scholarly journals COVID-19 infections post-vaccination by HIV status in the United States

2021 ◽  
Author(s):  
Sally B. Coburn ◽  
Elizabeth Humes ◽  
Raynell Lang ◽  
Cameron Stewart ◽  
Brenna C Hogan ◽  
...  
Keyword(s):  
Viral Load ◽  
Cumulative Incidence ◽  
The United States ◽  
Infection Risk ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Post Vaccination ◽  
Increased Risk ◽  
Vaccine Type

ABSTRACTImportanceRecommendations for additional doses of COVID vaccine are restricted to people with HIV who have advanced disease or unsuppressed HIV viral load. Understanding SARS-CoV-2 infection risk post-vaccination among PWH is essential for informing vaccination guidelines.ObjectiveEstimate the risk of breakthrough infections among fully vaccinated people with (PWH) and without (PWoH) HIV in the US.Design, setting, and participantsThe Corona-Infectious-Virus Epidemiology Team (CIVET)-II cohort collaboration consists of 4 longitudinal cohorts from integrated health systems and academic health centers. Each cohort identified individuals ≥18 years old, in-care, and fully vaccinated for COVID-19 through 30 June 2021. PWH were matched to PWoH on date fully vaccinated, age group, race/ethnicity, and sex at birth. Incidence rates per 1,000 person-years and cumulative incidence of breakthrough infections with 95% confidence intervals ([,]) were estimated by HIV status. Cox proportional hazards models estimated adjusted hazard ratios (aHR) of breakthrough infections by HIV status adjusting for demographic factors, prior COVID-19 illness, vaccine type (BNT162b2, [Pfizer], mRNA-1273 [Moderna], Jansen Ad26.COV2.S [J&J]), calendar time, and cohort. Risk factors for breakthroughs among PWH, were also investigated.ExposureHIV infectionOutcomeCOVID-19 breakthrough infections, defined as laboratory evidence of SARS-CoV-2 infection or COVID-19 diagnosis after an individual was fully vaccinated.ResultsAmong 109,599 individuals (31,840 PWH and 77,759 PWoH), the rate of breakthrough infections was higher in PWH versus PWoH: 44 [41, 48] vs. 31 [29, 33] per 1,000 person-years. Cumulative incidence at 210 days after date fully vaccinated was low, albeit higher in PWH versus PWoH overall (2.8% versus 2.1%, log-rank p<0.001, risk difference=0.7% [0.4%, 1.0%]) and within each vaccine type. Breakthrough infection risk was 41% higher in PWH versus PWoH (aHR=1.41 [1.28, 1.56]). Among PWH, younger age (18-24 versus 45-54), history of COVID-19 prior to fully vaccinated date, and J&J vaccination (versus Pfizer) were associated with increased risk of breakthroughs. There was no association of breakthrough with HIV viral load suppression or CD4 count among PWH.Conclusions and RelevanceCOVID-19 vaccination is effective against infection with SARS-CoV-2 strains circulating through 30 Sept 2021. PWH have an increased risk of breakthrough infections compared to PWoH. Recommendations for additional vaccine doses should be expanded to all PWH.

scholarly journals The complex relationship between CD4 count, HIV viral load, trimethoprim-sulfamethoxazole prophylaxis, and skin-and-soft-tissue infection risk in patients with HIV: insights from a causal diagram and simulation study

2016 ◽  
Vol 144 (13) ◽  
pp. 2889-2898 ◽  
Author(s):  
V. HEMMIGE ◽  
D. S. LAUDERDALE ◽  
M. Z. DAVID
Keyword(s):  
Staphylococcus Aureus ◽  
Viral Load ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
The United States ◽  
Tissue Infection ◽  
Hiv Viral Load ◽  
Causal Diagram ◽  
Increased Risk ◽  
Immunological Factors

SUMMARYSkin and soft tissue infection (SSTIs) due to Staphylococcus aureus, particularly community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), are common in human immunodeficiency virus (HIV)-infected populations in the United States. Studies have differed as to the importance of epidemiological and immunological factors in this relationship, and have employed conflicting strategies for variable selection in multivariate analyses. Developments in causal inference methods in epidemiology have emerged in the last decade to clarify relationships between variables and identify appropriate variables to include in and exclude from multivariate analysis. In this paper, we develop a causal diagram to clarify the pathways linking CA-MRSA and HIV. We focus on the role played by trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, prescribed to many severely immunocompromised HIV patients and potentially protective against SSTIs, which both mediates and moderates the relationship between immunological parameters and SSTI risk. We demonstrate, using simulated data, that statistical models may yield biased results if they do not account for how HIV viral load may also be a marker of adherence to TMP-SMX prophylaxis. We conclude with a proposed causal model that includes both the epidemiological as well as immunological factors that may explain the increased risk of initial and recurrent SSTI risk in HIV-infected populations.

scholarly journals 536. HIV Patients with COVID-19 in the Bronx: A Retrospective Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S335-S336
Author(s):  
Philip J Lee ◽  
Surksha Sirichand ◽  
Nataly Rios Gutierrez ◽  
Luis Gonzalez Corro ◽  
Carlos Cruz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Viral Load ◽  
Retrospective Review ◽  
Kidney Injury ◽  
The United States ◽  
Secondary Outcome ◽  
People Living With Hiv ◽  
Hiv Viral Load ◽  
Cd4 Counts ◽  
Increased Risk

Abstract Background Since the start of the pandemic there has been limited data on mortality in people living with HIV (PLWH) who have Coronavirus Disease 2019 (COVID-19) in the United States (US). We conducted a retrospective review to investigate potential risk factors associated with survival and need for medical ventilation for PLWH and COVID-19. Methods This is a retrospective observational cohort from a large academic center across three campuses, conducted from January 1, 2020 to April 30, 2020. Thirty day readmissions were observed from January 1, 2020 to May 31, 2020. Our patients were identified by an ICD-10 code (B20) corresponding to HIV and positive SARS-CoV-2 PCR test. As a primary endpoint, we compared survivors vs. non-survivors. As a secondary endpoint, we compared patients who needed mechanical ventilator (MV) vs. those who did not need MV. Results Seventy two PLWH (28 female patients (39%), median [IQR] age was 62 [-/+16] years) had positive SARS-CoV-2 PCR tests during this retrospective review. Median CD4+ count was 235 cells/ul and 11 (15%) had an HIV viral load &gt;200 copies/mL. The median length of stay was 5 days and 6 patients were directly discharged from the emergency department. Ten patients were readmitted within 30 days with SARS-CoV-2 – like symptoms and 2 are still inpatient. Twenty patients (27.8%) have expired. All non-survivors that expired had an undetectable HIV viral load (0%, p=0.02). The 11 patients with unsuppressed HIV viral loads at the start of the study period all survived, p=0.02. Non-survivors were more likely to have chronic kidney disease CKD (p&lt; 0.01) acute kidney injury (p&lt; 0.01), higher absolute neutrophils (p&lt; 0.01), and elevated IL-6 levels (p&lt; 0.01) compared to survivors. Fifteen patients (20.8%) required mechanical ventilation (MV), 3 (4.1%) of those patients survived. Patients that required MV were more likely to be male (p=0.01) obese (p&lt; 0.01) and had higher absolute neutrophil counts (p=0.01) versus those that did not need MV. Patients with lower CD4 counts (&lt; 200 cells/uL) did not require more mechanical ventilation (p=0.04). Table 1: Demographics, Primary and Secondary Outcome Results Conclusion PLWH who had COVID-19 had a high mortality rate. Since all the patients who died had an undetectable HIV viral load across CD4 counts, our study suggests that patients with uncontrolled HIV are not at an increased risk of mortality. Disclosures All Authors: No reported disclosures

Observational study of the populations accessing rapid point-of-care HIV testing in Winnipeg, Manitoba, Canada, through a retrospective chart review of site records

2017 ◽  
Vol 94 (3) ◽  
pp. 194-199 ◽  
Author(s):  
James Blain Johnston ◽  
Joss N Reimer ◽  
John L Wylie ◽  
Jared Bullard
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Clinical Outcomes ◽  
Point Of Care ◽  
Age Groups ◽  
Linkage To Care ◽  
Hiv Positive ◽  
Hiv Status ◽  
Viral Load Suppression ◽  
Hiv Test

ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

scholarly journals Threefold Increases in Population HIV Viral Load Suppression Among Men and Young Adults — Bukoba Municipal Council, Tanzania, 2014–2017

2019 ◽  
Vol 68 (30) ◽  
pp. 658-663
Author(s):  
Duncan MacKellar ◽  
Claire Steiner ◽  
Oscar E. Rwabiyago ◽  
Haddi J. Cham ◽  
Sherri Pals ◽  
...  
Keyword(s):  
Young Adults ◽  
Viral Load ◽  
Viral Load Suppression ◽  
Hiv Viral Load ◽  
Municipal Council

scholarly journals HIV virologic response better with single-tablet once daily regimens compared to multiple-tablet daily regimens

2018 ◽  
Vol 6 ◽  
pp. 205031211881691 ◽  
Author(s):  
Shashi N Kapadia ◽  
Robert R Grant ◽  
Susan B German ◽  
Baljinder Singh ◽  
Amy L Davidow ◽  
...  
Keyword(s):  
Viral Load ◽  
Confidence Interval ◽  
Undetectable Viral Load ◽  
The United States ◽  
Virologic Response ◽  
Hiv Treatment ◽  
Viral Load Suppression ◽  
Relative Risks ◽  
Treatment Naïve ◽  
Virologic Control

Background: Single-tablet regimens are preferred prescription choices for HIV treatment, but there are limited outcomes data comparing single-tablet regimens to multiple-tablet regimens. Methods: We retrospectively assessed treatment-naïve patients at a single urban HIV clinic in the United States for viral load suppression at 6 and 12 months after initiating either single-tablet or multiple-tablet regimens. Multivariate regression was performed to obtain relative risks and adjust for potential confounders. Results: Of 218 patients, 47% were on single-tablet regimens and 53% on multiple-tablet regimens; 77% of single-tablet regimen patients had undetectable viral load at 6 months compared to 61% of multiple-tablet regimen patients (p = 0.012). At 12 months, 82% on single-tablet regimens and 66% on multiple-tablet regimens (p = 0.019) had undetectable viral load. Relative risk of any detectable viral load was 1.6 (95% confidence interval: 1.1–2.5) for patients on multiple-tablet regimens compared to single-tablet regimens at 6 months, and 2.2 (95% confidence interval: 1.2–4.0) at 12 months. Conclusion: Single-tablet regimens may provide better virologic control than multiple-tablet regimens in urban HIV-infected persons.

scholarly journals Impact of HIV-Status Disclosure on HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy

2019 ◽  
Vol 81 (4) ◽  
pp. 379-386 ◽  
Author(s):  
Kirsty Brittain ◽  
Claude A. Mellins ◽  
Robert H. Remien ◽  
Tamsin K. Phillips ◽  
Allison Zerbe ◽  
...  
Keyword(s):  
Viral Load ◽  
Antiretroviral Therapy ◽  
Postpartum Women ◽  
Hiv Status ◽  
Hiv Viral Load ◽  
Hiv Status Disclosure ◽  
Status Disclosure

scholarly journals 717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S257-S258
Author(s):  
Veronique Wyffels ◽  
Maartje Smulders ◽  
Sandra Gavart ◽  
Debasish Mazumder ◽  
Rohit Tyagi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Respiratory Syncytial Virus ◽  
Cumulative Incidence ◽  
The United States ◽  
Term Infants ◽  
Increased Risk ◽  
Study Results ◽  
Syncytial Virus ◽  
Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–&lt;3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P &lt; 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

P5341Predictive factors of atherosclerotic cardiovascular diseases events in HIV-HVC co-infected patients: results from hepavih ANRS co13 cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Boccara ◽  
B K Tan ◽  
M Chalouni ◽  
D Salmon Ceron ◽  
A Cinaud ◽  
...  
Keyword(s):  
Viral Load ◽  
Sustained Viral Response ◽  
Biological Data ◽  
Personal History ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of

Abstract Introduction Several studies highlighted an increased risk of cardiovascular disease (CVD) in HIV-HCV co-infected patients without clearly identifying specific virologic factors associated with atherosclerotic CVD (ASCVD) events. Purpose Hence, we analyzed data collection from the French nationwide ANRS CO13 HEPAVIH cohort to determine the incidence of ASCVD events in HIV-HCV co-infected patients and the predictive factors associated with its occurrence. Methods The French multicenter nationwide ANRS CO13 HEPAVIH clinic-based cohort collected prospective clinical and biological data from HIV-HCV co-infected patients followed-up in 28 different university hospitals between December 2005 to November 2016. Participants with at least one year of follow-up were included. Primary outcome was the occurrence of major ASCVD events (cardiovascular death, acute coronary syndrome, coronary revascularization and stroke). Secondary outcomes were total ASCVD events including major ASCVD events and minor ASCVD events (peripheral arterial disease [PAD]). Incidence rates were estimated using Aalen-Johansen method and factors associated with ASCVD identified with Cox proportional hazards models. Results A total of 1213 patients were included: median age 45.4 years [42.1–49.0], 70.3% men, current smoking 70.2%, overweight 19.5%, liver cirrhosis 18.9%, chronic alcohol consumption 7.8%, diabetes mellitus (5.9%), personal history of CVD 2.7%, and statins use 4.1%. After a median follow-up of 5.1 years [3.9–7.0], 44 participants experienced at least one ASCVD event (26 major ASCVD event, and 20 a minor event). Incidences for total, major and minor ASCVD events were of 6.98 [5.19; 9.38], 4.01 [2.78; 6.00], and 3.17 [2.05; 4.92] per 1000 person-years, respectively. Personal history of CVD (Hazard Ratio (HR)=13.94 [4.25–45.66]), high total cholesterol (HR=1.63 [1.24–2.15]), low HDL cholesterol (HR=0.08 [0.02–0.34]) and undetectable HIV viral load (HR=0.41 [0.18–0.96]) were identified as independent factors associated with major ASCVD events while cirrhosis status, liver fibrosis and HCV sustained viral response were not. Cumulative incidence of CV events Conclusion HIV-HCV co-infected patients experience a high incidence of ASCVD events both coronary and peripheral artery diseases. Traditional CV risk factors are the main determinants of ASCVD whereas undetectable HIV viral load seems to be protective. Management of cholesterol abnormalities and controlling viral load are essential to modify this high cardiovascular risk. Acknowledgement/Funding Agence Natoinale de Recherche sur le SIDA et les Hépatites virales

Atherosclerotic Cardiovascular Events in Patients Infected With Human Immunodeficiency Virus and Hepatitis C Virus

2020 ◽  
Author(s):  
Boun Kim Tan ◽  
Mathieu Chalouni ◽  
Dominique Salmon Ceron ◽  
Alexandre Cinaud ◽  
Laure Esterle ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hepatitis C Virus ◽  
Cardiovascular Risk ◽  
Viral Load ◽  
Hepatitis C ◽  
Baseline Viral Load ◽  
Hiv Viral Load ◽  
Factors Associated ◽  
Increased Risk ◽  
Immunodeficiency Virus

Abstract Background An increased risk of cardiovascular disease (CVD) was reported in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), without identifying factors associated with atherosclerotic CVD (ASCVD) events. Methods HIV–HCV coinfected patients were enrolled in the ANRS CO13 HEPAVIH nationwide cohort. Primary outcome was total ASCVD events. Secondary outcomes were coronary and/or cerebral ASCVD events, and peripheral artery disease (PAD) ASCVD events. Incidences were estimated using the Aalen-Johansen method. Factors associated with ASCVD were identified using cause-specific Cox proportional hazards models. Results At baseline, median age of the study population (n=1213) was 45.4 (interquartile range [IQR] 42.1−49.0) years and 70.3% were men. After a median follow-up of 5.1 (IQR 3.9−7.0) years, the incidence was 6.98 (95% confidence interval [CI] 5.19−9.38) per 1000 person-years for total ASCVD events, 4.01 (2.78−6.00) for coronary and/or cerebral events, and 3.17 (2.05−4.92) for PAD ASCVD events. Aging (hazard ratio [HR] 1.06, 95% CI 1.01−1.12), prior CVD (HR 8.48, 95% CI 3.14−22.91), high total cholesterol (HR 1.43, 95% CI 1.11−1.83), high-density lipoprotein cholesterol (HR 0.22, 95% CI 0.08−0.63), statin use (HR 3.31, 95% CI 1.31−8.38), and high alcohol intake (HR 3.18, 95% CI 1.35−7.52) were independently associated with total ASCVD events, while undetectable baseline viral load (HR 0.41, 95%CI 0.18−0.96) with coronary and/or cerebral events. Conclusion HIV–HCV coinfected patients experienced a high incidence of ASCVD events. Some traditional cardiovascular risk factors were the main determinants of ASCVD. Controlling cholesterol abnormalities and maintaining undetectable HIV viral load are essential to control cardiovascular risk.

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