scholarly journals 892. Determination of the Unavailability of Alternative Antiretroviral Formulations

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S537-S538
Author(s):  
Milena M Murray ◽  
Devon Flynn ◽  
Leonard A Sowah ◽  
Aaron Austin ◽  
Eric Farmer
Keyword(s):  
Patient Care ◽  
Clinical Care ◽  
Advisory Board ◽  
Cost Of Care ◽  
People Living With Hiv ◽  
Material Support ◽  
Increased Risk ◽  
First Choice ◽  
Chewable Tablets ◽  
Potential Impact

Abstract Background Many pediatric and some adult people living with HIV (PLWH) are unable to swallow tablets and require alternative antiretroviral formulations (ARVF) such as liquids, chewable tablets, or powders for suspension. A growing number of issues with the timely procurement of alternative ARVF have been reported; the full scope of this problem is unknown. Without access to appropriate treatment, PLWH are at increased risk of poor disease outcomes. This study’s objective was to determine the scope of availability issues of ARVF and its potential impact on patient care. Methods An online survey invitation was sent to members of AAHIVM and the ACCP HIV PRN. Data collection included provider demographics, number of issues related to ARVF availability, time spent procuring ARVFs, and identification of unavailable formulations. To determine potential impact on clinical care and cost of care the time required to resolve shortages was summarized. Results The analyzable sample was 154, a majority of whom were pharmacists or physicians (n=132, 85.7%; Figure 1), in a clinical role (n=134, 87.0%), and serve pregnant patients (n=121, 79.2%). 85 (55.2%) practice at sites that provide care to > 300 PLWH, 81 (52.6%) practice at sites that did not serve pediatric patients. 525 instances of gaps in care due to ARVF unavailability were reported. In 283 instances, a more complex regimen was prescribed due to first-choice ARVF unavailability. Providers also reported 186 situations in which a less optimal regimen was used and 140 cases of treatment delays. The average time spent to resolve such issues was 2.7 hrs (CI: 1.3 – 4.2). The longest time reported was 72 hrs; most providers spent 1 hr or less. The most common unavailable ARVF were branded ritonavir 80 mg/mL solution (n=12), zidovudine 50 mg/5 mL syrup (n=11), raltegravir 100 mg chewable tablets (n=11), and raltegravir 100 mg granules for suspension (n=10). Branded nevirapine 50 mg/5 mL suspension (n=7) and generic nevirapine 50mg/5ml powder for suspension (n=11) were also reported more frequently. Distribution of Respondents by Provider Type Conclusion Our report suggests the unavailability of alternative ARVF has the potential to significantly impact patient care. Further research is needed to identify the root causes of this problem to determine specific solutions. Disclosures Milena M. Murray, PharmD, MSc, BCIDP, AAHIVP, Merck (Speaker’s Bureau)Theratechnologies (Other Financial or Material Support, Medical Advisory Board) Eric Farmer, PharmD, BCPS, AAHIVP, TheraTechnologies, Inc (Other Financial or Material Support, Medical Advisory Board)

The burden of HIV-associated neurocognitive impairment in Australia and its estimates for the future

Sexual Health ◽  
2011 ◽  
Vol 8 (4) ◽  
pp. 541 ◽  
Author(s):  
Lucette A. Cysique ◽  
Margaret P. Bain ◽  
Bruce J. Brew ◽  
John M. Murray
Keyword(s):  
Neurocognitive Disorders ◽  
Cost Of Care ◽  
People Living With Hiv ◽  
Full Time ◽  
Hiv Dementia ◽  
Older Individuals ◽  
Hospital Data ◽  
Increased Risk ◽  
The Future ◽  
Living With Hiv

Background The growing number of older individuals with HIV in Australia implies that the prevalence of dementia and additional HIV-associated neurocognitive disorders will increase. There are currently no estimates of the future burden of neurocognitive disease in this population. Methods: We estimated the number and age profile of people living with HIV to the end of 2009 using HIV/AIDS Registry data, and extrapolated these estimates to 2030. Prevalence of HIV-associated dementia (HAD) from 2005 to 2010 from a large Sydney hospital and cost estimates from the AIDS Dementia and HIV Psychiatry Service were used to estimate future HAD burden and costs. Results: Based on our calculations, the number of HIV-positive individuals in Australia will increase from 16 228 men and 1797 women in 2009 to 26 963 men and 5224 women in 2030, while the number of individuals aged 60+ years will increase from 1140 men and 78 women to 5442 men and 721 women, i.e. a 377% increase of older men and an 825% increase in older women. Based on a 7.8% (157/2004) HAD prevalence obtained from hospital data, individuals with HAD will increase in number from 1314 men and 143 women in 2009 to 2204 men and 421 women in 2030. An estimated 22 men and 2 women with non-HIV dementia in 2009 will increase to 104 men and 12 women by 2030. The annual cost of care will increase from ~$29 million in 2009 to $53 million in 2030, mostly for full-time residential care. Conclusions: Neurocognitive disorders will place an increasing burden on resources, especially as those living with HIV age. Because it is unclear if HAD is an increased risk factor for non-HIV dementia, our calculations may be conservative.

scholarly journals 426. COVID-19 Infection Prevention Practices That Exceed CDC Guidance: Balancing Extra Caution Against Impediments to Care

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S313-S314
Author(s):  
Shruti K Gohil ◽  
Edward Septimus ◽  
Kenneth Sands ◽  
Eunice J Blanchard ◽  
Julia Moody ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Patient Care ◽  
Infection Prevention ◽  
Clinical Care ◽  
Skin Irritation ◽  
Health Impacts ◽  
Respiratory Care ◽  
Material Support ◽  
Cleaning Products ◽  
Research Grant

Abstract Background At the outset of the COVID-19 pandemic, healthcare workers (HCWs) raised concerns about personal risks of acquiring infection during patient care. This led to more stringent infection prevention practices than CDC guidelines during a time of uncertainty about transmission and limited U.S. testing capacity. Hospitals were challenged to protect against true COVID-19 exposure risks, while avoiding use of unproven measures that could interfere with timely, high quality care. We evaluated hospital experiences with HCW COVID-19 exposure concerns impacting clinical workflow/management. Methods We conducted a 32-question structured survey of hospital infection prevention leaders (one per hospital) from CDC Prevention Epicenters, University of California (CA) Health system, HCA Healthcare, and the Southern CA Metrics Committee between May–Dec, 2020. We assessed facility characteristics and COVID-19 exposure concerns causing changes in respiratory care, procedure delays/modifications, requests to change infection prevention processes, disruptions in routine medical care, and health impacts of PPE overuse. Percentages were calculated among respondents for each question. Results Respondents represented 53 hospitals: 22 (42%) were small (< 200 beds), 14 (26%) medium (200-400 beds), and 17 (32%) large ( >400 beds) facilities. Of these, 11 (21%) provided Level 1 trauma care, and 22 (41%) provided highly immunocompromised patient care; 75% had cared for a substantial number of COVID-19 cases before survey completion. Majority reported changes in respiratory care delivery (71%-87%), procedural delays (75%-87%), requests to change infection prevention controls/protocols (58%-96%), and occupational health impacts of PPE overuse including skin irritation (98%) and carbon dioxide narcosis symptoms (55%) (Table). Conclusion HCW concerns over work-related COVID-19 exposure contributed to practice changes, many of which are unsupported by CDC guidance and resulted in healthcare delivery delays and alterations in clinical care. Pandemic planning and response must include the ability to rapidly develop evidence to guide infection prevention practice. Disclosures Shruti K. Gohil, MD, MPH, Medline (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnycke (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Co-Investigator in studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products) Edward Septimus, MD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic products) Kenneth Sands, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Eunice J. Blanchard, MSN RN, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Julia Moody, MS, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Deborah S. Yokoe, MD, MPH, Nothing to disclose Jonathan Grein, MD, Gilead (Other Financial or Material Support, Speakers fees) Stuart H. Cohen, MD, Seres (Research Grant or Support) Kimberly N. Smith, MBA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Brandon Carver, BA, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Russell Poland, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Jonathan B. Perlin, MD, PhD, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Richard Platt, MD, MSc, Medline (Research Grant or Support, Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals received contributed antiseptic product) Susan S. Huang, MD, MPH, Medline (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Molnlycke (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Stryker (Sage) (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)Xttrium (Other Financial or Material Support, Conducted studies in which participating hospitals and nursing homes received contributed antiseptic and cleaning products)

scholarly journals The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders

2020 ◽  
Vol 46 (4) ◽  
pp. 752-757 ◽  
Author(s):  
Nicole Kozloff ◽  
Benoit H Mulsant ◽  
Vicky Stergiopoulos ◽  
Aristotle N Voineskos
Keyword(s):  
Mental Health ◽  
Clinical Care ◽  
Health Service Delivery ◽  
Mental Health Service Delivery ◽  
The Public ◽  
Global Pandemic ◽  
Increased Risk ◽  
Potential Impact ◽  
Poor Outcomes ◽  
Outpatient Settings

Abstract The coronavirus disease-19 (COVID-19) global pandemic has already had an unprecedented impact on populations around the world, and is anticipated to have a disproportionate burden on people with schizophrenia and related disorders. We discuss the implications of the COVID-19 global pandemic with respect to: (1) increased risk of infection and poor outcomes among people with schizophrenia, (2) anticipated adverse mental health consequences for people with schizophrenia, (3) considerations for mental health service delivery in inpatient and outpatient settings, and (4) potential impact on clinical research in schizophrenia. Recommendations emphasize rapid implementation of measures to both decrease the risk of COVID-19 transmission and maintain continuity of clinical care and research to preserve safety of both people with schizophrenia and the public.

scholarly journals Molecular Detection of Mycobacterium tuberculosis: Impact on Patient Care

2001 ◽  
Vol 47 (8) ◽  
pp. 1553-1558 ◽  
Author(s):  
Karen L Kaul
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Patient Care ◽  
Molecular Detection ◽  
Clinical Care ◽  
Antibiotic Sensitivity ◽  
Cost Of Care ◽  
Pcr Assay ◽  
Smear Negative ◽  
Pcr Assays ◽  
The Impact

Abstract Background: Nucleic acid amplification technologies such as PCR are revolutionizing the detection of infectious pathogens such as tuberculosis (TB). Amplification technology offers the potential for the diagnosis of TB in a few hours with a high degree of sensitivity and specificity. However, molecular assays neither replace nor reduce the need for conventional smear and culture, speciation, and antibiotic sensitivity assays. Methods: We undertook prospective studies of sputum samples to assess the performance of two PCR-based assays for the detection of TB as well as the impact of more rapid availability of test results on patient care. Results: The sensitivity of both the in-house and Amplicor PCR assays was 100% for smear-positive sputa. For smear-negative sputa (two sputum samples collected during the first 24 h of hospitalization), the sensitivity was 85% for our in-house PCR assay and 74% for the Roche PCR assay. Approximately 10% of the smear- and culture-negative sputa yielded positive PCR results; however, more than one-half of these were positive with both the in-house and Amplicor assays, suggesting the presence of TB DNA or organisms. Several of these came from patients whose other samples grew Mycobacterium tuberculosis during the same admission, and others came from patients who had previously treated TB. Overall, the specificities of the in-house and Amplicor PCR assays in smear-negative patients were 86% and 93%, respectively. Conclusions: Molecular detection of slow-growing pathogens such as M. tuberculosis have the potential to improve clinical care through a dramatic reduction in the time required for detection and may provide substantial savings in the overall cost of care of a patient compared with conventional smear, culture, and speciation alone, despite the fact that conventional assays must still be performed for speciation of nontuberculous mycobacteria and for full assessment of antibiotic sensitivity.

Abstract WMP55: HIV Viral Load and Stroke Risk

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Barbara Harding ◽  
Tigran Avoundjian ◽  
Susan R Heckbert ◽  
Bridget M Whitney ◽  
Robin M Nance ◽  
...  
Keyword(s):  
Viral Load ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Clinical Care ◽  
Research Network ◽  
Hiv Care ◽  
Baseline Viral Load ◽  
People Living With Hiv ◽  
High Baseline ◽  
Increased Risk

Background: Among people living with HIV (PLWH), elevated plasma HIV RNA (viral load, [VL]), indicative of increased inflammation, may be associated with greater risk of stroke. Methods: Among adult PLWH receiving clinical care at six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites across the U.S. from January 2006 through January 2015, first ischemic or hemorrhagic stroke was identified from adjudicated clinical events. We considered baseline and time-updated VL. Baseline viral load was defined as the most recent viral load before 2006 or at CNICS cohort entry (if after 2006). Cox proportional hazards models were used to assess the relationship between baseline VL and time-updated VL and stroke. We estimated hazard ratios for risk of stroke (all stroke, and ischemic and hemorrhagic stroke separately) comparing the 75 th percentile of VL (“high VL”) to the 25 th percentile (“low VL”). All models were adjusted for age, sex, race/ethnicity, CNICS site, diabetes, treated hypertension, statin use, smoking, nadir CD4, BMI, hepatitis C virus coinfection, and baseline ART use. The hemorrhagic stroke model was also adjusted for FIB-4. Results: Among 16,648 PLWH over an average follow-up of 4.7 years, there were 146 total strokes (119 ischemic; 19 hemorrhagic). At baseline, the median VL was 41 copies/mL (IQR: 24, 3860). Individuals with high baseline VL were 1.57 times more likely to have a stroke than individuals with low baseline VL (95% CI: 1.22, 2.04). In addition, high baseline VL was associated with increased risk of ischemic stroke (HR: 1.48; 95% CI: 1.11, 1.97) and hemorrhagic stroke (HR: 2.5; 95% CI: 1.25, 4.98). The HR for all strokes comparing high VL and low VL individuals using time-updated VL was 1.84 (95% CI: 1.42-2.40). Conclusion: Our findings suggest that higher VL is associated with stroke risk after adjusting for traditional stroke risk factors, and may have a greater impact on incidence of hemorrhagic stroke. In addition to reducing HIV-related morbidity and mortality, improving HIV care may also reduce stroke risk.

Living with HIV in the Time of COVID-19

2020 ◽  
Vol 10 (1) ◽  
pp. 5-7
Author(s):  
Muhammad Naveed Noor
Keyword(s):  
Medical Care ◽  
Developing Country ◽  
People Living With Hiv ◽  
Evidence Based ◽  
Comorbid Conditions ◽  
Increased Risk ◽  
Associated Conditions ◽  
Living With Hiv

This commentary foregrounds the need to examine how the coronavirus disease 2019 (COVID-19) pandemic and associated conditions may be affecting the lives of people living with HIV (PLWH) in a developing country context like Pakistan. It raises some important questions on medical care and updated information regarding PLWH in the time of COVID-19. Since PLWH are at an increased risk of developing comorbid conditions – something that makes them more vulnerable to COVID-19 – it is critical that timely research and evidence-based actions are undertaken to protect their health.

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

scholarly journals Diagnostic exome-based preconception carrier testing in consanguineous couples: results from the first 100 couples in clinical practice

2021 ◽  
Author(s):  
Suzanne C. E. H. Sallevelt ◽  
Alexander P. A. Stegmann ◽  
Bart de Koning ◽  
Crool Velter ◽  
Anja Steyls ◽  
...  
Keyword(s):  
Autosomal Recessive ◽  
Rare Variants ◽  
Clinical Care ◽  
Carrier Testing ◽  
Carrier Status ◽  
Routine Diagnostics ◽  
Affected Offspring ◽  
Pathogenic Variants ◽  
Increased Risk ◽  
Genetics And Genomics

Abstract Purpose Consanguineous couples are at increased risk of being heterozygous for the same autosomal recessive (AR) disorder(s), with a 25% risk of affected offspring as a consequence. Until recently, comprehensive preconception carrier testing (PCT) for AR disorders was unavailable in routine diagnostics. Here we developed and implemented such a test in routine clinical care. Methods We performed exome sequencing (ES) for 100 consanguineous couples. For each couple, rare variants that could give rise to biallelic variants in offspring were selected. These variants were subsequently filtered against a gene panel consisting of ~2,000 genes associated with known AR disorders (OMIM-based). Remaining variants were classified according to American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) guidelines, after which only likely pathogenic and pathogenic (class IV/V) variants, present in both partners, were reported. Results In 28 of 100 tested consanguineous couples (28%), likely pathogenic and pathogenic variants not previously known in the couple or their family were reported conferring 25% risk of affected offspring. Conclusion ES-based PCT provides a powerful diagnostic tool to identify AR disease carrier status in consanguineous couples. Outcomes provided significant reproductive choices for a higher proportion of these couples than previous tests.

scholarly journals Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

2021 ◽  
pp. 112972982198990
Author(s):  
Kulli Kuningas ◽  
Nicholas Inston
Keyword(s):  
Decision Making ◽  
Kidney Disease ◽  
Vascular Access ◽  
Clinical Condition ◽  
The Elderly ◽  
Dialysis Access ◽  
Adverse Health Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

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