An Intervention to Reduce Drinking Among Individuals With HIV and Hepatitis C: A Pilot Randomized Controlled Trial.

OBJECTIVE: Heavy drinking poses serious risks to individuals with HIV, hepatitis C virus (HCV), and especially HIV/HCV coinfection. We adapted the National Institute on Alcohol Abuse and Alcoholism Clinician's Guide to address HIV/HCV coinfection and paired this with the "HealthCall" smartphone app to create an intervention tailored to HIV/HCV. After formative work and pretesting with HIV/HCV coinfected heavy drinkers, we conducted a pilot trial to determine potential of this new intervention for decreasing drinking. METHOD: A sample of 31 HIV/HCV coinfected heavy drinkers were randomly assigned to either intervention (n = 16) or control (n = 15; psychoeducation and brief advice) conditions. All participants completed a 60-day program consisting of approximately 25-minute-long baseline sessions and brief 5-10-minute booster sessions at 30 and 60 days, as well as an assessment-only follow-up at 90 days. Outcomes were measured using the Timeline Followback at baseline, 30, 60, and 90 days. Generalized linear models were used for analysis. RESULTS: Intervention participants drank fewer mean drinks per drinking day at 60 days (incidence rate ratio [IRR] = 0.43, p = .03) and 90 days (IRR = 0.34, p < .01). Intervention participants also reported fewer drinking days at 90 days (mean difference = 34.5%; p < .01). Self-efficacy differed between groups during intervention (p < .05). CONCLUSIONS: Although our sample was small, our results suggested lower drinking among participants who received a modified Clinician's Guide intervention plus use of the smartphone app HealthCall, in comparison with education and advice alone. A larger study is indicated to further examine this brief, disseminable intervention for HIV/HCV coinfected drinkers.

Persistently Elevated Risk of Syphilis Among Human Immunodeficiency Virus-Positive Men Receiving Care in a Status-Neutral Setting: A Retrospective Analysis.

BACKGROUND: Over the past decade, the incidence of primary and secondary syphilis has increased dramatically in the United States and Western Europe. Men living with human immunodeficiency virus (HIV) and those at risk of HIV infection experience disproportionately high rates of early syphilis (ES). We compared the odds of ES among HIV-positive and HIV-negative men participating in a status-neutral comprehensive HIV prevention and treatment program (CHP). METHODS: We conducted a retrospective analysis of men aged 18 to 65 years with ≥ 1 CHP visit and ≥2 rapid plasma reagin (RPR) tests performed between January 1, 2018, and December 31, 2021. Early syphilis was defined as newly reactive RPR with a minimum titer of ≥1:4 or a ≥ 4-fold increase in the RPR titer. Multiple logistic regression analyses were performed to determine predictors of ES. RESULTS: A total of 2490 men met the inclusion criteria, of whom 1426 (57.3%) were HIV-positive and 1064 (42.7%) were HIV-negative. Of the 393 men with ES, 284 (72.3%) were HIV-positive and 109 (27.7%) were HIV-negative. Human immunodeficiency virus-positive men had higher adjusted odds of ES (adjusted odds ratio, 2.86; 95% confidence interval, 2.45-3.27) than HIV-negative men did. Chlamydia or gonorrhea infection did not differ according to HIV status (adjusted odds ratio, 0.93; 95% confidence interval, 0.82-1.04). CONCLUSIONS: In our status-neutral care setting, HIV-positive status was associated with significantly higher odds of ES, but not chlamydia or gonorrhea. Our findings emphasize the vulnerability of HIV-positive men to syphilis in an era of effective HIV biomedical prevention.

HIV-1 Infection Does Not Change Disease Course or Inflammatory Pattern of SARS-CoV-2-Infected Patients Presenting at a Large Urban Medical Center in New York City.

BACKGROUND: The clinical impact of coronavirus disease 2019 (COVID-19) among people with HIV (PWH) remains unclear. In this retrospective cohort study of COVID-19, we compared clinical outcomes and laboratory parameters among PWH and controls. METHODS: Sixty-eight PWH diagnosed with COVID-19 were matched 1:4 to patients without known HIV diagnosis, drawn from a study population of all patients who were diagnosed with COVID-19 at an academic urban hospital. The primary outcome was death/discharge to hospice within 30 days of hospital presentation. RESULTS: PWH were more likely to be admitted from the emergency department than patients without HIV (91% vs 71%; P = .001). We observed no statistically significant difference between admitted PWH and patients without HIV in terms of 30-day mortality rate (19% vs 13%, respectively) or mechanical ventilation rate (18% vs 20%, respectively). PWH had higher erythrocyte sedimentation rates than controls on admission but did not differ in other inflammatory marker levels or nasopharyngeal/oropharyngeal severe acute respiratory syndrome coronavirus 2 viral load estimated by reverse transcriptase polymerase chain reaction cycle thresholds. CONCLUSIONS: HIV infection status was associated with a higher admission rate; however, among hospitalized patients, PWH did not differ from HIV-uninfected controls by rate of mechanical ventilation or death/discharge to hospice.

Clinical Characteristics and Outcomes in People Living With Human Immunodeficiency Virus Hospitalized for Coronavirus Disease 2019.

We describe the characteristics of 31 people living with human immunodeficiency virus hospitalized for severe acute respiratory syndrome coronavirus 2 infection. All patients were on antiretroviral therapy and virologically suppressed at the time of admission. Clinical course and outcomes were similar to those reported in other hospitalized cohorts.

Long-acting reversible contraception knowledge, attitudes and use among HIV-infected and -uninfected women and their providers.

OBJECTIVE(S): To describe differences in contraceptive knowledge, attitudes and use among HIV-infected and HIV-uninfected women served by an academic medical center in New York City and to describe gaps in knowledge and practice of gynecologic and HIV clinicians providing care at the same clinic sites where patients completed surveys. STUDY DESIGN: We conducted a survey comparing contraceptive knowledge, attitudes, reproductive histories and long-acting reversible contraception (LARC) use in HIV-infected and -uninfected women. We also conducted a survey to elicit clinician demographic characteristics and education, contraceptive practice patterns and their knowledge of current contraceptive guidelines. We surveyed clinicians and patients at five ambulatory sites. RESULTS: We screened 90% of patients approached. All 257 women who were eligible completed a survey. These included 107 (42%) HIV-infected women and 150 (58%) HIV-uninfected women. HIV-infected women were older, were more likely to be black/African-American, were less likely to be Latina, were more likely to receive public assistance and had lower educational attainment. HIV-infected women reported lower lifetime LARC use (12% vs. 28%) and higher recent condom use (58% vs. 25%) than HIV-uninfected women. Both groups reported similar attitudes toward intrauterine devices (IUDs) and implants. HIV clinicians were less likely to have had training in or discuss LARC methods with their patients. CONCLUSIONS: HIV-infected women were less likely to be current (last 30 days) or ever LARC users, despite having similar attitudes toward IUDs and implants, compared to HIV-uninfected women. HIV providers had lower levels of knowledge of HIV-specific contraceptive guidelines compared with gynecology practitioners. IMPLICATIONS: HIV-infected women and their providers share a knowledge gap regarding LARC. Increased interdisciplinary collaboration may help mitigate the resulting disparities in access to highly effective contraception in HIV-infected women. Knowledge of HIV-specific contraceptive guidelines and ability to place contraceptive implants were low among all surveyed providers, suggesting need for additional training.

Indication for treatment and severity of disease in treatment-naive patients with chronic hepatitis B virus infection.

BACKGROUND AND AIMS: The prevalence of chronic hepatitis B virus (HBV) infection in Europe is poorly defined. Data on the proportion of patients eligible for therapy are lacking but are crucial to meet WHO elimination goals. The aims of our study were to provide an estimate of the need for antiviral treatment and to assess the prevalence of advanced liver disease in treatment-naive, chronic HBV-infected patients. PATIENTS AND METHODS: We performed a retrospective, cross-sectional analysis of all treatment-naive HBV-infected patients. Baseline clinical assessments included sociodemographic data, hepatitis B-specific analyses, and liver stiffness measurement (LSM). RESULTS: Between 2010 and 2017, 465 patients with chronic HBV infection were referred, with 301 (64.7%) being eligible for our analysis. Overall, 40% were female, and the mean age was 39.3±13.1 years. Moreover, 61% of patients were born outside Europe, predominantly in the Asia-Pacific region. The median HBV viral load was 1630 IU/ml (interquartile range: 240-35 000 IU/ml), 145 (48.2%) patients had an HBV viral load above 2000 IU/ml, and 14.3% were HBeAg positive.Median LSM was 5.2 kPa (interquartile range: 4.2-6.6 kPa). LSM indicating clinically significant fibrosis (≥F2) was found in 96/271 (35.0%) patients, including 20/271 (7.4%) patients with suspected advanced fibrosis/cirrhosis. Overall, 26% of patients met EASL 2017 treatment criteria. CONCLUSION: In HBV-infected patients referred to one of the largest ID clinics in Berlin, only 26% met EASL treatment criteria and 7% had suspected cirrhosis at presentation. Only in 4% of all patients, a treatment indication could not be determined by a noninvasive approach.

Medical Reasons for Limiting Drinking: Data from a Sexual Health Clinic.

BACKGROUND: Heavy drinking poses health risks for individuals with HIV, and some individuals with HIV attempt to reduce drinking. Little is known about whether medical reasons motivate HIV-infected individuals to reduce drinking. OBJECTIVES: We evaluated medical reasons for limiting drinking among patients in a sexual health clinic, and explored whether these reasons could be operationalized as a new scale for research and clinical use in sexual health clinics. METHODS: A sample of 70 patients in a sexual health clinic who reported efforts to limit drinking in the past month (84% with self-reported HIV; 81% male; 50% Black) completed a nine-item medical reasons for limiting drinking scale on a tablet while waiting for their appointment. Exploratory factor analysis was performed to evaluate psychometric properties of the scale. RESULTS: Patients most commonly endorsed general concerns about health, and concerns about alcohol's effect on the liver. Support was found for a unidimensional (one-factor) eight-item scale, which evidenced good internal consistency (α = 0.84). Results were identical when analyses were restricted to the subset of 59 individuals who self-reported HIV infection. Conclusions/Importance: This study suggests that individuals in a sexual health clinic most commonly endorse broad nonspecific concerns about drinking and health, as well as concerns about their liver. This study yields an 8-item scale to measure medical reasons for limiting drinking in sexual health clinics and among individuals with HIV. This scale should enhance researchers' ability to study this important construct and may facilitate discussion of drinking reduction with HIV-infected heavy drinkers, requiring future study.

Heavy Drinking and Treatment among HIV/HCV Co-Infected Patients.

AIMS: Given the efficacy of new medications for Hepatitis C virus (HCV), we aimed to determine whether drinking relates to HCV treatment access among the high-risk group of individuals with HIV/HCV co-infection. METHODS: We sampled 210 patients in a sexual health clinic; of these, 39 reported HIV/HCV co-infection (79.49% male; 56.41% Black). Patients completed a self-report survey on drinking and treatment history. RESULTS: Those drinking despite health problems reported less HCV treatment (p =0.035). Drinking despite health problems did not relate to whether HCV treatment was recommended by providers, and binge drinking did not relate to either HCV outcome. Drinking was unrelated to HIV treatment. CONCLUSIONS: HIV/HCV co-infected individuals drinking despite health problems are in urgent need of attention, to reduce drinking and increase engagement in treatment. Drinking despite health problems m ay serve as an effective screening question to identify HIV/HCV co-infected drinkers who are most at risk of being untreated.

CROI 2014: Advances in antiretroviral therapy.

The 2014 Conference on Retroviruses and Opportunistic Infections (CROI) highlighted important advances in antiretroviral therapy, with an emphasis on HIV eradication strategies. Follow-up information about the Mississippi baby who remains free of HIV infection off antiretroviral therapy was presented, and a second baby and 1 adult may also have been cured with very early initiation of antiretroviral therapy. The HIV care cascade was again a major focus of the conference. Investigators from around the world presented data on the implementation, and limitations, of the care cascade paradigm. Scale-up of antiretroviral therapy continues and a number of presentations featured optimal ways to measure the impact of these efforts by applying lessons from implementation science and health care economics. Encouraging results from expanded prevention of mother-to-child transmission programs, especially Option B+, were highlighted. Extensive data on transmitted (primary) drug resistance in the United States and Europe were presented.

CROI 2013: Advances in antiretroviral therapy.

The 20th Conference on Retroviruses and Opportunistic Infections (CROI) presented important highlights of advances in antiretroviral therapy. Investigators emphasized new approaches to finding a cure for HIV infection, with a special focus on an infant who received combination antiretroviral therapy at 30 hours of age and may have achieved a functional cure in the absence of continued antiretroviral therapy. Challenges and opportunities for sustainable antiretroviral therapy under the Patient Protection and Affordable Care Act (PPACA) were discussed, and investigators around the globe examined attrition through the cascade of care for HIV disease and its implications. Knowledge of barriers to antiretroviral therapy in resource-limited settings (RLSs) continues to expand, as do innovative strategies for improving antiretroviral therapy access and uptake in these settings. Encouraging results from expanded prevention of mother-to-child transmission programs, including option B+, were presented. Prevalence of transmitted (primary) drug resistance appears to be increasing in the United States, and new detection techniques may increase access to resistance testing in RLSs.

Beyond virological suppression: the role of adherence in the late HAART era.

HAART has increased the life expectancy of HIV-infected individuals significantly. Optimal adherence to HAART results in viral suppression and immune recovery in the majority of HIV-infected persons. Data from the early HAART era suggest that adherence levels of greater than 95% are necessary to achieve and maintain virological suppression. However, the optimal threshold of adherence required to maximize the pharmacological benefits of contemporary antiretroviral regimens, particularly in the virologically suppressed patient, is unknown. This review examines new data on the role of adherence in the late HAART era, focusing on virological, immunological and epidemiological aspects. We begin with a discussion of the impact of adherence on viral dynamics and immunological parameters in the virologically suppressed patient. We then review the importance of adherence in emerging antiretroviral treatment strategies. Finally, we summarize accumulating data on the role of antiretroviral adherence in the prevention of HIV transmission. Taken together, the data reviewed reinforce the critical importance of adherence in the management of HIV infection in the late HAART era.

Characterizing medical providers for jail inmates in New York State.

OBJECTIVES: People who are incarcerated exhibit high rates of disease, but data evaluating the delivery of medical services to inmates are sparse, particularly for jail settings. We sought to characterize the primary medical care providers for county jail inmates in New York State. METHODS: From 2007 through 2009, we collected data on types of medical care providers for jail inmates in all New York State counties. We obtained data from state monitoring programs and e-mail questionnaires sent to county departments of health. RESULTS: In counties outside New York City (n = 57), jail medical care was delivered by local providers in 40 counties (70%), correctional medical corporations in 8 counties (14%), and public providers in 9 counties (16%). In New York City, 90% of inmates received medical care from a correctional medical corporation. Larger, urban jails, with a greater proportion of Black and Hispanic inmates, tended to use public hospitals or correctional medical corporations as health care vendors. CONCLUSIONS: Jail medical services in New York State were heterogeneous and decentralized, provided mostly by local physician practices and correctional medical corporations. There was limited state oversight and coordination of county jail medical care.

Advances in antiretroviral therapy.

The 17th Conference on Retroviruses and Opportunistic Infections maintained its tradition of being the preeminent forum for detailing the state-of-the-art of antiretroviral therapy. Abundant new and updated information was presented on investigational drugs, approaches to the management of treatment-naive and -experienced patients, the use of drugs for prevention of mother-to-child HIV-1 transmission, and HIV resistance to antiretroviral drugs. Of particular note were the continued advances in antiretroviral treatment and research emanating from resource-limited settings and from large clinical trials to determine the optimal initial antiretroviral drug regimen. Several interesting smaller studies were focused on HIV-1 pathogenesis and persistent viremia.

From public to private care the historical trajectory of medical services in a New York city jail.

Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation's largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.

Berberine sensitizes human glioma cells, but not normal glial cells, to ionizing radiation in vitro.

The identification of nontoxic agents that can enhance the efficacy of postoperative radiotherapy for patients with glioblastoma multiforme (GBM) remains a challenge in oncology. We evaluated human GBM cell lines for their responsiveness to berberine, an alkaloid compound used commonly in Asia as an antibiotic. In experiments measuring clonogenic survival, treatment with a nontoxic dose of berberine rendered GBM cells more sensitive than vehicle-treated control cells to x-rays. Such radiosensitization was not observed in parallel experiments with primary human glial cultures. These data suggest that berberine could be integrated with postoperative radiotherapy to selectively promote residual GBM tumor cell death