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  • Ovid Technologies (Wolters Kluwer Health)  (8)
  • Cachay, Edward R.  (8)
  • 2020-2024  (8)
Materialart
Verlag/Herausgeber
  • Ovid Technologies (Wolters Kluwer Health)  (8)
Person/Organisation
Sprache
Erscheinungszeitraum
  • 2020-2024  (8)
Jahr
Fachgebiete(RVK)
  • 1
    Online-Ressource
    Online-Ressource
    Risk of HCC With Hepatitis B Viremia Among HIV/HBV‐Coinfected Persons in North America
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Hepatology Vol. 74, No. 3 ( 2021-09), p. 1190-1202
    Details
    In: Hepatology, Ovid Technologies (Wolters Kluwer Health), Vol. 74, No. 3 ( 2021-09), p. 1190-1202
    Kurzfassung: Chronic HBV is the predominant cause of HCC worldwide. Although HBV coinfection is common in HIV, the determinants of HCC in HIV/HBV coinfection are poorly characterized. We examined the predictors of HCC in a multicohort study of individuals coinfected with HIV/HBV. Approach and Results We included persons coinfected with HIV/HBV within 22 cohorts of the North American AIDS Cohort Collaboration on Research and Design (1995‐2016). First occurrence of HCC was verified by medical record review and/or cancer registry. We used multivariable Cox regression to determine adjusted HRs (aHRs [95% CIs]) of factors assessed at cohort entry (age, sex, race, body mass index), ever during observation (heavy alcohol use, HCV), or time‐updated (HIV RNA, CD4+ percentage, diabetes mellitus, HBV DNA). Among 8,354 individuals coinfected with HIV/HBV (median age, 43 years; 93% male; 52.4% non‐White), 115 HCC cases were diagnosed over 65,392 person‐years (incidence rate, 1.8 [95% CI, 1.5‐2.1] events/1,000 person‐years). Risk factors for HCC included age 40‐49 years (aHR, 1.97 [1.22‐3.17]), age ≥50 years (aHR, 2.55 [1.49‐4.35] ), HCV coinfection (aHR, 1.61 [1.07‐2.40]), and heavy alcohol use (aHR, 1.52 [1.04‐2.23] ), while time‐updated HIV RNA 〉 500 copies/mL (aHR, 0.90 [0.56‐1.43]) and time‐updated CD4+ percentage 〈 14% (aHR, 1.03 [0.56‐1.90]) were not. The risk of HCC was increased with time‐updated HBV DNA 〉 200 IU/mL (aHR, 2.22 [1.42‐3.47]) and was higher with each 1.0 log 10 IU/mL increase in time‐updated HBV DNA (aHR, 1.18 [1.05‐1.34]). HBV suppression with HBV‐active antiretroviral therapy (ART) for ≥1 year significantly reduced HCC risk (aHR, 0.42 [0.24‐0.73] ). Conclusion Individuals coinfected with HIV/HBV on ART with detectable HBV viremia remain at risk for HCC. To gain maximal benefit from ART for HCC prevention, sustained HBV suppression is necessary.
    Materialart: Online-Ressource
    ISSN: 0270-9139 , 1527-3350
    URL: Article
    DOI: 10.1002/hep.31839
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2021
    ZDB Id: 1472120-X
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Association of the VACS Index With Hospitalization Among People With HIV in the NA-ACCORD
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 89, No. 1 ( 2022-01-1), p. 9-18
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 89, No. 1 ( 2022-01-1), p. 9-18
    Kurzfassung: People with HIV (PWH) have a higher hospitalization rate than the general population. The Veterans Aging Cohort Study (VACS) Index at study entry well predicts hospitalization in PWH, but it is unknown if the time-updated parameter improves hospitalization prediction. We assessed the association of parameterizations of the VACS Index 2.0 with the 5-year risk of hospitalization. Setting: PWH ≥30 years old with at least 12 months of antiretroviral therapy (ART) use and contributing hospitalization data from 2000 to 2016 in North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) were included. Three parameterizations of the VACS Index 2.0 were assessed and categorized by quartile: (1) “baseline” measurement at study entry; (2) time-updated measurements; and (3) cumulative scores calculated using the trapezoidal rule. Methods: Discrete-time proportional hazard models estimated the crude and adjusted associations (and 95% confidence intervals [CIs]) of the VACS Index parameterizations and all-cause hospitalizations. The Akaike information criterion (AIC) assessed the model fit with each of the VACS Index parameters. Results: Among 7289 patients, 1537 were hospitalized. Time-updated VACS Index fitted hospitalization best with a more distinct dose–response relationship [score 〈 43: reference; score 43–55: aHR = 1.93 (95% CI: 1.66 to 2.23); score 55–68: aHR = 3.63 (95% CI: 3.12 to 4.23); score ≥68: aHR = 9.98 (95% CI: 8.52 to 11.69)] than study entry and cumulative VACS Index after adjusting for known risk factors. Conclusions: Time-updated VACS Index 2.0 had the strongest association with hospitalization and best fit to the data. Health care providers should consider using it when assessing hospitalization risk among PWH.
    Materialart: Online-Ressource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002812
    RVK:
    XA 10000
    RVK:
    XA 51942
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2038673-4
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Development and Validation of a Model for Prediction of End-Stage Liver Disease in People With HIV
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 89, No. 4 ( 2022-04-1), p. 396-404
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 89, No. 4 ( 2022-04-1), p. 396-404
    Kurzfassung: End-stage liver disease (ESLD) is a leading cause of non–AIDS-related death among people with HIV (PWH). Factors that increase the progression of liver disease include comorbidities and HIV-specific factors, but we currently lack a tool to apply this evidence into clinical practice. Methods: We developed and validated a risk prediction model for ESLD among PWH who received care in 12 cohorts of the North American AIDS Cohort Collaboration on Research and Design between 2000 and 2016 and had fibrosis-4 index 〉 1.45. The first occurrence of ascites, variceal bleed, spontaneous bacterial peritonitis, or hepatic encephalopathy was verified by standardized medical record review. The Bayesian model averaging was used to select predictors among biomarkers and diagnoses and the Harrell C statistic to assess model discrimination. Results: Among 13,787 PWH in the training set, 82% were men and 54% were Black with a mean age of 48 years. Three hundred ninety ESLD events occurred over a mean 5.4 years. Among the ESLD cases, 52% had hepatitis C virus, 15% hepatitis B virus, and 31% alcohol use disorder. Twelve factors together predicted ESLD risk moderately well (C statistic 0.79, 95% confidence interval: 0.76 to 0.81): age, sex, race/ethnicity, chronic hepatitis B or C, and routinely collected laboratory values reflecting hepatic impairment (serum albumin, aspartate aminotransferase, total bilirubin, and platelets) and lipid metabolism (triglycerides, high-density lipoprotein, and total cholesterol). Our model performed well in the test set (C statistic 0.81, 95% confidence interval: 0.76 to 0.86). Conclusion: This model of readily accessible clinical parameters predicted ESLD in a large diverse population of PWH.
    Materialart: Online-Ressource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002886
    RVK:
    XA 10000
    RVK:
    XA 51942
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2038673-4
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 4
    Online-Ressource
    Online-Ressource
    Exploring definitions of retention in care for people living with HIV in the United States in the modern treatment era
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  AIDS Vol. 36, No. 8 ( 2022-07-1), p. 1181-1189
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 8 ( 2022-07-1), p. 1181-1189
    Kurzfassung: To describe retention in HIV care based on various definitions of retention in the modern treatment era. Design: A cohort study of people enrolled in care at seven mostly urban HIV clinics across the United States, 2010–2018. Methods: We estimated retention based on missed visits, kept visits, kept encounters (clinical visits, CD4 counts, and viral loads), and HIV labs. We contrasted risk factors for retention by different definitions and estimated odds ratios for of viral suppression and hazard ratios for mortality in 2 years immediately following the year in which retention was defined (the study year). Results: Across 108 171 person-years ( N  = 21 481 people), in 71% of years people kept ≥75% of scheduled visits; in 78%, people kept ≥2 visits 〉 90 days apart; in 74%, people had ≥2 HIV labs 〉 90 days apart; and in 47%, people had no gaps 〉 6 months in clinic visits. Missing 〉 25% of scheduled visits despite attending ≥2 visits 〉 90 days apart was associated with nonwhite non-Hispanic race/ethnicity, history of injection drug use, and prior AIDS diagnosis. In contrast, attending ≥75% of scheduled visits while not attending ≥2 visits 〉 90 days apart was associated with male sex, white race, no injection drug use history, and no prior AIDS diagnosis. Subsequent viral nonsuppression was more strongly associated with missed- than kept-visit measures of retention; 2-year mortality was only associated with failure to be retained by missed-visit measures. Discussion: Missed and kept-visit definitions of retention capture different constructs. Missed-visit measures are more strongly associated with poor HIV outcomes.
    Materialart: Online-Ressource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003232
    RVK:
    XA 16838
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2012212-3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Chronic obstructive pulmonary disease and the risk for myocardial infarction by type in people with HIV
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  AIDS Vol. 37, No. 5 ( 2023-04-1), p. 745-752
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 5 ( 2023-04-1), p. 745-752
    Kurzfassung: The relationship between chronic obstructive pulmonary disease (COPD) and cardiovascular disease in people with HIV (PWH) is incompletely understood. We determined whether COPD is associated with risk of myocardial infarction (MI) among PWH, and if this differs for type 1 (T1MI) and type 2 (T2MI). Design: We utilized data from five sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort, a multisite observational study. Methods: Our primary outcome was an adjudicated MI, classified as T1MI or T2MI. We defined COPD based on a validated algorithm requiring COPD diagnosis codes and at least 90-day continuous supply of inhalers. We conducted time-to-event analyses to first MI and used multivariable Cox proportional hazards models to measure associations between COPD and MI. Results: Among 12 046 PWH, 945 had COPD. Overall, 309 PWH had an MI: 58% had T1MI ( N  = 178) and 42% T2MI ( N  = 131). In adjusted models, COPD was associated with a significantly increased risk of all MI [adjusted hazard ratio (aHR) 2.68 (95% confidence interval (CI) 1.99–3.60)] even after including self-reported smoking [aHR 2.40 (95% CI 1.76–3.26)] . COPD was also associated with significantly increased risk of T1MI and T2MI individually, and with sepsis and non-sepsis causes of T2MI. Associations were generally minimally changed adjusting for substance use. Conclusion: COPD is associated with a substantially increased risk for MI, including both T1MI and T2MI, among PWH. Given the association with both T1MI and T2MI, diverse mechanistic pathways are involved. Future strategies to decrease risk of T1MI and T2MI in PWH who have COPD are needed.
    Materialart: Online-Ressource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003465
    RVK:
    XA 16838
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2023
    ZDB Id: 2012212-3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  AIDS Vol. 36, No. 8 ( 2022-07-1), p. 1095-1103
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 8 ( 2022-07-1), p. 1095-1103
    Kurzfassung: To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19. Design: Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020. Methods: We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4 + cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores. Results: Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40–59), 18% had a current CD4 + cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4 + cell count less than 350 cells/μl (proxy for CD4 + nadir), current low CD4 +  : CD8 + ratio, diabetes, and obesity. Conclusion: Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4 + cell count or current low CD4 +  : CD8 + ratio had greater risk of COVID-19.
    Materialart: Online-Ressource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003223
    RVK:
    XA 16838
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2012212-3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 7
    Online-Ressource
    Online-Ressource
    Risk factors for atrial fibrillation in a multicenter United States clinical cohort of people with HIV infection
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  AIDS Vol. 36, No. 6 ( 2022-05-1), p. 903-905
    Details
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 6 ( 2022-05-1), p. 903-905
    Kurzfassung: To assess atrial fibrillation risk factors in people with HIV, we identified incident atrial fibrillation in a large clinical cohort of people receiving care. Compared with 970 controls without atrial fibrillation, the 97 with adjudicated incident atrial fibrillation were older, less likely Hispanic, and had more coronary disease, heart failure, and chronic obstructive pulmonary disease. In multivariable analysis, nonuse of antiretroviral therapy and prescription of antiretroviral regimens with multiple core agents were associated with increased atrial fibrillation risk.
    Materialart: Online-Ressource
    ISSN: 0269-9370 , 1473-5571
    URL: Article
    DOI: 10.1097/QAD.0000000000003180
    RVK:
    XA 16838
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2012212-3
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 8
    Online-Ressource
    Online-Ressource
    Factors Associated With Severity of COVID-19 Disease in a Multicenter Cohort of People With HIV in the United States, March–December 2020
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  JAIDS Journal of Acquired Immune Deficiency Syndromes Vol. 90, No. 4 ( 2022-08-1), p. 369-376
    Details
    In: JAIDS Journal of Acquired Immune Deficiency Syndromes, Ovid Technologies (Wolters Kluwer Health), Vol. 90, No. 4 ( 2022-08-1), p. 369-376
    Kurzfassung: Understanding the spectrum of COVID-19 in people with HIV (PWH) is critical to provide clinical guidance and risk reduction strategies. Setting: Centers for AIDS Research Network of Integrated Clinic System, a US multisite clinical cohort of PWH in care. Methods: We identified COVID-19 cases and severity (hospitalization, intensive care, and death) in a large, diverse HIV cohort during March 1, 2020–December 31, 2020. We determined predictors and relative risks of hospitalization among PWH with COVID-19, adjusted for disease risk scores. Results: Of 16,056 PWH in care, 649 were diagnosed with COVID-19 between March and December 2020. Case fatality was 2%; 106 (16.3%) were hospitalized, and 12 died. PWH with current CD4 count 〈 350 cells/mm 3 [aRR 2.68; 95% confidence interval (CI): 1.93 to 3.71; P 〈 0.001] or lowest recorded CD4 count 〈 200 cells/mm 3 (aRR 1.67; 95% CI: 1.18 to 2.36; P 〈 0.005) had greater risks of hospitalization. HIV viral load and antiretroviral therapy status were not associated with hospitalization, although most of the PWH were suppressed (86%). Black PWH were 51% more likely to be hospitalized with COVID-19 compared with other racial/ethnic groups (aRR 1.51; 95% CI: 1.04 to 2.19; P = 0.03). Chronic kidney disease, chronic obstructive pulmonary disease, diabetes, hypertension, obesity, and increased cardiovascular and hepatic fibrosis risk scores were associated with higher hospitalization risk. PWH who were older, not on antiretroviral therapy, and with current CD4 count 〈 350 cells/mm 3 , diabetes, and chronic kidney disease were overrepresented among PWH who required intubation or died. Conclusions: PWH with CD4 count 〈 350 cells/mm 3 , and a history of CD4 count 〈 200 cells/mm 3 , have a clear excess risk of severe COVID-19, accounting for comorbidities associated with severe outcomes. PWH with these risk factors should be prioritized for COVID-19 vaccination and early treatment and monitored closely for worsening illness.
    Materialart: Online-Ressource
    ISSN: 1525-4135
    URL: Article
    DOI: 10.1097/QAI.0000000000002989
    RVK:
    XA 10000
    RVK:
    XA 51942
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 2038673-4
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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