Search

Objective: There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population. Methods: Population‐based health data were accessed for 2 cohorts of HIV‐positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV‐positive cohort was compared to the expected age‐, sex‐, calendar year‐, income‐specific, and region of birth‐specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART‐exposed") was also calculated. Results: The combined Sweden‐Canada cohort included 29,163 (75% men) HIV‐positive persons. During 242,248 person‐years of follow‐up, 14 incident MS cases were observed in the HIV‐positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV‐positive population was 0.53 (95% confidence interval [CI] = 0.32–0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31–0.96). Interpretation: This international population‐based study demonstrated a lower risk of MS among HIV‐positive individuals, and HIV‐positive ART‐exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2024;95:487–494 [ABSTRACT FROM AUTHOR]

This article presents the findings of a population-based study conducted in Ontario and British Columbia, Canada, on pediatric-onset multiple sclerosis (PoMS). The study found that the incidence rate of PoMS remained stable between 2003 and 2019, while the prevalence increased over time. The study highlights the need for appropriate resource allocation to support the growing PoMS population. The document provides information on the selection of cases, demographic characteristics, and compares the incidence and prevalence rates in Canada to other regions. It also discusses long-term outcomes and prognostic indicators of pediatric MS. [Extracted from the article]

Background We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring. Methods This population-based cohort study included singletons live-born without major malformations in Sweden (n  = 2 699 675) and British Columbia (BC), Canada (n  = 887 582) during 1990–2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure. Results Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10–1.20] and ASD (95% CI 1.07–1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02–1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08–1.32), congenital heart disease (HR 1.18, 95% CI 1.08–1.27), arrhythmia (HR 1.13, 95% CI 1.08–1.19) and valvular heart disease (HR 1.12, 95% CI 1.00–1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04–1.46), congenital heart disease (HR 1.17, 95% CI 1.01–1.33) and arrythmia (HR 1.12, 95% CI 1.01–1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD. Conclusions In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring. [ABSTRACT FROM AUTHOR]

Background: The primary objective of this study was to analyse the association between multiple sclerosis (MS) disease-modifying therapy (DMT) exposure and hospitalisation in patients infected with COVID-19. Methods: Associations between MS DMT exposure and COVID-19 hospitalisation were analysed using univariable and multi-variable-clustered propensity score weighted logistic regression, where the models were clustered on the individual patients to control for patients contributing multiple COVID-19 episodes. Findings: As of 18 January 2021, a total of 476 reported COVID-19 cases had been recorded in MS patients in the Swedish MS registry. Of these, 292 (61.3%) had confirmed COVID-19. The mean value (standard deviation (SD)) age at infection was 44.0 years (11.6). Of the 292 confirmed infections, 68 (23.2%) required hospitalisation. A total of 49 of the 164 confirmed COVID-19 patients on rituximab at baseline (29.9%) required hospitalisation, compared to a rate of 12.7% for all other DMTs combined. Rituximab in confirmed COVID-19 patients was associated with 2.95 times the odds of hospitalisation relative to any other DMT combined (odds ratio = 2.95; 95% confidence interval (CI) = 1.48–5.87). Interpretation: Rituximab treatment, known to increase the risk of severe infections in general, also confers such a risk for MS patients with COVID-19, in comparison with other MS DMTs. [ABSTRACT FROM AUTHOR]

Under-coding of secondary conditions in coded hospital health data: Impact of co-existing conditions, death status and number of codes in a record. People with multiple sclerosis (MS) have high rates of health care use, including hospitalizations, one of the most costly forms of care. While specificity is typically high based on hospital claims, this is not universal, and positive predictive values may be quite low for some conditions.[7] Thus, it is likely that some individuals without MS were captured in the MS cohort. [Extracted from the article]

Objectives: Multiple sclerosis (MS) is a chronic neurodegenerative disease of the central nervous system. Identifying MS at the population level is important for disease surveillance and allocation of resources. The Swedish National Patient Registry (NPR) has been used to study the epidemiology of MS, but the accuracy of this resource is not known. We aimed to validate a definition of MS using the Swedish NPR in Värmland County using a longitudinal cohort design. Materials and Methods: Data were extracted from the NPR, the Total Population Register, the Swedish MS Register, and medical records for the years 2001–2013. Fifteen algorithms of hospitalizations and clinic visits for MS were developed and compared with findings in medical records, which acted as the "gold standard" definition. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were estimated. Results: Of 805 eligible persons identified in the NPR, 763 had MS (94.8%) according to medical records. Of these, 544 (71.3%) were also registered in the SMSreg. The case definition that had a well‐balanced sensitivity and specificity required three or more clinic or hospital visits for MS (sensitivity of 85.3% (95% CI: 82.6–87.8) and specificity of 81.0% (95%CI: 65.9–91.4). Conclusions: Multiple case definitions with high sensitivity and moderate specificity were found, suggesting that the NPR can be used to accurately identify persons with MS. [ABSTRACT FROM AUTHOR]

Background: People with multiple sclerosis (PwMS) face health and social challenges of living with a chronic and potentially disabling condition. To disclose or conceal MS at work may critically affect individuals' work situation, career opportunities, and health. PwMS may experience a dilemma when assessing if the possible benefits of disclosing the diagnosis outweigh the possible risks. However, concealing in the long-term may have health implications and prevent opportunities for support and work adjustments. Few studies have examined what drives PwMS to disclose or conceal MS at work and the consequences of these ways of managing MS., Objectives: To explore the reasons PwMS report for disclosing and/or concealing their MS diagnosis in the workplace, as well as the consequences they have experienced., Methods: A web-based survey of PwMS was conducted in 2021. All individuals aged 20-50 listed in the Swedish MS registry were invited to participate. The response rate was 52% and among these participants, 3,810 (86%) completed questions regarding workplace disclosure and/or concealment of MS. Free-text responses on these topics were analyzed using inductive content analysis., Results: It was common to disclose MS in the workplace (85%). Identified drivers for disclosure and concealment related to four categories: Work-related, Social, Personal and Circumstantial. Work-related drivers focused on employment or protecting one's career, and changing one's work situation versus maintaining it. Social drivers included the need for support, addressing or preventing stigma, and being considerate of others. Personal drivers were linked to moral values/personal beliefs and processing of the diagnosis. Circumstantial drivers related to involuntary or unforeseen events, timing factors, one's medical condition and external opinion/advice. Identified consequences for disclosure and concealment related to three categories: Work-life, Social, and Personal. Work-life consequences included work arrangements, and career opportunities. Social consequences were linked to MS awareness, stigma, interactions and social support, as well as dynamics of work relationships. Personal consequences involved levels of disease acceptance, and attitudes toward managing MS., Conclusion: PwMS often described the question of disclosure as challenging and navigated it with caution, as both disclosure and concealment can yield favorable and unfavorable outcomes., Competing Interests: JD and AM: salaries funded partly by unrestricted research grants from Celgene/Bristol-Myers Squibb. CM previously been partly funded by an unrestricted research grant from Biogen and Celgene/Bristol-Myers Squibb when employed by Karolinska Institutet, and now employed by Macanda, a market access consulting company that collaborates with several pharmaceutical companies. EF: salary funded partly by an unrestricted research grant from Biogen and has received unrestricted research grants from Celgene/Bristol-Myers Squibb and speaker’s fees from Merck. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dervish, Arfuch, Murley, McKay, Machado, Wennman-Larsen and Friberg.)