Patient Demographics and the Utilization of a Novel 3-Anatomic-Site Testing Panel Including Rectal Self-Collection as Compared With Usual Care Testing.

BACKGROUND: At Kaiser Permanente Mid-Atlantic States, we designed a 3-anatomic-site panel (urine, oropharynx, and rectum) with a self-collect feature for rectal sites. We compared the proportion tested at each anatomic site, demographic factors, and HIV status between those who received the 3-site panel versus usual care. METHODS: Patients entered our laboratories without a prior appointment and underwent urine (usual care [patient collected]), oropharynx (laboratory technician collected), and rectal site (patient collected) testing. Providers recommended the panel to their patients. Patients then had the choice to accept or to reject the panel. Multivariate and logistic regressions were conducted to explore the relationship of age, sex, race, and HIV status with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) test results as well as the type of testing (3-site panel vs. usual care testing) received. RESULTS: A total of 145,854 patients received usual care testing as compared with 9227 who received the panel. For those who underwent usual care testing, 4.0% tested positive for CT and 0.85% for GC. For those who received the panel, 9.1% tested positive for CT and 6.4% for GC. Those who received the 3-site panel were more likely to test positive for CT (odds ratio [OR], 2.70; confidence interval [CI], 2.46-2.97) and GC (OR, 4.00; CI, 3.59-4.64). White patients were the most likely to receive the panel compared with Black patients (OR, 3.14; CI, 2.96-3.33). Patients with HIV had greater odds of undergoing the panel (OR, 15.62; CI, 14.67-16.64) and of testing positive for CT (OR, 1.27; CI, 1.07-1.51) and GC (OR, 1.39; CI, 1.14-1.68). CONCLUSIONS: Patients who received the panel had higher odds of testing positive for CT and GC compared with patients with usual testing. Physician training may address the racial and sex differences observed in the panel enrollment and increase utilization. Self-collection for rectal sites should lead to higher detection of CT and GC.

Gender differences in HIV drug resistance mutations and virological outcome.

BACKGROUND: Previous studies have shown that female gender has higher odds of developing HIV drug resistance mutations. We aimed to evaluate the gender differences in HIV drug resistance mutation patterns and outcomes in a cohort of an HIV-infected population who underwent genotype resistance testing (GRT). METHODS: We conducted a retrospective study from January 2004 to April 2007 of patients >12 years of age who underwent GRT in the HIV Outpatient Program Clinic (HOP) at the Medical Center of Louisiana at New Orleans. RESULTS: Among 391 patients included in the analysis, 130 were females and 261 were males. There were no major statistically significant differences in the baseline demographic, clinical, or genotypic characteristics between males and females before GRT except for race, presence of coexisting hepatitis B and C infection, prior diagnosis of tuberculosis, presence of thymidine analogue mutations (TAMs), and protease inhibitor (PI) mutations L90M and I84V (p < 0.05). Females showed a 1.6 fold probability of carrying nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.02-2.6), whereas males showed a 2-fold probability of carrying PI mutations (OR 2, 95% CI 1.12-3.8). Sixty-seven percent of males achieved virological suppression compared with 57% of females at 1 year (±6 months). Independent of history of optimal treatment and race, females showed 2-fold odds of having virological failure compared with males at 1 year (±6 months) after GRT (OR 2.0, 95% CI 1.04-3.8). CONCLUSIONS: Females did worse than males in regard to viral load suppression at the end of 1 year if they had documented HIV drug resistance at baseline. Further longitudinal studies are needed to confirm our findings.

Mycobacterium avium-avium-associated typhlitis mimicking appendicitis in an immunocompetent host.

Mycobacterium avium-intracellulare complex (MAC) primarily causes respiratory infection in patients with underlying lung disease or disseminated disease in immunocompromised patients. We report a unique case of MAC disease in the terminal ileum of a healthy patient, mimicking appendicitis. This case emphasizes the need to further explore MAC pathogenesis in immunocompetent hosts.