Background:
To determine whether Positive Health Check, a highly tailored video doctor intervention, can improve viral suppression and retention in care.
Setting:
Four clinics that deliver HIV ...primary care.
Methods:
A hybrid type 1 effectiveness-implementation randomized trial design was used to test study hypotheses. Participants (N = 799) who were not virally suppressed, were new to care, or had fallen out of care were randomly assigned to receive Positive Health Check or the standard of care alone. The primary endpoint was viral load suppression, and the secondary endpoint was retention in care, both assessed at 12 months, using an intention-to-treat approach. A priori subgroup analyses based on sex assigned at birth and race were examined as well.
Results:
There were no statistically significant differences between Positive Health Check (N = 397) and standard of care (N = 402) for either endpoint. However, statistically significant group differences were identified from a priori subgroup analyses. Male participants receiving Positive Health Check were more likely to achieve suppression at 12 months than male participants receiving standard of care adjusted risk ratio aRR 95% confidence interval (CI) = 1.14 (1.00 to 1.29),
P
= 0.046}. For retention in care, there was a statistically significant lower risk for a 6-month visit gap in the Positive Health Check arm for the youngest participants, 18–29 years old aRR (95% CI) = 0.55 (0.33 to 0.92),
P
= 0.024 and the oldest participants, 60–81 years old aRR (95% CI) = 0.49 (0.30 to 0.81),
P
= 0.006.
Conclusions:
Positive Health Check may help male participants with HIV achieve viral suppression, and younger and older patients consistently attend HIV care.
Registry Name:
Positive Health Check Evaluation Trial. Trial ID: 1U18PS004967-01. URL: https://clinicaltrials.gov/ct2/show/NCT03292913.
Imported cerebral malaria (CM) cases in non-endemic areas are often misdiagnosed, which delays treatment. Post-malaria neurological syndrome (PMNS) after recovery from severe malaria can also ...complicate diagnosis.
We report an imported malaria case from West Africa with two sequential episodes with neurological syndromes within about a month. The first episode was diagnosed as CM with microscopy-positive Plasmodium falciparum infection. The second episode, occurring a month after the recovery from the first CM episode, was consistent with PMNS, since malaria parasites were not detected by microscopy in peripheral blood smears. However, this diagnosis was complicated by the detection of Plasmodium vivax in peripheral blood by PCR, suggesting a potential cause of the second episode by P. vivax.
This study suggests that PMNS often occurs after severe falciparum malaria. Concurrent P. vivax infection with pathogenic biomass being predominantly extravascular further complicates accurate diagnosis.
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Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
People living with HIV (PLHIV) are more likely to suffer from pain compared to the general public. Pain often clusters with mental health symptoms and substance use. This study sought to evaluate ...mental health and substance use factors associated with any pain and severe pain intensities among PLHIV.
Data were derived from HIV+ adults (N = 733) recruited from community health centers across Florida who completed questionnaires regarding demographics, chronic pain, HIV clinical outcomes, mental health symptoms, and substance use information. Pain was assessed using the Brief Pain Inventory (BPI) short form. Multivariate logistic regression analysis was utilized to assess the relationship between selected covariates and pain.
Approximately half (45.0%) of participants reported having any current pain while 16.1% reported severe pain. The odds of having any current pain were 2.49 (CI 95% 1.48, 4.18, p < 0.01) times greater among PLHIV reporting anxiety and 1.69 (CI 95% 1.11, 2.57, p = 0.01) times greater among PLHIV reporting PTSD compared to those without those factors. The odds of having severe pain were 2.03 (CI 95% 1.03, 4.01, p = 0.04) times greater among PLHIV reporting anxiety and 2.02 (CI 95% 1.26, 3.24, p < 0.01) times greater among female participants compared to PLHIV without those factors respectively. Factors including depression, alcohol consumption, and marijuana use were not statistically associated with any current pain nor with severe pain.
The relationship between pain and mental health is complex. Thus, future research is needed to determine if pain treatments may reduce mental health symptoms or if treatments can be targeted to address both issues simultaneously.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The present study examines the HIV continuum of care outcomes among people living with HIV (PLWH) who have either recent (< 12-months) or distal (> 12-months) incarceration history compared to those ...without an incarceration history. A self-administered survey (as part of the Florida Cohort Study (n = 932)) was used to collect data on demographic information, linkage to care, retention in care, HIV medication adherence, viral suppression, and incarceration history. Those with recent incarceration history were least likely to report HIV medication adherence greater than or equal to 95% of the time (χ
2
= 8.79; p = 0.0124), always take their medications as directed (χ
2
= 15.29; p = 0.0005), and to have durable viral suppression (χ
2
= 16.65; p = 0.0002) compared to those distally or never incarcerated. In multivariable analyses, those never and distally incarcerated had greater odds of care linkage (vs recently incarcerated AOR = 2.58; CI: 1.31, 5.07; p = 0.0063, AOR = 2.09; CI: 1.11, 3.95; p = 0.0228, respectively). Those never incarcerated had greater odds of taking ART as directed (vs recently incarcerated AOR = 2.53; CI: 1.23 – 5.19; p = 0.0116). PLWH with an incarceration history may need more on-going monitoring and follow-up HIV care than those without previous incarceration regardless of when incarceration occurred.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Background
Patients with inborn errors of immunity (IEI) have increased risk of developing cancers secondary to impaired anti-tumor immunity. Treatment of patients with IEI and cancer is challenging ...as chemotherapy can exacerbate infectious susceptibility. However, the literature on optimal cancer treatment in the setting of IEI is sparse.
Objectives
We present a patient with specific antibody deficiency with normal immunoglobins (SADNI), immune dysregulation (ID), and stage III ovarian carcinoma as an example of the need to modify conventional treatment in the context of malignancy, IEI, and ongoing infections.
Methods
This is a retrospective chart review of the patient’s clinical manifestations, laboratory evaluation and treatment course.
Results
Our patient is a female with SADNI and ID diagnosed with stage III ovarian carcinoma at 60 years of age. Her ID accounted for antinuclear antibody positive (ANA+) mixed connective tissue diseases, polyarthralgia, autoimmune neutropenia, asthma, autoimmune thyroiditis, and Celiac disease. Due to the lack of precedent in the literature, her treatment was modified with continuous input from infectious disease, allergy/immunology and oncology specialist using a multidisciplinary approach.
The patient completed debulking surgery and 6 cycles of chemotherapy. The dosing for immunoglobulin replacement therapy was increased for prophylaxis. Chemotherapy doses were lowered for all cycles preemptively for IEI. The therapy included carboplatin, paclitaxel, bevacizumab, and pegfilgrastim. The patient completed six-months of maintenance medication involving bevacizumab.
Her treatment course was complicated by
Mycobacterium avium-complex
(MAC) infection, elevated bilirubin and liver enzymes attributed to excessive immunoglobulin replacement therapy, and urinary tract infection (UTI) and incontinence.
Cancer genetic analysis revealed no targetable markers and primary immunodeficiency gene panel of 407 genes by Invitae was unrevealing. Lab tests revealed no evidence of Epstein-Barr Virus (EBV) infection. Post-chemotherapy imaging revealed no evidence of cancer for 1 year and 4 months, but the disease relapsed subsequently. The patient’s lung scarring requires vigilance.
Conclusions
Our patient with ovarian cancer and IEI required modified treatment and prevention of complications. In cases of IEI, optimal chemotherapy should be titrated to minimize immunosuppression yet treat cancer aggressively while decreasing the risk of infection with prophylactic antibiotics and prolonged post-treatment surveillance, including pulmonary evaluation.
There are contradictory reports regarding the effects of protease inhibitors on the ECG measures of QT and PR interval durations. The effect of interrupting use of protease inhibitors on QT and PR ...progression is also unknown.
This analysis included 3719 participants from the Strategies for Management of Antiretroviral Therapy (SMART) study, of whom 1879 were randomized to receive intermittent antiretroviral therapy (ART) (drug conservation group), whereas the rest received these drugs continuously (viral suppression group). Linear regression analysis was used to compare four ritonavir-boosted protease inhibitor (protease inhibitor/r) regimens saquinavir (SQV/r), lopinavir (LPV/r), atazanavir (ATV/r), and other protease inhibitor/r, and nonboosted protease inhibitor regimens with nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens for Bazett's (QTcB) and Fredericia's (QTcF) heart rate corrected QT and PR. Changes in QTcB, QTcF, and PR after 12 and 24 months of randomization were compared in the drug conservation group and viral suppression group.
Average levels of QTcB, QTcF, and PR duration at entry were 415, 406, and 158 ms. At study entry, 49% of participants were taking an NNRTI (no protease inhibitor)-based regimen and 31% were prescribed a boosted protease inhibitor, the most common being LPV/r. After adjustment for baseline factors, QTcB and QTcF levels did not vary by boosted protease inhibitor group (P = 0.26 and P = 0.34, respectively). For those given any of the boosted protease inhibitors, QTcB was 1.5 ms lower than the NNRTI group (P = 0.04). Both boosted and nonboosted protease inhibitor-containing regimens were significantly associated (P < 0.01 for each) with longer PR intervals compared to the NNRTI group. After adjustment, the difference between boosted protease inhibitors and the NNRTI group was 5.11 ms (P < 0.01); for nonboosted protease inhibitors, this difference was 3.00 ms (P < 0.01). Following ART interruption, PR duration declined for both the boosted and nonboosted protease inhibitor groups and compared to the viral suppression group, significant changes in PR interval were observed 24 months after ART interruption of boosted protease inhibitors (P < 0.01).
Different protease inhibitor-based regimens have a similar, minimal effect on QT compared to NNRTI-based regimens. All protease inhibitor-based regimens (boosted and nonboosted) were associated with prolongation of PR, and interruption of protease inhibitor regimens reduced the prolonged PR duration. Further research is needed to confirm the findings of this study and assess the clinical relevance of the differences.
We aimed to identify disparities in self-reported HCV testing among persons living with HIV (PLWH) in Florida.
We utilized a cross-sectional study of 646 PLWH from the Florida Cohort study's baseline ...survey. Our analysis included chi-squared tests and logistic regression.
Participants that were 55 years old or above had more than twice the odds of reporting a past HCV test than those 18–34 years old (OR 2.47, 95% CI 1.22–5.0), which contrasted with Non-Hispanic Blacks who had lower odds of reporting a past HCV test than non-Hispanic Whites (OR 0.63, 95% CI 0.35–1.1). Drug use was also associated with higher odds of reporting a past HCV test for injection drugs (OR 2.9, 95% CI 1.0–8.43) and non-injection drugs (OR 1.52 CI 0.99–2.21). Individuals with education beyond high school had higher odds of reporting a past HCV test than those that did not attend/complete high school (OR 1.9 CI 1.11–3.16).
Our findings highlight the success of the Center for Disease Control and the U.S. Preventive Services Task Force's campaign in groups at high risk of HCV, such as baby boomers and Injection Drug Users (IDUs). However, they also reflect the current low HCV testing in PLWH that are 18–34 years old, have a low level of education, and are non-Hispanic Black. Our findings are of crucial public health significance because untreated HCV in PLWH is a major cause of severe liver disease and death. They reveal the current deficiencies in HCV testing, which is the initial step to identify underlying reasons for inadequate testing in specific groups and develop practical solutions.
Infectious disease, Hepatitis, HCV, HIV/AIDS, Disparities, Testing.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Marijuana use is common in persons with HIV, but there is limited evidence of its relationship with potential health benefits or harms.
Objective
The Marijuana Associated Planning and ...Long-term Effects (MAPLE) study was designed to evaluate the impact of marijuana use on HIV-related health outcomes, cognitive function, and systemic inflammation.
Methods
The MAPLE study is a longitudinal cohort study of participants living with HIV who were recruited from 3 locations in Florida and were either current marijuana users or never regular marijuana users. At enrollment, participants completed questionnaires that included detailed marijuana use assessments, underwent interviewer-administered neurocognitive assessments, and provided blood and urine samples. Ongoing follow-ups included brief telephone assessments (every 3 months), detailed questionnaires (annually), repeated blood and urine samples (2 years), and linkage to medical records and statewide HIV surveillance data. Supplemental measures related to intracellular RNA, COVID-19, Alzheimer disease, and the gut microbiome were added after study initiation.
Results
The MAPLE study completed enrollment of 333 persons between 2018 and 2021. The majority of participants in the sample were ≥50 years of age (200/333, 60.1%), male (181/333, 54.4%), cisgender men (173/329, 52.6%), non-Hispanic Black (221/333, 66.4%), and self-reported marijuana users (260/333, 78.1%). Participant follow-up was completed in 2022, with annual updates to HIV surveillance data through at least 2027.
Conclusions
The MAPLE study is the largest cohort specifically designed to understand the use of marijuana and its effects on HIV-related outcomes. The study population has significant diversity across age, sex, gender, and race. The data will help clinicians and public health officials to better understand patterns of marijuana use associated with both positive and negative health outcomes, and may inform recommendations for future clinical trials related to medical marijuana and HIV.
International Registered Report Identifier (IRRID)
DERR1-10.2196/37153
BACKGROUND:The clinical management of low-level viremia (LLV) remains unclear. The objective of this study was to investigate the association of blips and LLV with virologic failure.
METHODS:We ...enlisted patients who newly enrolled into the HIV Research Network between 2005 and 2015, had HIV-1 RNA more than 200 copies/ml, and were either antiretroviral therapy (ART)-naive or ART-experienced and not on ART. Patients were included who achieved virologic suppression (≤50 on two consecutive viral loads) and had at least two viral loads following suppression. Blips and LLV (≥2 consecutive >51 copies/ml) were categorized separately into three categoriesno blips/LLV, 51–200, 201–500. Cox proportional hazards regression was used to assess association between rates of blips/LLV and virologic failure (two consecutive >500).
RESULTS:The 2795 patients were mostly male (75.4%), black (50.3%), and MSM (52.9%). Median age was 38 years old (interquartile range 29–48). Most patients (88.8%) were ART-naive at study entry. Overall, 283 (10.1%) patients experienced virologic failure. A total of 152 (5.4%) patients experienced LLV to 51–200 and 110 (3.9%) patients experienced LLV to 201–500. Both LLV 51–200 adjusted hazard ratio (aHR) 1.83 (1.10,3.04) and LLV 201–500 aHR 4.26 (2.65,6.86) were associated with virologic failure. In sensitivity analysis excluding ART-experienced patients, the association between LLV 51 and 200 and virologic failure was not statistically significant.
CONCLUSION:LLV between 201 and 500 was associated with virologic failure, as was LLV between 51 and 200, particularly among ART-experienced patients. Patients with LLV below the current Department of Health and Human Services threshold for virologic failure (persistent viremia ≥200) may require more intensive monitoring because of increased risk for virologic failure.
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