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Murray MM, Lin J, Buros Stein A, Wilcox ML, Cottreau J, Postelnick M, Palella FJ. Relationship of polypharmacy to HIV RNA suppression in people aged ≥ 50 years living with HIV. HIV Med 2021; 22:742-749. [PMID: 34077632 DOI: 10.1111/hiv.13122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) aged ≥ 50 years face unique challenges regarding their medication therapies, especially antiretroviral therapy (ART). Use of ARTs, along with medications for comorbidities, may lead to adverse events, drug-drug interactions (DDIs) and poor adherence. The objective of this study was to identify the number of medications above which PLWH aged ≥ 50 years are less likely to be virally suppressed and to describe other associated patient-specific risk factors. METHODS This was a cross-sectional study of PLWH aged ≥ 50 years, prescribed ART, and seen at least once in the Northwestern Infectious Disease Center between 1 June 2013 and 31 May 2015. Variables concerning medication use and comorbidities were collected. The primary outcome was the presence of an undetectable plasma HIV RNA level (viral load). RESULTS Among the 621 included patients, there was a higher percentage taking ≤ 15 medications with an undetectable plasma HIV RNA (n = 453; 80.6%) vs. patients taking > 15 medications (n = 40; 67.8%; P = 0.03). Taking > 15 medications [odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.96], pulmonary disease (OR 0.54; 95% CI 0.3-0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22-0.68) decreased the odds of having an undetectable plasma HIV RNA. CONCLUSIONS PLWH taking > 15 medications were less likely to have an undetectable HIV RNA. Further studies are needed to evaluate the impact of overall medication economic burden on clinical outcomes among PLWH ≥ 50 years of age.
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Affiliation(s)
- M M Murray
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Lin
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA
| | - A Buros Stein
- Midwestern University, Office of Research and Sponsored Programs, Glendale, AZ, USA
| | - M L Wilcox
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - J Cottreau
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - M Postelnick
- Northwestern Memorial Hospital, Chicago, IL, USA
| | - F J Palella
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Cottenden J, Filter E, Cottreau J, Moore D, Bullock M, Huang WY, Arnason T. 295 Validation of a Cytotechnologist Manual Counting Service for the Ki67 Index in Neuroendocrine Tumors of the Pancreas and Gastrointestinal Tract. Am J Clin Pathol 2018. [DOI: 10.1093/ajcp/aqx123.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cottreau J, Kelly R, Topp T, Costa A, Filter ER, Arnason T. Spontaneous colonic perforation: a rare complication of collagenous colitis. Clin J Gastroenterol 2016; 9:140-4. [PMID: 27178398 DOI: 10.1007/s12328-016-0652-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/03/2016] [Indexed: 02/08/2023]
Abstract
Collagenous colitis is a clinicopathologic syndrome characterized by chronic watery diarrhea and unique histopathologic features. Spontaneous colonic perforation in the setting of collagenous colitis is a highly unusual complication, with only three cases reported in the literature to date. We present a fourth case and propose a potential pathologic mechanism for acute colonic perforation in this patient population.
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Affiliation(s)
| | - Ryan Kelly
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Trevor Topp
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of General Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Andreu Costa
- Dalhousie University Medical School, Halifax, NS, Canada.,Department of Diagnostic Imaging, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Emily R Filter
- Dalhousie University Medical School, Halifax, NS, Canada.,Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 734a, MacKenzie Bldg, 5788 University Ave, Halifax, NS, B3H 1V8, Canada
| | - Thomas Arnason
- Dalhousie University Medical School, Halifax, NS, Canada. .,Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 734a, MacKenzie Bldg, 5788 University Ave, Halifax, NS, B3H 1V8, Canada.
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Abstract
Ciliated foregut cysts typically arise in the liver and pancreas, with rare cases reported to arise in the gallbladder wall. Herein, we describe an unusual case of a patient with a ciliated foregut cyst arising from the wall of the common hepatic duct, which has not been reported previously. As a result of its unique anatomical location, the cyst was mistaken for a type II choledochal cyst on preoperative imaging. The cyst caused intermittent biliary obstruction that resolved following surgical resection.
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Affiliation(s)
| | - Andreu Costa
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Mark Walsh
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Thomas Arnason
- Dalhousie University Medical School, Halifax, Nova Scotia, Canada Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Cottreau J, Gruchy S, Kamionek M, Lauwers GY, Arnason T. Prevalence of oesophageal epidermoid metaplasia in 1048 consecutive patients and 58 patients with squamous neoplasms. Histopathology 2016; 68:988-95. [PMID: 26426946 DOI: 10.1111/his.12886] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
AIMS Oesophageal epidermoid metaplasia is defined by a dense granular layer with overlying hyperorthokeratosis, resembling the epidermis of skin. A possible association between epidermoid metaplasia, squamous dysplasia and squamous cell carcinoma has been proposed. The aim of this study was to compare the prevalence of epidermoid metaplasia in patients with oesophageal squamous neoplasms with that in a control cohort. METHODS AND RESULTS Medical records and slides from 1048 consecutive oesophageal biopsies and resections for any indication and 58 patients with oesophageal squamous neoplasms were reviewed. Two cases (0.19%) of epidermoid metaplasia were identified in the 1048-patient control group. The prevalence of epidermoid metaplasia was significantly higher (P < 0.05) in the 58 patients with oesophageal squamous neoplasms, two of whom (3.5%) had concurrent epidermoid metaplasia (odds ratio 18.1, 95% confidence interval 2.5-131). One case was associated with a verrucous carcinoma and the other with a well-differentiated, superficial (pT1), exophytic squamous cell carcinoma. No patients had epidermoid metaplasia in a biopsy prior to the diagnosis of squamous neoplasia. CONCLUSIONS The increased prevalence of epidermoid metaplasia observed in patients with squamous neoplasms provides some additional support for the proposed association. The hypothesis that epidermoid metaplasia is a precursor to squamous neoplasms remains unproven.
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Affiliation(s)
- Jonathan Cottreau
- Dalhousie University Medical School, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Steven Gruchy
- Dalhousie University Medical School, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.,Division of Gastroenterology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Gregory Y Lauwers
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Arnason
- Dalhousie University Medical School, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.,Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
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Yeo QM, Crutchley R, Cottreau J, Tucker A, Garey KW. Crofelemer, a novel antisecretory agent approved for the treatment of HIV-associated diarrhea. Drugs Today (Barc) 2013; 49:239-52. [PMID: 23616951 DOI: 10.1358/dot.2013.49.4.1947253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Secretory diarrhea has a significant impact on morbidity and mortality worldwide and may be a predominant or minor component of pathogenesis in diarrhea of various etiologies. Crofelemer is a first-in-class antidiarrheal medication with unique inhibitory mechanisms at both the cystic fibrosis transmembrane conductance regulator and the calcium-activated chloride channels which are responsible for chloride secretion and subsequent luminal hydration. The efficacy of crofelemer has been investigated in patients with HIV-associated diarrhea, diarrhea of various infectious etiologies, as well as diarrhea-predominant irritable bowel syndrome. Crofelemer was approved by the FDA in December 2012 to treat diarrhea in HIV/AIDS patients on antiretroviral therapy. Crofelemer is not absorbed in the body and well-tolerated in small trials performed to date although long-term safety data is lacking. Crofelemer may be an important addition to the currently available drugs for the management of secretory diarrhea.
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Affiliation(s)
- Q M Yeo
- National University of Singapore, Singapore.
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