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Tebas P, Lynn K, Azzoni L, Cocchella G, Papasavvas E, Fair M, Karanam B, Sharma P, Reeves JD, Petropoulos CJ, Lalley-Chareczko L, Kostman JR, Short W, Mounzer K, Montaner LJ. Susceptibility to 3BNC117 and 10-1074 in ART suppressed chronically infected persons. AIDS 2023; 37:1203-1207. [PMID: 37070542 PMCID: PMC10567989 DOI: 10.1097/qad.0000000000003575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The aim of this study was to assess the susceptibility of HIV to two HIV monoclonal antibodies (bnAbs), 3BNC117 and 10-1074, in individuals with chronically antiretroviral therapy (ART) suppressed HIV infection. DESIGN The susceptibility of bnAbs was determined using the PhenoSense mAb Assay, which is a cell-based infectivity assay designed to assess the susceptibility of luciferase-reporter pseudovirions. This assay is the only Clinical Laboratory Improvement Ammendment (CLIA)/College of American Pathologist (CAP) compliant screening test specifically developed for evaluating bnAb susceptibility in people with HIV infection. METHOD The susceptibility of luciferase-reporter pseudovirions, derived from HIV-1 envelope proteins obtained from peripheral bloodmononuclear cells of 61 ART-suppressed individuals, to 3BNC117 and 10-1074 bnAbs was assessed using the PhenoSense mAb assay. Susceptibility was defined as an IC 90 of <2.0 μg/ml and 1.5 μg/ml for 3BNC117 and 10-1074, respectively. RESULTS About half of the individuals who were chronically infected and virologically suppressed were found to harbor virus with reduced susceptibility to one or both of the tested bnAbs. CONCLUSIONS The reduced combined susceptibility of 3BNC117 and 10-1074 highlights a potential limitation of using only two bnAbs for pre-exposure prophylaxis or treatment. Further studies are needed to define and validate the clinical correlates of bnAb susceptibility.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, PA, USA
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Azzoni L, Giron LB, Vadrevu S, Zhao L, Lalley-Chareczko L, Hiserodt E, Fair M, Lynn K, Trooskin S, Mounzer K, Abdel-Mohsen M, Montaner LJ. Methadone use is associated with increased levels of sCD14, immune activation, and inflammation during suppressed HIV infection. J Leukoc Biol 2022; 112:733-744. [PMID: 35916053 DOI: 10.1002/jlb.4a1221-678rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Opioid use has negative effects on immune responses and may impair immune reconstitution in persons living with HIV (PLWH) infection undergoing antiretroviral treatment (ART). The effects of treatment with μ opioid receptor (MOR) agonists (e.g., methadone, MET) and antagonists (e.g., naltrexone, NTX) on immune reconstitution and immune activation in ART-suppressed PLWH have not been assessed in-depth. We studied the effects of methadone or naltrexone on measures of immune reconstitution and immune activation in a cross-sectional community cohort of 30 HIV-infected individuals receiving suppressive ART and medications for opioid use disorder (MOUD) (12 MET, 8 NTX and 10 controls). Plasma markers of inflammation and immune activation were measured using ELISA, Luminex, or Simoa. Plasma IgG glycosylation was assessed using capillary electrophoresis. Cell subsets and activation were studied using whole blood flow cytometry. Individuals in the MET group, but no in the NTX group, had higher plasma levels of inflammation and immune activation markers than controls. These markers include soluble CD14 (an independent predictor of morbidity and mortality during HIV infection), proinflammatory cytokines, and proinflammatory IgG glycans. This effect was independent of time on treatment. Our results indicate that methadone-based MOUD regimens may sustain immune activation and inflammation in ART-treated HIV-infected individuals. Our pilot study provides the foundation and rationale for future longitudinal functional studies of the impact of MOUD regimens on immune reconstitution and residual activation after ART-mediated suppression.
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Affiliation(s)
- Livio Azzoni
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Leila B Giron
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Surya Vadrevu
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Ling Zhao
- Perelman School of Medicine - University of PA, Philadelphia, Pennsylvania, USA
| | | | - Emily Hiserodt
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | - Matthew Fair
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Kenneth Lynn
- Perelman School of Medicine - University of PA, Philadelphia, Pennsylvania, USA
| | - Stacey Trooskin
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers, Philadelphia, Pennsylvania, USA
| | - Mohamed Abdel-Mohsen
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Luis J Montaner
- Vaccine and Immunotherapy Center, The Wistar Institute, Philadelphia, Pennsylvania, USA
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3
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Papasavvas E, Azzoni L, Pagliuzza A, Abdel-Mohsen M, Ross BN, Fair M, Howell BJ, Hazuda DJ, Chomont N, Li Q, Mounzer K, Kostman JR, Tebas P, Montaner LJ. Safety, Immune, and Antiviral Effects of Pegylated Interferon Alpha 2b Administration in Antiretroviral Therapy-Suppressed Individuals: Results of Pilot Clinical Trial. AIDS Res Hum Retroviruses 2021; 37:433-443. [PMID: 33323024 DOI: 10.1089/aid.2020.0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/12/2022] Open
Abstract
In the pilot NCT01935089 trial, we tested whether pegylated interferon alpha2b (Peg-IFN-α2b) with antiretroviral therapy (ART) was safe and could impact HIV and immune measures in blood and in gut-associated lymphoid tissue (GALT). Twenty HIV-1+ ART-suppressed individuals received 1 μg/kg/week Peg-IFN-α2b with ART for 20 weeks, with intermediate 4-week analytical ART interruption (ATI). Safety, immune activation, HIV viral load and integrated HIV DNA in blood, and HIV RNA and DNA in gut biopsies were measured. A total of 7/20 participants experienced grade 3-4 adverse events, while 17/20 participants completed the study. Of the 17 participants who completed the study, 8 remained suppressed during ATI, while all 17 were suppressed at end of treatment (EoT). As expected, treatment increased activation of T and natural killer (NK) cells and IFN-stimulated molecule expression on monocytes in periphery. While circulating CD4+ T cells showed a trend for a decrease in integrated HIV DNA, GALT showed a significant decrease in HIV-1 RNA+ cells as measured by in situ hybridization along with a reduction in total HIV DNA and cell-associated RNA by EoT. The observed decrease in HIV-1 RNA+ cells in GALT was positively associated with the decrease in activated NK cells and macrophages. This study documents for the first time that 20 weeks of immunotherapy with Peg-IFN-α2b+ART (inclusive of a 4-week ATI) is safe and results in an increase in blood and GALT immune activation and in a significant decrease in HIV-1 RNA+ cells in GALT in association with changes in innate cell activation.
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Affiliation(s)
| | - Livio Azzoni
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Amélie Pagliuzza
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Canada
| | | | - Brian N. Ross
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Matthew Fair
- The Wistar Institute, Philadelphia, Pennsylvania, USA
| | | | | | - Nicolas Chomont
- Centre de Recherche du CHUM and Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Canada
| | - Qingsheng Li
- School of Biological Sciences and Nebraska Center for Virology, University of Nebraska, Lincoln, Nebraska, USA
| | - Karam Mounzer
- Jonathan Lax Immune Disorders Treatment Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, Pennsylvania, USA
| | - Jay R. Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- University of Pennsylvania, Department of Medicine, Philadelphia, Pennsylvania, USA
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4
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Papasavvas E, Azzoni L, Ross BN, Fair M, Yuan Z, Gyampoh K, Mackiewicz A, Sciorillo AC, Pagliuzza A, Lada SM, Wu G, Goh SL, Bahnck-Teets C, Holder DJ, Zuck PD, Damra M, Lynn KM, Tebas P, Mounzer K, Kostman JR, Abdel-Mohsen M, Richman D, Chomont N, Howell BJ, Montaner LJ. Intact Human Immunodeficiency Virus (HIV) Reservoir Estimated by the Intact Proviral DNA Assay Correlates With Levels of Total and Integrated DNA in the Blood During Suppressive Antiretroviral Therapy. Clin Infect Dis 2021; 72:495-498. [PMID: 33527127 DOI: 10.1093/cid/ciaa809] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 02/26/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023] Open
Abstract
Accurate characterization of the human immunodeficiency virus (HIV) reservoir is imperative to develop an effective cure. HIV was measured in antiretroviral therapy-suppressed individuals using the intact proviral DNA assay (IPDA), along with assays for total or integrated HIV DNA, and inducible HIV RNA or p24. Intact provirus correlated with total and integrated HIV.
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Affiliation(s)
| | - Livio Azzoni
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Brian N Ross
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Matthew Fair
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Zhe Yuan
- Wistar Institute, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Steven M Lada
- Veterans Affairs San Diego Healthcare System and the University of California, San Diego, California, USA
| | - Guoxin Wu
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | | | | | - Paul D Zuck
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Kenneth M Lynn
- Presbyterian Hospital, University of Pennsylvania hospital, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karam Mounzer
- Jonathan Lax Immune Disorders Treatment Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, Pennsylvania, USA
| | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, Pennsylvania, USA
| | | | - Douglas Richman
- Veterans Affairs San Diego Healthcare System and the University of California, San Diego, California, USA
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5
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Papasavvas E, Kossenkov AV, Azzoni L, Zetola NM, Mackiewicz A, Ross BN, Fair M, Vadrevu S, Ramogola-Masire D, Sanne I, Firnhaber C, Montaner LJ. Gene expression profiling informs HPV cervical histopathology but not recurrence/relapse after LEEP in ART-suppressed HIV+HPV+ women. Carcinogenesis 2019; 40:225-233. [PMID: 30364933 DOI: 10.1093/carcin/bgy149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 12/30/2022] Open
Abstract
Identification of factors associated with human papillomavirus (HPV) cervical histopathology or recurrence/relapse following loop electrosurgical excision procedure (LEEP) would allow for better management of the disease. We investigated whether gene signatures could (i) associate with HPV cervical histopathology and (ii) identify women with post-LEEP disease recurrence/relapse. Gene array analysis was performed on paraffin-embedded cervical tissue-isolated RNA from two cross-sectional cohorts of antiretroviral therapy (ART)-suppressed HIV+HPV+ coinfected women: (i) 55 women in South Africa recruited into three groups: high risk (HR) (-) (n = 16) and HR (+) (n = 15) HPV without cervical histopathology and HR (+) HPV with cervical intraepithelial neoplasia (CIN) grade 1/2/3 (n = 24), (ii) 28 women in Botswana with CIN2/3 treated with LEEP 12-month prior to recruitment and presenting with (n = 13) and without (n = 15) lesion recurrence/relapse (tissue was analyzed at first LEEP). Three distinct gene expression signatures identified were able to segregate: (i) HR+ HPV and CIN1/2/3, (ii) HR HPV-free and cervical histopathology-free and (iii) HR+ HPV and cervical histopathology-free. Immune activation and neoplasia-associated genes (n = 272 genes; e.g. IL-1A, IL-8, TCAM1, POU4F1, MCM2, SMC1B, CXCL6, MMP12) were a feature of cancer precursor dysplasia within HR HPV infection. No difference in LEEP tissue gene expression was detected between women with or without recurrence/relapse. In conclusion, distinctive gene signatures were associated with presence of cervical histopathology in tissues from ART-suppressed HIV+/HPV+ coinfected women. Lack of detection of LEEP tissue gene signature able to segregate subsequent post-LEEP disease recurrence/relapse indicates additional factors independent of local gene expression as determinants of recurrence/relapse.
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Affiliation(s)
- Emmanouil Papasavvas
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Andrew V Kossenkov
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Livio Azzoni
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Nicola M Zetola
- The Botswana-UPenn Partnership, Department of Radiation Oncology, Gaborone, Botswana.,The University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, USA
| | - Agnieszka Mackiewicz
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Brian N Ross
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Matthew Fair
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | - Surya Vadrevu
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
| | | | - Ian Sanne
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Right To Care, Johannesburg, South Africa
| | - Luis J Montaner
- The Wistar Institute, HIV-1 Immunopathogenesis Laboratory, Philadelphia, PA, USA
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6
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Papasavvas E, Azzoni L, Kossenkov AV, Dawany N, Morales KH, Fair M, Ross BN, Lynn K, Mackiewicz A, Mounzer K, Tebas P, Jacobson JM, Kostman JR, Showe L, Montaner LJ. NK Response Correlates with HIV Decrease in Pegylated IFN-α2a-Treated Antiretroviral Therapy-Suppressed Subjects. J Immunol 2019; 203:705-717. [PMID: 31253727 DOI: 10.4049/jimmunol.1801511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/03/2019] [Indexed: 01/27/2023]
Abstract
We previously reported that pegylated IFN-α2a (Peg-IFN-α2a) added to antiretroviral therapy (ART)-suppressed, HIV-infected subjects resulted in plasma HIV control and integrated HIV DNA decrease. We now evaluated whether innate NK cell activity or PBMC transcriptional profiles were associated with decreases in HIV measures. Human peripheral blood was analyzed prior to Peg-IFN-α2a administration (ART, baseline), after 5 wk of ART+Peg-IFN-α2a, and after 12 wk of Peg-IFN-α2a monotherapy (primary endpoint). After 5 wk of ART+Peg-IFN-α2a, immune subset frequencies were preserved, and induction of IFN-stimulated genes was noted in all subjects except for a subset in which the lack of IFN-stimulated gene induction was associated with increased expression of microRNAs. Viral control during Peg-IFN-α2a monotherapy was associated with 1) higher levels of NK cell activity and IFN-γ-induced protein 10 (IP-10) on ART (preimmunotherapy) and 2) downmodulation of NK cell KIR2DL1 and KIR2DL2/DL3 expression, transcriptional enrichment of expression of genes associated with NK cells in HIV controller subjects, and higher ex vivo IFN-α-induced NK cytotoxicity after 5 wk of ART+Peg-IFN-α2a. Integrated HIV DNA decline after immunotherapy was also associated with gene expression patterns indicative of cell-mediated activation and NK cytotoxicity. Overall, an increase in innate activity and NK cell cytotoxicity were identified as correlates of Peg-IFN-α2a-mediated HIV control.
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Affiliation(s)
| | | | | | - Noor Dawany
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | | | | | - Kenneth Lynn
- Presbyterian Hospital-University of Pennsylvania Hospital, Philadelphia, PA 19104
| | | | - Karam Mounzer
- Jonathan Lax Immune Disorders Treatment Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, PA 19107
| | - Pablo Tebas
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Jeffrey M Jacobson
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140; and
| | - Jay R Kostman
- John Bell Health Center, Philadelphia Field Initiating Group for HIV-1 Trials, Philadelphia, PA 19107
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7
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Abdel-Mohsen M, Tomescu C, Vadrevu S, Spivak A, Kuri-Cervantes L, Wu G, Cox K, Vemula S, Fair M, Lynn K, Buzon M, Martinez-Picado J, Betts M, Planelles V, Mounzer K, Howell B, Hazuda D, Tebas P, Montaner L. CD32+ CD4+ T Cells are HIV transcriptionally active rather than a resting reservoir. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30531-8] [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: 11/30/2022] Open
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8
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Gilbert K, Mendiolina J, Kessler A, Rondon A, Keiser R, DiSante K, Fair M, Kocher T, Wetmore M, Cirocco R. Use of Relative Ratio to analyze Donor Specific Antibody – One center’s experience. Hum Immunol 2015. [DOI: 10.1016/j.humimm.2015.07.150] [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: 11/16/2022]
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9
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Pourmand A, Lucas R, Shokoohi H, Yadav K, Fair M. 120: A Prospective Cohort Study to Assess the Impact of Resident Education on Door to Disposition Time In a Community Teaching Hospital Emergency Department. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.163] [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: 11/30/2022]
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10
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Abstract
BACKGROUND There are barriers to acute stroke care in minority groups as well as a higher incidence of ischemic stroke when compared with non-Hispanic whites. OBJECTIVE To estimate the future economic burden of stroke in non-Hispanic whites, Hispanics, and African Americans in the United States from 2005 to 2050. METHODS We used U.S. Census estimates of the race-ethnic group populations age 45 years and older. We obtained stroke epidemiology and service utilization data from the Northern Manhattan Stroke Study and the Brain Attack Surveillance in Corpus Christi project and other published data. We estimated costs directly from Medicare reimbursement or from studies that used Medicare reimbursement. Direct and indirect costs considered included ambulance services, initial hospitalization, rehabilitation, nursing home costs, outpatient clinic visits, drugs, informal caregiving, and potential lost earnings. RESULTS The total cost of stroke from 2005 to 2050, in 2005 dollars, is projected to be 1.52 trillion dollars for non-Hispanic whites, 313 billion dollars for Hispanics, and 379 billion dollars for African Americans. The per capita cost of stroke estimates are highest in African Americans (25,782 dollars), followed by Hispanics (17,201 dollars), and non-Hispanic whites (15,597 dollars). Loss of earnings is expected to be the highest cost contributor in each race-ethnic group. CONCLUSIONS The economic burden of stroke in African Americans and Hispanics will be enormous over the next several decades. Further efforts to improve stroke prevention and treatment in these high stroke risk groups are necessary.
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Affiliation(s)
- D L Brown
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI, USA.
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11
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Wheeler JG, Fair M, Simpson PM, Rowlands LA, Aitken ME, Jacobs RF. Impact of a waiting room videotape message on parent attitudes toward pediatric antibiotic use. Pediatrics 2001; 108:591-6. [PMID: 11533323 DOI: 10.1542/peds.108.3.591] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To reduce the injudicious use of antibiotics, we developed an educational strategy that focused on parents of pediatric patients and their physicians. METHODS This intervention was conducted in 5 pediatric practices in Arkansas during a 9-month period. Baseline data on parent attitudes about antibiotics and physician practice habits were measured by questionnaire. During the following 36 weeks, an educational videotape about the judicious use of antibiotics was played in waiting rooms. The videotape on antibiotics used a standard script based on the recommendations of the American Academy of Pediatrics. The physicians and staff at each site were actors in the videotape. During week 2 and week 36 of videotape use, parent attitudes were measured again. After the baseline week, the physicians and staff in each site were provided a standard in-service review of the American Academy of Pediatrics recommendations for judicious use of antibiotics. A study nurse recruited patients, administered questionnaires, and reviewed charts on-site. RESULTS Parents who were exposed to the videotape were significantly less inclined to seek antibiotics for viral infections. Passively provided pamphlets were not read. No significant change in antibiotic prescribing by physicians was seen. CONCLUSION Parent-focused passive education tools are effective at changing parent attitudes toward the use of antibiotics. Although physicians have blamed parent attitudes and demands for the overuse of antibiotics, changes in parent attitudes in this study were not associated with changes in prescribing rates. Changes in parent attitudes may be necessary but do not seem sufficient for changes in antimicrobial prescribing patterns.
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Affiliation(s)
- J G Wheeler
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA.
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12
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Joseph KS, Kramer MS, Allen AC, Cyr M, Fair M, Ohlsson A, Wen SW. Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Paediatr Perinat Epidemiol 2000; 14:332-9. [PMID: 11101020 DOI: 10.1046/j.1365-3016.2000.00298.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.
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Affiliation(s)
- K S Joseph
- Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Ottawa, Canada.
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13
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Fair M, Cyr M, Allen AC, Wen SW, Guyon G, MacDonald RC. An assessment of the validity of a computer system for probabilistic record linkage of birth and infant death records in Canada. The Fetal and Infant Health Study Group. Chronic Dis Can 2000; 21:8-13. [PMID: 10813688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Studies on the validity of probabilistic record linkage are sparse. We performed a probabilistic linkage to link the 1984-1994 birth records (obtained from the Canadian Birth Data Base) with 1984-1995 infant death records (from the Canadian Mortality Data Base) in Canada. We extracted the linked birth-death records for Nova Scotia and Alberta (from January 1990 to December 1991) obtained from Statistics Canada's vital registration data and compared them with corresponding records from provincial data (primarily hospital records). The results showed that over 99% of infant deaths (153/155) in the Nova Scotia provincial data were successfully located in the linked Statistics Canada file; the corresponding figure for Alberta neonatal deaths was also 99% (365/367). The distributions of gestational age and birth weight in matched cases demonstrated high agreement between the two data sources. We conclude that the computer system for probabilistic linkage developed by Statistics Canada using the available personal identifying variables in the Canadian Birth Data Base and the Canadian Mortality Data Base is valid.
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Affiliation(s)
- M Fair
- Statistics Canada, Ottawa, Ontario, Canada
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14
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Joseph KS, Allen A, Kramer MS, Cyr M, Fair M. Changes in the registration of stillbirths < 500 g in Canada, 1985-95. Fetal-Infant Mortality Study Group of the Canadian Perinatal Surveillance System. Paediatr Perinat Epidemiol 1999; 13:278-87. [PMID: 10440048 DOI: 10.1046/j.1365-3016.1999.00191.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assessed recent temporal trends in the registration of stillbirths in Canada, with particular regard to stillbirths < 500 g. Data from the Statistics Canada live birth and stillbirth databases for the period 1985-95 were used for the study. The primary analysis was restricted to data from 10 of the 12 provinces and territories of Canada. Data from Newfoundland were excluded because birthweight distributions were not available prior to 1990, and data from Ontario were excluded because of concerns about data quality. The proportion of stillbirths < 500 g increased by 47% [95% confidence interval (CI) 32, 63%], from 12.7% of stillbirths with known birthweight in 1985-7 to 18.7% in 1993-5. Similarly, the rate of stillbirths < 500 g increased by 36% [95% CI 21, 53%], from 7.2 to 9.8 per 10,000 total births from 1985-7 to 1993-5. Similar increases in stillbirth rates were not observed in other low birthweight categories. Live births < 500 g increased 53% [95% CI 33, 77%], from 4.6 to 7.0 per 10,000 live births. Some provinces and territories had low rates of stillbirths < 500 g and no increasing trend, whereas other provinces showed higher rates and increases over time. These regional differences were consistent with differences in stillbirth definitions across the provinces and territories of Canada. Spatio-temporal comparisons of crude stillbirth rates are likely to be compromised unless differences and changes in birth registration practices are addressed.
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Affiliation(s)
- K S Joseph
- Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Ottawa, Canada.
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15
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Chen J, Fair M, Wilkins R, Cyr M. Maternal education and fetal and infant mortality in Quebec. Fetal and Infant Mortality Study Group of the Canadian Perinatal Surveillance System. Health Rep 1998; 10:53-64 (Eng); 57-70 (Fre). [PMID: 9842491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES This article examines differences in fetal and infant mortality by maternal education in the province of Quebec, where the rates are among the lowest in Canada. DATA SOURCE The data are from linked birth and infant death records (including stillbirths) for the 1990-1991 birth cohorts in Quebec. MAIN RESULTS Fetal and infant mortality rates were greater for the offspring of mothers with less than 12 years of education, compared with mothers with at least 14 years, even after adjusting for maternal age, parity, marital status and infant's sex. When intermediate factors such as birthweight or both gestational age and fetal growth were taken into account, the differentials in mortality by education diminished. If all education groups had experienced the low rates attained by the higher education group, the number of fetal and infant deaths would have been reduced by approximately 20%.
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Affiliation(s)
- J Chen
- Health Statistics Division, Statistics Canada, Ottawa.
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16
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Gibbons L, Poliquin C, Fair M, Wielgosz A, Mao Y. Patterns of recurrence and survival in AMI patients in Canada. Can J Cardiol 1993; 9:661-5. [PMID: 8221365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To describe the patterns of recurrence and survival of patients following their first acute myocardial infarction (AMI). DESIGN A retrospective follow-up study based on the population of Nova Scotia and Saskatchewan from 1981-85. SUBJECTS The analyses were performed on patients aged 25 to 75 years (n = 2083) who had been admitted to hospital with their first AMI during 1981 from the provinces of Nova Scotia and Saskatchewan. MAIN RESULTS The rate of recurrence of AMI was 10% in men and 7% in women, regardless of age. Median time to recurrence was 13 to 15 months in men and seven months in women. After the first AMI, mortality rates were higher in women one week and one month after the initial infarction, reaching statistical significance (only in the 55- to 74-year-old age group)--P < 0.01 and P < 0.02, respectively. Five-year mortality rates were significantly higher in the older age groups (P < 0.01), but were similar in men and women. CONCLUSIONS Reinfarction occurs more quickly in women, who also appear to be at a higher risk of death during the first month, and especially during the first week, postinfarction.
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Affiliation(s)
- L Gibbons
- Bureau of Chronic Disease Epidemiology, Laboratory Centre for Disease Control, Ottawa, Ontario
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17
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Goldberg MS, Carpenter M, Thériault G, Fair M. The accuracy of ascertaining vital status in a historical cohort study of synthetic textiles workers using computerized record linkage to the Canadian Mortality Data Base. Can J Public Health 1993; 84:201-4. [PMID: 8358698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Vital status of a cohort of 10,211 Quebec, synthetic textiles workers was ascertained through a probabilistic record linkage to the Canadian Mortality Data Base (CMDB); 5,033 of these workers were also traced using other sources. There was agreement in the vital status of all but 60 of the subjects traced jointly through the CMDB and the alternate sources. 41 subjects were declared 'deceased' from the CMDB but 'alive' from the alternate sources; it is likely that these subjects were indeed deceased. 19 subjects, declared 'deceased' with a fair degree of certainty from the alternate sources, were not identified from the computer search of the CMDB; 17 were found manually on the microfiche death records and two died outside of Canada. The probability of identifying deceased and living subjects from the CMDB was therefore estimated to be 98.2% (95% confidence interval: 97.5-98.7%) and about 100%, respectively. Estimates of cost are also presented, and it is concluded that use of the CMDB is the method of choice for tracing moderate to large cohorts.
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Affiliation(s)
- M S Goldberg
- Département de santé communautaire, Hôpital du Sacré-Coeur de Montréal, Québec
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18
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Egedahl RD, Fair M, Homik R. Mortality among employees at a hydrometallurgical nickel refinery and fertilizer complex in Fort Saskatchewan, Alberta (1954-1984). Can J Public Health 1993; 84:40-4. [PMID: 8500056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We examined the mortality experience of 1,643 male hydrometallurgical nickel refinery and fertilizer employees who were employed at Sherritt Gordon Limited in Fort Saskatchewan, Alberta for at least 12 continuous months during the years 1954 to 1978. Mortality ascertainment was obtained utilizing the Canadian Mortality Data Base maintained by Statistics Canada and covered the years 1954 through 1984. Cause-specific mortality analyses were accomplished using male, age and calendar-year adjusted death rates for Canada and the province of Alberta. Total mortality was observed to have been significantly below expectation. Statistically significant fewer observed deaths were found for circulatory disease, ischemic heart disease and deaths due to accidents, poisonings and violence while the category "other forms of heart disease" demonstrated a statistically significant elevation of observed deaths. No association was found in this study between employment at the Sherritt Gordon hydrometallurgical nickel refinery and the subsequent development of respiratory cancer.
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Affiliation(s)
- R D Egedahl
- Department of Pharmacology and Toxicology, University of Western Ontario
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Mao Y, Semenciw R, Morrison H, Koch M, Hill G, Fair M, Wigle D. Survival rates among patients with cancer in Alberta in 1974-78. CMAJ 1988; 138:1107-13. [PMID: 3370594 PMCID: PMC1267941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We calculated 5-year crude and relative survival rates, by age and sex, for patients in Alberta in whom cancer was diagnosed between 1974 and 1978. Cancers with low overall 5-year relative survival rates (less than 35%) included stomach cancer, cancer of the pancreas, lung cancer, brain cancer, multiple myeloma and myeloid leukemia. Cancers with high overall 5-year relative survival rates (more than 70%) included melanoma, breast cancer, cancer of the uterus, cancer of the bladder and Hodgkin's disease. Five-year relative survival rates were generally lower in the highest age group (75 years or more). A strong inverse relation between age and survival was noted for brain cancer, non-Hodgkin's lymphoma, Hodgkin's disease and myeloid leukemia.
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Affiliation(s)
- Y Mao
- Laboratory Centre for Disease Control, Department of National Health and Welfare, Ottawa, Ont
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