Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Kapogiannis BG [original query] |
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Preexposure prophylaxis for prevention of HIV acquisition among adolescents: Clinical considerations, 2020
Tanner MR , Miele P , Carter W , Valentine SS , Dunville R , Kapogiannis BG , Smith DK . MMWR Recomm Rep 2020 69 (3) 1-12 Preexposure prophylaxis (PrEP) with antiretroviral medication has been proven effective in reducing the risk for acquiring human immunodeficiency virus (HIV). The fixed-dose combination tablet of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) was approved by the U.S. Food and Drug Administration (FDA) for use as PrEP for adults in 2012. Since then, recognition has been increasing that adolescents at risk for acquiring HIV can benefit from PrEP. In 2018, FDA approved revised labeling for TDF/FTC that expanded the indication for PrEP to include adolescents weighing at least 77 lb (35 kg) who are at risk for acquiring HIV. In 2019, FDA approved the combination product tenofovir alafenamide (TAF)/FTC as PrEP for adolescents and adults weighing at least 77 lb (35 kg), excluding those at risk for acquiring HIV through receptive vaginal sex. This exclusion is due to the lack of clinical data regarding the efficacy of TAF/FTC in cisgender women.Clinical providers who evaluate adolescents for PrEP use must consider certain topics that are unique to the adolescent population. Important considerations related to adolescents include PrEP safety data, legal issues about consent for clinical care and confidentiality, the therapeutic partnership with adolescents and their parents or guardians, the approach to the adolescent patient's clinical visit, and medication initiation, adherence, and persistence during adolescence. Overall, data support the safety of PrEP for adolescents. PrEP providers should be familiar with the statutes and regulations about the provision of health care to minors in their states. Providers should partner with the adolescent patient for PrEP decisions, recognizing the adolescent's autonomy to the extent allowable by law and including parents in the conversation about PrEP when it is safe and reasonable to do so. A comprehensive approach to adolescent health is recommended, including considering PrEP as one possible component of providing medical care to adolescents who inject drugs or engage in sexual behaviors that place them at risk for acquiring HIV. PrEP adherence declined over time in the studies evaluating PrEP among adolescents, a trend that also has been observed among adult patients. Clinicians should implement strategies to address medication adherence as a routine part of prescribing PrEP; more frequent clinical follow-up is one possible approach.PrEP is an effective HIV prevention tool for protecting adolescents at risk for HIV acquisition. For providers, unique considerations that are part of providing PrEP to adolescents include the possible need for more frequent, supportive interactions to promote medication adherence. Recommendations for PrEP medical management and additional resources for providers are available in the U.S. Public Health Service clinical practice guideline Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2017 Update and the clinical providers' supplement Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2017 Update: Clinical Providers' Supplement (https://www.cdc.gov/hiv/clinicians/prevention/prep.html). |
The HIV continuum of care for adolescents and young adults attending 13 urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative
Kapogiannis BG , Koenig LJ , Xu J , Mayer KH , Loeb J , Greenberg L , Monte D , Banks-Shields M , Fortenberry JD . J Acquir Immune Defic Syndr 2020 84 (1) 92-100 BACKGROUND: Almost one-quarter of all new HIV diagnoses in the United States occur among persons aged 13-24 years. These youths have the poorest HIV care continuum (HCC) outcomes, yet few empirical youth-specific data are available. METHODS: The Strategic Multisite Initiative for the Identification, Linkage, and Engagement in Care of HIV-infected youth (SMILE) helped HIV-infected (mostly newly diagnosed) youth, aged 12-24 years, link to youth-friendly care, and evaluated each milestone of the HCC (October 2012-September 2014). Numbers of HIV-infected youth referred, linked, engaged, and retained in care were recorded, along with sociodemographics. Viral suppression (VS) was defined as >/=1 HIV viral load (VL) below the level of detection on study. Correlates of VS were examined using Cox proportional hazards models. RESULTS: Among 1411 HIV-infected youth, 1053 (75%) were linked, 839 (59%) engaged, and 473 (34%) retained in care at adolescent health care sites. Antiretroviral therapy was initiated among 474 (34%), and 166 (12%) achieved VS. Predictors of VS included lower VL at baseline [aHR 1.56 (95% CI: 1.32-1.89), P < 0.0001], recent antiretroviral therapy receipt [aHR 3.10 (95% CI: 1.86-5.18), P < 0.0001], and shorter time from HIV testing until referral to linkage coordinator [aHR 2.52 (95% CI: 1.50-4.23), P = 0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08-4.04), P = 0.0294 for 6 weeks to 3 months compared with >3 months]. CONCLUSIONS: Although this large national sample of predominately newly diagnosed youths linked to care at similar rates as adults, they achieved disproportionately lower rates of VS. Prompt referral to youth-friendly linkage services was an independent predictor of VS. Youth-focused interventions are urgently needed to improve their HCC outcomes. |
Implementation of an integrated approach to the National HIV/AIDS Strategy for improving human immunodeficiency virus care for youths
Fortenberry JD , Koenig LJ , Kapogiannis BG , Jeffries CL , Ellen JM , Wilson CM . JAMA Pediatr 2017 171 (7) 687-693 Importance: Youths aged 13 to 24 years old living with human immunodeficiency virus (HIV) are less likely than adults to receive the health and prevention benefits of HIV treatments, with only a small proportion having achieved sustained viral suppression. These age-related disparities in HIV continuum of care are owing in part to the unique developmental issues of adolescents and young adults as well as the complexity and fragmentation of HIV care and related services. This article summarizes a national, multiagency, and multilevel approach to HIV care for newly diagnosed youths designed to bridge some of these fragmentations by addressing National HIV/AIDS Strategy goals for people living with HIV. Design, Setting, and Participants: Three federal agencies developed memoranda of understanding to sequentially implement 3 protocols addressing key National HIV/AIDS Strategy goals. The goals were addressed in the Adolescent Trials Network, with protocols implemented in 12 to 15 sites across the United States. Outcome data were collected from recently diagnosed youth referred to the program. Main Outcomes and Measures: Cross-agency collaboration, youth-friendly linkage to care services, community mobilization to address structural barriers to care, cooperation among services clinicians to proportion of all men who have sex with men who tested, men who identified, and rates of linkage to prevention services. Results: The program addressed National HIV/AIDS Strategy goals 2 through 4 including steps within each goal. A total of 3986 HIV-positive youths were referred for care, with more than 75% linked to care within 6 weeks of referral, with almost 90% of those youths engaged in subsequent HIV care. Community mobilization efforts implemented and completed structural change objectives to address local barriers to care. Age and racial/ethnic group disparities were addressed through targeted training for culturally competent, youth-friendly care, and intensive motivational interviewing training. Conclusions and Relevance: A national program to address the National HIV/AIDS Strategy specifically for youths can improve coordination of federal resources as well as implement best-practice models that are adapted to decrease service fragmentation and systemic barriers at local jurisdictions. |
Mortality trends in the US Perinatal AIDS Collaborative Transmission Study (1986-2004)
Kapogiannis BG , Soe MM , Nesheim SR , Abrams EJ , Carter RJ , Farley J , Palumbo P , Koenig LJ , Bulterys M . Clin Infect Dis 2011 53 (10) 1024-34 BACKGROUND: Highly active antiretroviral therapy (HAART) has improved human immunodeficiency virus (HIV)-associated morbidity and mortality. The bimodal mortality distribution in HIV-infected children makes it important to evaluate temporal effects of HAART among a birth cohort with long-term, prospective follow-up. METHODS: Perinatal AIDS Collaborative Transmission Study (PACTS)/PACTS-HIV Follow-up of Perinatally Exposed Children (HOPE) study was a Centers for Disease Control and Prevention-sponsored multicenter, prospective birth cohort study of HIV-exposed uninfected and infected infants from 1985 until 2004. Mortality was evaluated for the no/monotherapy, mono-/dual-therapy, and HAART eras, that is, 1 January 1986 through 31 December 1990, from 1 January 1991 through 31 December 1996, and 1 January 1997 through 31 December 2004. RESULTS: Among 364 HIV-infected children, 56% were female and 69% black non-Hispanic. Of 98 deaths, 79 (81%) and 61 (62%) occurred in children ≤3 and ≤2 years old, respectively. The median age at death increased significantly across the eras (P < .0001). The average annual mortality rates were 18 (95% confidence interval [CI], 11.6-26.8), 6.9 (95% CI, 5.4-8.8), and 0.8 (95% CI, 0.4-1.5) events per 100 person-years for the no/monotherapy, mono-/dual-therapy and HAART eras, respectively. The corresponding 6-year survival rates for children born in these eras were 57%, 76%, and 91%, respectively (P < .0001). Among children who received HAART in the first 6 months of age, the probability of 6-year survival was 94%. Ten-year survival rates for HAART and non-HAART recipients were 94% and 45% (P < .05). HAART-associated reductions in mortality remained significant after adjustment for confounders (hazard ratio, 0.3; 95% CI, .08-.76). Opportunistic infections (OIs) caused 31.8%, 16.9%, and 9.1% of deaths across the respective eras (P = .051). CONCLUSIONS: A significant decrease in annual mortality and a prolongation in survival were seen in this US perinatal cohort of HIV-infected children. Temporal decreases in OI-associated mortality resulted in relative proportional increases of non-OI-associated deaths. (See the Editorial Commentary by Nachman, on pages 1035-6.) |
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