohepatic and retrocaval nodes >2 cm. A chest x-ray showed nodular and cavitary lesions, stable from prior imaging. The differential diagnoses in an AIDS patient with a gastrointestinal mass includes Kaposi’s sarcoma, lymphoproliferative process, or infection. The surgeons were concerned for tuberculosis as well, due to the hospital’s patient population, her bulky lymphadenopathy, and immune-compromised status. An exploratory laparotomy was performed and found jejunal perforations, mesenteric lymphadenopathy, and 3L of fluid in the abdomen. Pathology received 4 soft lymph nodes and a 57 cm segment of thickened small bowel with purulent perforation but no discrete mass. Microscopic examination showed a perforating pseudotumor and acute serositis extending to the margins of the specimen. Lymph node flow cytometry was negative for clonal populations. GMS stains highlighted innumerable “crushed-ping-pong-ball”-like fungal forms consistent with Pneumocystis in the jejunum and all 4 lymph nodes. A CMV immunohistochemical stain highlighted infected cells with nuclear enlargement and nuclear inclusions in the jejunum.
Results (if a Case Study enter NA)
NA
Conclusion
Extrapulmonary Pneumocystis infection is rare but clinicians, pathologists, and microbiologists must keep it in the differential of HIV patients, especially those who are not controlled on antiretroviral therapy.
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Affiliation(s)
- K Broder
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, UNITED STATES
| | - R L Geller
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, UNITED STATES
| | - C Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, UNITED STATES
| | - D Bhamidipati
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, UNITED STATES
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Fredericksen RJ, Nance RM, Whitney BM, Harding BN, Fitzsimmons E, Del Rio C, Eron J, Feaster DJ, Kalokhe AS, Mathews WC, Mayer KH, Metsch LR, Mugavero MJ, Potter J, O'Cleirigh C, Napravnik S, Rodriguez B, Ruderman S, Jac D, Crane HM. Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care. BMC Public Health 2021; 21:1824. [PMID: 34627181 PMCID: PMC8502266 DOI: 10.1186/s12889-021-11854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Among people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. We examined non-physical, psychological intimate partner violence (psy-IPV) and HIV care outcomes using data from two U.S. consortia. Methods We conducted multivariable analyses with robust standard errors to compare patients indicating/not indicating psy-IPV. Results Among PLWH (n = 5950), 9.5% indicated psy-IPV; these individuals were younger (− 3; 95% CI [− 2,-4], p-value < 0.001), less likely to be on antiretroviral treatment (ART) (0.73 [0.55,0.97], p = 0.03), less adherent to ART (− 4.2 [− 5.9,-2.4], p < 0.001), had higher odds of detectable viral load (1.43 [1.15,1.78], p = 0.001) and depression (2.63 [2.18,3.18], p < 0.001), and greater use of methamphetamines/crystal [2.98 (2.30,3.87),p < 0.001], cocaine/crack [1.57 (1.24,1.99),p < 0.001], illicit opioids [1.56 (1.13,2.16),p = 0.007], and marijuana [1.40 (1.15,1.70), p < 0.001]. Conclusion Psychological IPV, even in the absence of physical or sexual IPV, appears to be associated with HIV care outcomes and should be included in IPV measures integrated into routine HIV care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11854-x.
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Affiliation(s)
- R J Fredericksen
- Department of Medicine, University of Washington, Seattle, Washington, USA.
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - B N Harding
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - E Fitzsimmons
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - C Del Rio
- Department of Global Health, Emory University, Atlanta, Georgia
| | - J Eron
- School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - D J Feaster
- Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - A S Kalokhe
- Department of Medicine, Emory University, Atlanta, Georgia
| | - W C Mathews
- Department of Medicine, University of California - San Diego, San Diego, California, USA
| | - K H Mayer
- The Fenway Institute, Boston, MA, USA
| | - L R Metsch
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - J Potter
- Department of Medicine, Harvard University, Cambridge, MA, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S Napravnik
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - B Rodriguez
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - S Ruderman
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Delaney Jac
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
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4
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Pullen S, Marconi VC, Del Rio C, Head C, Nimmo M, O'Neil J, Ziebart M. From Silos to Solidarity: Case Study of a Patient-Centered, Integrative Approach to Opioid Tapering and Chronic Pain Mitigation in a Multidisciplinary AIDS Clinic. J AIDS HIV Treat 2021; 3:4-11. [PMID: 34263265 PMCID: PMC8277158 DOI: 10.33696/aids.3.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: People with HIV (PWH) are at a disproportionate risk for experiencing both chronic pain and opioid use disorder (OUD). Prescription opioid tapering is typically addressed within the “silo model” of medical care, whereby attention is focused solely on opioid addiction rather than also addressing chronic pain management, and limited communication occurs between patient and providers. Objective: This descriptive case study examined an integrative, collaborative care model consisting of Provider, Physical Therapist (PT), and Patient aimed at decreasing chronic pain and opioid use within a multidisciplinary HIV/AIDS clinic. Method: A physical-therapy based model of chronic pain mitigation and physician-driven opioid tapering was implemented. The Provider, PT, and Patient worked collaboratively to address physiological pain, pain coping skills and opioid tapering. A patient case example was used to illustrate the implementation of the model for a future, larger study in the same patient population. Results: This model was feasible in this case example in terms of clinic workflow and acceptability to both the Patient and Providers in this clinic. After the intervention, the Patient’s pain was fully eliminated, and he had ceased all opioid use. Conclusion: Results of this case study suggest that utilizing an integrative, patient-centered approach to both chronic pain management and opioid tapering may be feasible within the context of a multidisciplinary HIV/AIDS clinic. Generalizability is limited by case study model; however, this gives insight into the value of a collaborative alternative compared to a “silo” model of opioid tapering and chronic pain management in preparation for a larger study.
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Affiliation(s)
- S Pullen
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - V C Marconi
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, United States
| | - C Del Rio
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States.,Emory University Rollins School of Public Health, Department of Global Health, Atlanta, GA, United States
| | - C Head
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - M Nimmo
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - J O'Neil
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - M Ziebart
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
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5
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Justman J, Befus M, Hughes J, Wang J, Golin CE, Adimora AA, Kuo I, Haley DF, Del Rio C, El-Sadr WM, Rompalo A, Mannheimer S, Soto-Torres L, Hodder S. Sexual Behaviors of US Women at Risk of HIV Acquisition: A Longitudinal Analysis of Findings from HPTN 064. AIDS Behav 2015; 19:1327-37. [PMID: 25626889 DOI: 10.1007/s10461-014-0992-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Indexed: 11/24/2022]
Abstract
We describe the sexual behaviors of women at elevated risk of HIV acquisition who reside in areas of high HIV prevalence and poverty in the US. Participants in HPTN 064, a prospective HIV incidence study, provided information about individual sexual behaviors and male sexual partners in the past 6 months at baseline, 6- and 12-months. Independent predictors of consistent or increased temporal patterns for three high-risk sexual behaviors were assessed separately: exchange sex, unprotected anal intercourse (UAI) and concurrent partnerships. The baseline prevalence of each behavior was >30 % among the 2,099 participants, 88 % reported partner(s) with >1 HIV risk characteristic and both individual and partner risk characteristics decreased over time. Less than high school education and food insecurity predicted consistent/increased engagement in exchange sex and UAI, and partner's concurrency predicted participant concurrency. Our results demonstrate how interpersonal and social factors may influence sustained high-risk behavior by individuals and suggest that further study of the economic issues related to HIV risk could inform future prevention interventions.
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Affiliation(s)
- J Justman
- ICAP-Columbia University, Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 1315, New York, NY, 10032, USA,
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6
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Derbew M, Hunter B, Blumberg H, Del Rio C, Mariam D, Comeau D, Maura K. A qualitative assessment of the rapid scale up of medical students in
Ethiopia: An evaluation at Addis Ababa University. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.834] [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: 10/23/2022] Open
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7
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Kirkcaldy R, Murray E, Del Rio C, Hall G, Hook E, Whittington W, Papp J, Weinstock H. O1-S03.02 Cephalosporin susceptibility of Neisseria gonorrhoeae isolates in the USA, 2000-2010. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.14] [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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8
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McConnell P, Del Rio C, Preston T, Schmidt B, Darner R, Anstadt M. 126 Short-Term Support Via Direct Mechanical Ventricular Actuation Improves Cardiac Function in Chronically Failing Hearts. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.133] [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: 11/26/2022] Open
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9
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Valverde E, Del Rio C, Metsch L, Anderson-Mahoney P, Krawczyk CS, Gooden L, Gardener LI. Characteristics of Ryan White and non-Ryan White funded HIV medical care facilities across four metropolitan areas: results from the antiretroviral treatment and access studies site survey. AIDS Care 2010; 16:841-50. [PMID: 15385239 DOI: 10.1080/09546120412331290130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Ryan White Comprehensive AIDS Resources Emergency Act 1990 (CARE Act) is one of the largest federal programmes funding medical and support services for individuals with HIV disease. Data that report services and gaps in service coverage from the organizational perspective are very limited. The Antiretroviral Treatment and Access Studies included a mail survey of 176 HIV medical care facilities in four US inner cities on clinic characteristics, services and practices, and patient characteristics. Characteristics of 143 (85%) responding Ryan White (RW) funded and non-RW funded facilities are described. RW funded facilities reported offering more services than non-funded facilities including evening/weekend hours (49% vs. 18%), transportation (71% vs. 22%), and on-site risk reduction counselling (88% vs. 55%). More RW funded facilities reported offering on-site adherence support services, such as support groups (44% vs. 12%), formal classes (20% vs. 2%), and pillboxes (83% vs. 43%), and served a larger proportion of uninsured patients (41% vs. 4%) than non-funded facilities. Our analysis showed that the RW funded HIV care facilities offered more clinic, non-clinic, and adherence support services than non-RW funded facilities, indicating that the disparities in services were still related to CARE Act funding, controlling for private-public facility type.
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Affiliation(s)
- E Valverde
- Department of Epidemiology and Public Health, University of Miami, School of Medicine, Miami, FL 33136, USA.
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10
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Anthony MN, Gardner L, Marks G, Anderson-Mahoney P, Metsch LR, Valverde EE, Del Rio C, Loughlin AM. Factors associated with use of HIV primary care among persons recently diagnosed with HIV: Examination of variables from the behavioural model of health-care utilization. AIDS Care 2007; 19:195-202. [PMID: 17364398 DOI: 10.1080/09540120600966182] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The delay between testing positive for human immunodeficiency virus (HIV) and entering medical care can be better understood by identifying variables associated with use of HIV primary care among persons recently diagnosed with the virus. We report findings from 270 HIV-positive persons enrolled in the Antiretroviral Treatment Access Study (ARTAS). 74% had not seen an HIV care provider before enrollment; 26% had one prior visit only. Based on Andersen's behavioural model of health care utilization, several variables reflecting demographic, healthcare, illness, behavioural, and psychosocial dimensions were assessed and used to predict the likelihood that participants had seen an HIV care provider six months after enrollment. Overall, 69% had seen an HIV care provider by six months. In multivariate analysis, the likelihood of seeing a provider was significantly (p<.05) higher among men, Hispanics (vs. non-Hispanic Blacks), those with higher education, those who did not use injection drugs, those with three or more HIV-related symptoms, those with public health insurance (vs. no insurance), and those who received short-term case management (vs. passive referral). The findings support several conceptual categories of Andersen's behavioural model of health services utilization as applied to the use of HIV medical care among persons recently diagnosed with HIV.
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Affiliation(s)
- M N Anthony
- Northrop Grumman Information Technology, Atlanta, GA 30333, USA.
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11
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Rimland D, Guest JL, Hernández I, Del Rio C, Le NA, Brown WV. Antiretroviral therapy in HIV-positive men is associated with increased apolipoprotein CIII in triglyceride-rich lipoproteins. HIV Med 2006; 6:326-33. [PMID: 16156880 DOI: 10.1111/j.1468-1293.2005.00316.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
OBJECTIVES Dyslipidaemia has become a common problem in HIV disease, especially in patients on current antiretroviral therapy. However, the pathogenic mechanisms involved are not well understood or documented using conventional lipid measurements. METHODS Using a cross-sectional design, the prevalence of abnormal standard lipid measurements and novel biomarkers for abnormal lipid metabolism was determined in 271 HIV-positive men from two HIV clinics in Atlanta, GA, USA. RESULTS A total of 147 men were treated with protease inhibitors (PIs) for >3 months (54%), 84 were treated with nonnucleoside reverse transcriptase inhibitors (NNRTIs) for >3 months (31%) and 40 had not received antiretroviral therapy in the past 3 months (15%). Patients being treated with a PI had higher total cholesterol and triglyceride (TG) levels than patients on no therapy (P<0.05 for each). Patients in the NNRTI group had higher TG, lower high-density lipoprotein (HDL) levels, and higher low-density lipoprotein (LDL) levels than patients on no therapy (P<0.05 for each). Patients treated with either PIs or NNRTIs were more likely to have higher apolipoprotein CIII (apoCIII) levels (P<0.05 for each) than patients on no therapy. Elevated TG was associated with disproportionably elevated apoCIII levels in both treatment groups. CONCLUSIONS In this cross-sectional study of HIV-infected men, either PI or NNRTI therapy elevated levels of TG and apoCIII. Higher concentrations of apoCIII in apoB-containing lipoproteins [very low-density lipoproteins (VLDLs), intermediate density lipoprotein (IDL) and LDLs] have been predictive of an increased incidence of coronary events in clinical trials and more rapid progression of coronary lesions measured by angiography. These findings, on a background of an older population with additional risk factors of smoking and diabetes, portend future atherosclerotic events in these patients.
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Affiliation(s)
- D Rimland
- Atlanta VA Medical Center, Atlanta, GA 30033, USA.
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12
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Leonard MK, Arndt A, Barragán M, Porkert MT, Del Rio C, Blumberg H. 284 TUBERCULOSIS MENINGITIS AT AN ACADEMIC INNER-CITY HOSPITAL. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.283] [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: 11/18/2022]
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13
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Abstract
OBJECTIVE Pre-operative treatment with chemoradiotherapy (CRT) seems to improve local control and overall survival in patients with rectal cancer. The aims of the study were to analyse the impact on overall, disease free and cancer related survival of tumour response to pre-operative CRT and to analyse the influence of the degree of response on long-terms results. PATIENTS AND METHODS Patients with a locally advanced rectal cancer, treated by pre-operative CRT were studied. A radical resection of the rectal tumour with mesorectal excision was performed within 6-8 weeks. Judged on the final TNM classification patients were considered responders when the tumour showed histologically a complete response, microscopic residual disease or a partial response. Non-responders were those in whom the extent of disease remained stable or progressed. Results Radical excision was performed in 103 patients, and a palliative resection in five. Forty-three patients underwent abdominoperineal resection and 65 anterior resection of the rectum. Seventy-one (65.7%) patients showed a response to CRT, while 37 (34.3%) did not. The overall local and distant recurrence rates were 6.8% and 21.3%. Tumour recurrence (P < 0.008) and disease free survival (P < 0.007) were significantly different in responders and nonresponders. Of the 71 responders, 16 had a pathological complete response, 27 had persisting microscopic disease and 28 had macroscopic residual disease. No differences in cancer specific outcome were observed in these groups. CONCLUSION Pathological response to pre-operative CRT is associated with improved tumour recurrence and disease-free survival rates. Any response to pre-operative CRT appears to improve outcomes as much as a complete response.
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Affiliation(s)
- S Biondo
- Department of Surgery, Colorectal Unit, University of Barcelona, Barcelona, Spain.
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14
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Martinez M, Del Rio C, Navarro M, Pareja L, Martinez-Villacampa M, Dotor E, Rodon J, Cambray M. Preoperative chemoradiotherapy for locally advanced resectable rectal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Martinez
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - C. Del Rio
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M. Navarro
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - L. Pareja
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M. Martinez-Villacampa
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E. Dotor
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - J Rodon
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Cambray
- Catalan Institut of Oncology, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain
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Escribano PG, Nacher A, Del Rio C, González L, Acosta JL. Polymeric proton conducting systems based on commercial elastomers. II. Synthesis and microstructural characterization of films based on HSBR/EPDM/PP/PS/silica. J Appl Polym Sci 2004. [DOI: 10.1002/app.20741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Kelley CF, Hernandez I, Del Rio C. 213 THE CLINICAL AND EPIDEMIOLOGIC CHARACTERISTICS OF FOREIGN BORN LATINOS AT AN URBAN HIV CLINIC. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-766] [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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17
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Aguilar C, Martinez A, Martinez A, Del Rio C, Vazquez M. Diagnosis of deep venous thrombosis in the elderly: a higher D-dimer cut-off value is better? Haematologica 2001; 86:E28. [PMID: 11602435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Majem M, Navarro M, Urruticoechea A, Perez F, Cambray M, Del Rio C, Garcia del Muro J, Germa J. Preoperative chemoradiotherapy (CHT-RDT) in locally advanced rectal cancer (RC). Preliminary results. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81571-9] [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: 11/30/2022]
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20
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Jenny-Avital E, Del Rio C. Asymptomatic but discouraged. AIDS Clin Care 1999; 11:90-1. [PMID: 11366710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Del Rio C. Report from Washington meeting January 22-26. AIDS Clin Care 1997; 9:20-3. [PMID: 11364122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- C Del Rio
- Emory University, School of Medicine, Atlanta, GA
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23
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Del Rio C, Hernandez-Tepichin GH. Optimism rises on combination therapy and protease inhibitor data. AIDS Clin Care 1996; 8:19-20, 23. [PMID: 11363408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- C Del Rio
- Consejo Nacional de Prevencion y Control del SIDA, Mexico City, Mexico
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Abstract
In this paper an analysis is made of beverage preferences and their effect on alcohol consumption patterns. For this purpose we have used the 1993 Spanish National Household Health Survey conducted on members of the population aged 16 or over. Beer and spirits are consumed more frequently by young people and wine by older people. The most consumed daily drink is wine and beer on a weekly basis. Men always drank more frequently and consumed a greater number of drinks per occasion than women for the three types of drink analyzed. The study shows that beverage preference is an important factor in the characterization of alcohol use patterns.
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Affiliation(s)
- C Del Rio
- Drugs and Alcohol Research Group, Faculty of Medicine, University of Valladolid, Spain
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25
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Del Rio C. Second National Conference on Human Retroviruses. Good news, bad news, and no news. AIDS Clin Care 1995; 7:30, 33. [PMID: 11370657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- C Del Rio
- Consejo Nacional de Prevencion y Control del SIDA, Mexico City, Mexico
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Gue M, Junien JL, Del Rio C, Bueno L. Neuropeptide Y and sigma ligand (JO 1784) suppress stress-induced colonic motor disturbances in rats through sigma and cholecystokinin receptors. J Pharmacol Exp Ther 1992; 261:850-5. [PMID: 1318376] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The effects of neuropeptide Y (NPY), sigma ligand (JO 1784) and sulfated cholecystokinin octapeptide (CCK8s) on emotional stress (ES) and corticotropin-releasing hormone (CRH)-induced colonic hypermotility were evaluated in rats equipped with chronically implanted electrodes on the colon and a small catheter into the lateral ventricle of the brain. A 139% (97-172%) increase in colonic spike burst frequency was observed in rats placed in a test cage in which they had previously received electric footshocks, an event assimilated to an ES. Intracerebroventricular injection of CRH (0.5 microgram/kg) mimicked the effects of ES by increasing colonic spike burst frequency by 89.0%. Given i.c.v., both JO 1784 (0.1 microgram/kg) and NPY (0.15 microgram/kg) blocked these stimulatory effects. Similarly, i.c.v. administration of CCK8s (0.1 microgram/kg) abolished both ES and CRH stimulated colonic motility, an effect reproduced by central injection of JMV 180, a cholecystokinin (CCK) derivative with high affinity for CCKA receptors, (1 microgram/kg), but not by JMV 170, a CCK derivative with low affinity for CCKA receptor at similar or higher dose. BMY 14802 (a sigma receptor antagonist) injected s.c. (1 mg/kg) abolished the antagonistic effects of JO 1784 and NPY on the ES-induced colonic hyperkinesia. Injected i.c.v., devazepide (L 364,718), a CCKA receptor antagonist, at 0.1 and 1 microgram/kg, abolished the effect of both JO 1784 and NPY; by contrast L365,260, a CCKB antagonist, required a dose of 10 micrograms/kg to block the antagonistic effect of NPY and JO 1784.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Gue
- Department of Pharmacology, Institut National de la Recherche Agronomique, Toulouse, France
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Abstract
The authors present a case of a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) who developed peritonitis with Curvularia lunata and gram negative Enterobacteriaceae. A review of the literature indicates that human infections caused by Curvularia are uncommon despite the ubiquity of the organism in the environment. In this case, the organism was present in the Tenckhoff catheter, lacking attachment to it, but obstructing the flow. Treatment of fungal peritonitis during CAPD is discussed.
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Affiliation(s)
- J Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Del Rio C, Stephens DS, Knapp JS, Rice RJ, Schalla WO. Comparison of isolates of Neisseria gonorrhoeae causing meningitis and report of gonococcal meningitis in a patient with C8 deficiency. J Clin Microbiol 1989; 27:1045-9. [PMID: 2473091 PMCID: PMC267480 DOI: 10.1128/jcm.27.5.1045-1049.1989] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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] [Indexed: 01/01/2023] Open
Abstract
We studied a previously healthy 20-year-old woman who presented with gonococcal meningitis. The gonococcal isolate, HT-1, was prototrophic by auxotyping, was protein I serovar IB-1, and agglutinated with wheat germ lectin. This isolate differed from the proline-requiring, serovar IA-1 and IB-4, wheat germ-agglutination-negative gonococcal isolates recovered from three patients during a recent outbreak of gonococcal meningitis in Philadelphia. HT-1 was killed by normal pooled human sera (greater than or equal to 98% at 30 min) but not effectively killed by the convalescent-phase sera of the patient (greater than 30% survival at 30 min). Similar results were obtained when mucosal and cerebrospinal fluid isolates from a Philadelphia patient were exposed to these sera, but mucosal and blood isolates from another Philadelphia case showed increased resistance to killing by normal pooled human sera. Further characterization revealed multiple differences in outer membrane and cellular proteins and lipopolysaccharide between case isolates. Absence of the L8 lipopolysaccharide epitope was noted for all isolates. Sera of our patient were found to have low total hemolytic complement (CH100 = 21 U/ml; normal = 55 to 100 U/ml) due to deficiency of C8 (C8 less than 1,000 CH50 U/ml; normal = greater than or equal to 16,000 CH50 U/ml). This is the first reported case of gonococcal meningitis occurring in a patient with a terminal-complement deficiency. Gonococcal meningitis is a rare complication of gonococcal bacteremia. Both defects in host defenses (e.g., terminal-complement deficiency) and organisms with unusual virulence appear to contribute to the pathogenesis of this complication of gonococcal bacteremia.
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Affiliation(s)
- C Del Rio
- Veterans Administration Medical Center, Atlanta, Georgia 30033
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Lufschanowski R, Angelini P, Del Rio C, Hallman GL, Cooley DA, Leachman RD. Ventricular septal rupture, secondary to myocardial infarction. Chest 1974; 65:59-63. [PMID: 4809334 DOI: 10.1378/chest.65.1.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Hashimoto T, Joshi JC, Del Rio C, Handler P. Phosphoglucomutase. IV. Inactivation by beryllium ions. J Biol Chem 1967; 242:1671-9. [PMID: 4960829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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