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1. Behavioral Intervention Improves Treatment Outcomes Among HIV-Infected Individuals Who Have Delayed, Declined, or Discontinued Antiretroviral Therapy: A Randomized Controlled Trial of a Novel Intervention

Author

Gwadz, Marya, Cleland, Charles M, Applegate, Elizabeth, Belkin, Mindy, Gandhi, Monica, Salomon, Nadim, Banfield, Angela, Leonard, Noelle, Riedel, Marion, Wolfe, Hannah, Pickens, Isaiah, Bolger, Kelly, Bowens, DeShannon, Perlman, David, Mildvan, Donna, and The Heart to Heart Collaborative Research Team

Subjects
Public Health, Health Sciences, HIV/AIDS, Pediatric, Behavioral and Social Science, Infectious Diseases, Clinical Research, Mental Health, Pediatric AIDS, Clinical Trials and Supportive Activities, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Infection, Good Health and Well Being, Adult, Black or African American, Aged, Anti-Retroviral Agents, Behavior Therapy, CD4 Lymphocyte Count, Continuity of Patient Care, Female, Follow-Up Studies, HIV Infections, Healthcare Disparities, Hispanic or Latino, Humans, Male, Middle Aged, Motivational Interviewing, Patient Acceptance of Health Care, Patient Compliance, Treatment Outcome, Viral Load, Antiretroviral therapy, Intervention, Disparities, Motivational interviewing, Heart to Heart Collaborative Research Team, Public Health and Health Services, Social Work, Public health
Abstract

Nationally up to 60 % of persons living with HIV are neither taking antiretroviral therapy (ART) nor well engaged in HIV care, mainly racial/ethnic minorities. This study examined a new culturally targeted multi-component intervention to address emotional, attitudinal, and social/structural barriers to ART initiation and HIV care. Participants (N = 95) were African American/Black and Latino adults with CD4

Published
2015

2. HIV-Infected Individuals Who Delay, Decline, or Discontinue Antiretroviral Therapy: Comparing Clinic- and Peer-Recruited Cohorts

Author

Gwadz, Marya, Applegate, Elizabeth, Cleland, Charles, Leonard, Noelle Regina, Wolfe, Hannah, Salomon, Nadim, Belkin, Mindy, Riedel, Marion, Banfield, Angela, Sanfilippo, Lisa, Wagner, Andrea, Mildvan, Donna, and Team, The Heart to Heart Collaborative Research

Subjects
Behavioral and Social Science, Prevention, Pediatric, Pediatric AIDS, Mental Health, HIV/AIDS, Clinical Research, Infectious Diseases, Infection, Heart to Heart Collaborative Research Team, African-American, HIV, Latino, antiretroviral, barriers, decline, delay, discontinue, Public Health and Health Services
Abstract

A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or discontinue antiretroviral therapy (ART) when it is medically indicated (40-45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012-2013. Participants were engaged in structured 1-h assessments with reliable/valid measures on barriers to ART. We found that recruitment through peers (63.2%, 60/95) was more feasible than in clinics (36.8%, 35/90). Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1%) were male and African-American (76.8%), and 23.2% were Latino/Hispanic. Peer-recruited participants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct), and there were no differences in attitudes toward ART (e.g., mistrust), which were in the neutral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B = -10.4) and positively associated with self-efficacy (B = 5.5), positive outcome expectancies (B = 6.3), beliefs about personal necessity of ART (B = 17.5), and positive internal norms (B = 7.9). This study demonstrates the feasibility of engaging this vulnerable population through peer-referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared to those in hospital clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.

Published
2014

16. Treatment of Community-Acquired Pneumonia in Immunocompromised Adults

Author

Stephen Furmanek, Bin Cao, Gustavo Lopardo, Eric M. Mortensen, Mark L. Metersky, Francesco Blasi, Julio Ramirez, Francisco Arancibia, Michael S. Niederman, Yann-Erick Claessens, Patrick G. P. Charles, Scott E. Evans, Brandon J. Webb, Elie Azoulay, Takaya Maruyama, Yuichiro Shindo, Martin Witzenrath, Steven D. Burdette, Antoni Torres, Chadi A. Hage, Richard G. Wunderink, Kristina Crothers, Antonio Anzueto, Jean Chastre, Marcos I. Restrepo, Rodrigo Cavallazzi, Charles Feldman, Mathias W. Pletz, Donna Mildvan, Jordi Rello, Muriel Fartoukh, Carlos M. Luna, Stefano Aliberti, Forest W Arnold, James D. Chalmers, Daniel M. Musher, Thomas M. File, Charles S. Dela Cruz, Filipe Froes, Tobias Welte, Rosario Menéndez, Jose Bordon, Grant W. Waterer, Martin Gnoni, Xavier Duval, and Nathan C. Dean

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, education.field_of_study, business.industry, Population, Delphi method, Immunocompromised patient, Critical Care and Intensive Care Medicine, medicine.disease, Pneumocystis pneumonia, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, 030228 respiratory system, Community-acquired pneumonia, medicine, Initial treatment, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, education, business, Research question
Abstract

Background Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. Study Design and Methods This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. Results The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. Interpretation This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

Published
2020
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21. A Randomized, Partially Blinded Phase 2 Trial of Antiretroviral Therapy, HIV-Specific Immunizations, and Interleukin-2 Cycles to Promote Efficient Control of Viral Replication (ACTG A5024)

Author

The Adult AIDS Clinical Trials Group A5024 Protocol Team, Kilby, J. Michael, Bucy, R. Pat, Mildvan, Donna, Fischl, Margaret, Santana-Bagur, Jorge, Lennox, Jeff, Pilcher, Chris, Zolopa, Andrew, Lawrence, Jody, Pollard, Richard B., Habib, Raphaelle El, Sahner, David, Fox, Lawrence, Aga, Evgenia, Bosch, Ronald J., and Mitsuyasu, Ronald

Published
2006

22. Evidence That Intermittent Structured Treatment Interruption, but Not Immunization with ALVAC-HIV vCP1452, Promotes Host Control of HIV Replication: The Results of AIDS Clinical Trials Group 5068

Author

National Institute of Allergy and Infectious Diseases-AIDS Clinical Trials Group 5068 Protocol Team, Jacobson, Jeffrey M., Bucy, R. Pat, Spritzler, John, Saag, Michael S., Eron, Joseph J., Coombs, Robert W., Wang, Rui, Fox, Lawrence, Johnson, Victoria A., Cu-Uvin, Susan, Cohn, Susan E., Mildvan, Donna, O'Neill, Dorothy, Janik, Jennifer, Purdue, Lynette, O'Connor, Deborah K., Di Vita, Christine, and Frank, Ian

Published
2006

39. Sex differences in atazanavir pharmacokinetics and associations with time to clinical events: AIDS Clinical Trials Group Study A5202

Author

Venuto, Charles S., Mollan, Katie, Ma, Qing, Daar, Eric S., Sax, Paul E., Fischl, Margaret, Collier, Ann C., Smith, Kimberly Y., Tierney, Camlin, Morse, Gene D., Bolivar, Hector H., Navarro, Sandra, Koletar, Susan L., Gochnour, Diane, Seefried, Edward, Hoffman, Julie, Feinberg, Judith, Saemann, Michelle, Patterson, Kristine, Pittard, Donna, Currin, David, Upton, Kerry, Saag, Michael, Ray, Graham, Johnson, Steven, Santos, Bartolo, Funk, Connie A., Morgan, Michael, Jackson, Brenda, Tebas, Pablo, Thomas, Aleshia, Kim, Ge-Youl, Klebert, Michael K., Santana, Jorge L., Marrero, Santiago, Norris, Jane, Valle, Sandra, Cox, Gary Matthew, Silberman, Martha, Shaik, Sadia, Lopez, Ruben, Vasquez, Margie, Daskalakis, Demetre, Megill, Christina, Stroberg, Todd, Shore, Jessica, Taiwo, Babafemi, Goldman, Mitchell, Boston, Molly, Lennox, Jeffrey, del Rio, Carlos, Lane, Timothy W., Epperson, Kim, Luetkemeyer, Annie, Payne, Mary, Gripshover, Barbara, Antosh, Dawn, Reid, Jane, Adams, Mary, Storey, Sheryl S., Dunaway, Shelia B., Gallant, Joel, Wiggins, Ilene, Smith, Kimberly Y., Swiatek, Joan A., Timpone, Joseph, Kumar, Princy, Moe, Ardis, Palmer, Maria, Gothing, Jon, Delaney, Joanne, Whitely, Kim, Anderson, Ann Marie, Hammer, Scott M., Yin, Michael T., Jain, Mamta, Petersen, Tianna, Corales, Roberto, Hurley, Christine, Henry, Keith, Bordenave, Bette, Youmans, Amanda, Albrecht, Mary, Pollard, Richard B., Olusanya, Abimbola, Skolnik, Paul R., Adams, Betsy, Tashima, Karen T., Patterson, Helen, Ukwu, Michelle, Rogers, Lauren, Balfour, Henry H., Jr, Fox, Kathy A., Swindells, Susan, Van Meter, Frances, Robbins, Gregory, Burgett-Yandow, Nicole, Davis, Charles E., Jr, Boyce, Colleen, OʼBrien, William A., Casey, Gerianne, Morse, Gene D., Hsaio, Chiu-Bin, Meier, Jeffrey L., Stapleton, Jack T., Mildvan, Donna, Revuelta, Manuel, Currin, David, El Sadr, Wafaa, Loquere, Avelino, El-Daher, Nyef, Johnson, Tina, Gross, Robert, Maffei, Kathyrn, Hughes, Valery, Sturge, Glenn, McMahon, Deborah, Rutecki, Barbara, Wulfsohn, Michael, Cheng, Andrew, Bischofberger, Norbert, Dix, Lynn, and Liao, Qiming

Published
2014
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42. The Association of Cytopenias and Weight Loss with Hepatitis C Virus Virologic Response in HIV/HCV-Coinfected Patients Treated with PEG-IFN and RBV

Author

Jihad Slim MD, Donna Mildvan MD, Jian Han PhD, and Eli Korner PharmD, MPH

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Background: Pegylated interferon (PEG-IFN)/ribavirin (RBV)-related cytopenias have been associated with improved virological outcomes among hepatitis C virus (HCV)-monoinfected patients. This analysis evaluated PEG-IFN/RBV-related cytopenias with virological responses among HIV/HCV-coinfected patients. Methods: Pooled data from PARADIGM and AIDS Pegasys Ribavirin International CO-infection Trial (APRICOT) trials of HIV/HCV-infected patients treated with PEG-IFN/RBV. Virologic response was categorized as HCV RNA detectable (end of treatment nonresponders [ET-NR]) or nondetectable (end of treatment responders [ETR]). Declines in hemoglobin (Hgb), platelets, neutrophils, lymphocytes, and weight between the groups were compared via analysis of covariance and Cochran-Mantel-Haenszel test. Results: A total of 474 patients, 291 ET-NR and 183 ETR (67 relapsers, 116 with sustained virologic response), 81% male, 52% Caucasian, 88% noncirrhotic, and 67% nondetectable HIV. The ETR experienced greater Hgb declines (≥3.0 g/dL) from baseline (73.8% versus 55.0%; P < .0001), neutrophils ≤1 and ≤ 0.5 × 10 9 /L (66.1% versus 56.4%; P = .0334 and 42.6% versus 33.3%; P = .0312, respectively), and lymphocytes ≤1.5 and ≤0.5 × 10 9 /L (99.5% versus 87.6%; P < .0001 and 24.6% versus 14.9%; P =.0079, respectively). Conclusions: The HIV/HCV-coinfected patients with ETR experienced greater declines in Hgb, neutrophils, and lymphocytes than the ET-NR patients.

Published
2013
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43. Sex differences in the Toll-like receptor-mediated response of plasmacytoid dendritic cells to HIV-1

Author

Meier, Angela, Chang, J. Judy, Chan, Ellen S., Pollard, Richard B., Sidhu, Harlyn K., Kulkarni, Smita, Wen, Tom Fang, Lindsay, Robert J., Orellana, Liliana, Mildvan, Donna, Bazner, Suzane, Streeck, Hendrik, Alter, Galit, Lifson, Jeffrey D., Carrington, Mary, Bosch, Ronald J., Robbins, Gregory K., and Altfeld, Marcus

Subjects
Dendritic cells -- Health aspects -- Research, HIV infection -- Development and progression -- Control -- Research, Biological sciences, Health
Abstract

Manifestations of viral infections can differ between women and Men (1), and marked sex differences have been described in the course of HIV-1 disease. HIV-1-infected women tend to have lower viral loads early in HIV-1 infection but progress faster to AIDS for a given viral load than men (2-7). Here we show substantial sex differences in the response of plasmacytoid dendritic cells (pDCs) to HIV-1. pDCs derived from women produce markedly more interferon-[alpha (IFN-α) in response to HIV-1-encoded Toll-like receptor 7 (TLR7) ligands than pDCs derived from men, resulting in stronger secondary activation of [CD8.sup.+] T cells. In line with these in vitro studies, treatment-naive women chronically infected with HIV-1 had considerably higher levels of [CD8.sup.+] T cell activation than men after adjusting for viral load. These data show that sex differences in TLR-mediated activation of pDCs may account for higher immune activation in women compared to men at a given HIV-1 viral load and provide a mechanism by which the same level of viral replication might result in faster HIV-1 disease progression in women compared to men. Modulation of the TLR7 pathway in pDCs may therefore represent a new approach to reduce HIV-1-associated pathology., According to UNAIDS, almost half of all HIV-1-infected individuals worldwide are women. Studies comparing the course of HIV-1 infection between women and men have demonstrated considerable sex differences in the [...]

Published
2009

44. 'Management of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies'

Author

Ramirez, Julio A., Musher, Daniel M., Evans, Scott E., Dela Cruz, Charles, Crothers, Kristina A., Hage, Chadi A., Aliberti, Stefano, Anzueto, Antonio, Arancibia, Francisco, Arnold, Forest, Azoulay, Elie, Blasi, Francesco, Bordon, Jose, Burdette, Steven, Cao, Bin, Cavallazzi, Rodrigo, Chalmers, James, Charles, Patrick, Chastre, Jean, Claessens, Yann-Erick, Dean, Nathan, Duval, Xavier, Fartoukh, Muriel, Feldman, Charles, File, Thomas, Froes, Filipe, Furmanek, Stephen, Gnoni, Martin, Lopardo, Gustavo, Luna, Carlos, Maruyama, Takaya, Menendez, Rosario, Metersky, Mark, Mildvan, Donna, Mortensen, Eric, Niederman, Michael S., Pletz, Mathias, Rello, Jordi, Restrepo, Marcos I., Shindo, Yuichiro, Torres, Antoni, Waterer, Grant, Webb, Brandon, Welte, Tobias, Witzenrath, Martin, and Wunderink, Richard

Subjects
Adult, TNF, tumor necrosis factor, Consensus, TMP-SMX, trimethoprim-sulfamethoxazole, CAP, community-acquired pneumonia, DMARDs, disease-modifying anti-rheumatic drugs, Pneumonia, PCP, Pneumocystis jirovecii, Article, HIV, human immunodeficiency virus, PSI, Pneumonia Severity Index, Community-Acquired Infections, MDR, multiple drug resistant, Immunocompromised Host, PCR, polymerase chain reaction, NTM, non-tuberculous Mycobacteria, CRE, carbapenemase-producing Enterobacteriaceae, Humans, ESBL, extended spectrum beta-lactamase, BAL, bronchoalveolar lavage, CMV, Cytomegalovirus
Abstract

Background Community-acquired pneumonia (CAP) guidelines have improved the management and outcomes of patients with CAP, primarily by standardization of initial empiric therapy. But current society-published guidelines exclude immunocompromised patients. Research Question There is no concensus regarding the initial management of immunocompromised patients with suspected CAP. Study Design and Methods This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the management of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. Results The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiological work-up, general principles of empiric therapy, and empiric therapy for specific pathogens. Interpretation This document offer general suggestions for the initial management of the immunocompromised patient who arrives at the hospital with pneumonia.

Published
2020

45. Antibiotic Treatment Failure and Associated Outcomes Among Adult Patients With Community-Acquired Pneumonia in the Outpatient Setting: A Real-world US Insurance Claims Database Study

Author

Thomas P. Lodise, Donna Mildvan, Glenn S. Tillotson, James A. McKinnell, and Peter Classi

Subjects
medicine.medical_specialty, community-acquired pneumonia, medicine.drug_class, Antibiotics, antibiotic treatment failure, 030204 cardiovascular system & hematology, Treatment failure, Insurance claims, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, Internal medicine, Health care, Major Article, medicine, Outpatient setting, 030212 general & internal medicine, Adult patients, business.industry, medicine.disease, Pneumonia, AcademicSubjects/MED00290, Infectious Diseases, Oncology, outpatient, business
Abstract

Background Antibiotic treatment failure is common among patients with community-acquired pneumonia (CAP) who are managed in the outpatient setting and is associated with higher mortality and increased health care costs. This study’s objectives were to quantify the occurrence of antibiotic treatment failure (ATF) and to evaluate clinical and economic outcomes between CAP patients who experienced ATF relative to those who did not. Methods Retrospective analysis of the MarketScan Commercial & Medicare Supplemental Databases was performed, identifying patients ≥18 years old, with a pneumonia diagnosis in the outpatient setting, and who received a fluoroquinolone, macrolides, beta-lactam, or tetracycline. ATF was defined as any of the following events within 30 days of initial antibiotic: antibiotic refill, antibiotic switch, emergency room visit, or hospitalization. Outcomes included 30-day all-cause mortality and CAP-related health care costs. Results During the study period, 251 947 unique patients met inclusion criteria. The mean age was 52.2 years, and 47.7% were male. The majority of patients received a fluoroquinolone (44.4%) or macrolide (43.6%). Overall, 22.1% were classified as ATFs. Among 18–64-year-old patients, 21.2% experienced treatment failure, compared with 25.7% in those >65 years old. All-cause mortality was greater in the antibiotic failure group relative to the non–antibiotic failure group (18.1% vs 4.6%, respectively), and the differences in 30-day mortality between antibiotic failure groups increased as a function of age. Mean 30-day CAP-related health care costs were also higher in the patients who experienced treatment failure relative to those who did not ($2140 vs $54, respectively). Conclusions Treatment failure and poor outcomes from outpatient CAP are common with current guideline-concordant CAP therapies. Improvements in clinical management programs and therapeutic options are needed.

Published
2020
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47. Attitudes and perceptions of AIDS clinical trials group site coordinators on HIV clinical trial recruitment and retention: a descriptive study

Author

King, William D., Defreitas, Donna, Smith, Kimberly, Andersen, Janet, Perry, Lisa Patton, Adeyemi, Toyin, Mitty, Jennifer, Fritsche, Jan, Jeffries, Carrie, Littles, Melvin, Fischl, Margaret, Pavlov, Gregory, and Mildvan, Donna

Subjects
AIDS patients -- Beliefs, opinions and attitudes, AIDS patients -- Health aspects, AIDS patients -- Research, Clinical trials -- Demographic aspects, Clinical trials -- Research, Ethnic groups -- Health aspects, Ethnic groups -- Research, Ethnic groups -- Beliefs, opinions and attitudes, Health
Abstract

HIV-seropositive blacks, Hispanics, women of all ethnicities, and injection drug users (IDUs) have low rates of clinical trial participation. The opinions of research nurses and study coordinators as potential facilitators and barriers to access to clinical trials may contribute to this disparity. Study coordinators and research nurses from the adult AIDS Clinical Trials Group (ACTG) clinical trials units responded to an anonymous computer-based survey comprising multiple choice questions and clinical scenarios. Descriptive statistics were used to determine frequencies of responses. Recruitment rates of blacks, Hispanics, women and IDUs were mostly rated appropriate compared with the geographic region demographics. Most sites ranked white men as being the most interested in clinical trials. Sites rated their most effective interactions were with white men. Respondents felt they were less likely to enroll individuals who had missed previous clinical appointments or did not speak English. Perceptions that IDUs, Hispanics, blacks, and, to a lesser extent, women had less interest in clinical trials participation than white males may affect recruitment of the targeted populations. Interventions to improve interactions with targeted populations and to remove logistical and language barriers may improve the diversity of clinical trial participants.

Published
2007

48. Treatment of Community-Acquired Pneumonia in Immunocompromised Adults: A Consensus Statement Regarding Initial Strategies

Author

Ramirez, JA, Musher, DM, Evans, SE, Dela Cruz, C, Crothers, KA, Hage, CA, Aliberti, S, Anzueto, A, Arancibia, F, Arnold, F, Azoulay, E, Blasi, F, Bordon, J, Burdette, S, Cao, B, Cavallazzi, R, Chalmers, J, Charles, P, Chastre, J, Claessens, Y-E, Dean, N, Duval, X, Fartoukh, M, Feldman, C, File, T, Froes, F, Furmanek, S, Gnoni, M, Lopardo, G, Luna, C, Maruyama, T, Menendez, R, Metersky, M, Mildvan, D, Mortensen, E, Niederman, MS, Pletz, M, Rello, J, Restrepo, M, Shindo, Y, Torres, A, Waterer, G, Webb, B, Welte, T, Witzenrath, M, Wunderink, R, Ramirez, JA, Musher, DM, Evans, SE, Dela Cruz, C, Crothers, KA, Hage, CA, Aliberti, S, Anzueto, A, Arancibia, F, Arnold, F, Azoulay, E, Blasi, F, Bordon, J, Burdette, S, Cao, B, Cavallazzi, R, Chalmers, J, Charles, P, Chastre, J, Claessens, Y-E, Dean, N, Duval, X, Fartoukh, M, Feldman, C, File, T, Froes, F, Furmanek, S, Gnoni, M, Lopardo, G, Luna, C, Maruyama, T, Menendez, R, Metersky, M, Mildvan, D, Mortensen, E, Niederman, MS, Pletz, M, Rello, J, Restrepo, M, Shindo, Y, Torres, A, Waterer, G, Webb, B, Welte, T, Witzenrath, M, and Wunderink, R

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) guidelines have improved the treatment and outcomes of patients with CAP, primarily by standardization of initial empirical therapy. But current society-published guidelines exclude immunocompromised patients. RESEARCH QUESTION: There is no consensus regarding the initial treatment of immunocompromised patients with suspected CAP. STUDY DESIGN AND METHODS: This consensus document was created by a multidisciplinary panel of 45 physicians with experience in the treatment of CAP in immunocompromised patients. The Delphi survey methodology was used to reach consensus. RESULTS: The panel focused on 21 questions addressing initial management strategies. The panel achieved consensus in defining the population, site of care, likely pathogens, microbiologic workup, general principles of empirical therapy, and empirical therapy for specific pathogens. INTERPRETATION: This document offers general suggestions for the initial treatment of the immunocompromised patient who arrives at the hospital with pneumonia.

Published
2020

50. HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services

Author

Des Jarlais, Don C., Perlis, Theresa, Arasteh, Kamyar, Torian, Lucia V., Beatrice, Sara, Milliken, Judith, Mildvan, Donna, Yancovitz, Stanley, and Friedman, Samuel R.

Subjects
HIV (Viruses) -- Prevention, HIV (Viruses) -- Surveys, Government, Health care industry
Abstract

Objectives. We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250000 to 3000000 syringes exchanged annually. Methods. Serum samples were obtained from serial cross-sectional surveys of 3651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS. Results. HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990-1992, to 2.63/100 PYAR from 1993-1995, to 1.05/100 PYAR from 1996-1998, and to 0.77/100 PYAR from 1999-2002 (P Conclusions. STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention. (doi: 10.2105/AJPH.2003.036517)

Published
2005

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