Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Colasanti JA[original query] |
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Toward ending the HIV epidemic: Temporal trends and disparities in early art initiation and early viral suppression among people newly entering HIV care in the United States, 2012-2018
Li J , Humes E , Lee JS , Althoff KN , Colasanti JA , Bosch RJ , Horberg M , Rebeiro PF , Silverberg MJ , Nijhawan AE , Parcesepe A , Gill J , Shah S , Crane H , Moore R , Lang R , Thorne J , Sterling T , Hanna DB , Buchacz K . Open Forum Infect Dis 2022 9 (8) ofac336 BACKGROUND: In 2012, the US Department of Health and Human Services updated their HIV treatment guidelines to recommend antiretroviral therapy (ART) for all people with HIV (PWH) regardless of CD4 count. We investigated recent trends and disparities in early receipt of ART prescription and subsequent viral suppression (VS). METHODS: We examined data from ART-naïve PWH newly presenting to HIV care at 13 North American AIDS Cohort Collaboration on Research and Design clinical cohorts in the United States during 2012-2018. We calculated the cumulative incidence of early ART (within 30 days of entry into care) and early VS (within 6 months of ART initiation) using the Kaplan-Meier survival function. Discrete time-to-event models were fit to estimate unadjusted and adjusted associations of early ART and VS with sociodemographic and clinical factors. RESULTS: Among 11 853 eligible ART-naïve PWH, the cumulative incidence of early ART increased from 42% in 2012 to 82% in 2018. The cumulative incidence of early VS among the 8613 PWH who initiated ART increased from 83% in 2012 to 93% in 2018. In multivariable models, factors independently associated with delayed ART and VS included non-Hispanic/Latino Black race, residence in the South census region, being a male with injection drug use acquisition risk, and history of substance use disorder (SUD; all P ≤ .05). CONCLUSIONS: Early ART initiation and VS have substantially improved in the United States since the release of universal treatment guidelines. Disparities by factors related to social determinants of health and SUD demand focused attention on and services for some subpopulations. |
Receipt of baseline laboratory testing recommended by the HIV medicine association for people initiating HIV care, United States, 2015-2019
Weiser J , Tie Y , Lu JF , Colasanti JA , Fanfair RN , Beer L . Open Forum Infect Dis 2022 9 (7) ofac280 BACKGROUND: The HIV Medicine Association of the Infectious Disease Society of America publishes Primary Care Guidance for Persons with Human Immunodeficiency Virus. We assessed receipt of recommended baseline tests among newly diagnosed patients initiating HIV care. METHODS: The Medical Monitoring Project is a Centers for Disease Control and Prevention survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We analyzed data for 725 participants in the 2015-2019 data collection cycles who received an HIV diagnosis within the past 2 years and had ≥1 HIV provider visit. We estimated the prevalence of having recommended tests after the first HIV provider visit and between 3 months before and 3/6 months after the first HIV provider visit and estimated prevalence differences of having 4 combinations of tests by sociodemographic and clinical characteristics. RESULTS: Within 6 months of care initiation, HIV monitoring tests were performed for 91.3% (95% CI, 88.7%-93.8%) of patients; coinfection blood tests, 27.5% (95% CI, 22.5%-32.4%); site-based STI tests, 59.7% (95% CI, 55.4%-63.9%); and blood chemistry and hematology tests, 50.8% (95% CI, 45.8%-55.8%). Patients who were younger, gay, or bisexual were more likely to receive site-based STI tests, and patients receiving care at Ryan White HIV/AIDS Program (RWHAP)-funded facilities were more likely than patients at non-RWHAP-funded facilities to receive all test combinations. CONCLUSIONS: Receipt of recommended baseline tests among patients initiating HIV care was suboptimal but was more likely among patients at RWHAP-funded facilities. Embedding clinical decision support in HIV provider workflow could increase recommended baseline testing. |
Current and past immunodeficiency are associated with higher hospitalization rates among persons on virologically suppressive antiretroviral therapy for up to eleven years
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 . J Infect Dis 2020 224 (4) 657-666 BACKGROUND: Persons with HIV (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk. METHODS: In six 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 pre-suppression CD4 count <200 and ≥200 cells/µL, Poisson regression models estimated hospitalization incidence rate ratios (aIRR) comparing patients by time-updated CD4 count category, adjusted for cohort, age, gender, calendar year, suppression duration, and lowest pre-suppression CD4 count. RESULTS: The 6997 included patients (19 980 person-years) were 81% cisgender men and 40% White. Among patients with lowest pre-suppression CD4 <200 cells/μL (44%), patients with current CD4 200-350 versus >500 cells/μL had an aIRR of 1.44 during early suppression (95% CI 1.01-2.06), and 1.67 (1.03-2.72) during long-term suppression. Among patients with lowest pre-suppression CD4 ≥200 (56%), patients with current CD4 351-500 versus >500 cells/μL had an aIRR of 1.22 (0.93-1.60) during early suppression and 2.09 (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. |
Hospitalization rates and causes among persons with HIV in the US and Canada, 2005-2015
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 . J Infect Dis 2020 223 (12) 2113-2123 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 six clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV viral 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% CI 20.6-24.1) to 13.0 in 2015 (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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