ABSTRACT
OBJECTIVES: We sought to determine if tenofovir alafenamide (TAF) was associated with excessive weight gain, diabetes (DM), and hypertensive disorders of pregnancy (HDP) in persons with HIV. STUDY DESIGN: This is a retrospective cohort study of pregnant persons with HIV prescribed antiretroviral therapy (ART) during the period of 01/01/2009 to 12/31/2020. MAIN OUTCOMES MEASURES: χ2 tests were used to compare the proportion of persons with excessive weight gain, DM, and HDP according to ART regimens. Excess total gestational weight gain was calculated using BMI and Institute of Medicine recommendations for weight gain in pregnancy. HDP included gestational hypertension and preeclampsia. Logistic regression models were used to determine predictors of excessive weight gain, DM, and HDP. RESULTS: We identified 189 pregnant persons prescribed ART with (30) and without TAF (159). The percentage of persons with excessive gestational weight gain was not significantly different in persons prescribed TAF (32 %) and other ART (17 %), p = 0.2. Persons prescribed TAF were more likely to have HDP (30 %) compared to other ART (9 %), p = 0.001. In the adjusted analysis, DM [aOR 6.2 (95 % CI 1.2-32.7)] and TAF exposure [aOR 3.2 (95 % CI 1.0-8.9)] were significantly associated with HDP. CONCLUSION: Despite similar gestational weight gain, persons with HIV prescribed TAF were more likely to have HDP. Further understanding of the metabolic and cardiovascular impact of ART recommended for use during pregnancy is needed.
Subject(s)
Anti-HIV Agents , Diabetes Mellitus , Gestational Weight Gain , HIV Infections , Hypertension, Pregnancy-Induced , Pre-Eclampsia , Female , Pregnancy , Humans , Integrase Inhibitors , Retrospective Studies , Weight Gain , Anti-HIV Agents/adverse effects , HIV Infections/drug therapyABSTRACT
BACKGROUND: Because of a high incidence of Trichomonas infection among HIV-positive women, annual screening and treatment are recommended. Trichomonas infection is associated with a 2-fold risk of HIV transmission. The objective of this study was to determine if annual screening is cost-effective for the prevention of new HIV cases in susceptible male partners secondary to Trichomonas infection in HIV-positive women. METHODS: A decision tree analysis was constructed to model the costs of Trichomonas screening, treatment, and follow-up. 200 women cycled through the model for a period of 12 months. One hundred women were unscreened and 100 were screened and treated per recommendations. RESULTS: Annual Trichomonas screening and treatment saves US $553 (US $475- US $645) per woman in the prevention of HIV transmission to male partners. The cost-effectiveness of this strategy was maintained across all assumptions in a sensitivity analysis. CONCLUSIONS: Trichomonas screening and treatment for the purpose of decreasing new HIV infections is not only cost-effective but also cost saving in HIV-positive women. If Centers for Disease Control and Prevention treatment guidelines were followed in all HIV-positive women living in the United States, the lifetime cost of new HIV infections prevented would approximate US $159,264,000 and could potentially prevent new HIV cases secondary to female-to-male transmissions.
Subject(s)
Anti-Infective Agents/therapeutic use , HIV Seropositivity/transmission , Mass Screening/economics , Metronidazole/therapeutic use , Trichomonas Vaginitis/drug therapy , Trichomonas vaginalis/isolation & purification , Adult , Anti-Infective Agents/economics , Cost-Benefit Analysis , Decision Support Techniques , Female , Follow-Up Studies , Humans , Incidence , Male , Metronidazole/economics , Practice Guidelines as Topic , Quality-Adjusted Life Years , Sensitivity and Specificity , Trichomonas Vaginitis/diagnosis , Trichomonas Vaginitis/economics , United States/epidemiologyABSTRACT
OBJECTIVE: Anal cancer rates have increased in HIV+ patients. The prevalence of anal intraepithelial neoplasias (AINs) and progression to anal cancer in HIV+ men who have sex with men has been well described, and screening is cost-effective. Our objective was to determine whether anal cancer screening in HIV+ women is cost-effective. MATERIALS AND METHODS: A Markov model analysis of 100 HIV+ women was constructed. All women had a CD4 count less than 200 and were assumed to be on antiretrovirals. Rates of AIN were based on previous studies. Progression rates were extrapolated from previous data on HIV+ men who have sex with men. The 5-year model included 3 screening approaches: none, annual, and biennial. Anoscopy and biopsy were performed after an abnormal cytologic result. Low-grade AIN was followed with repeat cytology, and high-grade AIN was treated surgically. Anal cancer was treated surgically followed by chemotherapy and radiation. Sensitivity analyses (SAs) were performed to account for variable rates of AIN progression, anal cancer mortality, and anal cancer and HIV quality-adjusted life years. RESULTS: The incremental cost-effectiveness ratio of biennial anal cancer screening compared to no screening was $34,763. Cost-effectiveness was maintained across all assumptions in SA except for decreased progression rate of high-grade AIN to anal cancer. CONCLUSIONS: Biennial anal cancer screening in HIV+ women with CD4 counts less than 200 is cost-effective. Annual screening was not cost-effective, likely because of the slow progression of AIN to anal cancer. Further data on rates of AIN progression in HIV+ women based on CD4 count are needed to determine whether screening is cost-effective in women with higher CD4 counts.
