Missed Opportunities for HIV Testing of Patients Tested for Sexually Transmitted Infections at a Large Urban Health Care System From 2010 to 2015.

BACKGROUND: Appropriate testing of people at risk for HIV is an important piece of the HIV care continuum. We analyzed HIV testing patterns of patients tested for gonorrhea and chlamydia (GC/CT) at a large urban health care system in New York City. METHODS: We retrospectively studied HIV and GC/CT testing from 2010 to 2015. Data were collected from a clinical laboratory database and linked to electronic health records. Patients were older than age 13 years, not known to be HIV positive, and had had a GC/CT test. The main outcome was the proportion of patients who had both HIV and GC/CT testing performed at the same encounter. RESULTS: We analyzed 85 768 patients with 139 404 GC/CT testing encounters. Most of the testing encounters (88% for men and 94% for women) were in the outpatient setting. Same-day HIV testing improved from 59% in 2010 to 70% in 2015 for male patients, and from 41% to 51% for female patients. In multivariate regression, male sex was associated with receipt of an HIV test (odds ratio [OR], 2.49; P < .001). Emergency department (OR, 0.22; P < .0001) and inpatient (OR, 0.10; P < .0001) locations were negatively associated with receipt of HIV testing. Among patients with HIV and GC/CT testing at the same encounter, 37 were HIV positive. CONCLUSIONS: Concurrent HIV testing of patients being evaluated for GC/CT increased from 2010 to 2015. However, many patients failed to receive HIV testing, especially in emergency and inpatient settings. There continue to be missed opportunities for diagnosis of HIV among individuals with ongoing high-risk behavior.

Testosterone replacement therapy and polycythemia in HIV-infected patients.

We conducted a case-control study to assess testosterone use as a primary risk factor for polycythemia in 21 HIV-infected men. Any testosterone use within 2 months of first elevated hemoglobin was associated with polycythemia (matched odds ratio 6.55; 95% confidence interval 1.83-23.4; P = 0.004) and intramuscular administration demonstrated a stronger association than topical use. No adverse cardiovascular or thrombotic events were observed. HIV-infected patients taking testosterone should undergo routine hematologic monitoring with adjustment of therapy when appropriate.

Factors associated with poor immunologic response to virologic suppression by highly active antiretroviral therapy in HIV-infected women.

Virologic response to highly active antiretroviral therapy (HAART) typically results in a substantial rise in CD4 cell counts. We investigated factors associated with poor CD4 response among HIV-infected women followed at 6-monthly intervals in the Women's Interagency HIV Study. Women with nadir CD4 counts < 350 cells/mm3 who achieved at least 6 months of plasma HIV RNA < 400 copies/ml were studied. Demographic, clinical, and treatment factors were compared between immunologic nonresponders, defined as the lower quartile of CD4 count change after two visits with virologic suppression (< 56 cell/mm3; n = 38), and the remaining group of responders (n = 115). Immunologic nonresponders had lower baseline HIV RNA levels and higher CD4 counts, more frequently used HAART 6 months prior to achieving consistent viral suppression, and more commonly had HIV RNA levels > 80 but < 400 copies/mL at both suppressive visits (21 vs. 7.8%, p = 0.024). In multivariate analysis, higher CD4 count and lower HIV RNA level at the last presuppressive visit were associated with immune nonresponse. We conclude that higher baseline CD4 count and lower HIV RNA level were associated with poor immunologic response to HAART in women with virologic suppression for at least 6 months. Persistent low level viremia may also contribute.

Case-control study of diabetes mellitus in HIV-infected patients.

BACKGROUND: Diabetes mellitus (DM) is more prevalent among patients with HIV infection. Besides protease inhibitors (PIs), other factors may contribute to the development of DM. OBJECTIVE: To assess characteristics associated with the development of DM in HIV-infected persons. METHODS: We conducted a case-control study in an urban HIV clinic among patients with incident DM (49 cases) matched to 2 controls (n = 98) on age +/-5 years, race, sex, and length of clinic follow-up. There was a second set of unmatched controls (n = 196). RESULTS: Compared with matched controls, case patients had higher mean body mass index (BMI; 30.0 vs. 25.3 kg/m, matched odds ratio [OR] = 1.20; P < 0.001), higher alanine aminotransferase (ALT; 66 vs. 44 U/L, OR = 1.12 per 10 U/L; P = 0.013), and stronger family history of DM (50% vs. 29%, OR = 3.30; P = 0.009). Hepatitic C virus coinfection and PI use were not significant factors. In unmatched controls, there was no significant difference in age, sex, or ethnicity. In multivariate analyses, BMI (OR = 1.13 per kg/m; P = 0.012), family history (OR = 5.55; P = 0.014), and ALT (OR = 1.16; P = 0.012) were associated with DM. CONCLUSION: These findings suggest a complex interaction among genetic factors, body composition, and liver injury in the pathogenesis of DM in HIV-infected patients.

Impact of antiretroviral therapy on decreasing hospitalization rates of HIV-infected patients in 2001.

Effective antiretroviral therapy initially resulted in large decreases in hospitalization rates of HIV-infected patients. The goal of this study was to determine whether these gains were being maintained in 2001. A cross-sectional study of hospital admission characteristics during four time periods was performed. All patients receiving care at the HIV clinics of New York Presbyterian Hospital-Cornell Medical Center (NYPH) in New York City were included. In 1995, 883 outpatients were receiving care for HIV infection at NYPH; this increased to 1990 outpatients by 2001. Demographic and laboratory information was obtained for these outpatients, and diagnoses were recorded for all patients requiring hospitalization on at NYPH during the time periods January 1 through June 30, in 1995, 1997, 1999, and 2001. The incidence of hospital admission declined in all four time periods: 1995 (95 per 100 patient-years [pt-yr]), 1997 (48 per 100 pt-yr), 1999 (38 per 100 pt-yr, p < 0.05), and 2001 (25 per 100 pt-yr). The incidence of bacterial pneumonia and opportunistic infections (OIs) decreased in all four time periods. The median hospitalization were CD4(+) cell count for outpatients increased from 231 (1995) to 364 (2001). Important predictors of hospitalization were CD4(+) < 200, and IVDU as an HIV risk factor. Since 1995 and the introduction of highly active antiretroviral therapy, continuing increases in CD4(+) cell counts of outpatients has been reflected in persistent declines in hospitalization rates. Large decreases in OIs and pneumonia have been minimally offset by stable rates of hospital admissions for diagnoses such as hepatitis, cirrhosis, and cellulitis.