Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Kowalski P [original query] |
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Linking exposure to per- and polyfluoroalkyl substances (PFAS) in house dust and biomonitoring data in eight impacted communities
Minucci JM , DeLuca NM , Durant JT , Goodwin B , Kowalski P , Scruton K , Thomas K , Cohen Hubal EA . Environ Int 2024 188 108756 Per- and polyfluoroalkyl substances (PFAS) are widely used in industry and have been linked to various adverse health effects. Communities adjacent to sites where PFAS are manufactured, stored, or used may be at elevated risk. In these impacted communities, significant exposure often occurs through contaminated drinking water, yet less is known about the role of other pathways such as residential exposure through house dust. We analyzed a paired serum and house dust dataset from the Agency for Toxic Substances and Disease Registry's PFAS Exposure Assessments, which sampled eight United States communities with a history of drinking water contamination due to aqueous film forming foam (AFFF) use at nearby military bases. We found that serum PFAS levels of residents were significantly positively associated with the dust PFAS levels in their homes, for three of seven PFAS analyzed, when accounting for site and participant age. We also found that increased dust PFAS levels were associated with a shift in the relative abundance of PFAS in serum towards those chemicals not strongly linked to AFFF contamination, which may suggest household sources. Additionally, we analyzed participant responses to exposure questionnaires to identify factors associated with dust PFAS levels. Dust PFAS levels for some analytes were significantly elevated in households where participants were older and had lived at the home longer, cleaned less frequently, used stain resistant products, and had carpeted living rooms. Our results suggest that residential exposure to PFAS via dust or other indoor pathways may contribute to overall exposure and body burden, even in communities impacted by AFFF contamination of drinking water, and the magnitude of this exposure may also be influenced by demographic, behavioral, and housing factors. |
Correlation of wastewater surveillance data with traditional influenza surveillance measures in Cook County, Illinois, October 2022-April 2023
Faherty EAG , Yuce D , Korban C , Bemis K , Kowalski R , Gretsch S , Ramirez E , Poretsky R , Packman A , Leisman KP , Pierce M , Kittner A , Teran R , Pacilli M . Sci Total Environ 2023 912 169551 Influenza is a respiratory illness that can result in serious outcomes, particularly among persons who are immunocompromised, aged <5 years or aged >65 years. Traditional influenza surveillance approaches rely upon syndromic surveillance of emergency departments and public health reporting from clinicians and laboratories. Wastewater surveillance infrastructure developed to monitor SARS-CoV-2 is being used for influenza surveillance in the Chicago area. The goal was to evaluate timeliness and correlations between influenza virus detected through wastewater surveillance and traditional influenza surveillance measures to assess utility of wastewater surveillance for influenza at the county level. Specifically, we measured correlations between influenza virus gene copies in wastewater samples and 1) the number of intensive care unit admissions associated with a diagnosis of influenza, 2) the percentage emergency department (ED) visits for influenza-like-illness, and 3) the percentage of ED visits with influenza diagnosis at discharge(2) in Cook County. Influenza concentrations in wastewater were strongly correlated with traditional influenza surveillance measures, particularly for catchment areas serving >100,000 residents. Wastewater indicators lagged traditional influenza surveillance measures by approximately one week when analyzed in cross-correlations. Although wastewater data lagged traditional influenza surveillance measures in this analysis, it can serve as a useful surveillance tool as a complement to syndromic surveillance; it is a form of influenza surveillance that does not rely on healthcare-seeking behavior or reporting by healthcare providers. |
Signatures of somatic mutations and gene expression from p16INK4A positive head and neck squamous cell carcinomas (HNSCC).
Saba NF , Dinasarapu AR , Magliocca KR , Dwivedi B , Seby S , Qin ZS , Patel M , Griffith CC , Wang X , El-Deiry M , Steuer CE , Kowalski J , Shin DM , Zwick ME , Chen ZG . PLoS One 2020 15 (9) e0238497 Human papilloma virus (HPV) causes a subset of head and neck squamous cell carcinomas (HNSCC) of the oropharynx. We combined targeted DNA- and genome-wide RNA-sequencing to identify genetic variants and gene expression signatures respectively from patients with HNSCC including oropharyngeal squamous cell carcinomas (OPSCC). DNA and RNA were purified from 35- formalin fixed and paraffin embedded (FFPE) HNSCC tumor samples. Immuno-histochemical evaluation of tumors was performed to determine the expression levels of p16INK4A and classified tumor samples either p16+ or p16-. Using ClearSeq Comprehensive Cancer panel, we examined the distribution of somatic mutations. Somatic single-nucleotide variants (SNV) were called using GATK-Mutect2 ("tumor-only" mode) approach. Using RNA-seq, we identified a catalog of 1,044 and 8 genes as significantly expressed between p16+ and p16-, respectively at FDR 0.05 (5%) and 0.1 (10%). The clinicopathological characteristics of the patients including anatomical site, smoking and survival were analyzed when comparing p16+ and p16- tumors. The majority of tumors (65%) were p16+. Population sequence variant databases, including gnomAD, ExAC, COSMIC and dbSNP, were used to identify the mutational landscape of somatic sequence variants within sequenced genes. Hierarchical clustering of The Cancer Genome Atlas (TCGA) samples based on HPV-status was observed using differentially expressed genes. Using RNA-seq in parallel with targeted DNA-seq, we identified mutational and gene expression signatures characteristic of p16+ and p16- HNSCC. Our gene signatures are consistent with previously published data including TCGA and support the need to further explore the biologic relevance of these alterations in HNSCC. |
Functional outcome trajectories following inpatient rehabilitation for TBI in the United States: A NIDILRR TBIMS and CDC Interagency Collaboration
Dams-O'Connor K , Ketchum JM , Cuthbert JP , Corrigan JD , Hammond FM , Haarbauer-Krupa J , Kowalski RG , Miller AC . J Head Trauma Rehabil 2019 35 (2) 127-139 OBJECTIVE: To describe trajectories of functioning up to 5 years after traumatic brain injury (TBI) that required inpatient rehabilitation in the United States using individual growth curve models conditioned on factors associated with variability in functioning and independence over time. DESIGN: Secondary analysis of population-weighted data from a multicenter longitudinal cohort study. SETTING: Acute inpatient rehabilitation facilities. PARTICIPANTS: A total of 4624 individuals 16 years and older with a primary diagnosis of TBI. MAIN OUTCOME MEASURES: Ratings of global disability and supervision needs as reported by participants or proxy during follow-up telephone interviews at 1, 2, and 5 years postinjury. RESULTS: Many TBI survivors experience functional improvement through 1 and 2 years postinjury, followed by a decline in functioning and decreased independence by 5 years. However, there was considerable heterogeneity in outcomes across individuals. Factors such as older age, non-White race, lower preinjury productivity, public payer source, longer length of inpatient rehabilitation stay, and lower discharge functional status were found to negatively impact trajectories of change over time. CONCLUSIONS: These findings can inform the content, timing, and target recipients of interventions designed to maximize functional independence after TBI. |
CDK5 inhibition resolves PKA/cAMP-independent activation of CREB1 signaling in glioma stem cells
Mukherjee S , Tucker-Burden C , Kaissi E , Newsam A , Duggireddy H , Chau M , Zhang C , Diwedi B , Rupji M , Seby S , Kowalski J , Kong J , Read R , Brat DJ . Cell Rep 2018 23 (6) 1651-1664 Cancer stem cells promote neoplastic growth, in part by deregulating asymmetric cell division and enhancing self-renewal. To uncover mechanisms and potential therapeutic targets in glioma stem cell (GSC) self-renewal, we performed a genetic suppressor screen for kinases to reverse the tumor phenotype of our Drosophila brain tumor model and identified dCdk5 as a critical regulator. CDK5, the human ortholog of dCdk5 (79% identity), is aberrantly activated in GBMs and tightly aligned with both chromosome 7 gains and stem cell markers affecting tumor-propagation. Our investigation revealed that pharmaceutical inhibition of CDK5 prevents GSC self-renewal in vitro and in xenografted tumors, at least partially by suppressing CREB1 activation independently of PKA/cAMP. Finally, our TCGA GBM data analysis revealed that CDK5, stem cell, and asymmetric cell division markers segregate within non-mesenchymal patient clusters, which may indicate preferential dependence on CDK5 signaling and sensitivity to its inhibition in this group. |
Characterizing the interrelationships of prescription opioid and benzodiazepine drugs with worker health and workplace hazards
Kowalski-McGraw M , Green-McKenzie J , Pandalai SP , Schulte PA . J Occup Environ Med 2017 59 (11) 1114-1126 OBJECTIVE: Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use. METHODS: The scientific literature from 2000 to 2015 was searched to determine any interrelationships. RESULTS: Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers. CONCLUSION: Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures. |
Acute ischemic stroke after moderate to severe traumatic brain injury: Incidence and impact on outcome
Kowalski RG , Haarbauer-Krupa JK , Bell JM , Corrigan JD , Hammond FM , Torbey MT , Hofmann MC , Dams-O'Connor K , Miller AC , Whiteneck GG . Stroke 2017 48 (7) 1802-1809 BACKGROUND AND PURPOSE: Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. METHODS: A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. RESULTS: Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, -16.8 to -9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3-2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1-23.4; P<0.001). CONCLUSIONS: Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events. |
Factors influencing mine rescue team behaviors
Jansky JH , Kowalski-Trakofler KM , Brnich MJ , Vaught C . J Emerg Manag 2016 14 (1) 43-54 A focus group study of the first moments in an underground mine emergency response was conducted by the National Institute for Occupational Safety and Health (NIOSH), Office for Mine Safety and Health Research. Participants in the study included mine rescue team members, team trainers, mine officials, state mining personnel, and individual mine managers. A subset of the data consists of responses from participants with mine rescue backgrounds. These responses were noticeably different from those given by on-site emergency personnel who were at the mine and involved with decisions made during the first moments of an event. As a result, mine rescue team behavior data were separated in the analysis and are reported in this article. By considering the responses from mine rescue team members and trainers, it was possible to sort the data and identify seven key areas of importance to them. On the basis of the responses from the focus group participants with a mine rescue background, the authors concluded that accurate and complete information and a unity of purpose among all command center personnel are two of the key conditions needed for an effective mine rescue operation. |
Gene integrated set profile analysis: a context-based approach for inferring biological endpoints.
Kowalski J , Dwivedi B , Newman S , Switchenko JM , Pauly R , Gutman DA , Arora J , Gandhi K , Ainslie K , Doho G , Qin Z , Moreno CS , Rossi MR , Vertino PM , Lonial S , Bernal-Mizrachi L , Boise LH . Nucleic Acids Res 2016 44 (7) e69 The identification of genes with specific patterns of change (e.g. down-regulated and methylated) as phenotype drivers or samples with similar profiles for a given gene set as drivers of clinical outcome, requires the integration of several genomic data types for which an 'integrate by intersection' (IBI) approach is often applied. In this approach, results from separate analyses of each data type are intersected, which has the limitation of a smaller intersection with more data types. We introduce a new method, GISPA (Gene Integrated Set Profile Analysis) for integrated genomic analysis and its variation, SISPA (Sample Integrated Set Profile Analysis) for defining respective genes and samples with the context of similar, a priori specified molecular profiles. With GISPA, the user defines a molecular profile that is compared among several classes and obtains ranked gene sets that satisfy the profile as drivers of each class. With SISPA, the user defines a gene set that satisfies a profile and obtains sample groups of profile activity. Our results from applying GISPA to human multiple myeloma (MM) cell lines contained genes of known profiles and importance, along with several novel targets, and their further SISPA application to MM coMMpass trial data showed clinical relevance. |
Development of the Diabetes Technology Society Blood Glucose Monitor System Surveillance protocol
Klonoff DC , Lias C , Beck S , Parkes JL , Kovatchev B , Vigersky RA , Arreaza-Rubin G , Burk RD , Kowalski A , Little R , Nichols J , Petersen M , Rawlings K , Sacks DB , Sampson E , Scott S , Seley JJ , Slingerland R , Vesper HW . J Diabetes Sci Technol 2015 10 (3) 697-707 BACKGROUND: Inaccurate blood glucose monitoring systems (BGMSs) can lead to adverse health effects. The Diabetes Technology Society (DTS) Surveillance Program for cleared BGMSs is intended to protect people with diabetes from inaccurate, unreliable BGMS products that are currently on the market in the United States. The Surveillance Program will provide an independent assessment of the analytical performance of cleared BGMSs. METHODS: The DTS BGMS Surveillance Program Steering Committee included experts in glucose monitoring, surveillance testing, and regulatory science. Over one year, the committee engaged in meetings and teleconferences aiming to describe how to conduct BGMS surveillance studies in a scientifically sound manner that is in compliance with good clinical practice and all relevant regulations. RESULTS: A clinical surveillance protocol was created that contains performance targets and analytical accuracy-testing studies with marketed BGMS products conducted by qualified clinical and laboratory sites. This protocol entitled "Protocol for the Diabetes Technology Society Blood Glucose Monitor System Surveillance Program" is attached as supplementary material. CONCLUSION: This program is needed because currently once a BGMS product has been cleared for use by the FDA, no systematic postmarket Surveillance Program exists that can monitor analytical performance and detect potential problems. This protocol will allow identification of inaccurate and unreliable BGMSs currently available on the US market. The DTS Surveillance Program will provide BGMS manufacturers a benchmark to understand the postmarket analytical performance of their products. Furthermore, patients, health care professionals, payers, and regulatory agencies will be able to use the results of the study to make informed decisions to, respectively, select, prescribe, finance, and regulate BGMSs on the market. |
Spotlight on ATSDR: exposure investigations
Kowalski P , Anderson B , Moore S , Wilder L . J Environ Health 2013 76 (5) 40-42 One way that the Agency for Toxic Substances and Disease Registry (ATSDR) accomplishes its mission of serving the public by promoting healthy and safe environments and preventing harmful exposures is by investigating and evaluating the potential public health consequences of exposures to environmental contamination at a community or site-specific level (ATSDR, 2013a). The first step in this process often involves reviewing and analyzing existing environmental and exposure-related data to find out whether people have been, are being, or may be exposed to environmental contaminants. ATSDR typically relies on environmental and exposure-related data provided by state and federal partners. In cases where critical data are not available and may not be forthcoming from another agency, ATSDR can conduct a site-specific exposure investigation to fill an identified data gap. Exposure investigations may include collection of (1) environmental samples of soil, water, air, or biota (e.g., fish, crab, fruits, or vegetables that people consume) and/or (2) biological samples of a person’s urine or blood that may contain biomarkers suggesting exposure to a specific contaminant. | ATSDR uses the following criteria to determine whether a proposed exposure investigation is feasible: | Can an exposed population be identified? | Does a critical data gap exist that affects our ability to determine if a health hazard exists? | Can an exposure investigation be designed that will address the critical data gap? | Will the results of the exposure investigation affect the public health decision(s) for the site? |
Acanthamoeba keratitis: the persistence of cases following a multistate outbreak
Yoder JS , Verani J , Heidman N , Hoppe-Bauer J , Alfonso EC , Miller D , Jones DB , Bruckner D , Langston R , Jeng BH , Joslin CE , Tu E , Colby K , Vetter E , Ritterband D , Mathers W , Kowalski RP , Acharya NR , Limaye AP , Leiter C , Roy S , Lorick S , Roberts J , Beach MJ . Ophthalmic Epidemiol 2012 19 (4) 221-5 PURPOSE: To describe the trend of Acanthamoeba keratitis case reports following an outbreak and the recall of a multipurpose contact lens disinfection solution. Acanthamoeba keratitis is a serious eye infection caused by the free-living amoeba Acanthamoeba that primarily affects contact lens users. METHODS: A convenience sample of 13 ophthalmology centers and laboratories in the USA, provided annual numbers of Acanthamoeba keratitis cases diagnosed between 1999-2009 and monthly numbers of cases diagnosed between 2007-2009. Data on ophthalmic preparations of anti-Acanthamoeba therapies were collected from a national compounding pharmacy. RESULTS: Data from sentinel site ophthalmology centers and laboratories revealed that the yearly number of cases gradually increased from 22 in 1999 to 43 in 2003, with a marked increase beginning in 2004 (93 cases) that continued through 2007 (170 cases; p < 0.0001). The outbreak identified from these sentinel sites resulted in the recall of a contact lens disinfecting solution. There was a statistically significant (p ≤ 0.0001) decrease in monthly cases reported from 28 cases in June 2007 (following the recall) to seven cases in June 2008, followed by an increase (p = 0.0004) in reported cases thereafter; cases have remained higher than pre-outbreak levels. A similar trend was seen in prescriptions for Acanthamoeba keratitis chemotherapy. Cases were significantly more likely to be reported during summer than during other seasons. CONCLUSION: The persistently elevated number of reported cases supports the need to understand the risk factors and environmental exposures associated with Acanthamoeba keratitis. Further prevention efforts are needed to reduce the number of cases occurring among contact lens wearers. |
Global prevalence and major risk factors of diabetic retinopathy
Yau JW , Rogers SL , Kawasaki R , Lamoureux EL , Kowalski JW , Bek T , Chen SJ , Dekker JM , Fletcher A , Grauslund J , Haffner S , Hamman RF , Ikram MK , Kayama T , Klein BE , Klein R , Krishnaiah S , Mayurasakorn K , O'Hare JP , Orchard TJ , Porta M , Rema M , Roy MS , Sharma T , Shaw J , Taylor H , Tielsch JM , Varma R , Wang JJ , Wang N , West S , Xu L , Yasuda M , Zhang X , Mitchell P , Wong TY . Diabetes Care 2012 35 (3) 556-64 OBJECTIVE: To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS: A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20-79 years. RESULTS: A total of 35 studies (1980-2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5-34.8) for any DR, 6.96% (6.87-7.04) for proliferative DR, 6.81% (6.74-6.89) for diabetic macular edema, and 10.2% (10.1-10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A(1c), and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS: There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics. |
Training for safety in emergencies: inoculating for underground coal mine emergencies
Kingsley Westerman CY , Margolis KA , Kowalski-Trakofler KM . Prof Saf 2011 56 (11) 42-46 The potential for emergencies is ever-present in coal mining. This is illustrated by statistics which show that employees in coal mining are more likely to be killed or to incur a nonfatal injury or illness, and their injuries are more likely to be severe, than workers in private industry as a whole. As a result of this constant exposure to harm, coal miners must be highly trained to deal with various emergency scenarios. Some existing underground coal mine training focuses on rote performance of prescribed actions. For example, coal miners are taught when and how to put on self-contained self rescuers, which are respirators that provide 60 minutes of breathable air. Preparation based on inoculation theory principles differs from more traditional training in that it involves teaching trainees to think for themselves rather than simply teaching them how to perform a task or use a safety device. The principles of inoculation theory can be used for emergency safety training for miners as well as for workers in other high-risk industries. |
Underground mine refuge chamber expectations training: program development and evaluation
Margolis KA , Westerman CYK , Kowalski-Trakofler KM . Saf Sci 2011 49 (3) 522-530 Refuge chambers are new devices for underground coal mines that provide approximately 96 h of breathable air, water, food, and supplies in the event of an emergency where miners are unable to escape. Researchers at the National Institute for Occupational Safety and Health (NIOSH) developed a training program to prepare miners for what to expect psychologically and physiologically inside of a refuge chamber. The field tests of this training revealed that it was received very positively by miners and helped impart realistic views about the physical discomforts and psychological stresses of being inside a refuge chamber. |
A study of first moments in underground mine emergency response
Kowalski-Trakofler KM , Vaught C , Brnich MJ , Jansky JH . J Homel Secur Emerg Manag 2010 7 (1) Researchers at the National Institute for Occupational Safety and Health (NIOSH) conducted seven focus groups and 10 individual interviews to gather data on what happens in the first crucial moments of a mine emergency. The goal of the project was to learn about responses on-site during the initial phases of a mine emergency to further improve response. The subjects represented underground coal and salt mines in the southern, western, mid-western, and eastern parts of the United States. They included on-site responders, mine rescue team members, and experts in mine emergency response with extensive experience in managing mine disasters. The types of disasters the subjects experienced were diverse, including explosions, fires, and inundations (sudden floods of water or inrushes of dangerous gases). This study was unique in its focus on the first moments in an emergency response, in studying underground coal mine emergencies and in utilizing a focus group methodology. Results indicated that there were common themes in initial response, which included the importance of mine emergency planning and training, quantity and quality of communication providing information for decision-making, leadership and trust, plus individual personal issues. Previous relevant studies are presented and the researchers discuss the data providing specific examples. The article concludes with recommendations to enhance initial response in the first critical moments of an emergency. |
Advances in Identifying beryllium sensitization and disease
Middleton D , Kowalski P . Int J Environ Res Public Health 2010 7 (1) 115-124 Beryllium is a lightweight metal with unique qualities related to stiffness, corrosion resistance, and conductivity. While there are many useful applications, researchers in the 1930s and l940s linked beryllium exposure to a progressive occupational lung disease. Acute beryllium disease is a pulmonary irritant response to high exposure levels, whereas chronic beryllium disease (CBD) typically results from a hypersensitivity response to lower exposure levels. A blood test, the beryllium lymphocyte proliferation test (BeLPT), was an important advance in identifying individuals who are sensitized to beryllium (BeS) and thus at risk for developing CBD. While there is no true "gold standard" for BeS, basic epidemiologic concepts have been used to advance our understanding of the different screening algorithms. |
Detecting acute human immunodeficiency virus infection using 3 different screening immunoassays and nucleic acid amplification testing for human immunodeficiency virus RNA, 2006-2008
Patel P , Mackellar D , Simmons P , Uniyal A , Gallagher K , Bennett B , Sullivan TJ , Kowalski A , Parker MM , LaLota M , Kerndt P , Sullivan PS . Arch Intern Med 2010 170 (1) 66-74 BACKGROUND: The yield of nucleic acid amplification testing (NAAT) after routine screening for human immunodeficiency virus (HIV) antibody to detect acute HIV infection (AHI) may vary with different HIV-antibody assays. METHODS: From April 24, 2006, through March 28, 2008, patients underwent routine HIV-antibody screening using a first-generation assay at 14 county sexually transmitted disease (STD) clinics and 1 community clinic serving homosexual patients in Los Angeles; using a second-generation rapid test at 3 municipal STD clinics in New York; and using a third-generation assay at 80 public health clinics in Florida. To identify AHI, seronegative specimens were pooled for NAAT, followed by individual NAAT of specimens with positive findings. All AHI samples screened by first- and second-generation assays also underwent third-generation testing. RESULTS: We screened 37 012 persons using NAAT after first-generation testing; 35 AHIs were identified, increasing HIV case detection by 8.2%. After a second-generation rapid test, 6547 persons underwent NAAT; 7 AHIs were identified, increasing HIV case detection by 24.1%. After third-generation testing, 54 948 persons underwent NAAT; 12 AHI cases were identified, increasing HIV case detection by 1.4%. Overall, pooled NAAT after negative third-generation test results detected 26 AHI cases, increasing HIV case detection by 2.2%. Most of the AHI cases from Los Angeles (26 of 35 [74%]) were identified at the community clinic where NAAT after third-generation testing increased HIV case detection by 11.9%. CONCLUSIONS: Pooled NAAT after third-generation testing increases HIV case detection, especially in venues of high HIV seropositivity. Therefore, targeted AHI screening using pooled NAAT after third-generation testing may be most effective, warranting a cost-benefit analysis. |
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