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5. Bing Neel Syndrome

Author

Alexander, Abigail L., Jackson, Devon, Donahue, John E., Chirkov, Alexander, and Banerjee, Priya

Abstract

Suicide rapidly increased in the United States by 30% from 2000 to 2020, accounting for more than 800,000 deaths (Neurosci Res Program Bull. 1972; 10: 384–8). Studies have shown that there are a multitude of underlying issues, including mental illness, that elevate an individual's risk of dying by suicide (CDC WONDER: Underlying cause of death, 1999–2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2020). Presented here is a case of Bing Neel syndrome (BNS) found in a 69-year-old man who died by suicide by jumping off a 135′ bridge. His medical history was significant for traumatic brain injury, Waldenstrom macroglobulinemia (WM), major depressive disorder, suicidal ideation, and anxiety. Bing Neel syndrome is a rare central nervous system complication of WM. His wife reported an abrupt mental deterioration starting 5 years before his death, characterized by paranoia, depression, and insomnia. He had been a high-functioning university professor. His decline culminated with the loss of independence in his activities of daily living. At autopsy, it was found that he experienced blunt force injuries related to the fall, causing his death. A neuropathologic examination revealed a brisk and fulminant clonal CD20+/immunoglobulin M+ lymphocytic infiltrate, involving all sampled regions of his brain, consistent with WM. This workup was critical to obtaining an accurate pathologic diagnosis of BNS and understanding his full clinical status before death. Although BNS was not the proximate cause of death, this diagnosis aided the death investigation as a causal factor in his suicidality and was vital to providing his family closure.

Published
2023
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9. Improving HCV cure rates in HIV coinfected patients-A real world perspective

Author

Lakshmi, Seetha, Alcaide, Maria, Palacio, Ana M, Shaikhomer, Mohammed, Alexander, Abigail L, Wiehl, Genevieve, Pandey, Aman, Patel, Kunal, Jayaweera, Dushyantha, and Hernandez, Maria Del Pilar

Subjects
Male, Coinfection, HIV Infections, Hepatitis C, Chronic, Middle Aged, Viral Load, Article, Anti-Retroviral Agents, Multivariate Analysis, Outcome Assessment, Health Care, Humans, Reverse Transcriptase Inhibitors, Drug Therapy, Combination, Female, HIV Integrase Inhibitors, Aged, Retrospective Studies
Abstract

To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure.Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015.Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure.Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.

Published
2016

10. Improving HCV cure rates in HIV-coinfected patients - a real-world perspective.

Author

Lakshmi S, Alcaide M, Palacio AM, Shaikhomer M, Alexander AL, Gill-Wiehl G, Pandey A, Patel K, Jayaweera D, and Del Pilar Hernandez M

Subjects
Aged, Coinfection drug therapy, Drug Therapy, Combination, Female, HIV Integrase Inhibitors therapeutic use, Humans, Male, Middle Aged, Multivariate Analysis, Retrospective Studies, Reverse Transcriptase Inhibitors therapeutic use, Viral Load drug effects, Viral Load statistics & numerical data, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Hepatitis C, Chronic drug therapy, Outcome Assessment, Health Care statistics & numerical data
Abstract

Objectives: To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure., Methods: Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015., Results: Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure., Conclusions: Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.

Published
2016

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