Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Selik RM[original query] |
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Differences among diagnostic testing algorithms in the time from HIV diagnosis to care
Peruski AH , Wu B , Selik RM . J Clin Virol 2019 116 18-22 BACKGROUND: The association between the type of diagnostic testing algorithm for HIV infection and the time from diagnosis to care has not been fully evaluated. Here we extend an earlier analysis of this association by controlling for patient and diagnosing facility characteristics. STUDY DESIGN: Descriptive analysis of HIV infection diagnoses during 2016 reported to the National HIV Surveillance System through December 2017. Algorithm type: traditional = initial HIV antibody immunoassay followed by a Western blot or immunofluorescence antibody test; recommended = initial HIV antigen/antibody immunoassay followed by HIV-1/2 type-differentiating antibody test; rapid = two CLIA-waived rapid tests on the same date. RESULTS: In multivariate analyses controlling for patient and diagnosing facility characteristics, persons whose infection was diagnosed using the rapid algorithm were more likely to be linked to care within 30 days than those whose infection was diagnosed using the other testing algorithms (p < 0.01). The median time to link to care during a 30-day follow-up was 9.0 days (95% CI 8.0-12.0) after the rapid algorithm, 17.0 days (95% CI 17.0-18.0) after the recommended algorithm, and 23.0 days (95% CI 22.0-25.0) after the traditional algorithm. CONCLUSIONS: The time from HIV diagnosis to care varied with the type of testing algorithm. The median time to care was shortest for the rapid algorithm, longest for the traditional algorithm, and intermediate for the recommended algorithm. These results demonstrate the importance of choosing an algorithm with a short time between initial specimen collection and report of the final result to the patient. |
Viral loads within 6 weeks after diagnosis of HIV infection in early and later stages: Observational study using national surveillance data
Selik RM , Linley L . JMIR Public Health Surveill 2018 4 (4) e10770 BACKGROUND: Early (including acute) HIV infection is associated with viral loads higher than those in later stages. OBJECTIVE: This study aimed to examine the association between acute infection and viral loads near the time of diagnosis using data reported to the US National HIV Surveillance System. METHODS: We analyzed data on infections diagnosed in 2012-2016 and reported through December 2017. Diagnosis and staging were based on the 2014 US surveillance case definition for HIV infection. We divided early HIV-1 infection (stage 0) into two subcategories. Subcategory 0alpha: a negative or indeterminate HIV-1 antibody test was </=60 days after the first confirmed positive HIV-1 test or a negative or indeterminate antibody test or qualitative HIV-1 nucleic acid test (NAT) was </=180 days before the first positive test, the latter being a NAT or detectable viral load. Subcategory 0beta: a negative or indeterminate antibody or qualitative NAT was </=180 days before the first positive test, the latter being an HIV antibody or antigen/antibody test. We compared median earliest viral loads for each stage and subcategory in each of the first 6 weeks after diagnosis using only the earliest viral load for each individual. RESULTS: Of 203,392 infections, 56.69% (115,297/203,392) were reported with a quantified earliest viral load within 6 weeks after diagnosis and criteria sufficient to determine the stage at diagnosis. Among 5081 infections at stage 0, the median earliest viral load fell from 694,000 copies/mL in week 1 to 125,022 in week 2 and 43,473 by week 6. Among 30,910 infections in stage 1, the median earliest viral load ranged 15,412-17,495. Among 42,784 infections in stage 2, the median viral load declined from 44,973 in week 1 to 38,497 in week 6. Among 36,522 infections in stage 3 (AIDS), the median viral load dropped from 205,862 in week 1 to 119,000 in week 6. The median earliest viral load in stage 0 subcategory 0alpha fell from 1,344,590 copies/mL in week 1 to 362,467 in week 2 and 47,320 in week 6, while that in subcategory 0beta was 70,114 copies/mL in week 1 and then 32,033 to 44,067 in weeks 2-6. The median viral load in subcategory 0alpha was higher than that in subcategory 0beta in each of the first 6 weeks after diagnosis (P<.001). CONCLUSIONS: In the 1st week after diagnosis, viral loads in early infections are generally several times higher than those in later stages at diagnosis. By the 3rd week, however, most are lower than those in stage 3. High viral loads in early infection are much more common in subcategory 0alpha than in subcategory 0beta, consistent with 0alpha comprising mostly acute infections and 0beta comprising mostly postacute early infections. These findings may inform the prioritization of interventions for prevention. |
Trends in testing algorithms used to diagnose HIV infection, 2011-2015, United States and 6 dependent areas
Peruski AH , Dong X , Selik RM . J Clin Virol 2018 103 19-24 BACKGROUND: In 2014 the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL) issued updated laboratory testing recommendations for the diagnosis of HIV infection. OBJECTIVES: To examine trends in the use of HIV diagnostic testing algorithms, and determine whether the use of different algorithms is associated with selected patient characteristics and linkage to HIV medical care. STUDY DESIGN: Analysis of HIV infection diagnoses during 2011-2015 reported to the National HIV Surveillance System through December 2016. Algorithm classification: traditional=initial HIV antibody immunoassay followed by a Western blot or immunofluorescence antibody test; recommended=initial HIV antibody IA followed by HIV-1/2 type-differentiating antibody test; rapid=two CLIA-waived rapid tests on same date. RESULTS: During 2011-2015, the percentage of HIV diagnoses made using the traditional algorithm decreased from 84% to 16%, the percentage using the recommended algorithm increased from 0.1% to 64%, and the percentage using the rapid testing algorithm increased from 0.1% to 2%. The percentage of persons linked to care within 30days after HIV diagnosis in 2015 was higher for diagnoses using the recommended algorithm (59%) than for diagnoses using the traditional algorithm (55%) (p<0.05). CONCLUSIONS: During 2011-2015, the percentage of HIV diagnoses reported using the recommended and rapid testing algorithms increased while the use of the traditional algorithm decreased. In 2015, persons with HIV diagnosed using the recommended algorithm were more promptly linked to care than those with diagnosis using the traditional algorithm. |
HIV care and viral suppression during the last year of life: A comparison of HIV-infected persons who died of HIV-attributable causes with persons who died of other causes in 2012 in 13 US jurisdictions
Adih WK , Hall HI , Selik RM , Guo X . JMIR Public Health Surveill 2017 3 (1) e3 BACKGROUND: Little information is available about care before death among human immunodeficiency virus (HIV)-infected persons who die of HIV infection, compared with those who die of other causes. OBJECTIVE: The objective of our study was to compare HIV care and outcome before death among persons with HIV who died of HIV-attributable versus other causes. METHODS: We used National HIV Surveillance System data on CD4 T-lymphocyte counts and viral loads within 12 months before death in 2012, as well as on underlying cause of death. Deaths were classified as "HIV-attributable" if the reported underlying cause was HIV infection, an AIDS-defining disease, or immunodeficiency and as attributable to "other causes" if the cause was anything else. Persons were classified as "in continuous care" if they had ≥2 CD4 or viral load test results ≥3 months apart in those 12 months and as having "viral suppression" if their last viral load was <200 copies/mL. RESULTS: Among persons dying of HIV-attributable or other causes, respectively, 65.28% (2104/3223) and 30.88% (1041/3371) met AIDS criteria within 12 months before death, and 33.76% (1088/3223) and 50.96% (1718/3371) had viral suppression. The percentage of persons who received ≥2 tests ≥3 months apart did not differ by cause of death. Prevalence of viral suppression for persons who ever had AIDS was lower among those who died of HIV but did not differ by cause for those who never had AIDS. CONCLUSIONS: The lower prevalence of viral suppression among persons who died of HIV than among those who died of other causes implies a need to improve viral suppression strategies to reduce mortality due to HIV infection. |
Associations and trends in cause-specific rates of death among persons reported with HIV infection, 23 U.S. jurisdictions, through 2011
Adih WK , Selik RM , Hall HI , Babu AS , Song R . Open AIDS J 2016 10 144-157 BACKGROUND: Published death rates for persons with HIV have not distinguished deaths due to HIV from deaths due to other causes. Cause-specific death rates would allow better assessment of care needs. METHODS: Using data reported to the US national HIV surveillance system, we examined a) associations between selected decedent characteristics and causes of death during 2007-2011, b) trends in rates of death due to underlying causes among persons with AIDS during 1990-2011, and among all persons with diagnosed HIV infection (with or without AIDS) during 2000-2011. RESULTS: During 2007-2011, non-HIV-attributable causes of death with the highest rates per 1,000 person-years were heart disease (2.0), non-AIDS cancers other than lung cancer (1.4), and accidents (0.8). During 1990-2011, among persons with AIDS, the annual rate of death due to HIV-attributable causes decreased by 89% (from 122.0 to 13.2), and the rate due to non-HIV-attributable-causes decreased by 57% (from 20.0 to 8.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 11% to 43%. During 2000-2011, among persons with HIV infection, the rate of death due to HIV-attributable causes decreased by 69% (from 26.4 to 8.3), and the rate due to non-HIV-attributable causes decreased by 28% (from 10.5 to 7.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 25% to 48%. CONCLUSION: Among HIV-infected persons, as rates of death due to HIV-attributable causes decreased, rates due to non-HIV-attributable causes also decreased, but the percentages of deaths due to non-HIV-attributable causes, such as heart disease and non-AIDS cancers increased. |
Mortality risk after AIDS-defining opportunistic illness among HIV-infected persons - San Francisco, 1981-2012
Djawe K , Buchacz K , Hsu L , Chen MJ , Selik RM , Rose C , Williams T , Brooks JT , Schwarcz S . J Infect Dis 2015 212 (9) 1366-75 OBJECTIVE: To examine whether improved human immunodeficiency virus (HIV) treatment was associated with better survival after diagnosis of AIDS-defining opportunistic illnesses (AIDS-OIs) and how survival differed by AIDS-OI. DESIGN: We used HIV surveillance data to conduct a survival analysis. METHODS: We estimated survival probabilities after first AIDS-OI diagnosis among adult patients with AIDS in San Francisco during 3 treatment eras: 1981-1986; 1987-1996; and 1997-2012. We used Cox proportional hazards models to determine adjusted mortality risk by AIDS-OI in the years 1997-2012. RESULTS: Among 20 858 patients with AIDS, the most frequently diagnosed AIDS-OIs were Pneumocystis pneumonia (39.1%) and Kaposi sarcoma (20.1%). Overall 5-year survival probability increased from 7% in 1981-1986 to 65% in 1997-2012. In 1997-2012, after adjustment for known confounders and using Pneumocystis pneumonia as the referent category, mortality rates after first AIDS-OI were highest for brain lymphoma (hazard ratio [HR], 5.14; 95% confidence interval [CI], 2.98-8.87) and progressive multifocal leukoencephalopathy (HR, 4.22; 95% CI, 2.49-7.17). CONCLUSION: Survival after first AIDS-OI diagnosis has improved markedly since 1981. Some AIDS-OIs remain associated with substantially higher mortality risk than others, even after adjustment for known confounders. Better prevention and treatment strategies are still needed for AIDS-OIs occurring in the current HIV treatment era. |
CD4 T-lymphocyte percentages corresponding to CD4 T-lymphocyte count thresholds in a new staging system for HIV infection
Selik RM , Gebo KA , Borkowf CB , Whitmore SK , Espinoza L . J Acquir Immune Defic Syndr 2014 66 (4) e92-4 For epidemiologic surveillance of HIV infection in the United States, until this year, the staging system for adults (published in 2008) had been separate from the classification system for children (published in 1994).1,2 To design a single staging system for both adults and children based primarily on absolute CD4 T-lymphocyte counts, we retained the age-specific CD4 count thresholds used to define the boundaries between stages 1, 2, and 3 (called “immunologic categories” rather than “stages” in the 1994 classification for children). Values greater than or equal to the upper threshold indicate stage 1, values less than the upper threshold but greater than or equal to the lower threshold indicate stage 2, and values less than the lower threshold indicate stage 3 (AIDS). For children aged <1 year, the lower and upper CD4 count thresholds are 750 and 1500 (cells/μL); for children aged 1 to <6 years, they are 500 and 1000; for children aged 6 to <13 and for adults and adolescents aged 13 or older, they are 200 and 500. | Those staging/classification systems used both the absolute CD4 count and the CD4 percentage of total lymphocytes to classify cases into stages; if the CD4 count and the CD4 percentage indicated different stages, the more advanced of the 2 stages was selected. If one of these measurements was not available, the classification was based solely on the other measurement. The lower and upper CD4 percentage thresholds in those staging/classification systems were 15% and 25% for all 3 age groups of children, and 14% and 29% for adults and adolescents.1,2 In developing an updated staging system, we reassessed the relationship between the CD4 counts and the CD4 percentages and selected the mean CD4 percentage corresponding to each CD4 count threshold. |
Revised surveillance case definition for HIV infection - United States, 2014
Selik RM , Mokotoff ED , Branson B , Owen SM , Whitmore S , Hall HI . MMWR Recomm Rep 2014 63 1-10 Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged <13 years). The revisions were made to address multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition. |
Disparities among US states in HIV-related mortality in persons with HIV infection, 2001–2007
Hanna DB , Selik RM , Tang T , Gange SJ . AIDS 2011 26 (1) 95-103 OBJECTIVE: To examine interstate variation in US HIV case-fatality rates, and compare them with corresponding conventional HIV death rates. DESIGN: Cross-sectional analysis using data on deaths due to HIV infection from the National Vital Statistics System and data on persons 15 years or older living with HIV infection in 2001-2007 in 37 U.S. states from the national HIV/AIDS Reporting System. METHODS: State rankings by age-adjusted HIV case-fatality rates (with HIV-infected population denominators) were compared with rankings by conventional death rates (with general population denominators). Negative binomial regression determined case-fatality rate ratios (RRs) among states, adjusted for age, sex, race/ethnicity, year, and state-level markers of late HIV diagnosis. RESULTS: Based on 3,096,729 HIV-infected person-years, the overall HIV case-fatality rate was 20.6/1,000 person-years (95% confidence interval [CI], 20.3-20.9). Age-adjusted rates by state ranged from 9.6 (95% CI 6.8-12.4) in Idaho to 32.9 (95% CI 29.8-36.0) in Mississippi, demonstrating significant differences across states, even after adjusting for race/ethnicity (p < 0.0001). Many states with low conventional death rates had high case-fatality rates. Nine of the ten states with the highest case-fatality rates were located in the U.S. South. CONCLUSIONS: Case-fatality rates complement and are not entirely concordant with conventional death rates. Interstate differences in these rates may reflect differences in secondary and tertiary prevention of HIV-related mortality among infected persons. These data suggest that state-specific contextual barriers to care may impede improvements in quality and disparities of health-care without targeted interventions. |
Trends in diseases reported on US death certificates that mentioned HIV infection, 1996-2006
Adih WK , Selik RM , Xiaohong Hu . J Int Assoc Physicians AIDS Care (Chic) 2011 10 (1) 5-11 OBJECTIVE: We examined trends during 1996-2006 in diseases reported on death certificates that mentioned HIV infection. METHODS: We analyzed multiple-cause mortality data compiled from all US death certificates with any mention of HIV to determine the annual percentages of deaths with various diseases. RESULTS: Deaths reported with HIV during 1996-2006 decreased from 35,340 to 13,750. Standardized percentages of death certificates reporting AIDS-defining opportunistic infections also decreased: pneumocytosis (6.3% to 5.1%), nontuberculous mycobacteriosis (5.5% to 1.8%), cytomegalovirus (5.7% to 1.2%). Non-Hodgkin's lymphoma rose from 4.8% in 1996 to 6.4% in 1997 and declined to 5.0% in 2001, while Kaposi's sarcoma declined from 3.7% in 1996 to 1.7% in 2001; these AIDS-defining cancers had stable percentages after 2001. All other cancers increased during 1996-2006 (2.7% to 7.3%). The percentage of deaths with diseases not specifically attributable to HIV increased: liver disease (5.8% to 13.0%), kidney disease (7.9% to 12.0%), and heart disease (4.9% to 10.2%). CONCLUSION: Among deaths reported with HIV, the percentages reported with HIV-attributable diseases decreased, while the percentages reported with other diseases increased. Consequently, these other life-threatening diseases need more attention in the management of HIV-infected persons. |
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