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.

scholarly journals Trends in Childhood Viable Pregnancy and Risk of Stillbirth in the United States

2021 ◽  
Author(s):  
Sahra Ibrahimi ◽  
Deepa Dongarwar ◽  
Korede K. Yusuf ◽  
Sitratullah Olawunmi Maiyegun ◽  
Hamisu M. Salihu
Keyword(s):  
Proportional Hazards ◽  
Census Data ◽  
The United States ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Early Years ◽  
Teen Mothers ◽  
Population Census ◽  
Hazard Ratios ◽  
The Us

Abstract The objective of this study was to assess trends in childhood viable pregnancy over the previous three decades as well as the risk of stillbirth in these highly vulnerable child mothers. We conducted a population-based retrospective cohort study that used Birth datasets, Fetal Death datasets, and the US population census data: 1982-2017. To assess the association between various socio-demographic and maternal comorbidities and stillbirth, we generated adjusted hazard ratios (AHR) from Cox Proportional Hazards Regression models. Overall, there were declines in the stillbirth rates in both teens (15-19 years old) and child mothers aged ≤ 14 years, but the rate remained consistently higher among child mothers. Compared to teen mothers, childhood pregnancy was modestly associated with elevated risk for stillbirth. Childhood pregnancy is a risk factor for stillbirth. These findings further underscore the need for sustained efforts and policies to prevent pregnancies in the early years of reproductive development.

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 < .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.

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.

Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Faye L Norby ◽  
Lindsay G Bengtson ◽  
Lin Y Chen ◽  
Richard F MacLehose ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Real World ◽  
Proportional Hazards ◽  
Large Population ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Gi Bleeding ◽  
Cox Proportional Hazards Models ◽  
The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

scholarly journals Epidemiology of Human Immunodeficiency Virus in the United States

2007 ◽  
Vol 20 (3) ◽  
pp. 478-488 ◽  
Author(s):  
Susan Hariri ◽  
Matthew T. McKenna
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
The United States ◽  
Population Based ◽  
True Incidence ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Fundamental Shift

SUMMARY The human immunodeficiency virus (HIV) epidemic emerged in the early 1980s with HIV infection as a highly lethal disease among men who have sex with men and among frequent recipients of blood product transfusions. Advances in the treatment of HIV infection have resulted in a fundamental shift in its epidemiology, to a potentially chronic and manageable condition. However, challenges in the prevention of this infection remain. In particular, increasing evidence suggests that transmission of drug-resistant virus is becoming more common and that the epidemic is having a profound impact on morbidity and mortality in ethnic and racial minority subgroups in the United States. New population-based data collection systems designed to describe trends in behaviors associated with HIV transmission and better methods for measuring the true incidence of transmission will better elucidate the characteristics of HIV infection in the United States and inform future public health policies.

Long-Term Survivors of Gastric Cancer: A California Population-Based Study

2012 ◽  
Vol 30 (28) ◽  
pp. 3507-3515 ◽  
Author(s):  
Pamela L. Kunz ◽  
Matthew Gubens ◽  
George A. Fisher ◽  
James M. Ford ◽  
Daphne Y. Lichtensztajn ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Gastroesophageal Junction ◽  
The United States ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Intestinal Histology ◽  
Hospital Size

Purpose In the United States, gastric cancer is rapidly fatal with a 25% 5-year survival. Of the few patients who survive, little is known about their demographic, clinical, and tumor characteristics. Patients and Methods Data regarding all cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed in California between 1988 and 2005 were obtained from the California Cancer Registry, a member of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. A Cox proportional hazards model was constructed to understand the independent relationships of patient demographic, disease, and treatment factors with survival. Results We identified 47,647 patients diagnosed with gastric or GEJ cancer. Of those, only 9,325 (20%) survived at least 3 years. Variables associated with longer survival were localized stage (hazard ratio [HR], 0.20), surgery with diagnosis in 2002 or later (HR, 0.34), surgery with diagnosis in 2001 or before (0.37), regional stage (HR, 0.53), chemotherapy (HR, 0.56), intestinal histology (HR, 0.74), well- or moderately differentiated tumors (HR, 0.76), radiation (HR, 0.80), Asian/Pacific Islander race (HR, 0.81), treatment at an academic hospital (HR, 0.85), fundus/body/antrum location (HR, 0.90), highest socioeconomic status quintile (HR, 0.91), female sex (HR, 0.92), Hispanic race (HR, 0.92), and hospital size more than 150 beds (HR, 0.94). Kaplan-Meier curves showed longer median disease-specific survival (DSS) in patients with tumors originating in the fundus/body/antrum compared with esophagus/cardia (13.4 v 10.8 months). Intestinal histology had significantly longer median DSS (28.9 months) compared with other (11.0 months) or diffuse (10.1 months) histology. Conclusion Patients who survive gastric and GEJ cancer more than 3 years after diagnosis have demographic and pathologic characteristics distinct from those who do not survive.

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.

scholarly journals A Single Quantifiable Viral Load Is Predictive of Virological Failure in Human Immunodeficiency Virus (HIV)-Infected Patients on Combination Antiretroviral Therapy: The Austrian HIV Cohort Study

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Gisela Leierer ◽  
Katharina Grabmeier-Pfistershammer ◽  
Andrea Steuer ◽  
Mario Sarcletti ◽  
Maria Geit ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Virological Failure ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Combination Antiretroviral Therapy ◽  
Limit Of Quantification ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background.  Viral loads (VLs) detectable at low levels are not uncommon in patients on combination antiretroviral therapy (cART). We investigated whether a single quantifiable VL predicted virological failure (VF). Methods.  We analyzed patients receiving standard regimens with at least 1 VL measurement below the limit of quantification (BLQ) in their treatment history. The first VL measurement after 6 months of unmodified cART served as baseline VL for the subsequent analyses of the time to reach single VL levels of ≥200, ≥400, and ≥1000 copies/mL. Roche TaqMan 2.0 was used to quantify human immunodeficiency virus-1 ribonucleic acid. Factors associated with VF were determined by Cox proportional hazards models. Results.  Of 1614 patients included in the study, 68, 44, and 34 experienced VF ≥200, ≥400, and ≥1000 copies/mL, respectively. In multivariable analyses, compared with patients who were BLQ, a detectable VL ≤ 50 and VL 51–199 copies/mL predicted VF ≥ 200 copies/mL (hazards ratio [HR] = 2.19, 95% confidence interval [CI] = 1.06–4.55 and HR = 4.21, 95% CI = 2.15–8.22, respectively). In those with VL 51–199 copies/mL, a trend for an increased risk of VF ≥400 and VF ≥1000 copies/mL could be found (HR = 2.13, 95% CI = 0.84–5.39 and HR = 2.52, 95% CI = 0.96–6.60, respectively). Conclusions.  These findings support closer monitoring and adherence counseling for patients with a single measurement of quantifiable VL <200 copies/mL.

scholarly journals Mortality from Diabetes by Hispanic Groups: Evidence from the US National Longitudinal Mortality Study

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Augustine J. Kposowa
Keyword(s):  
Family Income ◽  
Proportional Hazards ◽  
Social Science Research ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Differential Mortality ◽  
Mortality Data ◽  
Mortality Study ◽  
Hispanic Origin ◽  
The Us

Diabetes is a leading cause of morbidity and mortality in the United States, especially in minority communities. In mortality research, Hispanics are frequently studied as a homogeneous group. The present study was undertaken to compare diabetes deaths among persons of Hispanic origin by disaggregating groups in order to determine whether the components in the Hispanic label have differential mortality. Data utilized were from the US National Longitudinal Mortality Study. Cox proportional hazards regression models were fitted to the data. Findings showed that individuals in the broader Hispanic label were 28% more likely to die from diabetes mellitus than non-Hispanic whites (ARR = 1.28, CI = 1.05, 1.55). When groups were broken down, it was observed that Mexicans were 50% more likely to die of diabetes than their non-Hispanic white counterparts. No other Hispanic origin group was significantly associated with diabetes mortality risk. Education and family income were strong predictors of mortality, regardless of Hispanic origin grouping. It was concluded from the analysis that future behavioral and social science research would be more informative if the broader Hispanic label was broken down into subcategories. Failure to do so might lead to drawing false inferences as a finding may well hold for one group within the Hispanic label, but not for others.

scholarly journals Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012–2016

2020 ◽  
Author(s):  
Dawn K Smith ◽  
Patrick S Sullivan ◽  
Betsy Cadwell ◽  
Lance A Waller ◽  
Azfar Siddiqi ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infections ◽  
The United States ◽  
Virus Diagnosis ◽  
Hiv Surveillance ◽  
Immunodeficiency Virus ◽  
The Us ◽  
Diagnosis Rate ◽  
Exposure Prophylaxis

Abstract Background Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. Methods We used 2012–2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. Results From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], −5.2% to −2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, −1.77% to −.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, −2.12% to −.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. Conclusions We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections.

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