Outcomes Among Patients Hospitalized for COVID-19 Treated with Remdesivir in an Urban Center Pre-COVID-19 Vaccination.

OBJECTIVE: Data on treatment outcomes among minority populations treated with remdesivir are limited. We sought to evaluate outcomes among patients hospitalized with COVID-19 and treated with remdesivir among a predominantly Black and LatinX population. METHODS: This was a retrospective cohort study of adult patients hospitalized with COVID-19 and treated with remdesivir at an urban hospital in Newark, NJ, between May 1, 2020, and April 30, 2021, prior to widespread COVID-19 vaccination uptake. We describe 28-day mortality by demographic, socio-economic, and clinical factors, including clinical status by World Health Organization's (WHO) 8-point Ordinal Scale for Clinical Improvement. RESULTS: A total of 206 patients met study inclusion criteria (52% were male, 41% non-Hispanic Black and 42% Hispanic). Overall mortality at 28 days was 11%. Eighty-one percent of patients with baseline WHO status of 4 or greater recovered by day 14. Mortality was higher among those who were older (p = 0.01), those with underlying diabetes mellitus (p = 0.047), those with more severe illness on admission by WHO Ordinal Scale (WHO status ≥ 4), and those on concomitant tociluzimab or convalescent plasma use. CONCLUSIONS: We found that remdesivir was effective in treating most COVID-19 patients in our study. Traditional risk factors, such as advanced age and underlying co-morbidities, were associated with worse clinical outcomes and deaths.

Lipoprotein(a): a Case for Universal Screening in Youth.

PURPOSE OF REVIEW: Lipoprotein(a) has emerged as a strong independent risk factor for cardiovascular disease. Targeted screening recommendations for Lp(a) measurement exist for adults and youth known to be at high-risk. However, Lp(a) measurements are not included in universal screening guidelines in the US; hence, most families in the US with high Lp(a) levels who are at risk of future atherosclerotic heart disease, stroke, or aortic stenosis are not recognized. Lp(a) measurement included as part of routine universal lipid screening in youth would identify those children at risk of ASCVD and enable family cascade screening with identification and early intervention for affected family members. RECENT FINDINGS: Lp(a) levels can be reliably measured in children as young as two years of age. Lp(a) levels are genetically determined. The Lp(a) gene is inherited in a co-dominant fashion. Serum Lp(a) attains adult levels by two years of age and is stable for the lifetime of the individual. Novel therapies that aim to specifically target Lp(a) are in the pipeline, including nucleic acid-based molecules such as antisense oligonucleotides and siRNAs. Inclusion of a single Lp(a) measurement performed as part of routine universal lipid screening in youth (ages 9-11; or at ages 17-21) is feasible and cost effective. Lp(a) screening would identify youth at-risk of ASCVD and enable family cascade screening with identification and early intervention for affected family members.

HIV Prevention Research Experiences Among Men Who Have Sex With Men and Transgender Persons of Color.

PURPOSE: Black and Latinx MSM and transgender POC disproportionately experience new HIV diagnoses. Determining effective HIV prevention methods requires the inclusion of these communities in research and thorough post-trial experience evaluations. This study sought to evaluate the experiences of Black and Latinx MSM and transgender POC in HIV prevention research and identify facilitators and barriers to continued trials participation. METHODS: A survey was developed in partnership with the community engagement team based on emerging themes during research participant check-ins with the team. The survey was built in REDCap and distributed to participants via text message. The survey assessed experiences with the research process time commitments, study responsibilities, compensation, experiences with Truvada®, characteristics of the research study team and site, barriers to continued study participation, willingness to participate in future studies, and overall satisfaction. All statistical analysis was completed in Stata. RESULTS: Forty-four participants were enrolled in the study. Most participants (98%) were satisfied with their experiences in HIV prevention research. Job or school schedules were the most frequently cited barrier to study participation while Truvada® provision and adequate study visit compensation, length, number, and frequency were facilitators. Participants reported that research staff made them feel comfortable when talking about sexual behaviors, alcohol use, mental health, drug use, housing problems, violence in relationships, and legal problems. CONCLUSIONS: Evaluating the experiences of key communities in HIV prevention research can help identify barriers and facilitators to clinical trials engagement and improve the design of future trials.

Disease Progression in Children With Perinatal Human Immunodeficiency Virus Correlates With Increased PD-1+ CD8 T Cells That Coexpress Multiple Immune Checkpoints.

BACKGROUND: PD-1 marks exhausted T cells, with weak effector functions. Adults living with human immunodeficiency virus (HIV) have increased levels of PD-1+ CD8 T cells that correlate with HIV disease progression, yet little is known about the role of PD-1+ CD8 T cells in children with perinatal HIV. METHODS: We enrolled 76 Kenyan children with perinatal HIV and 43 children who were HIV unexposed and quantified PD-1 levels on CD8 T cells; their coexpression with immune checkpoints (ICs) 2B4, CD160, and TIM3; correlates with immune activation and HIV disease progression; and HIV-specific and -nonspecific proliferative responses. RESULTS: PD-1+ CD8 T-cell frequencies are elevated in children with perinatal HIV and associated with disease progression. The majority of PD-1+ CD8 T cells coexpress additional ICs. ART initiation lowers total PD-1 levels and coexpression of multiple ICs. The frequency of PD-1+2B4+CD160+TIM3- in PD-1+ CD8 T cells predicts weaker HIV-specific proliferative responses, suggesting that this subset is functionally exhausted. CONCLUSIONS: Children with perinatal HIV have high levels of PD-1+ CD8 T cells that are a heterogeneous population differentially coexpressing multiple ICs. Understanding the complex interplay of ICs is essential to guide the development of PD-1-directed immunotherapies for pediatric HIV remission and cure.