331 results on '"Napravnik S"'
Search Results
2. Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care
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Fredericksen, RJ, Nance, RM, Whitney, BM, Harding, BN, Fitzsimmons, E, Del Rio, C, Eron, J, Feaster, DJ, Kalokhe, AS, Mathews, WC, Mayer, KH, Metsch, LR, Mugavero, MJ, Potter, J, O’Cleirigh, C, Napravnik, S, Rodriguez, B, Ruderman, S, JAC, Delaney, and Crane, HM
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Epidemiology ,Health Services and Systems ,Public Health ,Health Sciences ,HIV/AIDS ,Drug Abuse (NIDA only) ,Violence Against Women ,Mental Health ,Substance Misuse ,Behavioral and Social Science ,Clinical Research ,Violence Research ,Mental health ,Peace ,Justice and Strong Institutions ,Anti-Retroviral Agents ,Cross-Sectional Studies ,HIV Infections ,Humans ,Intimate Partner Violence ,Prevalence ,Sexual Partners ,Viral Load ,Psychological violence ,HIV care ,Patient reported outcomes ,Public Health and Health Services ,Health services and systems ,Public health - Abstract
BackgroundAmong people living with HIV (PLWH), physical intimate partner violence (IPV) is associated with poor virologic, psychiatric, and behavioral outcomes. We examined non-physical, psychological intimate partner violence (psy-IPV) and HIV care outcomes using data from two U.S. consortia.MethodsWe conducted multivariable analyses with robust standard errors to compare patients indicating/not indicating psy-IPV.ResultsAmong PLWH (n = 5950), 9.5% indicated psy-IPV; these individuals were younger (- 3; 95% CI [- 2,-4], p-value
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- 2021
3. Risk of End‐Stage Renal Disease in HIV‐Positive Potential Live Kidney Donors
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Muzaale, AD, Althoff, KN, Sperati, CJ, Abraham, AG, Kucirka, LM, Massie, AB, Kitahata, MM, Horberg, MA, Justice, AC, Fischer, MJ, Silverberg, MJ, Butt, AA, Boswell, SL, Rachlis, AR, Mayor, AM, Gill, MJ, Eron, JJ, Napravnik, S, Drozd, DR, Martin, JN, Bosch, RJ, Durand, CM, Locke, JE, Moore, RD, Lucas, GM, and Segev, DL
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Biomedical and Clinical Sciences ,Clinical Sciences ,HIV/AIDS ,Infectious Diseases ,Sexually Transmitted Infections ,Kidney Disease ,Aetiology ,2.2 Factors relating to the physical environment ,Renal and urogenital ,Infection ,Good Health and Well Being ,Adult ,Case-Control Studies ,Female ,Follow-Up Studies ,Glomerular Filtration Rate ,Graft Rejection ,Graft Survival ,HIV Infections ,HIV Seropositivity ,HIV-1 ,Humans ,Incidence ,Kidney Failure ,Chronic ,Kidney Function Tests ,Kidney Transplantation ,Living Donors ,Male ,Middle Aged ,Nephrectomy ,North America ,Prognosis ,Risk Factors ,Viral Load ,clinical research/practice ,donors and donation: living ,infection and infectious agents ,infectious disease ,kidney transplantation/nephrology ,viral: human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome ,Medical and Health Sciences ,Surgery ,Clinical sciences ,Immunology - Abstract
New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load
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- 2017
4. Lessons Learned From the Design and Implementation of Myocardial Infarction Adjudication Tailored for HIV Clinical Cohorts
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Crane, HM, Heckbert, SR, Drozd, DR, Budoff, MJ, Delaney, JAC, Rodriguez, C, Paramsothy, P, Lober, WB, Burkholder, G, Willig, JH, Mugavero, MJ, Mathews, WC, Crane, PK, Moore, RD, Napravnik, S, Eron, JJ, Hunt, P, Geng, E, Hsue, P, Barnes, GS, McReynolds, J, Peter, I, Grunfeld, C, Saag, MS, Kitahata, MM, and Investigators, for the Centers for AIDS Research Network of Integrated Clinical Systems Cohort
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Epidemiology ,Health Sciences ,HIV/AIDS ,Cardiovascular ,Heart Disease ,Sexually Transmitted Infections ,Infectious Diseases ,Heart Disease - Coronary Heart Disease ,Infection ,Adult ,Aged ,Aged ,80 and over ,Cohort Studies ,Decision Support Techniques ,Epidemiologic Research Design ,False Positive Reactions ,Female ,HIV Infections ,Humans ,Male ,Middle Aged ,Myocardial Infarction ,Predictive Value of Tests ,Sensitivity and Specificity ,Single-Blind Method ,HIV ,myocardial infarction ,validation ,Centers for AIDS Research Network of Integrated Clinical Systems Cohort Investigators ,Mathematical Sciences ,Medical and Health Sciences - Abstract
We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.
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- 2014
5. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era.
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Ma, J., Luu, B., Ruderman, S. A., Whitney, B. M., Merrill, J. O., Mixson, L. S., Nance, R. M., Drumright, L. N., Hahn, A. W., Fredericksen, R. J., Chander, G., Lau, B., McCaul, M. E., Safren, S., O'Cleirigh, C., Cropsey, K., Mayer, K. H., Mathews, W. C., Moore, R. D., and Napravnik, S.
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CLINICAL drug trials ,HIV infection transmission ,SUBSTANCE abuse ,PATIENT compliance ,SELF-evaluation ,STATISTICAL models ,ANTIRETROVIRAL agents ,METHAMPHETAMINE ,ACADEMIC medical centers ,VIRAL load ,RESEARCH funding ,MULTIPLE regression analysis ,QUESTIONNAIRES ,VISUAL analog scale ,CD4 lymphocyte count ,SEVERITY of illness index ,HIV infections ,MULTIVARIATE analysis ,DESCRIPTIVE statistics ,RELATIVE medical risk ,PSYCHOLOGY of HIV-positive persons ,HEROIN ,MEN who have sex with men ,RESEARCH ,CANNABIS (Genus) ,ALCOHOLISM ,INDIVIDUALIZED medicine ,HEALTH outcome assessment ,COMPARATIVE studies ,DISEASE susceptibility ,INFECTIOUS disease transmission ,CONFIDENCE intervals ,DRUGS of abuse ,CRACK cocaine ,REGRESSION analysis ,EVALUATION ,DISEASE risk factors ,ADULTS - Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Vaporized Nicotine (E-cigarette) and Tobacco Smoking Among People with HIV: Use Patterns and Associations with Depression and Panic Symptoms
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Hahn, AW, primary, Ruderman, SA, additional, Nance, RM, additional, Whitney, BW, additional, Eltonsy, S, additional, Haidar, L, additional, Delaney, JAC, additional, Drumright, LN, additional, Ma, J, additional, Mayer, KH, additional, O’Cleirigh, C, additional, Napravnik, S, additional, Eron, JJ, additional, Christopoulos, K, additional, Bamford, L, additional, Cachay, E, additional, Jacobson, JM, additional, Willig, A, additional, Cropsey, K, additional, Chander, G, additional, Crane, HM, additional, and Fredericksen, RJ, additional
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- 2022
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7. Predicting Risk of Multidrug-Resistant Enterobacterales Infections Among People With HIV
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Henderson, H.I., Williams, B., Wohl, D.A., Van Duin, D., Napravnik, S., Kosorok, M.R., Gower, E.W., Kinlaw, A.C., and Aiello, A.E.
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Background: Medically vulnerable individuals are at increased risk of acquiring multidrug-resistant Enterobacterales (MDR-E) infections. People with HIV (PWH) experience a greater burden of comorbidities and may be more susceptible to MDR-E due to HIV-specific factors. Methods: We performed an observational study of PWH participating in an HIV clinical cohort and engaged in care at a tertiary care center in the Southeastern United States from 2000 to 2018. We evaluated demographic and clinical predictors of MDR-E by estimating prevalence ratios (PRs) and employing machine learning classification algorithms. In addition, we created a predictive model to estimate risk of MDR-E among PWH using a machine learning approach. Results: Among 4734 study participants, MDR-E was isolated from 1.6% (95% CI, 1.2%-2.1%). In unadjusted analyses, MDR-E was strongly associated with nadir CD4 cell count ≤200 cells/mm3 (PR, 4.0; 95% CI, 2.3-7.4), history of an AIDS-defining clinical condition (PR, 3.7; 95% CI, 2.3-6.2), and hospital admission in the prior 12 months (PR, 5.0; 95% CI, 3.2-7.9). With all variables included in machine learning algorithms, the most important clinical predictors of MDR-E were hospitalization, history of renal disease, history of an AIDS-defining clinical condition, CD4 cell count nadir ≤200 cells/mm3, and current CD4 cell count 201-500 cells/mm3. Female gender was the most important demographic predictor. Conclusions: PWH are at risk for MDR-E infection due to HIV-specific factors, in addition to established risk factors. Early HIV diagnosis, linkage to care, and antiretroviral therapy to prevent immunosuppression, comorbidities, and coinfections protect against antimicrobial-resistant bacterial infections.
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- 2022
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8. Characterizing the neighborhood risk environment in multisite clinic-based cohort studies: A practical geocoding and data linkages protocol for protected health information
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Mugavero M.J., Agil D., Wilson-Barthes M.G., Dulin A.J., Nassel A., Howe C.J., and Napravnik S.
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Background Maintaining patient privacy when geocoding and linking residential address information with neighborhood-level data can create challenges during research. Challenges may arise when study staff have limited training in geocoding and linking data, or when non-study staff with appropriate expertise have limited availability, are unfamiliar with a study’s population or objectives, or are not affordable for the study team. Opportunities for data breaches may also arise when working with non-study staff who are not on-site. We detail a free, user-friendly protocol for constructing indices of the neighborhood risk environment during multisite, clinic-based cohort studies that rely on participants’ protected health information. This protocol can be implemented by study staff who do not have prior training in Geographic Information Systems (GIS) and can help minimize the operational costs of integrating geographic data into public health projects. Methods This protocol demonstrates how to: (1) securely geocode patients’ residential addresses in a clinic setting and match geocoded addresses to census tracts using Geographic Information System software (Esri, Redlands, CA); (2) ascertain contextual variables of the risk environment from the American Community Survey and ArcGIS Business Analyst (Esri, Redlands, CA); (3) use geoidentifiers to link neighborhood risk data to census tracts containing geocoded addresses; and (4) assign randomly generated identifiers to census tracts and strip census tracts of their geoidentifiers to maintain patient confidentiality. Results Completion of this protocol generates three neighborhood risk indices (i.e., Neighborhood Disadvantage Index, Murder Rate Index, and Assault Rate Index) for patients’ coded census tract locations. Conclusions This protocol can be used by research personnel without prior GIS experience to easily create objective indices of the neighborhood risk environment while upholding patient confidentiality. Future studies can adapt this protocol to fit their specific patient populations and analytic objectives.
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- 2022
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9. Resistance in Enterobacterales Is Higher among People Living with Human Immunodeficiency Virus
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Henderson, H.I., Gower, E.W., Napravnik, S., Aiello, A.E., Wohl, D.A., Kinlaw, A.C., Van Duin, D., and Williams, B.
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Background: Multidrug-resistant Enterobacterales (MDR-E) are important pathogens. People living with human immunodeficiency virus (HIV; PLWH) may be at greater risk for MDR-E infection given relatively high antibiotic exposure and burden of comorbidities. Methods: We analyzed data from 36 521 patients in a healthcare system in North Carolina who had a clinical culture with growth of an Enterobacterales species from 2000 to 2018; 440 were PLWH. We used generalized linear models to estimate prevalence ratios and differences, contrasting PLWH and people not living with HIV (PNLWH) for resistance to individual antibiotic classes, as well as MDR-E. We assessed trends in prevalence over time by calculating the 5-year moving average and fitting restricted cubic spline models. Results: The overall prevalence of MDR-E was higher among PLWH (21.5%; 95% confidence interval [CI], 18.2%-25.1%) vs PNLWH (16.5%; 95% CI, 16.2%-16.9%), with an adjusted prevalence ratio of 1.38 (95% CI, 1.14-1.65). PLWH had higher rates of antimicrobial resistance than PNLWH for all antibiotic classes analyzed, including penicillins, penicillin/beta lactamase inhibitor combinations, and sulfonamides. MDR-E prevalence was 3 to 10 percentage points higher among PLWH than PNLWH throughout the study period based on the 5-year moving average. Conclusions: In a large clinical study population in the southeastern United States from 2000 to 2018, the prevalence of antibacterial resistance among Enterobacterales was consistently higher among PLWH than PNLWH. These data highlight the importance of identifying and mitigating the factors that contribute to antimicrobial resistance in PLWH, given the potential clinical consequences of these resistant pathogens.
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- 2022
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10. Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998–2010
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Koethe, JR, Jenkins, CA, Lau, B, Shepherd, BE, Silverberg, MJ, Brown, TT, Blashill, AJ, Anema, A, Willig, A, Stinnette, S, Napravnik, S, Gill, J, Crane, HM, and Sterling, TR
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- 2015
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11. Rapid analysis of local data to inform off-label tocilizumab use early in the COVID-19 pandemic
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Marx, A., Schmitz, J.L., Gay, C.L., Kim, M.K., Rimland, C.A., Swygard, H., Bramson, B., Fischer, W.A., Eron, J.J., Napravnik, S., Carson, S.S., Parr, J.B., Morgan, C.E., Bell, G.J., and Hedrick, T.
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The interleukin-6 receptor antagonist tocilizumab became widely used early in the coronavirus disease 2019 (COVID-19) pandemic based on small observational studies that suggested clinical benefit in COVID-19 patients with a hyperinflammatory state. To inform our local treatment algorithms in the absence of randomized clinical trial results, we performed a rapid analysis of the first 11 hospitalized COVID-19 patients treated with tocilizumab at our academic medical center. We report their early clinical outcomes and describe the process by which we assembled a team of diverse trainees and stakeholders to extract, analyze, and disseminate data during a time of clinical uncertainty.
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- 2021
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12. COVID-19 symptoms at time of testing and association with positivity among outpatients tested for SARS-CoV-2
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Smedberg, J.R., Wohl, D.A., Whinna, H.C., Davy-Mendez, T., Weber, D.J., Miller, M.B., Barzin, A.H., Thompson, C.M., Napravnik, S., Ruegsegger, L., and Gilleskie, M.
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Introduction Symptoms associated with SARS-CoV-2 infection remain incompletely understood, especially among ambulatory, non-hospitalized individuals. With host factors, symptoms predictive of SARS-CoV-2 could be used to guide testing and intervention strategies. Methods Between March 16 and September 3, 2020, we examined the characteristics and symptoms reported by individuals presenting to a large outpatient testing program in the Southeastern US for nasopharyngeal SARS-CoV-2 RNA RT-PCR testing. Using self-reported symptoms, demographic characteristics, and exposure and travel histories, we identified the variables associated with testing positive using modified Poisson regression. Results Among 20,177 tested individuals, the proportion positive was 9.4% (95% CI, 9.0���9.8) and was higher for men, younger individuals, and racial/ethnic minorities (all P
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- 2021
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13. Additional file 2 of Correlates of psychological intimate partner violence with HIV care outcomes on patients in HIV care
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Fredericksen, R. J., Nance, R. M., Whitney, B. M., Harding, B. N., Fitzsimmons, E., Del Rio, C., Eron, J., Feaster, D. J., Kalokhe, A. S., Mathews, W. C., Mayer, K. H., Metsch, L. R., Mugavero, M. J., Potter, J., O’Cleirigh, C., Napravnik, S., Rodriguez, B., Ruderman, S., JAC, Delaney, and Crane, H. M.
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Data_FILES - Abstract
Additional file 2.
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- 2021
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14. The Authors Reply
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Crane, H. M., Heckbert, S. R., Drozd, D. R., Budoff, M. J., Delaney, J. A. C., Rodriguez, C., Paramsothy, P., Lober, W. B., Burkholder, G., Willig, J. H., Mugavero, M. J., Mathews, W. C., Crane, P. K., Moore, R. D., Napravnik, S., Eron, J. J., Hunt, P., Geng, E., Hsue, P., Barnes, G. S., McReynolds, J., Peter, I., Grunfeld, C., Saag, M. S., and Kitahata, M. M.
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- 2014
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15. Physical activity trends and metabolic health outcomes in people living with HIV in the US, 2008–2015
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Buford, T.W., Bamman, M.M., Webel, A.R., Rodriguez, B., Geng, E.H., Crane, H.M., Moore, R.D., Zinski, A., Burkholder, G.A., Willig, A.L., Napravnik, S., Willig, J.H., Eron, J.J., Blashill, A.J., Westfall, A.O., Mathews, W.C., Levitan, E.B., Muhammad, J., and Overton, E.T.
- Abstract
Despite its potential to improve metabolic health outcomes, longitudinal physical activity (PA) patterns and their association with cardiometabolic disease among people living with HIV (PLWH) have not been well characterized. We investigated this relationship among PLWH in the Centers for AIDS Research Network of Integrated Clinical Systems with at least one PA self-report between 2008 and 2015. The 4-item Lipid Research Clinics PA instrument was used to categorize habitual PA levels as: Very Low, Low, Moderate, or High. We analyzed demographic differences in PA patterns. Multivariable generalized estimating equation regression models were fit to assess longitudinal associations of PA with blood pressure, lipid, and glucose levels. Logistic regression modeling was used to assess the odds of being diagnosed with obesity, cardiovascular disease (CVD), cerebrovascular disease, hypertension, diabetes, or multimorbidity. A total of 40,462 unique PA assessments were provided by 11,719 participants. Only 13% of PLWH reported High PA, while 68% reported Very Low/Low PA at baseline and did not increase PA levels during the study period. Compared to those reporting High PA, participants with Very Low PA had almost 2-fold increased risk for CVD. Very Low PA was also associated with several risk factors associated with CVD, most notably elevated triglycerides (odds ratio 25.4), obesity (odds ratio 1.9), hypertension (odds ratio 1.4), and diabetes (odds ratio 2.3; all p < 0.01). Low levels of PA over time among PLWH are associated with increased cardiometabolic disease risk.
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- 2020
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16. Postpartum HIV care continuum outcomes in the southeastern USA
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Antono, A.C., Eron, J.J., Farel, C.E., Pence, B.W., Patterson, K.B., Chen, J.S., Rahangdale, L., Durr, A.L., Zakharova, O., and Napravnik, S.
- Abstract
The aim of this study was to evaluate postpartum HIV care outcomes.Design:A prospective clinical cohort of women with HIV and a live birth at the University of North Carolina, 1996-2014.Methods:We estimated two stages of the HIV care continuum in the first 24 months postpartum: care retention (at least two visits per year, ≥90 days apart) and viral suppression (HIV RNA
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- 2019
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17. Sex-Based Differences in Inpatient Burn Mortality
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van Duin, D., Knowlin, L., Nizamani, R., Williams, F.N., Jones, S.W., Charles, A., Strassle, P.D., Napravnik, S., and Cairns, B.A.
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Background: Among burn patients, research is conflicted, but may suggest that females are at increased risk of mortality, despite the opposite being true in non-burn trauma. Our objective was to determine whether sex-based differences in burn mortality exist, and assess whether patient demographics, comorbid conditions, and injury characteristics explain said differences. Methods: Adult patients admitted with burn injury—including inhalation injury only—between 2004 and 2013 were included. Inverse probability of treatment weights (IPTW) and inverse probability of censor weights (IPCW) were calculated using admit year, patient demographics, comorbid conditions, and injury characteristics to adjust for potential confounding and informative censoring. Standardized Kaplan–Meier survival curves, weighted by both IPTW and IPCW, were used to estimate the 30-day and 60-day risk of inpatient mortality across sex. Results: Females were older (median age 44 vs. 41 years old, p < 0.0001) and more likely to be Black (32% vs. 25%, p < 0.0001), have diabetes (14% vs. 10%, p < 0.0001), pulmonary disease (14% vs. 7%, p < 0.0001), heart failure (4% vs. 2%, p = 0.001), scald burns (45% vs. 26%, p < 0.0001), and inhalational injuries (10% vs. 8%, p = 0.04). Even after weighting, females were still over twice as likely to die after 60 days (RR 2.87, 95% CI 1.09, 7.51). Conclusion: Female burn patients have a significantly higher risk of 60-day mortality, even after accounting for demographics, comorbid conditions, burn size, and inhalational injury. Future research efforts and treatments to attenuate mortality should account for these sex-based differences. The project was supported by the National Institutes of Health, Grant Number UL1TR001111.
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- 2019
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18. Opioid misuse among persons with HIV engaged in care in the Southeastern US
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Napravnik, S., Davy-Mendez, T., Schranz, A.J., and Eron, J.J.
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The prevalence of opioid misuse by people living with HIV (PLWH) during the current US opioid epidemic has not been fully described. Among a cohort of persons engaged in HIV care in North Carolina, we examined the prevalence of and risk factors for opioid misuse, defined as self-reported “street” opioid use (e.g., heroin) or nonmedical prescription opioid use on a patient reported outcomes survey. Recent (past three-month) opioid misuse among 1,440 PLWH in care 2012–2017 was 2% (95% CI 2-3%) and lifetime misuse 15% (13-16%). Persons reporting lifetime or recent misuse more commonly had hepatitis C and reported injecting drugs. In multivariable logistic regression models, male-to-male sexual contact was inversely associated with recent or lifetime misuse. White/non-Hispanic race/ethnicity was associated with lifetime misuse and CD4 count and viral load were not associated with opioid misuse. Among 32 persons reporting recent misuse, 81% had a contemporaneous viral load
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- 2019
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19. Drug Use Mediates the Relationship Between Depressive Symptoms and Adherence to ART Among Recently Incarcerated People Living with HIV
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Golin, C.E., Flynn, P.M., DiPrete, B., Hill, L.M., Carda-Auten, J., Gottfredson, N.C., Groves, J.S., Napravnik, S., Pence, B.W., Knight, K., and Wohl, D.
- Abstract
Depression is a known risk factor for antiretroviral therapy (ART) non-adherence, but little is known about the mechanisms explaining this relationship. Identifying these mechanisms among people living with HIV (PLHIV) after release from prison is particularly important, as individuals during this critical period are at high risk for both depression and poor ART adherence. 347 PLHIV recently released from prison in North Carolina and Texas were included in analyses to assess mediation of the relationship between depressive symptoms at 2 weeks post-release and ART adherence (assessed by unannounced telephone pill counts) at weeks 9–21 post-release by the hypothesized explanatory mechanisms of alcohol use, drug use, adherence self-efficacy, and adherence motivation (measured at weeks 6 and 14 post-release). Indirect effects were estimated using structural equation models with maximum likelihood estimation and bootstrapped confidence intervals. On average, participants achieved 79% ART adherence. The indirect effect of depression on adherence through drug use was statistically significant; greater symptoms of depression were associated with greater drug use, which was in turn associated with lower adherence. Lower adherence self-efficacy was associated with depressive symptoms, but not with adherence. Depression screening and targeted mental health and substance use services for depressed individuals at risk of substance use constitute important steps to promote adherence to ART after prison release.
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- 2019
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20. Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy
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Patterson, K, Napravnik, S, Eron, J, Keruly, J, and Moore, R
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- 2007
21. Comparison of Kaposi Sarcoma Risk in Human Immunodeficiency Virus-Positive Adults Across 5 Continents: A Multiregional Multicohort Study
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Rohner E., Butikofer L., Schmidlin K., Sengayi M., Maskew M., Giddy J., Garone D., Moore R. D., D'Souza G., Goedert J. J., Achenbach C., Gill M. J., Kitahata M. M., Patel P., Silverberg M. J., Castilho J., McGowan C., Chen Y. -M. A., Law M., Taylor N., Paparizos V., Bonnet F., Verbon A., Fatkenheuer G., Post F. A., Sabin C., Mocroft A., Le Moing V., Dronda F., Obel N., Grabar S., Spagnuolo V., Antinori A., Quiros-Roldan E., Mussini C., Miro J. M., Meyer L., Hasse B., Konopnicki D., Roca B., Barger D., Raben D., Clifford G. M., Franceschi S., Brockmeyer N., Chakraborty R., Egger M., Bohlius J., Judd A., Zangerle R., Touloumi G., Warszawski J., Dabis F., Krause M. M., Ghosn J., Leport C., Wittkop L., Reiss P., Wit F., Prins M., Bucher H., Gibb D., Del Amo J., Thorne C., Kirk O., Stephan C., Perez-Hoyos S., Hamouda O., Bartmeyer B., Chkhartishvili N., Noguera-Julian A., Monforte A. D., Prieto L., Conejo P. R., Soriano-Arandes A., Battegay M., Kouyos R., Tookey P., Casabona J., Castagna A., Konopnick D., Goetghebuer T., Sonnerborg A., Teira R., Garrido M., Haerry D., De Wit S., Costagliola D., D'Arminio-Monforte A., Chene G., Schwimmer C., Termote M., Campbell M., Frederiksen C. M., Friis-Moller N., Kjaer J., Brandt R. S., Berenguer J., Bouteloup V., Cozzi-Lepri A., Davies M. -A., Dorrucci M., Dunn D., Furrer H., Guiguet M., Lambotte O., Leroy V., Lodi S., Matheron S., Monge S., Nakagawa F., Paredes R., Phillips A., Puoti M., Schomaker M., Smit C., Sterne J., Thiebaut R., Torti C., Van Der Valk M., Tanser F., Vinikoor M., MacEte E., Wood R., Stinson K., Fatti G., Phiri S., Chimbetete C., Malisita K., Eley B., Fritz C., Hobbins M., Kamenova K., Fox M., Prozesky H., Technau K., Sawry S., Benson C. A., Bosch R. J., Kirk G. D., Boswell S., Mayer K. H., Grasso C., Hogg R. S., Harrigan P. R., Montaner J. S. G., Yip B., Zhu J., Salters K., Gabler K., Buchacz K., Brooks J. T., Gebo K. A., Carey J. T., Rodriguez B., Horberg M. A., Thorne J. E., Rabkin C., Margolick J. B., Jacobson L. P., Klein M. B., Rourke S. B., Rachlis A. R., Cupido P., Hunter-Mellado R. F., Mayor A. M., Deeks S. G., Martin J. N., Saag M. S., Mugavero M. J., Willig J., Eron J. J., Napravnik S., Crane H. M., Drozd D. R., Haas D., Rebeiro P., Turner M., Bebawy S., Rogers B., Justice A. C., Dubrow R., Fiellin D., Gange S. J., Anastos K., Althoff K. N., McKaig R. G., Freeman A. M., Lent C., Van Rompaey S. E., Morton L., McReynolds J., Lober W. B., Abraham A. G., Lau B., Zhang J., Jing J., Modur S., Wong C., Hogan B., Desir F., Liu B., You B., Cahn P., Cesar C., Fink V., Sued O., Dell'Isola E., Perez H., Valiente J., Yamamoto C., Grinsztejn B., Veloso V., Luz P., De Boni R., Wagner S. C., Friedman R., Moreira R., Pinto J., Ferreira F., Maia M., De Menezes Succi R. C., MacHado D. M., De Fatima Barbosa Gouvea A., Wolff M., Cortes C., Rodriguez M. F., Allendes G., Pape J. W., Rouzier V., Marcelin A., Perodin C., Luque M. T., Padgett D., Madero J. S., Ramirez B. C., Belaunzaran P., Vega Y. C., Gotuzzo E., Mejia F., Carriquiry G., McGowan C. C., Shepherd B. E., Sterling T., Jayathilake K., Person A. K., Rebeiro P. F., Giganti M., Duda S. N., Maruri F., Vansell H., Ly P. S., Khol V., Zhang F. J., Zhao H. X., Han N., Lee M. P., Li P. C. K., Lam W., Chan Y. T., Kumarasamy N., Saghayam S., Ezhilarasi C., Pujari S., Joshi K., Gaikwad S., Chitalikar A., Merati T. P., Wirawan D. N., Yuliana F., Yunihastuti E., Imran D., Widhani A., Tanuma J., Oka S., Nishijima T., Choi J. Y., Na S., Kim J. M., Sim B. L. H., Gani Y. M., David R., Kamarulzaman A., Syed Omar S. F., Ponnampalavanar S., Azwa I., Ditangco R., Uy E., Bantique R., Wong W. W., Ku W. W., Wu P. C., Ng O. T., Lim P. L., Lee L. S., Ohnmar P. S., Avihingsanon A., Gatechompol S., Phanuphak P., Phadungphon C., Kiertiburanakul S., Sungkanuparph S., Chumla L., Sanmeema N., Chaiwarith R., Sirisanthana T., Kotarathititum W., Praparattanapan J., Kantipong P., Kambua P., Ratanasuwan W., Sriondee R., Nguyen K. V., Bui H. V., Nguyen D. T. H., Nguyen D. T., Cuong D. D., An N. V., Luan N. T., Sohn A. H., Ross J. L., Petersen B., Cooper D. A., Law M. G., Jiamsakul A., Boettiger D. C., Ellis D., Bloch M., Agrawal S., Vincent T., Allen D., Smith D., Rankin A., Baker D., Templeton D. J., Jackson E., McCallum K., Ryder N., Sweeney G., Cooper D., Carr A., MacRae K., Hesse K., Finlayson R., Gupta S., Langton-Lockton J., Shakeshaft J., Brown K., Idle S., Arvela N., Varma R., Lu H., Couldwell D., Eswarappa S., Smith D. E., Furner V., Cabrera G., Fernando S., Cogle A., Lawrence C., Mulhall B., Boyd M., Petoumenos K., Puhr R., Huang R., Han A., Gunathilake M., Payne R., O'Sullivan M., Croydon A., Russell D., Cashman C., Roberts C., Sowden D., Taing K., Marshall P., Orth D., Youds D., Rowling D., Latch N., Warzywoda E., Dickson B., Donohue W., Moore R., Edwards S., Boyd S., Roth N. J., Lau H., Read T., Silvers J., Zeng W., Hoy J., Watson K., Bryant M., Price S., Woolley I., Giles M., Korman T., Williams J., Nolan D., Allen A., Guelfi G., Mills G., Wharry C., Raymond N., Bargh K., Templeton D., Medical Microbiology & Infectious Diseases, Global Health, Infectious diseases, APH - Aging & Later Life, AII - Infectious diseases, APH - Global Health, Graduate School, APH - Digital Health, APH - Personalized Medicine, Bohlius, Julia, Cohere In, Eurocoord, Castagna, Antonella, Rohner, E, Butikofer, L, Schmidlin, K, Sengayi, M, Maskew, M, Giddy, J, Garone, D, Moore, R, D'Souza, G, Goedert, J, Achenbach, C, Gill, M, Kitahata, M, Patel, P, Silverberg, M, Castilho, J, Mcgowan, C, Chen, Y, Law, M, Taylor, N, Paparizos, V, Bonnet, F, Verbon, A, Fatkenheuer, G, Post, F, Sabin, C, Mocroft, A, Le Moing, V, Dronda, F, Obel, N, Grabar, S, Spagnuolo, V, Antinori, A, Quiros-Roldan, E, Mussini, C, Miro, J, Meyer, L, Hasse, B, Konopnicki, D, Roca, B, Barger, D, Raben, D, Clifford, G, Franceschi, S, Brockmeyer, N, Chakraborty, R, Egger, M, Bohlius, J, Judd, A, Zangerle, R, Touloumi, G, Warszawski, J, Dabis, F, Krause, M, Ghosn, J, Leport, C, Wittkop, L, Reiss, P, Wit, F, Prins, M, Bucher, H, Gibb, D, Del Amo, J, Thorne, C, Kirk, O, Stephan, C, Perez-Hoyos, S, Hamouda, O, Bartmeyer, B, Chkhartishvili, N, Noguera-Julian, A, Monforte, A, Prieto, L, Conejo, P, Soriano-Arandes, A, Battegay, M, Kouyos, R, Tookey, P, Casabona, J, Castagna, A, Konopnick, D, Goetghebuer, T, Sonnerborg, A, Teira, R, Garrido, M, Haerry, D, De Wit, S, Costagliola, D, D'Arminio-Monforte, A, Chene, G, Schwimmer, C, Termote, M, Campbell, M, Frederiksen, C, Friis-Moller, N, Kjaer, J, Brandt, R, Berenguer, J, Bouteloup, V, Cozzi-Lepri, A, Davies, M, Dorrucci, M, Dunn, D, Furrer, H, Guiguet, M, Lambotte, O, Leroy, V, Lodi, S, Matheron, S, Monge, S, Nakagawa, F, Paredes, R, Phillips, A, Puoti, M, Schomaker, M, Smit, C, Sterne, J, Thiebaut, R, Torti, C, Van Der Valk, M, Tanser, F, Vinikoor, M, Macete, E, Wood, R, Stinson, K, Fatti, G, Phiri, S, Chimbetete, C, Malisita, K, Eley, B, Fritz, C, Hobbins, M, Kamenova, K, Fox, M, Prozesky, H, Technau, K, Sawry, S, Benson, C, Bosch, R, Kirk, G, Boswell, S, Mayer, K, Grasso, C, Hogg, R, Harrigan, P, Montaner, J, Yip, B, Zhu, J, Salters, K, Gabler, K, Buchacz, K, Brooks, J, Gebo, K, Carey, J, Rodriguez, B, Horberg, M, Thorne, J, Rabkin, C, Margolick, J, Jacobson, L, Klein, M, Rourke, S, Rachlis, A, Cupido, P, Hunter-Mellado, R, Mayor, A, Deeks, S, Martin, J, Saag, M, Mugavero, M, Willig, J, Eron, J, Napravnik, S, Crane, H, Drozd, D, Haas, D, Rebeiro, P, Turner, M, Bebawy, S, Rogers, B, Justice, A, Dubrow, R, Fiellin, D, Gange, S, Anastos, K, Althoff, K, Mckaig, R, Freeman, A, Lent, C, Van Rompaey, S, Morton, L, Mcreynolds, J, Lober, W, Abraham, A, Lau, B, Zhang, J, Jing, J, Modur, S, Wong, C, Hogan, B, Desir, F, Liu, B, You, B, Cahn, P, Cesar, C, Fink, V, Sued, O, Dell'Isola, E, Perez, H, Valiente, J, Yamamoto, C, Grinsztejn, B, Veloso, V, Luz, P, De Boni, R, Wagner, S, Friedman, R, Moreira, R, Pinto, J, Ferreira, F, Maia, M, De Menezes Succi, R, Machado, D, De Fatima Barbosa Gouvea, A, Wolff, M, Cortes, C, Rodriguez, M, Allendes, G, Pape, J, Rouzier, V, Marcelin, A, Perodin, C, Luque, M, Padgett, D, Madero, J, Ramirez, B, Belaunzaran, P, Vega, Y, Gotuzzo, E, Mejia, F, Carriquiry, G, Shepherd, B, Sterling, T, Jayathilake, K, Person, A, Giganti, M, Duda, S, Maruri, F, Vansell, H, Ly, P, Khol, V, Zhang, F, Zhao, H, Han, N, Lee, M, Li, P, Lam, W, Chan, Y, Kumarasamy, N, Saghayam, S, Ezhilarasi, C, Pujari, S, Joshi, K, Gaikwad, S, Chitalikar, A, Merati, T, Wirawan, D, Yuliana, F, Yunihastuti, E, Imran, D, Widhani, A, Tanuma, J, Oka, S, Nishijima, T, Choi, J, Na, S, Kim, J, Sim, B, Gani, Y, David, R, Kamarulzaman, A, Syed Omar, S, Ponnampalavanar, S, Azwa, I, Ditangco, R, Uy, E, Bantique, R, Wong, W, Ku, W, Wu, P, Ng, O, Lim, P, Lee, L, Ohnmar, P, Avihingsanon, A, Gatechompol, S, Phanuphak, P, Phadungphon, C, Kiertiburanakul, S, Sungkanuparph, S, Chumla, L, Sanmeema, N, Chaiwarith, R, Sirisanthana, T, Kotarathititum, W, Praparattanapan, J, Kantipong, P, Kambua, P, Ratanasuwan, W, Sriondee, R, Nguyen, K, Bui, H, Nguyen, D, Cuong, D, An, N, Luan, N, Sohn, A, Ross, J, Petersen, B, Cooper, D, Jiamsakul, A, Boettiger, D, Ellis, D, Bloch, M, Agrawal, S, Vincent, T, Allen, D, Smith, D, Rankin, A, Baker, D, Templeton, D, Jackson, E, Mccallum, K, Ryder, N, Sweeney, G, Carr, A, Macrae, K, Hesse, K, Finlayson, R, Gupta, S, Langton-Lockton, J, Shakeshaft, J, Brown, K, Idle, S, Arvela, N, Varma, R, Lu, H, Couldwell, D, Eswarappa, S, Furner, V, Cabrera, G, Fernando, S, Cogle, A, Lawrence, C, Mulhall, B, Boyd, M, Petoumenos, K, Puhr, R, Huang, R, Han, A, Gunathilake, M, Payne, R, O'Sullivan, M, Croydon, A, Russell, D, Cashman, C, Roberts, C, Sowden, D, Taing, K, Marshall, P, Orth, D, Youds, D, Rowling, D, Latch, N, Warzywoda, E, Dickson, B, Donohue, W, Edwards, S, Boyd, S, Roth, N, Lau, H, Read, T, Silvers, J, Zeng, W, Hoy, J, Watson, K, Bryant, M, Price, S, Woolley, I, Giles, M, Korman, T, Williams, J, Nolan, D, Allen, A, Guelfi, G, Mills, G, Wharry, C, Raymond, N, and Bargh, K
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Male ,viruses ,HIV Infections ,Men who have sex with men ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,Antiretroviral therapy ,Cohort study ,HIV ,Kaposi sarcoma ,Adolescent ,Adult ,Anti-Retroviral Agents ,CD4 Lymphocyte Count ,Female ,HIV-1 ,Humans ,Middle Aged ,Sarcoma, Kaposi ,Viral Load ,Young Adult ,030212 general & internal medicine ,Articles and Commentaries ,Incidence (epidemiology) ,Hazard ratio ,virus diseases ,Sarcoma ,3. Good health ,Infectious Diseases ,030220 oncology & carcinogenesis ,Cohort ,Coinfection ,Microbiology (medical) ,antiretroviral therapy ,610 Medicine & health ,Kaposi ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,360 Social problems & social services ,medicine ,cohort study ,business.industry ,medicine.disease ,Confidence interval ,business ,Demography - Abstract
Background We compared Kaposi sarcoma (KS) risk in adults who started antiretroviral therapy (ART) across the Asia-Pacific, South Africa, Europe, Latin, and North America. Methods We included cohort data of human immunodeficiency virus (HIV)-positive adults who started ART after 1995 within the framework of 2 large collaborations of observational HIV cohorts. We present incidence rates and adjusted hazard ratios (aHRs). Results We included 208140 patients from 57 countries. Over a period of 1066572 person-years, 2046 KS cases were diagnosed. KS incidence rates per 100000 person-years were 52 in the Asia-Pacific and ranged between 180 and 280 in the other regions. KS risk was 5 times higher in South African women (aHR, 4.56; 95% confidence intervals [CI], 2.73-7.62) than in their European counterparts, and 2 times higher in South African men (2.21; 1.34-3.63). In Europe, Latin, and North America KS risk was 6 times higher in men who have sex with men (aHR, 5.95; 95% CI, 5.09-6.96) than in women. Comparing patients with current CD4 cell counts ≥700 cells/µL with those whose counts were
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- 2017
22. HIV viral suppression trends over time among HIV-infected patients receiving care in the United States, 1997 to 2015 a cohort study
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Eron, J.J., Christopoulos, K.A., Crane, H.M., Wilson, I.B., Whitney, B.M., Chris Delaney, J.A., Mayer, K.H., Lau, B., Kitahata, M.M., Rodriguez, B., Simoni, J.M., Mugavero, M.J., Moore, R.D., Christopher Mathews, W., Safren, S.A., Fredericksen, R.J., Napravnik, S., Saag, M.S., Aunon, F.M., and Nance, R.M.
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Background: Because HIV viral suppression is essential for optimal outcomes and prevention efforts, understanding trends and predictors is imperative to inform public health policy. Objective: To evaluate viral suppression trends in people living with HIV (PLWH), including the relationship of associated factors, such as demographic characteristics and integrase strand transfer inhibitor (ISTI) use. Design: Longitudinal observational cohort study. Setting: 8 HIV clinics across the United States. Participants: PLWH receiving clinical care. Measurements: To understand trends in viral suppression (≤400 copies/mL), annual viral suppression rates from 1997 to 2015 were determined. Analyses were repeated with tests limited to 1 random test per person per year and using inverse probability of censoring weights to address loss to follow-up. Joint longitudinal and survival models and linear mixed models of PLWH receiving antiretroviral therapy (ART) were used to examine associations between viral suppression or continuous viral load (VL) levels and demographic factors, substance use, adherence, and ISTI use. Results: Viral suppression increased from 32% in 1997 to 86% in 2015 on the basis of all tests among 31 930 PLWH. In adjusted analyses, being older (odds ratio [OR], 0.76 per decade [95% CI, 0.74 to 0.78]) and using an ISTI-based regimen (OR, 0.54 [CI, 0.51 to 0.57]) were associated with lower odds of having a detectable VL, and black race was associated with higher odds (OR, 1.68 [CI, 1.57 to 1.80]) (P < 0.001 for each). Similar patterns were seen with continuous VL levels; when analyses were limited to 2010 to 2015; and with adjustment for adherence, substance use, or depression. Limitation: Results are limited to PLWH receiving clinical care. Conclusion: HIV viral suppression rates have improved dramatically across the United States, which is likely partially attributable to improved ART, including ISTI-based regimens. However, disparities among younger and black PLWH merit attention.
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- 2018
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23. Evaluating the Population Impact on Racial/Ethnic Disparities in HIV in Adulthood of Intervening on Specific Targets: A Conceptual and Methodological Framework
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Drozd, D.R., Boswell, S.L., Dulin-Keita, A., Cole, S.R., Moore, R.D., Mugavero, M.J., Lau, B., Mathews, W.C., Eron, J.J., Geng, E., Napravnik, S., Crane, H.M., Hogan, J.W., CFAR Network of Integrated Clinical Systems, and Howe, C.J.
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Reducing racial/ethnic disparities in human immunodeficiency virus (HIV) disease is a high priority. Reductions in HIV racial/ethnic disparities can potentially be achieved by intervening on important intermediate factors. The potential population impact of intervening on intermediates can be evaluated using observational data when certain conditions are met. However, using standard stratification-based approaches commonly employed in the observational HIV literature to estimate the potential population impact in this setting may yield results that do not accurately estimate quantities of interest. Here we describe a useful conceptual and methodological framework for using observational data to appropriately evaluate the impact on HIV racial/ethnic disparities of interventions. This framework reframes relevant scientific questions in terms of a controlled direct effect and estimates a corresponding proportion eliminated. We review methods and conditions sufficient for accurate estimation within the proposed framework. We use the framework to analyze data on 2,329 participants in the CFAR [Centers for AIDS Research] Network of Integrated Clinical Systems (2008-2014) to evaluate the potential impact of universal prescription of and ≥95% adherence to antiretroviral therapy on racial disparities in HIV virological suppression. We encourage the use of the described framework to appropriately evaluate the potential impact of targeted interventions in addressing HIV racial/ethnic disparities using observational data.
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- 2018
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24. Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States
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Williams, J.R., Moore, R.D., Eron, J.J., Mugavero, M.J., Mayer, K.H., Dombrowski, J.C., Donovan, D.M., Rodriguez, B., Mathews, C., Hartzler, B., Napravnik, S., Geng, E.H., and Crane, H.M.
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Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18–29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.
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- 2018
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25. Types of Myocardial Infarction Among Human Immunodeficiency Virus-Infected Individuals in the United States
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Crane, HM, Paramsothy, P, Drozd, DR, Nance, RM, Delaney, JAC, Heckbert, SR, Budoff, MJ, Burkholder, GA, Willig, JH, Mugavero, MJ, Mathews, WC, Crane, PK, Moore, RD, Eron, JJ, Napravnik, S, Hunt, PW, Geng, E, Hsue, P, Rodriguez, C, Peter, I, Barnes, GS, McReynolds, J, Lober, WB, Crothers, K, Feinstein, MJ, Grunfeld, C, Saag, MS, Kitahata, MM, and Cl, CAIDSRNI
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Adult ,Male ,Time Factors ,Myocardial Infarction ,HIV Infections ,Coronary Angiography ,Cardiovascular ,Risk Assessment ,Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Cohort ,Electrocardiography ,Risk Factors ,Clinical Research ,Humans ,Heart Disease - Coronary Heart Disease ,Retrospective Studies ,Incidence ,HIV ,Hematology ,Middle Aged ,United States ,Survival Rate ,Good Health and Well Being ,Infectious Diseases ,Heart Disease ,Female ,Infection ,Follow-Up Studies - Abstract
ImportanceThe Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown.ObjectivesTo characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs.Design, setting, and participantsThis longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts adjudicated each event, categorizing each definite or probable MI as type 1 or type 2 and identifying the causes of type 2 MI.Main outcomes and measuresThe number and proportion of type 1 vs type 2 MIs, demographic and clinical characteristics among those with type 1 vs type 2 MIs, and the causes of type 2 MIs.ResultsAmong 571 patients (median age, 49 years [interquartile range, 43-55 years]; 430 men and 141 women) with definite or probable MIs, 288 MIs (50.4%) were type 2 and 283 (49.6%) were type 1. In analyses of type 1 MIs, 79 patients who underwent cardiac interventions, such as coronary artery bypass graft surgery, were also included, totaling 362 patients. Sepsis or bacteremia (100 [34.7%]) and recent use of cocaine or other illicit drugs (39 [13.5%]) were the most common causes of type 2 MIs. A higher proportion of patients with type 2 MIs were younger than 40 years (47 of 288 [16.3%] vs 32 of 362 [8.8%]) and had lower current CD4 cell counts (median, 230 vs 383 cells/µL), lipid levels (mean [SD] total cholesterol level, 167 [63] vs 190 [54] mg/dL, and mean (SD) Framingham risk scores (8% [7%] vs 10% [8%]) than those with type 1 MIs or who underwent cardiac interventions.Conclusions and relevanceApproximately half of all MIs among HIV-infected individuals were type 2 MIs caused by heterogeneous clinical conditions, including sepsis or bacteremia and recent use of cocaine or other illicit drugs. Demographic characteristics and cardiovascular risk factors among those with type 1 and type 2 MIs differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand MI outcomes and to guide prevention and treatment.
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- 2017
26. Identifying HIV care enrollees at-risk for cannabis use disorder
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Mugavero, M.J., Donovan, D.M., Hartzler, B., Mathews, W.C., Carlini, B.H., Moore, R.D., Newville, H., Geng, E.H., Eron, J.J., Rodriguez, B., Mayer, K.H., Crane, H.M., and Napravnik, S.
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Increased scientific attention given to cannabis in the United States has particular relevance for its domestic HIV care population, given that evidence exists for both cannabis as a therapeutic agent and cannabis use disorder (CUD) as a barrier to antiretroviral medication adherence. It is critical to identify relative risk for CUD among demographic subgroups of HIV patients, as this will inform detection and intervention efforts. A Center For AIDS Research Network of Integrated Clinical Systems cohort (N = 10,652) of HIV-positive adults linked to care at seven United State sites was examined for this purpose. Based on a patient-report instrument with validated diagnostic threshold for CUD, the prevalence of recent cannabis use and corresponding conditional probabilities for CUD were calculated for the aggregate sample and demographic subgroups. Generalized estimating equations then tested models directly examining patient demographic indices as predictors of CUD, while controlling for history and geography. Conditional probability of CUD among cannabis-using patients was 49%, with the highest conditional probabilities among demographic subgroups of young adults and those with non-specified sexual orientation (67–69%) and the lowest conditional probability among females and those 50+ years of age (42% apiece). Similarly, youthful age and male gender emerged as robust multivariate model predictors of CUD. In the context of increasingly lenient policies for use of cannabis as a therapeutic agent for chronic conditions like HIV/AIDS, current study findings offer needed direction in terms of specifying targeted patient groups in HIV care on whom resources for enhanced surveillance and intervention efforts will be most impactful.
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- 2017
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27. Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States
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Crane, H.M., Dombrowski, J.C., Eron, J.J., Mayer, K.H., Moore, R.D., Donovan, D.M., Napravnik, S., Hartzler, B., Mugavero, M.J., Rodriguez, B., Geng, E.H., and Christopher Mathews, W.
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mental disorders ,behavioral disciplines and activities - Abstract
Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: (1) a 48 % SUD prevalence rate (between-site range of 21–71 %), with 20 % of the sample evidencing polysubstance use disorder; (2) substance-specific SUD rates of 31 % for marijuana, 19 % alcohol, 13 % methamphetamine, 11 % cocaine, and 4 % opiate; and (3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.
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- 2017
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28. Risk Factors for Healthcare-Associated Infections in Adult Burn Patients
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Napravnik, S., Williams, F.N., Van Duin, D., Sickbert-Bennett, E.E., Strassle, P.D., Jones, S.W., Lachiewicz, A.M., Weber, D.J., and Cairns, B.A.
- Abstract
OBJECTIVE Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-Associated infections (HAIs) in adult burn patients. DESIGN Retrospective cohort study. SETTING Tertiary-care burn center. PATIENTS Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013. METHODS HAIs were determined in real-Time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed. RESULTS Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to 6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64-11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74-18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17-2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA. CONCLUSIONS Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.
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- 2017
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29. Longitudinal opioid use among HIV-infected patients, 2000 to 2014
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Brunet, L., Heine, A.D., Napravnik, S., Leone, P.A., and Eron, J.J.
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Longitudinal opioid prescription use is unknown among HIV-infected patients. Group-based trajectory modeling followed by multinomial logistic regression was used to identify distinct trajectories and their association with baseline characteristics among 1239 HIV-infected UNC CFAR HIV Clinical Cohort participants, 2000-2014. Three trajectories were identified: (1) 72% never/sporadic opioid use (referent group), (2) 11% episodic use (associated with female sex, depression, drug-related diagnoses, antiretroviral therapy use, and undetectable HIV RNA), and (3) 16% chronic use (associated with older age, female sex, and mental health diagnoses). Overall, opioid prescription decreased substantially with longer time in HIV care among both episodic and chronic users.
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- 2017
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30. Financial Barriers and Lapses in Treatment and Care of HIV-Infected Adults in a Southern State in the United States
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Javadi, K., Kirby, C., Wohl, D.A., Kuwahara, R.K., Farel, C., Napravnik, S., and Rosen, D.L.
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virus diseases ,health care economics and organizations - Abstract
Antiretroviral (ARV) adherence has largely been considered from the perspective of an individual's behavior with less attention given to potential structural causes for lapses in treatment, such as the cost of medications and care. HIV medication expense is typically covered by third party payers. However, private insurance premiums and deductibles may rise, or policies terminated such as with a change in employment. Likewise, a patient's eligibility for publicly funded coverage like state AIDS Drug Assistance Programs (ADAP) or Medicaid can also be lost. We conducted a one-Time survey of a sample of 300 patients receiving HIV care at a single large academic center in the south of United States to examine lapses in HIV therapy due to financial reasons. We found that during the prior year, financial issues including medication cost or coverage led to a lapse in ARVs in 10% (n = 31) of participants. However, of the 42% (n = 125) participants who had been enrolled in ADAP at any time during the prior year, 21% (n = 26) reported an ARV lapse due to problems with ADAP or medication cost. Respondents cited ADAP's required semi-Annual renewal process and other administrative issues as the cause of ARV lapses. The median duration of missed ARVs was 2 weeks (range of
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- 2017
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31. Randomized controlled trial of an intervention to maintain suppression of HIV viremia after prison release: The impact trial
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Knight, K., Pence, B.W., Golin, C.E., Flynn, P.M., Mugavaro, M.J., Cole, S.R., White, B.L., Rosen, D.L., Groves, J.S., Fogel, C., Gould, M., Carda-Auten, J., Napravnik, S., and Wohl, D.A.
- Abstract
Background: HIV-infected individuals transitioning from incarceration to the community are at risk for loss of viral suppression. We compared the effects of imPACT, a multidimensional intervention to promote care engagement after release, to standard care on sustaining viral suppression after community re-entry. Methods: This trial randomized 405 HIV-infected inmates being released from prisons in Texas and North Carolina with HIV-1 RNA levels 0.99). Conclusions: Higher rates of HIV suppression and medical care engagement than expected based on previous literature were observed among HIV-infected patients with suppressed viremia released from prison. Randomization to a comprehensive intervention to motivate and facilitate HIV care access after prison release did not prevent loss of viral suppression. A better understanding of the factors influencing prison releasees' linkage to community care, medication adherence, and maintenance of viral suppression is needed to inform policy and other strategic approaches to HIV prevention and treatment.
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- 2017
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32. HIV Care Initiation Delay among Rural Residents in the Southeastern United States, 1996 to 2012
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Eron, J.J., Jr., Mugavero, M.J., Napravnik, S., Lopes, B.L.W., and Miller, W.C.
- Abstract
Background: Delaying HIV care initiation may lead to greater morbidity, mortality, and further HIV transmission. Rural residence may be associated with delayed diagnosis and linkage to care, with negative clinical outcomes. Objective: To examine the association between rural patient residence and CD4 cell count at HIV care initiation in a large HIV clinical cohort in the Southeastern United States. Methods: We included HIV-infected patients who initiated care between 1996 and 2012 with a geocodable address and no previous history of HIV clinical care. Patient residence was categorized as urban or rural using United States Department of Agriculture Rural Urban Commuting Area codes. Multivariable linear regression models were fit to estimate the association between patient residence and CD4 cell count at HIV care initiation. Results: Among 1396 patients who met study inclusion criteria, 988 had a geocodable address. Overall, 35% of patients resided in rural areas and presented to HIV care with a mean CD4 cell count of 351 cells/mm 3 (SD, 290). Care initiation mean CD4 cell counts increased from 329 cells/mm 3 (SD, 283) in 1996-2003 to 391 cells/mm 3 (SD, 292) in 2008-2012 (P = 0.006). Rural in comparison with urban patients presented with lower CD4 cell counts with an unadjusted and adjusted mean difference of -48 cells/mm 3 [95% confidence interval, -86 to -10) and -37 cells/mm 3 (95% confidence interval: -73 to -2), respectively, consistently observed across calendar years. Conclusions: HIV care initiation at low CD4 cell counts was common in this Southeastern US cohort and more common among rural area residents.
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- 2017
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33. The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals
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Kim, H.N., Chander, G., Mayer, K.H., Eron, J.J., Moore, R., Merrill, J.O., Rodriguez, C.V., Crane, H.M., Van Rompaey, S., Christopoulos, K., Hutton, H., Cachay, E.R., McCaul, M.E., Geng, E., Kitahata, M.M., Napravnik, S., Mugavero, M.J., and Saag, M.S.
- Abstract
We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2–7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5–2.8), diabetes (aOR 2.3, 95% CI 1.8–2.9), current CD4 500 copies/mL (aOR 1.3, 95% CI 1.0–1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6–2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1–2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2–2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.
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- 2017
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34. Assessing effects of behavioral intervention on treatment outcomes among patients initiating HIV care: Rationale and design of iENGAGE intervention trial
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Modi, R., primary, Amico, K.R., additional, Knudson, A., additional, Westfall, A.O., additional, Keruly, J., additional, Crane, H.M., additional, Quinlivan, E.B., additional, Golin, C., additional, Willig, J., additional, Zinski, A., additional, Moore, R., additional, Napravnik, S., additional, Bryan, L., additional, Saag, M.S., additional, and Mugavero, M.J., additional
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- 2018
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35. Non-initiation of hepatitis C virus antiviral therapy in patients with human immunodeficiency virus/hepatitis C virus co-infection
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Kashuba, A.D.M., Wohl, D.A., Adimora, A.A., Oramasionwu, C.U., Napravnik, S., and Mao, L.
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AIM: To assess whether reasons for hepatitis C virus (HCV) therapy non-initiation differentially affect racial and ethnic minorities with human immunodeficiency virus (HIV)/HCV co-infection. METHODS: Analysis included co-infected HCV treatment- naïve patients in the University of North Carolina CFAR HIV Clinical Cohort (January 1, 2004 and December 31, 2011). Medical records were abstracted to document non-modifiable medical (e.g. , hepatic decompensation, advanced immunosuppression), potentially modifiable medical (e.g. , substance abuse, severe depression, psychiatric illness), and non-medical (e.g. , personal, social, and economic factors) reasons for non-initiation. Statistical differences in the prevalence of reasons for non-treatment between racial/ethnic groups were assessed using the two-tailed Fisher's exact test. Three separate regression models were fit for each reason category. Odds ratios and their 95%CIs (Wald's) were computed. RESULTS: One hundred and seventy-one patients with HIV/HCV co-infection within the cohort met study inclusion. The study sample was racially and ethnically diverse; most patients were African-American (74%), followed by Caucasian (19%), and Hispanic/other (7%). The median age was 46 years (interquartile range = 39-50) and most patients were male (74%). Among the 171 patients, reasons for non-treatment were common among all patients, regardless of race/ethnicity (50% with ≥ 1 non-modifiable medical reason, 66% with ≥ 1 potentially modifiable medical reason, and 66% with ≥ 1 non-medical reason). There were no significant differences by race/ethnicity. Compared to Caucasians, African-Americans did not have increased odds of nonmodifiable [adjusted odds ratio (aOR) = 1.47, 95%CI: 0.57-3.80], potentially modifiable (aOR = 0.72, 95%CI: 0.25-2.09) or non-medical (aOR = 0.90, 95%CI: 0.32-2.52) reasons for non-initiation. CONCLUSION: Race/ethnicity alone is not predictive of reasons for HCV therapy non-initiation. Targeted interventions are needed to improve access to therapy for all co-infected patients, including minorities.
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- 2016
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36. Body Mass Index and Early CD4+ T-cell Recovery among Adults Initiating Antiretroviral Therapy in North America, 1998–2010
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Jenkins, CA, Napravnik, S, Silverberg, MJ, Gill, J, Crane, HM, Brown, TT, Lau, B, Koethe, JR, Sterling, TR, Shepherd, BE, Stinnette, S, Anema, A, Blashill, AJ, and Willig, A
- Abstract
Adipose tissue affects several aspects of the cellular immune system, but prior epidemiologic studies have differed on whether a higher body mass index (BMI) promotes CD4+ T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count.
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- 2015
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37. Temporal Trends in Presentation and Survival for HIV-Associated Lymphoma in the Antiretroviral Therapy Era
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Burkholder, G. A., Napravnik, S., Deeks, S. G., Patel, M. R., Gopal, S., Reid, E. G., Yanik, E. L., Rodriguez, B., Richards, K. L., Achenbach, C. J., Moore, R. D., Cole, S. R., Mayer, K. H., Eron, J. J., and Kitahata, M. M.
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hemic and lymphatic diseases - Abstract
Lymphoma is the leading cause of cancer-related death among HIV-infected patients in the antiretroviral therapy (ART) era.
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- 2013
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38. Lymphoma Immune Reconstitution Inflammatory Syndrome in the Center for AIDS Research Network of Integrated Clinical Systems Cohort
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Gopal, S., primary, Patel, M. R., additional, Achenbach, C. J., additional, Yanik, E. L., additional, Cole, S. R., additional, Napravnik, S., additional, Burkholder, G. A., additional, Mathews, W. C., additional, Rodriguez, B., additional, Deeks, S. G., additional, Mayer, K. H., additional, Moore, R. D., additional, Kitahata, M. M., additional, Richards, K. L., additional, and Eron, J. J., additional
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- 2014
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39. Temporal Trends in Presentation and Survival for HIV-Associated Lymphoma in the Antiretroviral Therapy Era
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Gopal, S., primary, Patel, M. R., additional, Yanik, E. L., additional, Cole, S. R., additional, Achenbach, C. J., additional, Napravnik, S., additional, Burkholder, G. A., additional, Reid, E. G., additional, Rodriguez, B., additional, Deeks, S. G., additional, Mayer, K. H., additional, Moore, R. D., additional, Kitahata, M. M., additional, Eron, J. J., additional, and Richards, K. L., additional
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- 2013
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40. Late Entry to HIV Care Among Latinos Compared With Non-Latinos in a Southeastern US Cohort
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Dennis, A. M., primary, Napravnik, S., additional, Sena, A. C., additional, and Eron, J. J., additional
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- 2011
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41. Copy-Years Viremia as a Measure of Cumulative Human Immunodeficiency Virus Viral Burden
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Cole, S. R., primary, Napravnik, S., additional, Mugavero, M. J., additional, Lau, B., additional, Eron, J. J., additional, and Saag, M. S., additional
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- 2009
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42. Anti-retroviral therapy reduces incident tuberculosis in HIV-infected children
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Edmonds, A., primary, Lusiama, J., additional, Napravnik, S., additional, Kitetele, F., additional, Van Rie, A., additional, and Behets, F., additional
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- 2009
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43. Randomized Study of the Safety and Efficacy of Fish Oil (Omega-3 Fatty Acid) Supplementation with Dietary and Exercise Counseling for the Treatment of Antiretroviral Therapy--Associated Hypertriglyceridemia
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Wohl, D. A., primary, Tien, H.-C., additional, Busby, M., additional, Cunningham, C., additional, MacIntosh, B., additional, Napravnik, S., additional, Danan, E., additional, Donovan, K., additional, Hossenipour, M., additional, and Simpson, R. J., additional
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- 2005
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44. Frequency of HIV-related medication errors and associated risk factors in hospitalized patients.
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Pastakia SD, Corbett AH, Raasch RH, Napravnik S, and Correll TA
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- 2008
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45. Abused women's concerns about safety and the therapeutic environment during psychiatric hospitalization.
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Gallop R, Engels S, DiNunzio R, and Napravnik S
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- 1999
46. Prevalence and transmission dynamics of HIV-1 transmitted drug resistance in a southeastern cohort
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Okeke, N.L., Levintow, S.N., Virkud, A., Mkumba, L., Miller, W.C., Sebastian, J., Dennis, A.M., Hué, S., Eron, J.J., and Napravnik, S.
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3. Good health - Abstract
Background. Transmitted drug resistance (TDR) compromises clinical management and outcomes. Transmitted drug resistance surveillance and identification of growing transmission clusters are needed in the Southeast, the epicenter of the US HIV epidemic. Our study investigated prevalence and transmission dynamics in North Carolina. Methods. We analyzed surveillance drug resistance mutations (SDRMs) using partial pol sequences from patients presenting to 2 large HIV outpatient clinics from 1997 to 2014. Transmitted drug resistance prevalence was defined as =1 SDRMs among antiretroviral therapy (ART)-naïve patients. Binomial regression was used to characterize prevalence by calendar year, drug class, and demographic and clinical factors. We assessed the transmission networks of patients with TDR with maximum likelihood trees and Bayesian methods including background pol sequences (n = 15 246). Results. Among 1658 patients with pretherapy resistance testing, =1 SDRMs was identified in 199 patients, with an aggregate TDR prevalence of 12% (95% confidence interval, 10% to 14%) increasing over time (P =.02). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs; 8%) was common, followed by nucleoside reverse transcriptase inhibitors (4%) and protease inhibitors (2%). Factors associated with TDR were being a man reporting sex with men, white race, young age, higher CD4 cell count, and being a member of a transmission cluster. Transmitted drug resistance was identified in 106 clusters ranging from 2 to 26 members. Cluster resistance was primarily NNRTI and dominated by ART-naïve patients or those with unknown ART initiation. Conclusions. Moderate TDR prevalence persists in North Carolina, predominantly driven by NNRTI resistance. Most TDR cases were identified in transmission clusters, signifying multiple local transmission networks and TDR circulation among ARTnaïve persons. Transmitted drug resistance surveillance can detect transmission networks and identify patients for enhanced services to promote early treatment.
47. Mortality following myocardial infarction among HIV-infected persons: The Center for AIDS Research Network of Integrated Clinical Systems (CNICS)
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Crothers, K., Peter, I., Moore, R.D., Crane, H.M., Lober, W.B., Mathews, W.C., Delaney, J.A.C., Grunfeld, C., Napravnik, S., Kitahata, M.M., Hsue, P., Willig, J.H., Saag, M.S., Feinstein, M.J., Burkholder, G.A., Geng, E., Heckbert, S.R., Budoff, M.J., Lloyd-Jones, D.M., Hunt, P.W., Mugavero, M.J., Drozd, D.R., Nance, R.M., and Eron, J.J.
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3. Good health - Abstract
Background: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. Methods: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. Results: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. Conclusions: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.
48. Risk of End-Stage Renal Disease in HIV-Positive Potential Live Kidney Donors
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Moore, R.D., Rachlis, A.R., Silverberg, M.J., Muzaale, A.D., Locke, J.E., Eron, J.J., Gill, M.J., Mayor, A.M., Durand, C.M., Bosch, R.J., Boswell, S.L., Kitahata, M.M., Drozd, D.R., Martin, J.N., Massie, A.B., Napravnik, S., Butt, A.A., Fischer, M.J., Segev, D.L., Justice, A.C., Abraham, A.G., Kucirka, L.M., Lucas, G.M., Sperati, C.J., Horberg, M.A., and Althoff, K.N.
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3. Good health - Abstract
New federal regulations allow HIV-positive individuals to be live kidney donors; however, potential candidacy for donation is poorly understood given the increased risk of end-stage renal disease (ESRD) associated with HIV infection. To better understand this risk, we compared the incidence of ESRD among 41 968 HIV-positive participants of North America AIDS Cohort Collaboration on Research and Design followed for a median of 5 years with the incidence of ESRD among comparable HIV-negative participants of National Health and Nutrition Examination III followed for a median of 14 years. We used risk associations from multivariable Cox proportional hazards regression to derive cumulative incidence estimates for selected HIV-positive scenarios (no history of diabetes, hypertension, AIDS, or hepatitis C virus coinfection) and compared these estimates with those from similarly selected HIV-negative scenarios. For 40-year-old HIV-positive individuals with health characteristics that were similar to those of age-matched kidney donors, viral load
49. Emulating a trial of joint dynamic strategies: An application to monitoring and treatment of HIV-positive individuals
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Boswell, S.L., Miro, J.M., Crane, H., Alejos, B., Meyer, L., Costagliola, D., Egger, M., Moore, R.D., Reiss, P., Grinsztejn, B., van Sighem, A., Justice, A., Bucher, H.C., Sabin, C., Mathews, W.C., Abgrall, S., Touloumi, G., Gill, J., Napravnik, S., Seage III, G.R., Phillips, A., Seng, R., Logan, R., Furrer, H., Jarran, I., Hernan, M.A., Saag, M., Porter, K., Muga, R., Mugavero, M.J., Eron, J.J., Drozd, D.R., Deeks, S.G., Hernandez-DiÂaz, S., Le Marec, F., Pacheco, A., Robins, J.M., Ferrer, E., Bonnet, F., Caniglia, E.C., Tate, J., Jose, S., Cain, L.E., and Casabona, J.
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3. Good health - Abstract
Decisions about when to start or switch a therapy often depend on the frequency with which individuals are monitored or tested. For example, the optimal time to switch antiretroviral therapy depends on the frequency with which HIV-positive individuals have HIV RNA measured. This paper describes an approach to use observational data for the comparison of joint monitoring and treatment strategies and applies the method to a clinically relevant question in HIV research: when can monitoring frequency be decreased and when should individuals switch from a first-line treatment regimen to a new regimen?. We outline the target trial that would compare the dynamic strategies of interest and then describe how to emulate it using data from HIV-positive individuals included in the HIV-CAUSAL Collaboration and the Centers for AIDS Research Network of Integrated Clinical Systems. When, as in our example, few individuals follow the dynamic strategies of interest over long periods of follow-up, we describe how to leverage an additional assumption: no direct effect of monitoring on the outcome of interest. We compare our results with and without the “no direct effect†assumption. We found little differences on survival and AIDS-free survival between strategies where monitoring frequency was decreased at a CD4 threshold of 350 cells/μl compared with 500 cells/μl and where treatment was switched at an HIV-RNA threshold of 1000 copies/ml compared with 200 copies/ml. The “no direct effect†assumption resulted in efficiency improvements for the risk difference estimates ranging from an 7- to 53-fold increase in the effective sample size.
50. Attrition among human immunodeficiency virus (HIV)- infected patients initiating antiretroviral therapy in China, 2003-2010
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Zhu, H., Zhao, D., Wohl, D., Eron, J., Ma, Y., Zhang, Y., Liu, Z., Dou, Z., Cole, S., Cohen, M., Zhang, F., and Napravnik, S.
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virus diseases ,3. Good health - Abstract
Background: Mortality and morbidity from HIV have dramatically decreased in both high- and low-income countries. However, some patients may not benefit from combination antiretroviral therapy (cART) because of inadequate access to HIV care, including attrition after care initiation. Methodology/Principal Findings: The study population included all HIV-infected patients receiving cART through the Chinese National Free Antiretroviral Treatment Program from 1 January 2003 to 31 December 2010 (n = 106,542). We evaluated retention in HIV care and used multivariable Cox proportional hazard models to identify independent factors predictive of attrition. The cumulative probability of attrition from cART initiation was 9% at 12 months, 13% at 18 months, 16% at 24 months and 24% at 60 months. A number of factors were associated with attrition, including younger age, male gender, and being single or divorced. Patients with higher CD4 cell counts at cART initiation were more likely to drop out of HIV care. The proportion of patients remaining in HIV care increased in more recent calendar years and among patients who initiated modern cART regimens. Conclusions/Significance: Retention in HIV care is essential for optimizing individual and public health outcomes. Attrition, even the degree observed in our study, can lead to premature morbidity and mortality, and possibly affect further transmission of HIV and HIV resistant drug variants. Effective strategies to promote retention in HIV care programs are needed. In China these strategies may include focusing particularly on younger male patients and those with higher CD4 cell counts at therapy initiation.
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