Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-30 (of 43 Records) |
Query Trace: Hops E [original query] |
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Emerging from the shadows: Trends in HIV ambulatory care, viral load testing, and viral suppression in a U.S. HIV cohort, 2019-2022: Impact of COVID-19 pandemic
Tedaldi EM , Hou Q , Armon C , Mahnken J , Palella F , Simoncini G , Fuhrer J , Mayer C , Ewing AC , Chagaris K , Carlson K , Li J , Buchacz K . J Investig Med 2024 10815589241252592 OBJECTIVES: Analyze the acute impact and the longer-term recovery of COVID-19 pandemic effects on clinical encounter types, HIV viral load (VL) testing and suppression (HIV VL<200 copies/mL). DESIGN: Longitudinal cohort study of participants seen during 2019-2022 at eight HIV Outpatient Study (HOPS) sites. METHODS: Generalized linear mixed models (GLMM) estimated monthly rates of all encounters, office and telemedicine visits, and HIV VL tests using 2010-2022 data. We examined factors associated with non-suppressed VL (VL ≥ 200 copies/mL) and not having ambulatory care visits during the pandemic using GLMM for logistic regression with 2017-2022 and 2019-2022 data, respectively. RESULTS: Of 2351 active participants, 76.0% were male, 57.6% aged ≥ 50 years, 40.7% non-Hispanic White, 38.2% non-Hispanic Black, 17.3% Hispanic/Latino, and 51.0% publicly insured. The monthly rates of in-person and telemedicine visits varied during 2020 through mid-year 2022. Multivariable logistic regression showed persons with no encounters were more likely to be male or have VL ≥ 200 copies/mL. For participants with ≥1 VL test, the prevalence rate of HIV VL ≥ 200 copies/mL during 2020 was close to the rates from 2014 to 2019. The change in probability of viral suppression was not associated with participant's age, sex, race/ethnicity or insurance type. CONCLUSION: In thent encounters declined over 2 years during the pandemic with variations in telemedicine and in-person events, with relative maintenance of viral suppression. Ongoing recovery from the impact of COVID-19 on ambulatory care will require continued efforts to improve retention and patient access to medical services. |
Electronic vapor product use among high school students - Youth Risk Behavior Survey, United States, 2021
Oliver BE , Jones SE , Hops ED , Ashley CL , Miech R , Mpofu JJ . MMWR Suppl 2023 72 (1) 93-99 Commercial tobacco use is the leading cause of preventable disease and death in the United States. Despite declines in overall tobacco product use among youths, disparities persist. This report uses biennial data from the 2015-2021 cycles of the nationally representative Youth Risk Behavior Survey to assess prevalence and trends in electronic vapor product (EVP) use among high school students, including ever use, current use (past 30 days), and daily use. Data from 2021 also included usual source of EVPs among students who currently used EVPs. Overall, in 2021, 36.2% had ever used EVPs, 18.0% currently used EVPs, and 5.0% used EVPs daily, with variation in prevalence by demographic characteristics. Prevalence of ever use and current use of EVPs was higher among female students than male students. Prevalence of ever use, current use, and daily use of EVPs was lower among Asian students than Black or African American (Black), Hispanic, Native Hawaiian or other Pacific Islander, White, and multiracial students. Prevalence of ever use, current use, and daily use of EVPs was higher among bisexual students than among students who were not bisexual. During 2015-2021, although ever use of EVPs decreased overall (from 44.9% to 36.2%) and current use of EVPs was stable overall, daily EVP use increased overall (from 2.0 to 5.0%) and among female (from 1.1% to 5.6%), male (from 2.8% to 4.5%), Black (from 1.1% to 3.1%), Hispanic (from 2.6% to 3.4%), multiracial (from 2.8% to 5.3%) and White (from 1.9% to 6.5%) students. Among students who currently use EVPs, 54.1% usually got or bought EVPs from a friend, family member, or someone else. Continued surveillance of EVP and other tobacco product use is necessary to document and understand youth tobacco product usage. These findings can be used to inform youth-focused tobacco prevention and control strategies at the local, state, tribal, and national levels. |
The third international hackathon for applying insights into large-scale genomic composition to use cases in a wide range of organisms.
Walker K , Kalra D , Lowdon R , Chen G , Molik D , Soto DC , Dabbaghie F , Khleifat AA , Mahmoud M , Paulin LF , Raza MS , Pfeifer SP , Agustinho DP , Aliyev E , Avdeyev P , Barrozo ER , Behera S , Billingsley K , Chong LC , Choubey D , De Coster W , Fu Y , Gener AR , Hefferon T , Henke DM , Höps W , Illarionova A , Jochum MD , Jose M , Kesharwani RK , Kolora SRR , Kubica J , Lakra P , Lattimer D , Liew CS , Lo BW , Lo C , Lötter A , Majidian S , Mendem SK , Mondal R , Ohmiya H , Parvin N , Peralta C , Poon CL , Prabhakaran R , Saitou M , Sammi A , Sanio P , Sapoval N , Syed N , Treangen T , Wang G , Xu T , Yang J , Zhang S , Zhou W , Sedlazeck FJ , Busby B . F1000Res 2022 11 530 In October 2021, 59 scientists from 14 countries and 13 U.S. states collaborated virtually in the Third Annual Baylor College of Medicine & DNANexus Structural Variation hackathon. The goal of the hackathon was to advance research on structural variants (SVs) by prototyping and iterating on open-source software. This led to nine hackathon projects focused on diverse genomics research interests, including various SV discovery and genotyping methods, SV sequence reconstruction, and clinically relevant structural variation, including SARS-CoV-2 variants. Repositories for the projects that participated in the hackathon are available at https://github.com/collaborativebioinformatics. |
Incidence of hyperlipidemia among adults initiating antiretroviral therapy in the HIV Outpatient Study (HOPS), USA, 2007-2021
Li J , Agbobli-Nuwoaty S , Palella FJ , Novak RM , Tedaldi E , Mayer C , Mahnken JD , Hou Q , Carlson K , Thompson-Paul AM , Durham MD , Buchacz K . AIDS Res Treat 2023 2023 4423132 Current U.S. guidelines recommend integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) as initial treatment for people with HIV (PWH). We assessed long-term effects of INSTI use on lipid profiles in routine HIV care. We analyzed medical record data from the HIV Outpatient Study's participants in care from 2007 to 2021. Hyperlipidemia was defined based on clinical diagnoses, treatments, and laboratory results. We calculated hyperlipidemia incidence rates and rate ratios (RRs) during initial ART and assessed predictors of incident hyperlipidemia by using Poisson regression. Among 349 eligible ART-naïve PWH, 168 were prescribed INSTI-based ART (36 raltegravir (RAL), 51 dolutegravir (DTG), and 81 INSTI-others (elvitegravir and bictegravir)) and 181 non-INSTI-based ART, including 68 protease inhibitor (PI)-based ART. During a median follow-up of 1.4 years, hyperlipidemia rates were 12.8, 22.3, 22.7, 17.4, and 12.6 per 100 person years for RAL-, DTG-, INSTI-others-, non-INSTI-PI-, and non-INSTI-non-PI-based ART, respectively. In multivariable analysis, compared with the RAL group, hyperlipidemia rates were higher in INSTI-others (RR = 2.25; 95% confidence interval (CI): 1.29-3.93) and non-INSTI-PI groups (RR = 1.89; CI: 1.12-3.19) but not statistically higher for the DTG (RR = 1.73; CI: 0.95-3.17) and non-INSTI-non-PI groups (RR = 1.55; CI: 0.92-2.62). Other factors independently associated with hyperlipidemia included older age, non-Hispanic White race/ethnicity, and ART without tenofovir disoproxil fumarate. PWH using RAL-based regimens had lower rates of incident hyperlipidemia than PWH receiving non-INSTI-PI-based ART but had similar rates as those receiving DTG-based ART, supporting federal recommendations for using DTG-based regimens as the initial therapy for ART-naïve PWH. |
Unmet need for solid organ transplantation among people with HIV and end stage kidney or liver disease: A brief report from the HIV Outpatient Study, 2009-2023
Mayer C , Agbobli-Nuwoaty SE , Li J , Carlson K , Pallela FJ , Durham MD , Buchacz K . J Acquired Immune Defic Syndr 2024 Background:Persons with HIV (PWH) with end stage kidney disease (ESKD) who are eligible for kidney transplantation have post-transplantation outcomes similar to those without HIV infection. However, barriers to referral to care, evaluation, and receipt of transplants remain for PWH. We sought to identify PWH with ESKD or end stage liver disease (ESLD) who would be candidates for organ transplant and to review their clinical outcomes.Methods:We analyzed data from participants in the HIV Outpatient Study (HOPS) between 01-01-2009 and 06-30-2023, with a diagnosis of ESKD or ESLD. We identified a subset of PWH who would otherwise meet the general criteria for kidney or liver transplantation. Targeted clinical outcomes included dialysis, transplantation, and death.Results:Among 5,215 PWH in the HOPS, 258 with ESKD and 23 with ESLD would otherwise meet criteria for transplant. However, only 9 kidney and 2 liver transplants were performed.Conclusion:Low transplantation rates among eligible PWH may suggest timely referral to care and evaluation for kidney and liver transplantation often does not occur. Expanding access for PWH with ESKD to both deceased and living donor kidney allografts is needed. Kidney and liver transplant centers also need to seek ways to broaden access to eligible PWH with ESKD or ESLD. Copyright © 2024 Wolters Kluwer Health, Inc. |
Struggling, helping and adapting: Crowdfunding motivations and outcomes during the early US COVID-19 pandemic.
Kenworthy N , Jung JK , Hops E . Sociol Health Illn 2022 45 (2) 298-316 During the early months of COVID-19, many people in the US turned to charitable crowdfunding to seek and provide assistance. Little is known about the needs, hopes or experiences that motivated US pandemic crowdfunding and how these were correlated with campaign success. This study uses a mixed-methods data analysis of a randomised cluster sample of 919 US GoFundMe campaigns during the first 7 months of the pandemic. Overall, most campaigns performed poorly, and 38% got no donations at all. The largest proportion of campaigns aimed to address individual, acute financial struggles, often arising from considerable challenges accessing or qualifying for government assistance. These campaigns, as well as those involving campaigners and beneficiaries of colour, tended to be least successful. Qualitative thematic analysis revealed three key crowdfunding motivations that reflect individualistic, agentive responses to the pandemic: struggling, helping and adapting. These motivations reveal a shift away from social suffering and collective mobilisation and towards largely individualised efforts of survival as digital crowdfunding becomes a key domain of crisis response. Crowdfunding platforms are playing an increasingly important role in mediating and influencing individual and collective responses to crisis, which has important political ramifications for how societies perceive and address health emergencies. |
A heavy burden: preexisting physical and psychiatric comorbidities, and differential increases among male and female participants after initiating antiretroviral therapy in the HIV Outpatient Study, 2008-2018
Tedaldi EM , Armon C , Li J , Mahnken J , Simoncini G , Palella FJ , Carlson K , Buchacz K . AIDS Res Hum Retroviruses 2022 38 (7) 519-529 Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates including insurance type, CD4+ cell count, ART regimen and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm3), 79% were male, 66% non-white, 44% publicly-insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥ 30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads were associated with most physical comorbidities, and being a current/former smoker and higher viral loads were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment. |
Aging, trends in CD4/CD8 ratio and clinical outcomes with persistent HIV suppression in the HIV outpatient study (HOPS)
Novak RM , Armon C , Battalora L , Buchacz K , Li J , Ward D , Carlson K , Palella FJJr . AIDS 2022 36 (6) 815-827 BACKGROUND: Age blunts CD4+ lymphocyte cell count/mm3 (CD4) improvements observed with antiretroviral therapy (ART)-induced viral suppression among people with HIV (PWH). Prolonged viral suppression reduces immune dysregulation, reflected by rising CD4/CD8 ratios (CD4/CD8). We studied CD4/CD8 over time to determine whether it predicts risk for select comorbidities and mortality among aging PWH with viral suppression. METHODS: We studied HIV Outpatient Study (HOPS) participants prescribed ART during 2000-2018 who achieved a VL<200copies/mL on or after January 1, 2000, and remained virally suppressed at least one year thereafter. We modeled associations of CD4/CD8 with select incident comorbidities and all-cause mortality using Cox regression and controlling for demographic and clinical factors. RESULTS: Of 2,480 eligible participants,1,145 (46%) were aged<40years, 835 (34%) 40-49years, and 500 (20%) 50years. At baseline, median CD4/CD8 was 0.53 (interquartile range: 0.30-0.84) and similar among all age groups (P=0.18). CD4/CD8 values and percent of participants with CD4/CD8 0.70 increased within each age group (P<0.001 for all). CD4/CD8 increase was greatest for PWH aged<40years at baseline. In adjusted models, most recent CD4/CD8<1.00 and<0.70 were independently associated with higher risk of non-AIDS cancer and mortality, respectively. CONCLUSIONS: Pre-treatment immune dysregulation may persist as indicated by CD4/CD8<0.70. Persistent viral suppression can improve immune dysregulation over time, reducing comorbidity and mortality risk. Monitoring CD4/CD8 among ART-treated PWH with lower values provide a means to assess for mortality and co-morbidity risk. |
Disparities in Treatment with Direct-Acting Hepatitis C Virus Antivirals Persist Among Adults Coinfected with HIV and Hepatitis C Virus in US Clinics, 2010-2018
Simoncini GM , Hou Q , Carlson K , Buchacz K , Tedaldi E , Palella F Jr , Durham M , Li J . AIDS Patient Care STDS 2021 35 (10) 392-400 Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection carries substantial risk for all-cause mortality and liver-related morbidity and mortality, yet many persons coinfected with HIV/HCV remain untreated for HCV. We explored demographic, clinical, and sociodemographic factors among participants in routine HIV care associated with prescription of direct-acting antivirals (DAAs). The HIV Outpatient Study (HOPS) is an ongoing longitudinal cohort study of persons with HIV in care at participating clinics since 1993. There are currently eight study sites in six US cities. We analyzed medical records data of HOPS participants diagnosed with HCV since June 2010. Sustained virological response (SVR) was documented with first undetectable HCV viral load (VL). We assessed factors associated with being prescribed DAAs by multi-variable logistic regression and described the cumulative rate of SVR. Among 306 eligible participants, 131 (43%) were prescribed DAA therapy. Factors associated with greater odds of being prescribed DAA were older age, private health insurance, higher CD4 cell count, being a person who injects drugs, and receiving care at publicly funded sites (p < 0.05). Of 127 (97%) participants with at least 1 follow-up HCV VL, 110 (87%) achieved SVR at 12 weeks. Of the total 131 participants, 123 (94%) eventually achieved SVR. Less than half of HIV/HCV coinfected patients in HOPS have been prescribed DAAs. Interventions are needed to address deficits in DAA prescription, including among patients with public or no health insurance, younger age, and lower CD4 cell count. |
Incident bone fracture and mortality in a large HIV cohort outpatient study, 2000-2017, USA
Battalora L , Armon C , Palella F , Li J , Overton ET , Hammer J , Fuhrer J , Novak RM , Carlson K , Spear JR , Buchacz K . Arch Osteoporos 2021 16 (1) 117 We evaluated the association of bone fracture with mortality among persons with HIV, controlling for sociodemographic, behavioral, and clinical factors. Incident fracture was associated with 48% greater risk of all-cause mortality, underscoring the need for bone mineral density screening and fracture prevention. PURPOSE/INTRODUCTION: Low bone mineral density (BMD) and fracture are more common among persons with HIV (PWH) than those without HIV infection. We evaluated the association of bone fracture with mortality among PWH, controlling for sociodemographic, behavioral, and clinical factors. METHODS: We analyzed data from HIV Outpatient Study (HOPS) participants seen at nine US HIV clinics during January 1, 2000, through September 30, 2017. Incident fracture rates and post-fracture mortality were compared across four calendar periods. Cox proportional hazards analyses determined factors associated with all-cause mortality among all participants and those with incident fracture. RESULTS: Among 6763 HOPS participants, 504 (7.5%) had incident fracture (median age = 47 years) and 719 (10.6%) died. Of fractures, 135 (26.8%) were major osteoporotic (hip/pelvis, wrist, spine, arm/shoulder). During observation, 27 participants with major osteoporotic fractures died (crude mortality 2.97/100 person-years [PY]), and 48 with other site fractures died (crude mortality 2.51/100 PY). Post-fracture, age- and sex-adjusted all-cause mortality rates per 100 PY decreased from 8.5 during 2000-2004 to 1.9 during 2013-2017 (P<0.001 for trend). In multivariable analysis, incident fracture was significantly associated with all-cause mortality (Hazard Ratio 1.48, 95% confidence interval 1.15-1.91). Among 504 participants followed post-fracture, pulmonary, kidney, and cardiovascular disease, hepatitis C virus co-infection, and non-AIDS cancer, remained independently associated with all-cause mortality. CONCLUSIONS: Incident fracture was associated with 48% greater risk of all-cause mortality among US PWH in care, underscoring the need for BMD screening and fracture prevention. Although fracture rates among PWH increased during follow-up, post-fracture death rates decreased, likely reflecting advances in HIV care. |
The HIV Outpatient Study - 25 years of HIV patient care and epidemiologic research
Buchacz K , Armon C , Palella FJJr , Novak RM , Fuhrer J , Tedaldi E , Ward D , Mayer C , Battalora L , Carlson K , Purinton S , Durham M , Li J . Open Forum Infect Dis 2020 7 (5) ofaa123 Background: The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum. Methods: We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993-2017) and mortality (1994-2017) for 10 566 HOPS participants. Results: The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm(3) to 640 cells/mm(3) from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P < .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92.2% in 2017. Conclusions: Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative. |
Rates of suicidal ideation among HIV-infected patients in care in the HIV Outpatient Study 2000-2017, USA
Durham MD , Armon C , Mahnken JD , Novak RM , Palella F , Tedaldi E , Buchacz K . Prev Med 2020 134 106011 BACKGROUND: Suicidal ideation (SI) refers to an individual thinking about, considering or planning suicide. Identifying and characterizing persons with HIV (PWH) at greater risk for SI may lead to better suicide prevention strategies and quality of life improvement. METHODS: Using clinical data gathered from medical chart abstraction for HIV Outpatient Study (HOPS) participants from 2000 to 2017, we assessed SI frequency among PWH in care and explored factors associated with the presence of SI diagnoses using linear mixed models analyses of case-matched participants. RESULTS: Among 6706 participants, 224 (3.3%) had a charted diagnosis of SI. Among those with SI, median age (interquartile range [IQR]) was 43.4years [IQR: 38.7-50.3], median (IQR) CD4 count was 439 cells/mm(3) (IQR: 237-686), 71.4% were male, 54% were men who have sex with men (MSM), 25.4% heterosexual, and 13.4% persons who inject drugs. In multivariable analysis, persons at increased risk for SI were more likely to be: <50years old (adjusted rate ratio [aRR] 1.86, 95% confidence interval [95%CI] 1.36-2.53), non-Hispanic/Latino black (aRR 1.75; 95%CI 1.29-2.38), have CD4+ cell count <350 cells/mm(3) (aRR 1.32; 95%CI 1.05-1.65), have a viral load >/=50 copies/mL (aRR 1.49; 95%CI 1.12-1.98), have stopped antiretroviral therapy (aRR 1.46; 95%CI 1.10-1.95), have a history of: alcohol dependence (aRR 2.75; 95%CI 1.67-4.52), and drug overdose (aRR 4.09; 95%CI 2.16-7.71). CONCLUSION: Routine mental health assessment and monitoring are needed in HIV clinical practice to better understand factors associated with SI and to inform the development of preventive interventions. |
Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care
Palella FJ Jr , Hart R , Armon C , Tedaldi E , Yangco B , Novak R , Battalora L , Ward D , Li J , Buchacz K . AIDS 2019 33 (15) 2327-2335 OBJECTIVE: To understand the epidemiology of non-AIDS-related chronic comorbidities (NACMs) among aging persons with HIV (PWH) DESIGN:: Prospective multicenter observational study to assess, in an age stratified fashion, number and types of NACMs by demographic and HIV factors. METHODS: Eligible participants were seen during 1/1/1997 - 6/30/2015, followed >5.0 years, received antiretroviral therapy (ART), and virally suppressed [HIV viral load (VL) < 200 copies/mL >/=75% of observation time]. Age was stratified (18-40, 41-50, 51-60, >/=61 years). NACMs included cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, arthritis, viral hepatitis, anemia, and psychiatric illness. RESULTS: Of 1540 patients, 1247 (81%) were men, 406 (26%) non-Hispanic blacks (NHB), 183 (12%) Hispanics/Latinos, 575 (37%) with public insurance, 939 (61%) men who have sex with men (MSM), and 125 (8%) with injection drug use history. By age strata 18-40, 41-50, 51-60, >/=61 years, there were 180, 502, 560, and 298 patients, respectively. Median HIV Outpatient Study (HOPS) observation was 10.8 years (range: min-max = 5.0-18.5). Mean number of NACMs increased with older age category; 1.4, 2.1, 3.0, and 3.9, respectively (P < 0.001), as did prevalence of most NACMs (P < 0.001). Age-related differences NACM number were primarily due to anemia, hepatitis C virus infection, and diabetes. Differences (all P < 0.05) in NACM number existed by sex (women >men, 3.9 vs 3.4), race/ethnicity (NHB >non-NHB, 3.8 vs 3.4), and insurance status (public >private, 4.3 vs 3.1). CONCLUSIONS: Age-related increases existed in prevalence and number of NACMs, with disproportionate burden among women, NHBs, and the publicly insured. These groups should be targeted for screening and prevention strategies aimed at NACM reduction. |
Excess heart age in adult outpatients in routine HIV care
Thompson-Paul AM , Palella FJJr , Rayeed N , Ritchey MD , Lichtenstein KA , Patel D , Yang Q , Gillespie C , Loustalot F , Patel P , Buchacz K . AIDS 2019 33 (12) 1935-1942 OBJECTIVE: Cardiovascular disease (CVD) is a common cause of morbidity and mortality among persons living with HIV (PLWH). We used individual cardiovascular risk factor profiles to estimate heart age for PLWH in medical care in the U.S. DESIGN: Cross-sectional analyses of HIV Outpatient Study (HOPS) data METHODS:: Included in this analysis were participants aged 30-74 years, without prior CVD, >/= 2 HOPS clinic visits during 2010-2017, >/=1 year of follow-up, and available covariate data. We calculated age and race/ethnicity-adjusted heart age and excess heart age (chronological age minus heart age), using a Framingham risk score-based model. RESULTS: We analyzed data from 2467 men and 619 women (mean chronologic age 49.3 and 49.1 years, and 23.6% and 54.6% Non-Hispanic/Latino black, respectively). Adjusted excess heart age was 11.5 y (95% confidence interval, 11.1-12.0) among men and 13.1 y (12.0-14.1) among women. Excess heart age was seen among all age groups beginning with persons aged 30-39 y (men, 7.8 [6.9-8.8]; women, 7.7 [4.9-10.4]), with the highest excess heart age among participants aged 50-59 y (men, 13.7 y [13.0-14.4]; women, 16.4 y [14.8-18.0]). More than 50% of participants had an excess heart age of >/=10 years. CONCLUSIONS: Excess heart age is common among PLWH, begins in early adulthood, and impacts both women and men. Among PLWH, CVD risk factors should be addressed early and proactively. Routine use of the heart age calculator may help optimize CVD risk stratification and facilitate interventions for aging PLWH. |
Time spent with HIV viral load >1500 copies/mL among patients in HIV care, 2000-2014
Mendoza MCB , Gardner L , Armon C , Rose C , Palella FJ Jr , Novak R , Tedaldi E , Buchacz K . AIDS 2018 32 (14) 2033-2042 OBJECTIVE: Sexual HIV transmission is more likely to occur when plasma HIV RNA level (viral load, VL) exceeds 1,500 copies/mL. We assessed the percentage of person-time spent with VL >1,500 copies/mL (pPT>1500) among adults with HIV in care. DESIGN: Observational cohort in eight United States HIV clinics. METHODS: Participants had >/=1 HIV Outpatient Study (HOPS) clinic visit and >/=2 VLs during 2000-2014. We assessed pPT>1500 in time intervals between consecutive VL pairs, overall and by ART status. Trends in pPT>1500 and associations between pPT>1500 and chosen baseline demographics and clinical characteristics were analyzed using generalized estimating equations. RESULTS: There were 5,873 patients contributing 37,794 person-years [py]; 86.0% py were prescribed ART, with increasing coverage over time. Over 2000-2014 pPT>1500 was 24.2%, decreasing from 38.3% in 2000-2002 to 11.3% in 2012-2014. During observation time with ART prescribed, pPT>1500 was 16.4% overall, decreasing from 29.9% in 2000-2002 to 8.0% in 2012-2014. pPT>1500 was higher in patients <35 vs. >/=50 years old (31.5% vs. 15.6%), women vs. men (30.8% vs. 22.3%), and black vs. white and Latino/Hispanic patients (32.7% vs. 19.9% and 23.7%, respectively). Multivariable correlates of higher pPT>1,500 included no prescribed ART, being younger, non-Hispanic black vs. white, baseline VL >1,500 copies/mL or lower CD4+ count, and baseline public vs. private insurance. CONCLUSIONS: pPT>1500 declined during 2000-2014. Results support decreasing HIV transmission risk from persons in HIV care over the last decade, and the need to focus interventions on patient groups more consistently viremic. |
Risk factors and incidence of syphilis in HIV-infected persons, the HIV Outpatient Study, 1999-2015
Novak RM , Ghanem A , Hart R , Ward D , Armon C , Buchacz K . Clin Infect Dis 2018 67 (11) 1750-1759 Background: Since 2000, the incidence of syphilis has been increasing, especially among gay, bisexual and other men who have sex with men (MSM) in the United States (U.S.). We assessed temporal trends and associated risk factors for newly diagnosed syphilis infections among HIV-infected patients during a 16-year period. Methods: We analyzed data from the HIV Outpatient Study (HOPS) cohort participants seen at ten U.S. HIV clinics during 1999 - 2015. New syphilis cases were defined based on laboratory parameters and clinical diagnoses. We assessed incidence rates of syphilis and performed Cox proportional hazards regression analyses of sociodemographic, clinical and behavioral risk factors for new syphilis infections. Results: We studied 6888 HIV-infected participants; 641 had one or more new syphilis diagnoses during a median follow-up of 5.2 years. Most participants were male (78%), aged 31-50 years, and 56% were MSM. There were 799 syphilis diagnoses for an overall incidence of 1.8 per 100 person-years (py) (95% Confidence Interval [CI] 1.6-1.9); incidence rate increased from 0.4 (CI 0.2-0.8) to 2.2 (CI 1.4-3.5) per 100 py during 1999 - 2015. In multivariable analyses adjusting for calendar year, risk factors for syphilis included: being aged 18-30 years (hazard ratio [HR] 1.3, CI 1.1-1.6) vs. 31-40 years, being MSM (HR 3.1, CI 2.4-4.1) vs. heterosexual male, and being non-Hispanic black (HR 1.6, CI 1.4-1.9) vs. non-Hispanic white. Conclusions: The increases in the syphilis incidence rate through 2015, reflect ongoing sexual risk, and highlight the need for enhanced prevention interventions among HIV-infected patients in care. |
Disparities in HIV viral load suppression by race/ethnicity among men who have sex with men in the HIV Outpatient Study
Buchacz K , Armon C , Tedaldi E , Palella FJ , Novak RM , Ward D , Hart R , Durham M , Brooks J . AIDS Res Hum Retroviruses 2018 34 (4) 357-364 INTRODUCTION: Maximizing the rates of virologic suppression (VS) among gay, bisexual, and other men who have sex with men (MSM) is essential to limiting HIV morbidity and sexual transmission of HIV in the United States. METHODS: We analyzed data for MSM of non-Hispanic white (white), non-Hispanic black (black) or Hispanic/Latino race/ethnicity in the HIV Outpatient Study (HOPS) at nine U.S. HIV clinics. VS (HIV RNA < 50 copies/mL) was measured closest to January 1, 2015. We modeled factors associated with VS among persons prescribed ART for >/= 6 months and assessed VS for a subset of participants with behavioral interview data. RESULTS: Among 1,303 MSM studied, 24% were black and 11% were Hispanic/Latino. Fewer black than white or Hispanic/Latino MSM had any documented ART use history (92% vs. 99% and 94%, respectively), and fewer had VS (72% vs. 91% and 81%), P < 0.001. In analyses of MSM prescribed ART, which adjusted for insurance type, duration of ART use, and CD4+ cell count, blacks had lower prevalence of VS than whites (adjusted prevalence ratio [PR] 0.87, 95% confidence interval [95% CI] 0.81-0.93) and Hispanics/Latinos did not (PR 0.95, 95% CI 0.88-1.02). Among 331 MSM with interview data, 6% had no VS but reported anal sex without a condom with an HIV-uninfected or unknown HIV serostatus male partner in the past six months. DISCUSSION: In this study of HIV-infected MSM, blacks had a significantly lower prevalence of VS than white men. Optimizing HIV care and prevention among all MSM will require addressing underlying risk factors and social determinants of health that contribute to racial/ethnic disparities in HIV outcomes. |
Incidence of hepatitis C virus infection in the Human Immunodeficiency Virus Outpatient Study Cohort, 2000-2013
Samandari T , Tedaldi E , Armon C , Hart R , Chmiel JS , Brooks JT , Buchacz K . Open Forum Infect Dis 2017 4 (2) ofx076 BACKGROUND: There are few recent studies of incident hepatitis C virus (HCV) infection among human immunodeficiency virus (HIV)-infected patients in the United States. METHODS: We studied HIV Outpatient Study (HOPS) participants seen in 9 HIV-specialty clinics who had ≥1 clinical encounter during 2000-2013 and ≥2 HCV-related tests, the first of which was a negative HCV antibody test (Ab). Hepatitis C virus incident cases were identified by first positive HCV Ab, viral load, or genotype. We assessed rates of incident HCV overall, by calendar intervals, and by demographic and HIV risk strata, and we explored risk factors for incident HCV using Cox proportional hazards models. RESULTS: The 1941 eligible patients (median age 40 years, 23% female, 61% men who had sex with men [MSM], and 3% persons who injected drugs [PWID]) experienced 102 (5.3%) incident HCV infections for an overall incidence of 1.07 (95% confidence interval [CI], 0.87-1.30) per 100 person-years (py). Hepatitis C virus incidence decreased from 1.83 in 2000-2003 to 0.88 in 2011-2013 (P = .024), with decreases observed (P < .05) among PWID and heterosexuals, but not among MSM. Overall, MSM comprised 59% of incident cases, and PWID were at most risk for incident HCV infection (adjusted hazard ratio [aHR] for PWID = 4.62 and 95% CI = 2.11-10.13; for MSM, aHR = 1.48 and 95% CI = 0.86-2.55 compared with heterosexuals). CONCLUSIONS: Among HIV-infected patients in care during 2000-2013, incidence of HCV infection exceeded 1 case per 100 py. Our findings support recommendations for annual HCV screenings for HIV-infected persons, including persons with only MSM risk, to enable HCV diagnosis and treatment for coinfected individuals. |
Sexually transmitted disease testing of human immunodeficiency virus-infected men who have sex with men: Room for improvement
Dean BB , Scott M , Hart R , Battalora L , Novak RM , Durham MD , Brooks JT , Buchacz K . Sex Transm Dis 2017 44 (11) 678-684 BACKGROUND: In the United States, sexually transmitted infection (STI) testing is recommended at least annually for sexually active men who have sex with men (MSM). We evaluated human immunodeficiency virus (HIV) providers' STI testing practices and frequency of positive test results. METHODS: We analyzed data from HIV Outpatient Study (HOPS) participants who, from 2007 to 2014, completed a confidential survey about risk behaviors. Using medical records data, we assessed the frequency of gonorrhea, chlamydia, and syphilis testing and positive results during the year after the survey for MSM who reported sex without a condom in the prior 6 months. We compared testing frequency and positivity for men having 1, 2 to 3, and 4 or more sexual partners. Correlates of STI testing were assessed using general linear model to derive relative risks (RR) with associated 95% confidence intervals (CI). RESULTS: Among 719 MSM, testing frequency was 74.5%, 74.3%, and 82.9% for gonorrhea, chlamydia, and syphilis, respectively, and was higher in those men who reported more sexual partners (P < 0.001 for all). In multivariable analysis, testing for gonorrhea was significantly more likely among non-Hispanic black versus white men (RR, 1.17; 95% CI, 1.03-1.33), among men seen in private versus public clinics (RR, 1.16; 95% CI, 1.05-1.28), and among men with 2 to 3 and 4 or more sexual partners versus 1 partner (RR, 1.12; 95% CI, 1.02-1.23, and RR, 1.18; 95% CI, 1.08-1.30, respectively). Correlates of chlamydia and syphilis testing were similar. Test positivity was higher among men with more sexual partners: for gonorrhea 0.0%, 3.0%, and 6.7% for men with 1, 2 to 3, and 4 or more partners, respectively (P < 0.001, syphilis 3.7%, 3.8% and 12.5%, P < 0.001). CONCLUSIONS: Among HIV-infected MSM patients in HIV care who reported sex without a condom, subsequent testing was not documented in clinic records during the following year for up to a quarter of patients. Exploring why STI testing did not occur may improve patient care. |
Cardiovascular disease risk prediction in the HIV outpatient study
Thompson-Paul AM , Lichtenstein KA , Armon C , Palella FJ Jr , Skarbinski J , Chmiel JS , Hart R , Wei SC , Loustalot F , Brooks JT , Buchacz K . Clin Infect Dis 2016 63 (11) 1508-1516 BACKGROUND: Cardiovascular disease (CVD) risk prediction tools are often applied to populations beyond those in which they were designed when validated tools for specific subpopulations are unavailable. METHODS: Using data from 2,283 HIV-infected adults aged ≥18 years, who were active in the HIV Outpatient Study (HOPS), we assessed performance of three commonly used CVD prediction models developed for general populations: Framingham general cardiovascular Risk Score (FRS), American College of Cardiology/American Heart Association Pooled Cohort equations (PCE), and Systematic COronary Risk Evaluation (SCORE) high-risk equation, and one model developed in HIV-infected persons: the Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) study equation. C-statistics assessed model discrimination and the ratio of expected to observed events (E/O) and Hosmer-Lemeshow chi2 P-value assessed calibration. RESULTS: From January 2002 through September 2013, 195 (8.5%) HOPS participants experienced an incident CVD event in 15,056 person-years. The FRS demonstrated moderate discrimination and was well calibrated (C-statistic: 0.66, E/O: 1.01, P=0.89). The PCE and D:A:D risk equations demonstrated good discrimination but were less well calibrated (C-statistics: 0.71, 0.72 and E/O: 0.88, 0.80, respectively; P<0.001 for both), while SCORE performed poorly (C-statistic: 0.59, E/O: 1.72, P =0.48). CONCLUSION: Only the FRS accurately estimated risk of CVD events, while PCE and D:A:D underestimated risk. Although these models could potentially be used to rank U.S. HIV-infected individuals at higher or lower risk for CVD, the models may fail to identify substantial numbers of HIV-infected persons with elevated CVD risk who could potentially benefit from additional medical treatment. |
A matter of perspective: Comparison of the characteristics of persons with HIV infection in the United States from the HIV Outpatient Study, Medical Monitoring Project, and National HIV Surveillance System
Buchacz K , Frazier EL , Hall HI , Hart R , Huang P , Franklin D , Hu X , Palella FJ , Chmiel JS , Novak RM , Wood K , Yangco B , Armon C , Brooks JT , Skarbinski J . Open AIDS J 2015 9 123-133 Comparative analyses of the characteristics of persons living with HIV infection (PLWH) in the United States (US) captured in surveillance and other observational databases are few. To explore potential joint data use to guide HIV treatment and prevention in the US, we examined three CDC-funded data sources in 2012: the HIV Outpatient Study (HOPS), a multisite longitudinal cohort; the Medical Monitoring Project (MMP), a probability sample of PLWH receiving medical care; and the National HIV Surveillance System (NHSS), a surveillance system of all PLWH. Overall, data from 1,697 HOPS, 4,901 MMP, and 865,102 NHSS PLWH were analyzed. Compared with the MMP population, HOPS participants were more likely to be older, non-Hispanic/Latino white, not using injection drugs, insured, diagnosed with HIV before 2009, prescribed antiretroviral therapy, and to have most recent CD4+ T-lymphocyte cell count ≥ 500 cells/mm(3) and most recent viral load <200 copies/mL. The MMP population was demographically similar to all PLWH in NHSS, except it tended to be slightly older, HIV diagnosed more recently, and to have AIDS. Our comparative results provide an essential first step for combined epidemiologic data analyses to inform HIV care and prevention for PLWH in the US. |
Long-term immunologic and virologic responses on raltegravir-containing regimens among ART-experienced participants in the HIV Outpatient Study
Buchacz K , Wiegand R , Armon C , Chmiel JS , Wood K , Brooks JT , Palella FJ Jr . HIV Clin Trials 2015 16 (4) 139-46 OBJECTIVES: Raltegravir (RAL)-containing antiretroviral therapy (ART) produced better immunologic and virologic responses than optimized background ART in clinical trials of heavily ART-experienced patients, but few data exist on long-term outcomes in routine HIV care. METHODS: We studied ART-experienced HIV outpatient study (HOPS) participants seen at 10 US HIV-specialty clinics during 2007-2011.We identified patients who started (baseline date) either continuous ≥ 30 days of RAL-containing or RAL-sparing ART, and used propensity score (PS) matching methods to account for baseline clinical and demographic differences. We used Kaplan-Meier methods and log-rank tests for the matched subsets to evaluate probability of death, achieving HIV RNA < 50 copies/ml, and CD4 cell count (CD4) increase of ≥ 50 cells mm(- 3) during follow-up. RESULTS: Among 784 RAL-exposed and 1062 RAL-unexposed patients, 472 from each group were matched by PS. At baseline, the 472 RAL-exposed patients (mean nadir CD4, 205 cells mm(- 3); mean baseline CD4, 460 cells mm(- 3); HIV RNA < 50 copies ml(- 1) in 61%; mean years on prescribed ART, 7.5) were similar to RAL unexposed. During a mean follow-up of over 3 years, mortality rates and immunologic and virologic trajectories did not differ between the two groups. Among patients with detectable baseline HIV RNA levels, 76% of RAL-exposed and 63% of RAL-unexposed achieved HIV RNA < 50 copies ml(- 1) (P = 0.51); 69 and 58%, respectively, achieved a CD4 increase ≥ 50 cells mm(- 3) (P = 0.70). DISCUSSION: In our large cohort of US ART-experienced patients with a wide spectrum of clinical history, similar outcomes were observed when prescribed RAL containing versus other contemporary ART. |
Seasonal influenza vaccination rates in the HIV Outpatient Study - United States, 1999-2013
Durham MD , Buchacz K , Armon C , Patel P , Wood K , Brooks JT . Clin Infect Dis 2015 60 (6) 976-7 Due to the high burden of estimated annual deaths and hospitalizations associated with influenza epidemics in the United States [1, 2], annual influenza vaccination is recommended for persons aged ≥6 months, and for those who are at increased risk of influenza-related complications, including persons with human immunodeficiency virus (HIV) infections [3]. In 2011, we published data from the HIV Outpatient Study (HOPS), an open prospective HIV cohort study of HIV-infected outpatients seen in 9 well-established community-based private practices, public health clinics, and university-based clinics, describing annual rates of influenza vaccination among HIV-infected persons in care during influenza seasons from 1999 to 2008 [4]. We found that an average of 35% of HOPS participants received an influenza vaccination while under observation during the time period under investigation. This letter serves as an update to the previous analysis by including 5 years of additional data describing influenza vaccination rates among HOPS participants through 30 June 2013. | Among 6548 active patients (patients with at least 1 clinical encounter during the time period under investigation), 4788 were vaccinated at any time between 1 July 1999 and 30 June 2013. The annual vaccination rates ranged from a low of 26.4% to a high of 50.9% (average, 38.7%; linear regression trend P = .043; Figure 1) during the influenza seasons studied. The HOPS recorded the highest rate of vaccination during the 2009–2010 H1N1 influenza season, but that level was not sustained in subsequent seasons. Although we detected an overall temporal increase in influenza vaccination rates over the 14-year period, the observed rates continued to be consistently lower than published recommendations and below the goal of 70% set for Healthy People 2020 [3, 5], underscoring the need for improving adherence to guidelines for annual influenza vaccination for HIV-infected persons. |
HIV viral load monitoring frequency and risk of treatment failure among immunologically stable HIV-infected patients prescribed combination antiretroviral therapy
Young B , Hart RL , Buchacz K , Scott M , Palella F , Brooks JT . J Int Assoc Provid AIDS Care 2015 14 (6) 536-43 The authors sought to assess whether viral load (VL) monitoring frequency was associated with differential rates of virologic failure (VF) among HIV Outpatient Study (HOPS) participants seen during 1999 to 2013, who had maintained VL <50 copies/mL, CD4 counts ≥300 cells/mm(3), and been prescribed a stable combination antiretroviral regimen for at least 2 years. The authors required VL and CD4 testing to have occurred regularly for the entire 2-year period. The authors assessed rates of VF comparing patients who maintained a frequent VL testing (≥3 VLs) to those who shifted to a less frequent schedule (2 VL) after the 2-year period. Virologic failure was observed among 116 of 573 participants. The authors did not detect statistically significant difference in frequency of VF among patients undergoing frequent (21.0%) versus less frequent VL testing (19.6%), even after multivariable adjustment. Biannual VL monitoring for stable patients with aviremia could generate substantial cost savings without the increased risk of VF. |
Statin use is associated with incident diabetes mellitus among patients in the HIV Outpatient Study
Lichtenstein KA , Hart RL , Wood KC , Bozzette S , Buchacz K , Brooks JT . J Acquir Immune Defic Syndr 2015 69 (3) 306-11 INTRODUCTION: Statin therapy is effective in the prevention of cardiovascular disease in the general population but has been shown to modestly increase the risk for incident diabetes mellitus (DM). METHODS: We analyzed incident DM in HIV Outpatient Study (HOPS) participants followed at 8 HIV clinic sites during 2002-2011, comparing rates among those who initiated statin therapy during that period with those who did not. Using Cox proportional hazards models, we examined the association between cumulative years of statin exposure and the risk of developing DM, after controlling for age, sex, race/ethnicity, antiretroviral history, prevalent hepatitis C, body mass index, and cumulative exposure to protease inhibitor therapy. We also adjusted for propensity scores to account for residual confounding by indication. RESULTS: Of 4692 patients analyzed, 590 (12.6%) initiated statin therapy and 355 (7.2%) developed DM. Incident DM was independently associated with statin therapy (adjusted hazard ratio, 1.14 per year of statin use), as well as older age, Hispanic/Latino ethnicity, non-Hispanic/Latino black race, antiretroviral-naive status, prevalent hepatitis C, and body mass index ≥30 kg/m (P < 0.05 for all). The association of statin use with incident DM was similar in the model adjusted for propensity score. CONCLUSIONS: Statin use was associated with a modestly increased risk of incident DM in an HIV-infected population, similar to existing data for the general population. HIV-infected patients should be monitored for glucose intolerance, but statins should not be withheld if clinically indicated for cardiovascular disease risk reduction. |
Trends in use of genotypic resistance testing and frequency of major drug resistance among antiretroviral-naive persons in the HIV Outpatient Study, 1999-2011.
Buchacz K , Young B , Palella FJ Jr , Armon C , Brooks JT . J Antimicrob Chemother 2015 70 (8) 2337-46 BACKGROUND: Monitoring antiretroviral drug resistance can inform treatment recommendations; however, there are few such data from US patients before they initiate ART. METHODS: We analysed data from HIV Outpatient Study (HOPS) participants from nine US HIV clinics who were diagnosed with HIV infection during 1999-2011. Using the IAS-USA December 2010 guidelines, we assessed the frequency of major drug resistance mutations (mDRMs) related to antiretroviral agents in viral isolates from patients who underwent commercial genotypic testing (GT) for resistance before initiating ART. We employed general linear regression models to assess factors associated with having undergone GT, and then factors associated with having mDRM. RESULTS: Among 1531 eligible patients, 758 (49.5%) underwent GT before first ART, increasing from 15.5% in 1999-2002 to 75.9% in 2009-11 (P < 0.001). GT was carried out a median of 1.2 months after the diagnosis of HIV. In adjusted regression analyses, patients with pre-ART CD4+ T lymphocyte counts ≥200 cells/mm3 or with HIV RNA levels >5.0 log10 copies/mL and those with a first HOPS visit in 2006 or later were significantly (P < 0.05) more likely to have undergone GT. Of the 758 patients, 114 (15.0%) had mDRMs; mutations relating to NRTIs, NNRTIs and PIs were present in 8.0%, 7.1% and 2.6%, respectively. There was no temporal change in the frequency of mDRM, and mDRMs were associated with an HIV RNA level <4.0 log10 copies/mL. CONCLUSIONS: During 1999-2011, GT use among antiretroviral-naive patients became more common, but a quarter of patients in recent years remained untested. The frequency of mDRMs remained stable over time at about 15%. |
Disparities in initiation of combination antiretroviral treatment and in virologic suppression among patients in the HIV Outpatient Study (HOPS), 2000-2013
Novak RM , Hart RL , Chmiel JS , Brooks JT , Buchacz K . J Acquir Immune Defic Syndr 2015 70 (1) 23-32 OBJECTIVES: The National HIV/AIDS Strategy emphasizes virologic suppression to reduce HIV incidence in the United States. We assessed temporal trends of and disparities in time to combination antiretroviral therapy (cART) initiation and HIV virologic suppression (VS) in a large, demographically diverse cohort of HIV-infected patients. DESIGN: We included antiretroviral-naive HIV Outpatient Study (HOPS) participants from 2000-2013 enrolled within six months of their HIV diagnosis who attended ≥ 2 HIV care-related visits. METHODS: We evaluated time from HIV diagnosis to first use of cART, time from HIV diagnosis to VS and time from first use of cART to VS. Kaplan-Meier time-to-event curves and Cox proportional hazards models were used to assess temporal trends and correlates of initiating cART and achieving HIV VS (<500 copies/mL). RESULTS: Among 1,156 HOPS patients (median age, 37 years; 43.2% non-Hispanic/Latino black [NHB], 14.1% Hispanic/Latino), estimated median times from HIV diagnosis to cART initiation, and from HIV diagnosis to VS, both shortened by > 40% during the 13.5-year study period, reaching, respectively, 2.5 and 5.4 months. In multivariable analyses, NHB patients (as compared with non-Hispanic/Latino white) and those who had injected drugs (as compared with those who did not) initiated cART in a less timely fashion. After adjusting for CD4+ cell count and viral load at cART initiation, NHB patients and those aged < 30 years (compared with ≥ 40 years) had lower rates of VS. CONCLUSIONS: Despite improvements in HIV treatment over time, patients who were NHB, younger, or used injection drugs had less favorable outcomes. |
HIV laboratory monitoring reliably identifies persons engaged in care
Dean BB , Debes R , Buchacz K , Bozzette SA , Wood K , Brooks JT . J Acquir Immune Defic Syndr 2014 68 (2) 133-9 BACKGROUND: Attendance at biannual medical encounters has been proposed as a minimum national standard for adequate engagement in HIV care. Using data from the HIV Outpatient Study (HOPS), we analyzed how well dates of HIV-related laboratory testing correlated with attendance at biannual medical encounters. METHODS: HOPS is an open prospective cohort study of HIV-infected patients receiving outpatient care in the United States. The data set included dates for laboratory measurements and medical encounters. We included patients with at least one HIV laboratory test (CD4 cell count or plasma HIV RNA viral load) during 2010-2011. An HIV laboratory test was defined as associated with a medical encounter if it occurred within three weeks of the encounter. We assessed the predictive value of HIV laboratory tests as a proxy for adequate engagement in clinical care, defined as having had ≥2 HIV laboratory tests within one year and performed >90 days apart. RESULTS: A total of 10,321 HIV laboratory tests were recorded from 2,909 patients. Adequate engagement in clinical care based on medical encounters was 88.2%, and 77.3% when based on laboratory tests. Using HIV laboratory tests to assess engagement had a sensitivity of 85.7%, specificity of 86.0%, and positive and negative predictive values of 97.9% and 44.5%. Of the 22.7% classified as not engaged in care by the proxy measure, over half (55.5%) were actually engaged. CONCLUSION: Using laboratory monitoring reliably classified persons as engaged in care. Of the 22.7% of patients classified as not engaged in care, most were actually engaged. |
Factors associated with mortality among persistently viraemic triple-antiretroviral-class-experienced patients receiving antiretroviral therapy in the HIV Outpatient Study (HOPS)
Palella FJ Jr , Armon C , Buchacz K , Chmiel JS , Novak RM , D'Aquila RT , Brooks JT . J Antimicrob Chemother 2014 69 (10) 2826-34 BACKGROUND: Identifying factors associated with mortality for HIV-infected patients with persistent viraemia despite antiretroviral (ARV) therapy may inform diagnostic and treatment strategies. METHODS: We analysed data from viraemic triple-ARV-class-experienced HIV Outpatient Study patients seen during 1 January 1999 to 31 December 2012 who, despite treatment that included ARVs from three major drug classes [nucleoside analogue reverse transcriptase inhibitors, non-nucleoside analogue reverse transcriptase inhibitors and protease inhibitors (PIs)], had plasma HIV RNA levels [viral load (VL)] >1000 copies/mL ['triple ARV class failure' (TCF)]. The baseline was defined as the date of meeting the TCF criteria during 1999-2008. We identified factors associated with mortality using Cox regression. RESULTS: Of 597 patients who met the TCF criteria (median follow-up after baseline 4.9 years), 115 (19.3%) died. Baseline factors associated with mortality were age per 10 years [hazard ratio (HR) 1.61, 95% CI 1.28-2.02], risk of HIV from use of injection drugs (HR 1.81, 95% CI 1.10-2.98), CD4+ T cell count <200 cells/mm3 (HR 3.68, 95% CI 2.41-5.62), VL ≥5.0 log10 copies/mL (HR 2.91, 95% CI 1.88-4.49) and receiving a first combination ARV therapy regimen that was PI-based (HR 2.44, 95% CI 1.47-4.06); receiving a novel ARV agent during follow-up (HR 0.45, 95% CI 0.22-0.93) was protective. Genotypic resistance testing results were available for 274 (45.9%) of the TCF patients, of whom 47 (17.2%) died. In this group, factors associated with death were increasing age (HR 1.94, 95% CI 1.36-2.78, per 10 year increment), risk of HIV from use of injection drugs (HR 2.71, 95% CI 1.37-5.39), baseline VL ≥5.0 log10 copies/mL (HR 5.35, 95% CI 2.82-10.1) and receiving PI-based first combination ARV therapy regimen (HR 3.20, 95% CI 1.25-8.17). No HIV mutations or combinations of mutations were significantly associated with survival. CONCLUSIONS: Factors significantly associated with mortality risk among TCF patients who received ongoing ARV therapy included traditional clinical predictors but not the presence, type or number of HIV genetic mutations. The use of novel ARV drugs by these ARV therapy-experienced patients was associated with an improved survival. |
Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population
Holtzman C , Armon C , Tedaldi E , Chmiel JS , Buchacz K , Wood K , Brooks JT . J Gen Intern Med 2013 28 (10) 1302-10 BACKGROUND: Among aging HIV-infected adults, polypharmacy and its consequences have not been well-described. OBJECTIVE: To characterize the extent of polypharmacy and the risk of antiretroviral (ARV) drug interactions among persons of different ages. DESIGN AND PARTICIPANTS: Cross-sectional analysis among patients within the HIV Outpatient Study (HOPS) cohort who were prescribed ARVs during 2006-2010. MAIN MEASURES: We used the University of Liverpool HIV drug interactions database to identify ARV/non-ARV interactions with potential for clinical significance. KEY RESULTS: Of 3,810 patients analyzed (median age 46 years, 34 % ≥ 50 years old) at midpoint of observation, 1,494 (39 %) patients were prescribed ≥ 5 non-ARV medications: 706 (54 %) of 1,312 patients ≥ 50 years old compared with 788 (32 %) of 2,498 patients < 50 years. During the five-year period, the number of patients who were prescribed at least one ARV/non-ARV combination that was contraindicated or had moderate or high evidence of interaction was 267 (7 %) and 1,267 (33 %), respectively. Variables independently associated with having been prescribed a contraindicated ARV/non-ARV combination included older age (adjusted odds ratio [aOR] per 10 years of age 1.17, 95 % CI 1.01-1.35), anxiety (aOR 1.78, 95 % CI 1.32-2.40), dyslipidemia (aOR 1.96, 95 % CI 1.28-2.99), higher daily non-ARV medication burden (aOR 1.13, 95 % CI 1.10-1.17), and having been prescribed a protease inhibitor (aOR 2.10, 95 % CI 1.59-2.76). Compared with patients < 50 years, older patients were more likely to have been prescribed an ARV/non-ARV combination that was contraindicated (unadjusted OR 1.44, 95 % CI 1.14-1.82), or had moderate or high evidence of interaction (unadjusted OR 1.29, 95 % CI 1.15-1.44). CONCLUSIONS: A substantial percentage of patients were prescribed at least one ARV/non-ARV combination that was contraindicated or had potential for a clinically significant interaction. As HIV-infected patients age and experience multiple comorbidities, systematic reviews of current medications by providers may reduce risk of such exposures. |
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