scholarly journals Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012–2017

2020 ◽  
Author(s):  
Ya-Lin A Huang ◽  
Guoyu Tao ◽  
Dawn K Smith ◽  
Karen W Hoover
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Female Sex ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. Methods We analyzed data from the IBM MarketScan Research Database to identify persons aged 18–64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence. Results We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [CI], 13.3–14.1), compared to 6.8 months (95% CI, 6.1–7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [HR], 1.81 [95% CI, 1.56–2.11]) and younger age (18–24 years: HR, 2.38 [95% CI, 2.11–2.69]) predicted nonpersistence. Conclusions More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.

scholarly journals Deaths Attributable to Cancer in the US Human Immunodeficiency Virus Population During 2001–2015

2020 ◽  
Author(s):  
Marie-Josèphe Horner ◽  
Meredith S Shiels ◽  
Ruth M Pfeiffer ◽  
Eric A Engels
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Kaposi Sarcoma ◽  
Cancer Registries ◽  
The United States ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Attributable Mortality ◽  
Immunodeficiency Virus ◽  
The Us

Abstract Background Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001–2015. Methods We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality, we could perhaps cut these words to accommodate the word limit. However readers will probably want to know what statistical adjustments were made to the model. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non–AIDS-defining cancers. Results Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non–AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001–2005 to 313.6 per 100 000 person-years during 2011–2015, while the PAF increased from 12.6% to 17.1%; the PAF for non–AIDS-defining cancers increased from 7.2% to 11.8% during 2011–2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non–AIDS-defining cancers. Conclusions Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non–AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality.

‘How come they don’t talk about it in school?’ Identifying adolescent barriers to PrEP use

2021 ◽  
Author(s):  
Leslie Gailloud ◽  
Tatiana Gonzalez-Argoti ◽  
Sophia Philip ◽  
Lena S Josephs ◽  
Joanne E Mantell ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Thematic Analysis ◽  
The United States ◽  
Health Centers ◽  
Perceived Need ◽  
School Based ◽  
Immunodeficiency Virus ◽  
School Based Health Centers ◽  
Exposure Prophylaxis

Abstract Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13–24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15–17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.

scholarly journals Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Ume L Abbas ◽  
Camden J Hallmark ◽  
Marlene McNeese ◽  
Vagish Hemmige ◽  
Joseph Gathe ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
The United States ◽  
Lessons Learned ◽  
Accelerated Expansion ◽  
Public Health Response ◽  
Treatment And Prevention ◽  
Health Response ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract A strategy titled “Ending the HIV Epidemic: A Plan for America” aims to reduce human immunodeficiency virus (HIV) incidence in the United States by at least 90% by 2030, using diagnosis, treatment, and prevention strategies. Texas is a Southern state that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished, which could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua, and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.

Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States

2019 ◽  
Vol 70 (9) ◽  
pp. 1884-1890 ◽  
Author(s):  
Jose A Serpa ◽  
Gabriel N Huynh ◽  
Julie B Nickell ◽  
Hongyu Miao
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Sexually Transmitted Infections ◽  
State Level ◽  
The United States ◽  
Incidence Rates ◽  
Interrupted Time Series Analysis ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) decreases HIV transmission. Some studies have raised concerns about a potential association between the implementation of HIV PrEP and the growing incidence rates of sexually transmitted infections (STIs) in the United States. Methods We conducted a quasi-experimental (interrupted time series) analysis of STI (syphilis, gonorrhea, and chlamydia) rates before (2000–2012) and after (2013–2017) the implementation of HIV PrEP. We also performed correlations between HIV PrEP utilization and STI cases at the national (2012–2017) and state (2017) levels. We defined HIV PrEP utilization as the number of people taking tenofovir disoproxil fumarate/emtricitabine for HIV prevention. Results HIV PrEP implementation was associated with 25% (relative risk [RR] 1.254, 95% confidence interval [CI] 1.245–1.263; P < .001) and 26% (RR 1.260, 95% CI 1.257–1.264; P < .001) increases in syphilis and gonorrhea rates, respectively, and a 12% reduction in chlamydia rates (RR: 0.884, 95% CI 0.883–0.885; P < .001). HIV PrEP utilization was correlated with the numbers of syphilis, gonorrhea, and chlamydia cases (spearman coefficients 1.00, 0.94, and 0.94, respectively; P < .001, P < .01, and P < .01, respectively). At the state level, HIV PrEP was also correlated with the number of cases of syphilis, gonorrhea, and chlamydia (spearman coefficients 0.85, 0.81, and 0.85, respectively; Ps < .001 for all correlations). Conclusions The implementation and utilization of HIV PrEP in the United States were associated with increased rates of STIs. Further studies to confirm these associations and to elucidate potential causes are needed.

Survival outcomes following cytoreductive nephrectomy (CN) in patients with metastatic renal cell sarcomas (MRCS).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e22519-e22519
Author(s):  
Midhun Malla ◽  
Sarah E Johnston ◽  
Yan D Zhao ◽  
Vipul Pareek
Keyword(s):  
Proportional Hazards ◽  
Soft Tissue Sarcomas ◽  
Patient Characteristics ◽  
The United States ◽  
Current Treatment ◽  
Cox Proportional Hazards ◽  
Age At Diagnosis ◽  
Spindle Cell Sarcoma ◽  
Kidney Tumors ◽  
Level 1

e22519 Background: RCS are rare soft tissue sarcomas and account for 0.8-2.7% of malignant kidney tumors. Level 1 evidence guiding optimal patient management is lacking due to the rarity of this disease. Utilizing the NCDB, we analyzed prognostic factors, the current treatment patterns and outcomes in patients with RCS in the United States. Methods: The NCDB was queried from 2004- 2015 for patients diagnosed with MRCS. Baseline patient characteristics were summarized using descriptive statistics. Impact of baseline demographic, Clinicopathologic variables and treatment on overall survival (OS) was evaluated using univariate (UV) and multivariable (MV) cox proportional hazards analysis. Results: 454 patients diagnosed with MRCS between 2004- 2015 were included in this analysis. Median age at diagnosis was 63. Males (62%) had higher incidence of RCS compared with females. 86% (n = 389) were Caucasian, while only 9.5% (n = 43) were African American. Right and left kidneys were equally affected. Spindle cell sarcoma was the most common histology (n = 276). 37.5% (n = 170) underwent CN. 49% of patients received chemotherapy (n = 216) and 24% received radiation therapy (n = 109). Overall, 48% (n = 82) of patients who underwent nephrectomy had chemotherapy. Median OS was 4.5 months (3.8-5.2 mos.). On UV analysis age ≥ 55 years (HR: 1.92, p < 0.001), no systemic treatment (HR: 1.91, P < 0.01), and no CN (HR: 2.1, p < .001) had worse OS. On MV analysis, patients who did not undergo CN had significantly worsened OS compared to CN (7.56 vs 3.35 mos., HR-1.91, CI: 1.52- 2.41 p < 0.001). Patients who received chemotherapy after CN had a better OS (13.3 vs 3.7 mos., p < 0.001). Conclusions: MRCS is an aggressive malignancy with a median OS of less than 5 months. Age at diagnosis, CN and systemic therapy had a statistically significant impact on OS. Given the rarity of the tumor and inadequacy of guidelines, these results can be considered in making management decisions. We understand the limitations of a registry-based study and hence, prospective multi-national clinical trials are essential to further guide us on management of this rare tumor. [Table: see text]

scholarly journals Kaposi Sarcoma Rates Among Persons Living With Human Immunodeficiency Virus in the United States: 2008—2016

2020 ◽  
Author(s):  
Qianlai Luo ◽  
Anna Satcher Johnson ◽  
H Irene Hall ◽  
Elizabeth K Cahoon ◽  
Meredith Shiels
Keyword(s):  
Human Immunodeficiency Virus ◽  
Age Groups ◽  
Kaposi Sarcoma ◽  
Cancer Registries ◽  
The United States ◽  
Geographic Region ◽  
Incidence Rates ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
Racial Ethnic

Abstract Background Recent studies have suggested that Kaposi sarcoma (KS) rates might be increasing in some racial/ethnic groups, age groups, and US regions. We estimated recent US trends in KS incidence among people living with human immunodeficiency virus (HIV; PLWH). Methods Incident KS patients aged 20–59 years were obtained from 36 cancer registries and assumed to be living with HIV. The number of PLWH was obtained from national HIV surveillance data from 2008 to 2016. Age-standardized KS rates and annual percent changes (APCs) in rates were estimated by age, sex, race/ethnicity, state, and region. Results Between 2008 and 2016, the age-adjusted KS rate among PLWH was 116/100 000. Rates were higher among males, in younger age groups, and among white PLWH. Washington, Maine, and California had the highest KS rates among PLWH. KS rates among PLWH decreased significantly (average APC = −3.2% per year, P &lt; .001) from 136/100 000 to 97/100 000 between 2008 and 2016. There were no statistically significant increases in KS rates in any age, sex, or racial/ethnic group or in any geographic region or state. However, there were nondecreasing trends in some states and in younger age groups, primarily among black PLWH. Conclusions KS incidence rates among PLWH have decreased nationally between 2008 and 2016. Though there were no statistically significant increases in KS rates in any demographic or geographic group, nondecreasing/stagnant KS trends in some states and among younger and black PLWH highlight the need for early diagnosis and treatment of HIV infection.

Association of gender, age, and ethnicity with survival in patients with pancreas cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15587-e15587
Author(s):  
M. Ottochian ◽  
D. Yang ◽  
A. El-Khoueiry ◽  
S. Iqbal ◽  
A. Pohl ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
The United States ◽  
Lymph Node Involvement ◽  
Cox Proportional Hazards ◽  
Age At Menarche ◽  
Age Group

e15587 Background: Pancreatic cancer (PC) is the fourth leading cause of cancer death in the United States. However little is still known about factors that influence its development and progression. Recent data suggest that PC is, at least in part, an estrogen- dependent disease; there is growing epidemiological evidence that aspects of reproductive history and hormonal exposure are associated with risk of this disease. It was shown that age at menarche of <13 is associated with less risk of PC. However no data are available whether gender is associated with outcome in patients with PC. The purpose of this study was to test whether age, gender or ethnicity influence the outcome in PC. Methods: The data of the 50,302 adults diagnosed with PC between 1988 and 2004 were extracted from the Surveillance Epidemiology and End Results public use database. These included 24,240 patients diagnosed with localized pancreatic cancer (LPC) and 26,062 patients with metastatic pancreatic cancer (MPC). Demographic, clinical variables and survival time were retrieved. The primary endpoint was overall survival. We constructed Cox proportional hazards models to evaluate association between patient characteristics and survival in LPC and MPC separately. Pair interactions were also tested. Results: On multivariate analysis gender, age, race, marital status, tumor size, grade, histology, type of treatment and lymph node involvement were found to be independent predictors of survival. Females had a significant longer survival, with an HR of 0.959 (95% CI: 0.932–0.987) among patients with LPC and an HR of 0.918 (95%CI: 0.894–0.942) among patients with MPC. Each age group displayed a significant longer survival than its correspondent older age group. When we combined age and gender in the analysis, females had a longer survival than males in each single age group in the MPC group. In the LPC group the longer survival of female patients was only observed in the youngest age group. Conclusions: This is the first and largest study to address gender and outcome in PC. Our data suggest that the estrogen pathway may play an important prognostic role in patient with this disease. These data also warrant further in vitro and in vivo investigations on the mechanisms of estrogen and pancreas progression. No significant financial relationships to disclose.

Differences in survival for metastatic colorectal cancer patients by lines of therapy received.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14016-e14016
Author(s):  
Brian S. Seal ◽  
Benjamin Chastek ◽  
Mahesh Kulakodlu ◽  
Satish Valluri
Keyword(s):  
Proportional Hazards ◽  
Survival Rates ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
First Line ◽  
Cox Proportional Hazards Models ◽  
Stage 4 ◽  
Similar Survival ◽  
The Impact

e14016 Background: Improvements in survival for advanced-stage CRC patients who receive chemotherapy have been reported. We compared survival rates for patients with 3+ vs. <3 lines of therapy. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of metastasis were included. Registry data included original stage and date of diagnosis. Linked healthcare claims from the Life Sciences Research Database, a large US health insurance database affiliated with OptumInsight, were used to identify lines of therapy after metastases and patient characteristics. Death data were obtained from the Social Security Administration’s master death file. Patients were categorized by number of lines of therapy received (0, 1, 2, 3+) and original stage at diagnosis (0-2, 3, 4, unknown). Survival following metastases was evaluated using Cox proportional hazards models controlling for lines of therapy received, stage, and other patient characteristics. Results: 598 patients, followed for a mean of 653 days after becoming metastatic, were included. Mean unadjusted length of follow-up was lowest among patients who received no chemotherapy (516 days) or only 1 line (511 days), and increased to 627 days for those with 2 lines and 930 days for those with 3+ lines. However, multivariate analysis indicated that patients with 3+ lines had comparable survival vs. those with 0 (HR=0.79), 1 (HR=1.59), or 2 (HR=1.15) lines of therapy (p>0.05 for all comparisons). Compared to patients who presented with stage 4 CRC, those who progressed from stage 0-2 (HR=1.22), stage 3 (HR=0.83), or unknown stage (HR=1.18) had similar survival after metastases (p>0.05 for all comparisons). After excluding 94 patients who didn’t receive chemotherapy, patients treated with an oxaliplatin-based regimen (HR=1.28; p=0.24) in first line had similar survival compared to patients treated with an irinotecan-based or anti-EGFR regimen in first line. Conclusions: Lines of therapy received and initial stage were not associated with survival after development of metastases.

scholarly journals Hepatotoxicity and Liver-Related Mortality in Women of Childbearing Potential Living With Human Immunodeficiency Virus and High CD4 Cell Counts Initiating Efavirenz-Containing Regimens

2020 ◽  
Author(s):  
Debika Bhattacharya ◽  
Amita Gupta ◽  
Camlin Tierney ◽  
Sharon Huang ◽  
Marion G Peters ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Severe Hepatotoxicity ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Related Mortality

Abstract Background Severe hepatotoxicity in people with human immunodeficiency virus (HIV) receiving efavirenz (EFV) has been reported. We assessed the incidence and risk factors of hepatotoxicity in women of childbearing age initiating EFV-containing regimens. Methods In the Promoting Maternal and Infant Survival Everywhere (PROMISE) trial, ART-naive pregnant women with HIV and CD4 count ≥ 350 cells/μL and alanine aminotransferase ≤ 2.5 the upper limit of normal were randomized during the antepartum and postpartum periods to antiretroviral therapy (ART) strategies to assess HIV vertical transmission, safety, and maternal disease progression. Hepatotoxicity was defined per the Division of AIDS Toxicity Tables. Cox proportional hazards models were constructed with covariates including participant characteristics, ART regimens, and timing of EFV initiation. Results Among 3576 women, 2435 (68%) initiated EFV at a median 121.1 weeks post delivery. After EFV initiation, 2.5% (61/2435) had severe (grade 3 or higher) hepatotoxicity with an incidence of 2.3 (95% confidence interval [CI], 2.0–2.6) per 100 person-years. Events occurred between 1 and 132 weeks postpartum. Of those with severe hepatotoxicity, 8.2% (5/61) were symptomatic, and 3.3% (2/61) of those with severe hepatotoxicity died from EFV-related hepatotoxicity, 1 of whom was symptomatic. The incidence of liver-related mortality was 0.07 (95% CI, .06–.08) per 100 person-years. In multivariable analysis, older age was associated with severe hepatotoxicity (adjusted hazard ratio per 5 years, 1.35 [95% CI, 1.06–1.70]). Conclusions Severe hepatotoxicity after EFV initiation occurred in 2.5% of women and liver-related mortality occurred in 3% of those with severe hepatotoxicity. The occurrence of fatal events underscores the need for safer treatments for women of childbearing age.

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