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Background Human immunodeficiency virus (HIV)–related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade. Methods We analyzed the National Inpatient Sample for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100 000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques. Results From 2011 to 2018, there were an estimated 1 710 164 (95% confidence interval [CI], 1 659 566–1 760 762) hospital discharges for PWH with 154 430 (95% CI, 148 669–159 717 [9.2%]) associated with an OI, of which 9336 (95% CI, 8813–9857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age, male sex, non-White race/ethnicity, and being uninsured (all likelihood ratio [LR] P <.001). Higher OI-related mortality was associated with older age (LR P <.001), male sex (LR P =.001), Hispanic race/ethnicity (LR P <.001), and being uninsured (LR P =.009). The OI-related hospitalization rate fell from 2725.3 (95% CI, 2266.9–3183.7) per 100 000 PWH in 2011 to 1647.3 (95% CI, 1492.5–1802.1) in 2018 (P <.001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). Conclusions Our findings indicate an ongoing need for continued funding of HIV testing, health insurance for all PWH, OI screening initiatives, review of current prophylaxis guidelines, and recruitment of more HIV clinicians. [ABSTRACT FROM AUTHOR]

People with human immunodeficiency virus (HIV) have a 50% excess risk for intensive care unit (ICU) admission, often for non-HIV-related conditions. Despite this, clear guidance for managing antiretroviral therapy (ART) in this setting is lacking. Selecting appropriate ART in the ICU is complex due to drug interactions, absorption issues, and dosing adjustments. Continuing ART in the ICU can be challenging due to organ dysfunction, drug interactions, and formulary limitations. However, with careful consideration, continuation is often feasible through dose adjustments or alternative administration methods. Temporary discontinuation of ART may be beneficial depending on the clinical scenario. Clinicians should actively seek resources and support to mitigate adverse events and drug interactions in critically ill people with HIV. Navigating challenges in the ICU can optimize ART and improve care and outcomes for critically ill people with HIV. This review aims to identify strategies for addressing the challenges associated with the use of modern ART in the ICU. [ABSTRACT FROM AUTHOR]

Given the large numbers of people with HIV (PWH) with Medicaid coverage, it is important to understand the patient experience with Medicaid. Understanding experiences with and attitudes around the program have important policy and clinical implications. The objective was to understand the patient perspective of PWH in Virginia, who transitioned to Medicaid in 2019 due to Medicaid expansion. English-speaking PWH who gained Medicaid due to Medicaid expansion in 2019 were recruited at one Virginia Ryan White HIV/AIDS Program clinic. The goal was to enroll >33% of those who newly were on Medicaid for 2019. Participants were surveyed about demographic characteristics, and semistructured interviews were performed. Descriptive analyses were performed for cohort characteristics. Using qualitative description and an open coding strategy, codebooks were generated for the interviews and themes were identified. The cohort (n = 28) met our recruitment goal. Most participants had positive feelings about Medicaid before enrollment (general: 68%; good for general health: 75%, and good for HIV care: 67%) and after enrollment (general: 93% and good for HIV care: 93%). All participants expressed incomplete understanding about Medicaid before enrollment. Seventy-nine percent needed outside help to complete enrollment. Approximately 40% described overlaps of Medicaid with other insurance/payers or gaps in insurance coverage when transitioning from one insurance/payer (such as AIDS Drug Assistance Program [ADAP] medication provision and ADAP-subsidized insurance) to Medicaid. Participants suggested more access or easier access to information about Medicaid and more explanation of Medicaid benefits would be helpful. Our findings indicate participants had mostly positive perceptions of Medicaid before and after enrollment. Even with enrollment help, participants voiced that dealing with insurance is hard. Medicaid and other programs should prioritize more access to information, smoother processes, and less burdensome enrollment/re-enrollment. [ABSTRACT FROM AUTHOR]

Background Guidelines recommend annual screening for gonorrhea/chlamydia in sexually active people with HIV at multiple sites (urogenital, oropharyngeal, rectal). In the first year of multisite screening at our Ryan White HIV/AIDS Program clinic, we studied (1) sexual history documentation rate, (2) sexually transmitted infection (STI) screening rate, (3) characteristics associated with STIs, and (4) the percentage of extragenital STIs that would have been missed without multisite screening. Methods Participants were ≥14 years old with ≥1 in-person medical visit at our clinic in 2019. Descriptive analyses were performed, and adjusting for number of sites tested, a log-binomial model was used to estimate the association between characteristics and STI diagnosis in men. Results In this cohort (n = 857), 21% had no sexual history recorded. Almost all STI diagnoses were among males (99.3%). Sixty-eight percent (253/375) received appropriate urogenital testing, 63% (85/134) received appropriate oropharyngeal testing, and 69% (72/105) received appropriate rectal testing. In male participants with ≥1 STI test (n = 347), Hispanic ethnicity and having a detectable HIV viral load were associated with an STI diagnosis. Of those diagnosed with an STI who had multisite testing, 96% (n = 25/26) were positive only at an extragenital site. Conclusions Screening rates were similar across all anatomical sites, indicating no obvious bias against extragenital testing. In males, STIs were more frequently diagnosed in people who identify as Hispanic and those with detectable viral loads, which may indicate more condomless sex in these populations. Based on infections detected exclusively at extragenital sites, our clinic likely underdiagnosed STIs before implementation of multisite screening. [ABSTRACT FROM AUTHOR]

[The author explores areas of consonance and contrast in the backgrounds and methodologies of Edward Schillebeeckx and Ivone Gebara, especially as these are illumined in their respective approaches to the symbol of the cross. While both critique the ways that this central Christian symbol has functioned to contribute to oppression, they diverge in their views of its inherent redeemability. The juxtaposition of the thought of Schillebeeckx and Gebara on this issue reveals a fundamental tension in the Church and in theological thought today, even as it expresses a potentially unifying intuition.], IVONE GEBARA, a Brazilian Sister of Notre Dame, is a leading ecofeminist philosopher and theologian in Latin America. She taught for many years at the Theology Institute of Recife, Brazil. [...]

A study of sediment alteration on the west flank of the West Hackberry dome, Louisiana Gulf Coast, has documented the existence of approximately 5 X 10 to the tenth power kg of authigenic calcite-pyrite cement in Miocene sands at depths of 1.4 to 2.1 km in a 1.5 by 1.5 km area adjacent to the dome. The Sr, C, and S isotopic compositions of the cements support the hypothesis that Ca and S were derived from dissolution of salt-dome anhydrite and that carbonate was derived by thermochemical oxidation of methane and by sulfate reduction, possibly at temperatures as low as 70 degrees C. Constraints on the maximum aqueous concentrations of Ca that could be produced by dissolving diapiric salt require that greater than 5 X 10 to the ninth power m cube of aqueous fluid, equivalent to a fluid volume/pore volume ratio of greater than 250:1, were involved in destroying salt, transporting Ca and SO4, and precipitating these cements. The presence of such cements requires a dynamic subsurface mass-transport regime involving either large volumes of fluid or fluids that are extensively recirculated.