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Damas J, Munting A, Fellay J, Haerry D, Marzolini C, Tarr PE, Steffen A, Braun DL, Stoeckle M, Bernasconi E, Tshikung ON, Fux CA, Darling KEA, Béguelin C, Wandeler G, Cavassini M, Surial B. Weight, anthropometric and metabolic changes after discontinuing antiretroviral therapy containing tenofovir alafenamide (TAF) in people with HIV. Clin Infect Dis 2024:ciae189. [PMID: 38606792 DOI: 10.1093/cid/ciae189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 01/12/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Antiretroviral therapy (ART)-related weight gain is of particular concern in people with HIV (PWH). While weight gain was observed among PWH receiving tenofovir alafenamide (TAF), little is known about the potential reversibility after TAF discontinuation. We evaluated weight and metabolic changes 12 months after TAF discontinuation in the Swiss HIV Cohort Study. METHODS We included participants who received at least six months of TAF-containing ART between January 2016 and March 2023. Using multivariable mixed-effect models, changes in weight and lipid levels were compared between individuals who continued TAF and those who switched to one of the following TAF-free regimens: TDF-based ART, dolutegravir/lamivudine (DTG/3TC), or long-acting cabotegravir/rilpivirine (CAB/RPV). RESULTS Of 6555 participants (median age 54 years, 24.3% female, 13% Black), 5485 (83.7%) continued and 1070 (16.3%) stopped TAF. Overall, discontinuing TAF was associated with an adjusted mean weight change of -0.54 kg (95% CI -0.98 to -0.11) after 12 months. In stratified analyses, switching from TAF to TDF led to an adjusted mean weight decrease of -1.84 kg (CI -2.72 to -0.97), and to a decrease in mean total cholesterol (-0.44 mmol/L) and triglycerides (-0.38 mmol/L) after 12 months. Switching from TAF-based ART to DTG/3TC (-0.17 kg, CI -0.82 to 0.48) or long-acting CAB/RPV (-0.64 kg, CI -2.16 to 0.89) did not lead to reductions in weight. CONCLUSIONS Replacing TAF with TDF in PWH led to a decrease in body weight and an improved lipid profile within one year. Weight changes were not observed among individuals who switched to DTG/3TC or long-acting CAB/RPV.
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Affiliation(s)
- José Damas
- Infectious Diseases Service, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Aline Munting
- Infectious Diseases Service, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland + Biomedical Data Science Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Catia Marzolini
- Department of Infectious Diseases, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Basel, Switzerland
| | - Ana Steffen
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marcel Stoeckle
- Department of Infectious Diseases, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Olivier Nawej Tshikung
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Katharine E A Darling
- Infectious Diseases Service, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Charles Béguelin
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Riebensahm C, Berzigotti A, Surial B, Haerry D, Günthard HF, Tarr PE, Furrer H, Rauch A, Wandeler G. Brief Report: Decreased Physical Activity and Prolonged Sitting Time Are Associated With Liver Steatosis in People With HIV. J Acquir Immune Defic Syndr 2024; 95:179-184. [PMID: 37988659 DOI: 10.1097/qai.0000000000003328] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Physical activity (PA) regulates intrahepatic storage of fat and reduces the risk of liver steatosis. Given our limited understanding of the pathogenesis of metabolic complications in people with HIV (PWH), it remains unclear whether evidence from the general population can be extrapolated to PWH. We investigated the association between PA and liver steatosis in a single site of the Swiss HIV Cohort Study. METHODS We screened consecutive Swiss HIV Cohort Study participants using vibration-controlled transient elastography and defined liver steatosis as controlled attenuation parameter ≥248 dB/m. PA was measured using the International PA Questionnaire. We evaluated the association of 3 different measures of PA with liver steatosis in separate multivariable logistic regression models. RESULTS Of 466 participants, 127 (27.3%) were female, median age was 52 years (interquartile range 43-59), and 244 (52.4%) were overweight (body mass index [BMI] ≥25 kg/m 2 ). Liver steatosis was present in 235 (50.4%) individuals. In multivariable analysis, PA below the recommendations of the European Association for the Study of the Liver was associated with steatosis (adjusted odds ratio, 2.34; 95% confidence interval [CI]: 1.44 to 3.85). Using alternative scales of PA, including metabolic equivalents task minutes (min) per week (adjusted odds ratio 0.76, 95% CI: 0.60 to 0.94) and sitting hours per day (aOR, 1.16; 1.07 to 1.26), yielded comparable results, and associations were similar when we restricted the analyses to lean (BMI <25 kg/m 2 ) subjects. CONCLUSIONS Insufficient PA and prolonged sitting time were associated with liver steatosis among PWH, independent of BMI. Our results support the importance of promoting PA to prevent liver steatosis in PWH.
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Affiliation(s)
- Carlotta Riebensahm
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hepatology, Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland; and
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Berton M, Bettonte S, Stader F, Decosterd L, Tarr PE, Livio F, Cavassini M, Braun DL, Kusejko K, Hachfeld A, Bernasconi E, Calmy A, Schmid P, Battegay M, Marzolini C. Antiretroviral Drug Exposure and Response in Obese and Morbidly Obese People With Human Immunodeficiency Virus (HIV): A Study Combining Modelling and Swiss HIV Cohort Data. Clin Infect Dis 2024; 78:98-110. [PMID: 37602428 PMCID: PMC10810714 DOI: 10.1093/cid/ciad495] [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: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Obesity is increasingly prevalent among people with HIV (PWH) and can possibly result in suboptimal antiretroviral drug (ARV) exposure and response. However, this has not been thoroughly evaluated given that obese PWH are underrepresented in clinical trials. We performed virtual trials using physiologically based pharmacokinetic (PBPK) modelling combined with observed clinical data to provide ARV dosing guidance in obese individuals. METHODS Each trial included a cohort of virtual adults with a body mass index (BMI) between 18.5 and 60 kg/m2. Therapeutic drug-monitoring data from the Swiss HIV Cohort Study (SHCS) were used to verify the predictive performance of the model. Subsequently, the model was applied to predict the pharmacokinetics of ARVs for different obesity classes. The association between ARV plasma concentrations and virological response was investigated in obese and nonobese individuals. RESULTS The PBPK model predicted an average reduction in ARV exposure of ∼20% and trough concentrations of ∼6% in obese (BMI ≥30 kg/m2) compared with nonobese (BMI: 18.5-25 kg/m2) individuals, consistent with observed clinical data. Etravirine and rilpivirine were the most impacted, especially in individuals with BMI >40 kg/m2 whose trough concentrations were below the clinical target threshold. Obese PWH in the SHCS did not have a higher rate of unsuppressed viral load than nonobese PWH. CONCLUSIONS The concentrations of ARVs are modestly reduced in obese individuals, with no negative impact on the virological response. Our data provide reassurance that standard doses of ARVs are suitable in obese PWH, including those who gained substantial weight with some of the first-line ARVs.
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Affiliation(s)
- Mattia Berton
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sara Bettonte
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Laurent Decosterd
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Françoise Livio
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Patrick Schmid
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Service and Laboratory of Clinical Pharmacology, Department of Laboratory Medicine and Pathology, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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Lüthi-Corridori G, Roth AI, Boesing M, Jaun F, Tarr PE, Leuppi-Taegtmeyer AB, Leuppi JD. Diagnosis and Therapy of Community-Acquired Pneumonia in the Emergency Department: A Retrospective Observational Study and Medical Audit. J Clin Med 2024; 13:574. [PMID: 38276080 PMCID: PMC10816545 DOI: 10.3390/jcm13020574] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite advances in therapy, community-acquired pneumonia (CAP) is still associated with significant morbidity and mortality. Several studies conducted in different countries have reported suboptimal adherence to the guidelines. However, there are currently no available data on adherence to CAP guidelines specifically in Switzerland. OBJECTIVES The aim of this study was to audit the quality of diagnosis and therapy of CAP at a Swiss general hospital. METHODS A retrospective, observational, single-center cohort study was conducted, including patients older than 18 years diagnosed with CAP and admitted to a medical ward throughout 2019 without prior antibiotic therapy prescribed by their general practitioner (GP). The baseline characteristics of the patients were analyzed, and the diagnostic workup and treatment were compared to the Swiss guidelines for CAP. RESULTS A total of 254 patients diagnosed with CAP were included in this study (median age 78 years, 51.6% males). Atypical pneumonia was diagnosed in 4% of patients, while an organism was identified in 33% of cases, with Streptococcus pneumoniae being the most frequently detected pathogen (57%). A chest image was taken in almost all patients. Documentation of respiratory rate was missing in 23% of cases. Procalcitonin was measured in 23.2% of cases. Pneumococcal and legionella urinary antigen testing was performed on approximately 90% of all patients and blood cultures were drawn in approximately 80% of patients. In 39% of cases, arterial blood gas analysis was performed. Guideline adherence for the administration of empiric antibiotics was documented/recorded in 75% of cases. Twelve different antibiotic regimens were administered, and they were mostly amoxicillin/clavulanate with or without macrolides, as suggested by the guidelines. In particular, the use of ceftriaxone was higher (19.7%) compared to the Swiss guidelines. The average length of antibiotic therapy was longer (8.2 days) compared to the guidelines (5-7 days). Oral steroid therapy was administered to 29.1% of patients, including to 75% of those diagnosed with COPD. CONCLUSION Overall, guideline adherence was moderately low, especially with regards to the assessment of respiratory rate, performance of arterial blood gas analysis, and sputum collection. Regarding antibiotic therapy, the use of ceftriaxone and the length of antibiotic therapy should be reduced. Further research is needed to identify the reasons for guideline non-adherence, and to find effective measures for the improvement of guideline adherence.
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Affiliation(s)
- Giorgia Lüthi-Corridori
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Andrea I. Roth
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Maria Boesing
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Fabienne Jaun
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Philip E. Tarr
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- University Center for Internal Medicine, Infectious Diseases and Hospital Epidemiology Service, Cantonal Hospital Baselland, 4101 Bruderholz, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4031 Basel, Switzerland
| | - Jörg D. Leuppi
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
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Hovaguimian F, Kouyos RD, Kusejko K, Schmidt AJ, Tarr PE, Bernasconi E, Braun DL, Calmy A, Notter J, Stoeckle M, Surial B, Christinet V, Darling KEA, Depmeier C, Läuchli S, Reinacher M, Rasi M, Nicca D, Bruggmann P, Haerry D, Bize R, Low N, Vock F, El Amari EB, Böni J, Bosshard PP, Fehr JS, Hampel B. Incidence of sexually transmitted infections and association with behavioural factors: Time-to-event analysis of a large pre-exposure prophylaxis (PrEP) cohort. HIV Med 2024; 25:117-128. [PMID: 37771207 DOI: 10.1111/hiv.13543] [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: 03/24/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Our objective was to obtain long-term data on the incidence of sexually transmitted infections (STIs) and their association with behavioural factors after widespread pre-exposure prophylaxis (PrEP) implementation. METHODS This was a time-to-event analysis of a national PrEP cohort in Switzerland (SwissPrEPared study). Participants were people without HIV interested in taking PrEP with at least two STI screening visits. Primary outcomes were incidence rate of gonorrhoea, chlamydia, and syphilis. The association between behavioural factors and STI diagnosis was expressed using hazard ratios. We adjusted for testing frequency and calendar year. RESULTS This analysis included 3907 participants enrolled between April 2019 and April 2022, yielding 3815.7 person-years of follow-up for gonorrhoea (15 134 screenings), 3802.5 for chlamydia (15 141 screenings), and 3858.6 for syphilis (15 001 screenings). The median age was 39 years (interquartile range [IQR] 32-47), 93.8% (n = 3664) identified as men who have sex with men (MSM). The incidence was 22.8 (95% confidence interval [CI] 21.3-24.4) per 100 person-years for gonorrhoea, 26.3 (95% CI 24.7-28.0) for chlamydia, and 4.4 (95% CI 3.8-5.1) for syphilis. Yearly incidence rates decreased between 2019 (all bacterial STIs: 81.6; 95% CI 59.1-109.9) and 2022 (all bacterial STIs: 49.8; 95% CI 44.6-55.3). Participants reporting chemsex substance use were at higher risk of incident STIs, as were those reporting multiple sexual partners. Younger age was associated with a higher risk of gonorrhoea and chlamydia. CONCLUSIONS Incidence rates of bacterial STIs decreased over time. Young MSM, those with multiple partners, and those using chemsex substances were at increased risk of STIs.
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Affiliation(s)
- Frédérique Hovaguimian
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Philip E Tarr
- Kantonsspital Baselland, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedialiero Cantonale, Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Julia Notter
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Katharine E A Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Severin Läuchli
- Dermatologic Center Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Reinacher
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Manuela Rasi
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dunja Nicca
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | | | - Raphaël Bize
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philipp P Bosshard
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan S Fehr
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Benjamin Hampel
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Checkpoint Zurich, Zurich, Switzerland
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Schwenke JM, Thorball CW, Schoepf IC, Ryom L, Hasse B, Lamy O, Calmy A, Wandeler G, Marzolini C, Kahlert CR, Bernasconi E, Kouyos RD, Günthard HF, Ledergerber B, Fellay J, Burkhalter F, Tarr PE. Association of a Polygenic Risk Score With Osteoporosis in People Living With HIV: The Swiss HIV Cohort Study. J Infect Dis 2023; 228:742-750. [PMID: 37225667 PMCID: PMC10503954 DOI: 10.1093/infdis/jiad179] [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: 02/10/2023] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Bone mineral density (BMD) loss may be accelerated in people with HIV (PLWH). It is unknown whether a polygenic risk score (PRS) is associated with low BMD in PLWH. METHODS Swiss HIV Cohort Study participants of self-reported European descent underwent ≥2 per-protocol dual x-ray absorptiometry (DXA) measurements ≥2 years apart (2011-2020). Univariable and multivariable odds ratios (ORs) for DXA-defined osteoporosis were based on traditional and HIV-related risk factors and a genome-wide PRS built from 9413 single-nucleotide polymorphisms associated with low BMD in the general population. Controls were free from osteoporosis/osteopenia on all DXA measurements. RESULTS We included 438 participants: 149 with osteoporosis and 289 controls (median age, 53 years; 82% male, 95% with suppressed HIV RNA). Participants with unfavorable osteoporosis PRS (top vs bottom quintile) had univariable and multivariable-adjusted osteoporosis ORs of 4.76 (95% CI, 2.34-9.67) and 4.13 (1.86-9.18), respectively. For comparison, hepatitis C seropositivity, 5-year tenofovir disoproxil fumarate exposure, and parent history of hip fracture yielded univariable osteoporosis ORs of 2.26 (1.37-3.74), 1.84 (1.40-2.43), and 1.54 (0.82-2.9). CONCLUSIONS In PLWH in Switzerland, osteoporosis was independently associated with a BMD-associated PRS after adjustment for established risk factors, including exposure to tenofovir disoproxil fumarate.
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Affiliation(s)
- Johannes M Schwenke
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital, University of Lausanne
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne
| | - Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Lene Ryom
- CHIP, Centre of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen
- Department of Infectious Diseases, Hvidovre University Hospital, Denmark
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich
| | - Olivier Lamy
- Bone Unit, Lausanne University Hospital, University of Lausanne
| | | | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
| | | | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale Lugano, University of Geneva and Università della Svizzera italiana, Lugano
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich
- Institute of Medical Virology, University of Zurich
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich
- Institute of Medical Virology, University of Zurich
| | - Bruno Ledergerber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital, University of Lausanne
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne
| | - Felix Burkhalter
- University Department of Nephrology and Dialysis, Kantonsspital Baselland, University of Basel,Bruderholz, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz
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Surial B, Chammartin F, Damas J, Calmy A, Haerry D, Stöckle M, Schmid P, Bernasconi E, Fux CA, Tarr PE, Günthard HF, Wandeler G, Rauch A. Impact of Integrase Inhibitors on Cardiovascular Disease Events in People With Human Immunodeficiency Virus Starting Antiretroviral Therapy. Clin Infect Dis 2023; 77:729-737. [PMID: 37157869 PMCID: PMC10495132 DOI: 10.1093/cid/ciad286] [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: 02/18/2023] [Revised: 04/15/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) have been associated with an increased risk for cardiovascular disease (CVD) events. We investigated the impact of starting INSTI-based antiretroviral therapy (ART) on CVD events among treatment-naïve people with human immunodeficiency virus using a target trial framework, which reduces the potential for confounding and selection bias. METHODS We included Swiss HIV Cohort Study participants who were ART-naïve after May 2008, when INSTIs became available in Switzerland. Individuals were categorized according to their first ART regimen (INSTI vs other ART) and were followed from ART start until the first of CVD event (myocardial infarction, stroke, or invasive cardiovascular procedure), loss to follow-up, death, or last cohort visit. We calculated hazard ratios and risk differences using pooled logistic regression models with inverse probability of treatment and censoring weights. RESULTS Of 5362 participants (median age 38 years, 21% women, 15% of African origin), 1837 (34.3%) started INSTI-based ART, and 3525 (65.7%) started other ART. Within 4.9 years (interquartile range, 2.4-7.4), 116 CVD events occurred. Starting INSTI-based ART was not associated with an increased risk for CVD events (adjusted hazard ratio, 0.80; 95% confidence interval [CI], .46-1.39). Adjusted risk differences between individuals who started INSTIs and those who started other ART were -0.17% (95% CI, -.37 to .19) after 1 year, -0.61% (-1.54 to 0.22) after 5 years, and -0.71% (-2.16 to 0.94) after 8 years. CONCLUSIONS In this target trial emulation, we found no difference in short- or long-term risk for CVD events between treatment-naïve people with human immunodeficiency virus who started INSTI-based ART and those on other ART.
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Affiliation(s)
- Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - José Damas
- Division of Infectious Diseases, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | | | - Marcel Stöckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Christoph A Fux
- Division of Infectious Diseases, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zimmermann C, Jusufoska M, Tolic J, Abreu de Azevedo M, Tarr PE, Deml MJ. Pharmacists' approaches to vaccination consultations in Switzerland: a qualitative study comparing the roles of complementary and alternative medicine (CAM) and biomedicine. BMJ Open 2023; 13:e074883. [PMID: 37696631 PMCID: PMC10496653 DOI: 10.1136/bmjopen-2023-074883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Many community pharmacies in Switzerland provide complementary and alternative medicine (CAM) approaches in addition to providing biomedical services, and a few pharmacies specialise in CAM. A common perception is that CAM providers are sceptical towards, or opposed to, vaccination. OBJECTIVES Key objectives of this study are to examine the potential roles of biomedically oriented and CAM-specialised pharmacists regarding vaccine counselling and to better understand the association between vaccine hesitancy and CAM. DESIGN We conducted semistructured, qualitative interviews. Transcripts were coded and analysed using thematic analysis. Interview questions were related to: type of pharmaceutical care practised, views on CAM and biomedicine, perspectives on vaccination, descriptions of vaccination consultations in community pharmacies and views on vaccination rates. SETTING Qualitative interviews in three language regions of Switzerland (German, French and Italian). PARTICIPANTS We interviewed 18 pharmacists (N=11 biomedically oriented, N=7 CAM specialised). RESULTS Pharmacist participants expressed generally positive attitudes towards vaccination. Biomedically oriented pharmacists mainly advised customers to follow official vaccination recommendations but rarely counselled vaccine-hesitant customers. CAM-specialised pharmacists were not as enthusiastic advocates of the Swiss vaccination recommendations as the biomedically oriented pharmacists we interviewed. Rather, they considered that each customer should receive individualised, nuanced vaccination advice so that customers can reach their own decisions. CAM-specialised pharmacists described how mothers in particular preferred getting a second opinion when they felt insufficiently advised by biomedically oriented paediatricians. CONCLUSIONS Vaccination counselling in community pharmacies represents an additional option to customers who have unmet vaccination consultation needs and who seek reassurance from healthcare professionals (HCPs) other than physicians. By providing individualised vaccination counselling to vaccine-hesitant customers, CAM-specialised pharmacists are likely meeting specific needs of vaccine-hesitant customers. As such, research and implementation efforts should more systematically involve pharmacists as important actors in vaccination provision. CAM-specialised pharmacists particularly should not be neglected as they are important HCPs who counsel vaccine-hesitant customers.
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Affiliation(s)
- Clara Zimmermann
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Meliha Jusufoska
- University of Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Josipa Tolic
- University of Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Marta Abreu de Azevedo
- University of Basel, Basel, Switzerland
- Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - Michael J Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
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Avery EF, Kleynhans JN, Ledergerber B, Schoepf IC, Thorball CW, Kootstra NA, Reiss P, Ryom L, Braun DL, Thurnheer MC, Marzolini C, Seneghini M, Bernasconi E, Cavassini M, Buvelot H, Kouyos RD, Fellay J, Günthard HF, Tarr PE. Leukocyte Count and Coronary Artery Disease Events in People With Human Immunodeficiency Virus: A Longitudinal Study. Clin Infect Dis 2023; 76:1969-1979. [PMID: 36688465 PMCID: PMC10249993 DOI: 10.1093/cid/ciad033] [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: 08/26/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND People with human immunodeficiency virus (HIV; PWH) have increased cardiovascular risk. Higher leukocyte count has been associated with coronary artery disease (CAD) events in the general population. It is unknown whether the leukocyte-CAD association also applies to PWH. METHODS In a case-control study nested within the Swiss HIV Cohort Study, we obtained uni- and multivariable odds ratios (OR) for CAD events, based on traditional and HIV-related CAD risk factors, leukocyte count, and confounders previously associated with leukocyte count. RESULTS We included 536 cases with a first CAD event (2000-2021; median age, 56 years; 87% male; 84% with suppressed HIV RNA) and 1464 event-free controls. Cases had higher latest leukocyte count before CAD event than controls (median [interquartile range], 6495 [5300-7995] vs 5900 [4910-7200]; P < .01), but leukocytosis (>11 000/µL) was uncommon (4.3% vs 2.1%; P = .01). In the highest versus lowest leukocyte quintile at latest time point before CAD event, participants had univariable CAD-OR = 2.27 (95% confidence interval, 1.63-3.15) and multivariable adjusted CAD-OR = 1.59 (1.09-2.30). For comparison, univariable CAD-OR for dyslipidemia, diabetes, and recent abacavir exposure were 1.58 (1.29-1.93), 2.19 (1.59-3.03), and 1.73 (1.37-2.17), respectively. Smoking and, to a lesser degree, alcohol and ethnicity attenuated the leukocyte-CAD association. Leukocytes measured up to 8 years before the event were significantly associated with CAD events. CONCLUSIONS PWH in Switzerland with higher leukocyte counts have an independently increased risk of CAD events, to a degree similar to traditional and HIV-related risk factors.
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Affiliation(s)
- Emma F Avery
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Julia N Kleynhans
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Hepatology, Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Global Health and Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Lene Ryom
- Centre of Excellence for Health, Immunity, and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Maria C Thurnheer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Marco Seneghini
- Division of Infectious Diseases, Kantonsspital St Gallen, St. Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale Lugano, University of Geneva and Università della Svizzera italiana, Lugano, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hélène Buvelot
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Schoepf IC, Esteban-Cantos A, Thorball CW, Rodés B, Reiss P, Rodríguez-Centeno J, Riebensahm C, Braun DL, Marzolini C, Seneghini M, Bernasconi E, Cavassini M, Buvelot H, Thurnheer MC, Kouyos RD, Fellay J, Günthard HF, Arribas JR, Ledergerber B, Tarr PE. Epigenetic ageing accelerates before antiretroviral therapy and decelerates after viral suppression in people with HIV in Switzerland: a longitudinal study over 17 years. Lancet Healthy Longev 2023; 4:e211-e218. [PMID: 37148893 DOI: 10.1016/s2666-7568(23)00037-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Accelerated epigenetic ageing can occur in untreated HIV infection and is partially reversible with effective antiretroviral therapy (ART). We aimed to make a long-term comparison of epigenetic ageing dynamics in people with HIV during untreated HIV infection and during suppressive ART. METHODS In this longitudinal study, conducted over 17 years in HIV outpatient clinics in Switzerland, we applied 5 established epigenetic age estimators (epigenetic clocks) in peripheral blood mononuclear cells (PBMCs) in Swiss HIV Cohort Study participants before or during suppressive ART. All participants had a longitudinal set of PBMC samples available at four timepoints (T1-T4). T1 and T2 had to be 3 years or longer apart, as did T3 and T4. We assessed epigenetic age acceleration (EAA) and a novel rate of epigenetic ageing. FINDINGS Between March 13, 1990, and Jan 18, 2018, we recruited 81 people with HIV from the Swiss HIV Cohort Study. We excluded one participant because a sample did not meet quality checks (transmission error). 52 (65%) of 80 patients were men, 76 (95%) were white, and the median patient age was 43 (IQR 37·5-47) years. Per year of untreated HIV infection (median observation 8·08 years, IQR 4·83-11·09), mean EAA was 0·47 years (95% CI 0·37 to 0·57) for Horvath's clock, 0·43 years (0·3 to 0·57) for Hannum's clock, 0·36 years (0·27 to 0·44) for SkinBlood clock, and 0·69 years (0·51 to 0·86) for PhenoAge. Per year of suppressive ART (median observation 9·8 years, IQR 7·2-11), mean EAA was -0·35 years (95% CI -0·44 to -0·27) for Horvath's clock, -0·39 years (-0·50 to -0·27) for Hannum's clock, -0·26 years (-0·33 to -0·18) for SkinBlood clock, and -0·49 years (-0·64 to -0·35) for PhenoAge. Our findings indicate that people with HIV epigenetically aged by a mean of 1·47 years for Horvath's clock, 1·43 years for Hannum's clock, 1·36 years for SkinBlood clock, and 1·69 years for PhenoAge per year of untreated HIV infection; and 0·65 years for Horvath's clock, 0·61 years for Hannum's clock, 0·74 years for SkinBlood clock, and 0·51 years for PhenoAge, per year of suppressive ART. GrimAge showed some change in the mean EAA during untreated HIV infection (0·10 years, 0·02 to 0·19) and suppressive ART (-0·05 years, -0·12 to 0·02). We obtained very similar results using the rate of epigenetic ageing. Contribution of multiple HIV-related, antiretroviral, and immunological variables, and of a DNA methylation-associated polygenic risk score to EAA was small. INTERPRETATION In a longitudinal study over more than 17 years, epigenetic ageing accelerated during untreated HIV infection and decelerated during suppressive ART, highlighting the importance of limiting the duration of untreated HIV infection. FUNDING Swiss HIV Cohort Study, Swiss National Science Foundation, and Gilead Sciences.
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Affiliation(s)
- Isabella C Schoepf
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Andrés Esteban-Cantos
- HIV/AIDS and Infectious Diseases Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain; CIBER of Infectious Diseases, Madrid, Spain
| | - Christian W Thorball
- Precision Medicine Unit, Centre hospitalier universitaire vaudois, Switzerland; School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Berta Rodés
- HIV/AIDS and Infectious Diseases Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain; CIBER of Infectious Diseases, Madrid, Spain
| | - Peter Reiss
- Amsterdam UMC, location University of Amsterdam, Global Health, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Javier Rodríguez-Centeno
- HIV/AIDS and Infectious Diseases Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain; CIBER of Infectious Diseases, Madrid, Spain
| | - Carlotta Riebensahm
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Dominique L Braun
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Marco Seneghini
- Division of Infectious Diseases, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ente Ospedaliero Cantonale, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital University of Lausanne, Switzerland
| | - Hélène Buvelot
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | | | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Centre hospitalier universitaire vaudois, Switzerland; School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland; Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - José R Arribas
- HIV/AIDS and Infectious Diseases Research Group, Hospital La Paz Institute for Health Research, Madrid, Spain; CIBER of Infectious Diseases, Madrid, Spain
| | - Bruno Ledergerber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.
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Schoepf IC, Thorball CW, Kovari H, Ledergerber B, Buechel RR, Calmy A, Weber R, Kaufmann PA, Nkoulou R, Schwenke JM, Braun DL, Fellay J, Tarr PE. Polygenic Risk Scores for Prediction of Subclinical Coronary Artery Disease in Persons With Human Immunodeficiency Virus (HIV): The Swiss HIV Cohort Study. Clin Infect Dis 2023; 76:48-56. [PMID: 36097729 DOI: 10.1093/cid/ciac758] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In people with human immunodeficiency virus (HIV) (PWH), individual polygenic risk scores (PRSs) are associated with coronary artery disease (CAD) events. Whether PRSs are associated with subclinical CAD is unknown. METHODS In Swiss HIV Cohort Study participants of European descent, we defined subclinical CAD as presence of soft, mixed, or high-risk plaque (SMHRP) on coronary computed tomography (CT) angiography, or as participants in the top tertile of the study population's coronary artery calcium (CAC) score, using noncontrast CT. We obtained univariable and multivariable odds ratios (ORs) for subclinical CAD endpoints based on nongenetic risk factors, and validated genome-wide PRSs built from single nucleotide polymorphisms associated with CAD, carotid intima-media thickness (IMT), or longevity in the general population. RESULTS We included 345 genotyped participants (median age, 53 years; 89% male; 96% suppressed HIV RNA); 172 and 127 participants had SMHRP and CAC, respectively. CAD-associated PRS and IMT-associated PRS were associated with SMHRP and CAC (all P < .01), but longevity PRS was not. Participants with unfavorable CAD-PRS (top quintile) had an adjusted SMHRP OR = 2.58 (95% confidence interval [CI], 1.18-5.67), and a CAC OR = 3.95 (95% CI, 1.45-10.77) vs. bottom quintile. Unfavorable nongenetic risk (top vs. bottom quintile) was associated with adjusted SMHRP OR = 24.01 (95% CI, 9.75-59.11), and a CAC-OR = 65.07 (95% CI, 18.48-229.15). Area under the receiver operating characteristic curve increased when we added CAD-PRS to nongenetic risk factors (SMHRP: 0.75 and 0.78, respectively; CAC: 0.80 and 0.83, respectively). CONCLUSIONS In Swiss PWH, subclinical CAD is independently associated with an individual CAD-associated PRS. Combining nongenetic and genetic cardiovascular risk factors provided the most powerful subclinical CAD prediction.
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Affiliation(s)
- Isabella C Schoepf
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Hepatology, Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Johannes M Schwenke
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Lucas Ramanathan P, Baldesberger N, Dietrich LG, Speranza C, Lüthy A, Buhl A, Gisin M, Koch R, Nicca D, Suggs LS, Huber BM, Deml MJ, Tarr PE. Health Care Professionals' Interest in Vaccination Training in Switzerland: A Quantitative Survey. Int J Public Health 2022; 67:1604495. [PMID: 36531605 PMCID: PMC9749818 DOI: 10.3389/ijph.2022.1604495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/14/2022] [Indexed: 08/27/2023] Open
Abstract
Objectives: Health care professionals (HCPs) play an important role for patients' vaccination decisions. To counsel patients/clients appropriately, HCPs need current factual knowledge about vaccines and strong communication skills. Methods: We conducted an online survey with physicians, pharmacists, nurses, and midwives in Switzerland (01.11.2020-31.03.2021). We evaluated: 1) interest in vaccination knowledge and counseling training; 2) vaccination recommendation practices; 3) experience with vaccination counseling/administration; 4) comfort level in addressing vaccine hesitancy (VH); 5) perspectives on patient/client VH, delays, and refusals. Results: In total, 1,933 practicing HCPs responded (496 physicians, 226 pharmacists, 607 nurses, 604 midwives). 43% physicians, 31% pharmacists, 15% nurses, and 23% midwives felt comfortable counseling VH patients/clients. 96% physicians, 98% pharmacists, 85% nurses, and 91% midwives were interested in additional vaccination-related training. All professionals mentioned safety, efficacy, and side effects as topics of most interest for additional training. Conclusion: Results demonstrate a high interest among HCPs for additional vaccination-related training. In addition to factual information about vaccination, such training will likely benefit from a communication component, given the low rates of comfort reported by HCPs when counseling VH patients/clients.
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Affiliation(s)
- Pia Lucas Ramanathan
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
- Pharmaceutical Care Research Group, Basel, Switzerland
| | - Nadja Baldesberger
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
- Pharmaceutical Care Research Group, Basel, Switzerland
| | - Léna G. Dietrich
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Camilla Speranza
- Institute of Public Health, and Institute of Communication and Public Policy, Università della Svizzera italiana, Lugano, Switzerland
| | - Alyssa Lüthy
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Buhl
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
| | - Martina Gisin
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | | | - Dunja Nicca
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - L. Suzanne Suggs
- Institute of Public Health, and Institute of Communication and Public Policy, Università della Svizzera italiana, Lugano, Switzerland
- Swiss School of Public Health, Zurich, Switzerland
| | - Benedikt M. Huber
- Center for Integrative Pediatrics, Department of Pediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Michael J. Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
| | - Philip E. Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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Riebensahm C, Berzigotti A, Surial B, Günthard HF, Tarr PE, Furrer H, Rauch A, Wandeler G. Factors Associated With Liver Steatosis in People With Human Immunodeficiency Virus on Contemporary Antiretroviral Therapy. Open Forum Infect Dis 2022; 9:ofac538. [PMID: 36381613 PMCID: PMC9648562 DOI: 10.1093/ofid/ofac538] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/12/2022] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Given the impact of new antiretroviral drugs on weight and metabolic parameters, their potential contribution to the development of liver steatosis is of concern. We investigated the determinants of liver steatosis in patients on antiretroviral therapy (ART) in the Swiss HIV Cohort Study (SHCS). METHODS Between 2019 and 2021, we measured liver stiffness and controlled attenuation parameter (CAP) using transient elastography in consecutive SHCS participants at Bern University Hospital. Individuals with viral hepatitis coinfection and pregnant women were excluded. We used multivariable logistic regression to explore factors associated with steatosis. RESULTS Of 416 participants, 113 (27.2%) were female, median age was 51 years (interquartile range [IQR], 43-59), 305 (73.3%) were of European origin, and 212 (51.0%) were overweight/obese (body mass index [BMI] ≥25 kg/m2). Liver steatosis (CAP ≥248 dB/m) was present in 212 (51.0%) participants, 11 (5.2%) of whom had significant fibrosis or cirrhosis. One hundred seventy-nine (43.0%) met the criteria for metabolic-associated fatty liver disease (MAFLD). Among 64 individuals with a BMI <25 kg/m2 and liver steatosis, 31 (48.4%) had MAFLD. In multivariable analyses, BMI ≥25 kg/m2 (adjusted odds ratio, 5.76; 95% confidence interval, 3.57-9.29), age ≥50 years (1.88, 1.14-3.09), European origin (3.16, 1.69-5.89), and current use of tenofovir alafenamide (1.70, 1.08-2.69) were associated with liver steatosis. Exposure to integrase inhibitors was not associated with liver steatosis (0.83, 0.51-1.37). CONCLUSIONS Our findings suggest a high prevalence of liver steatosis among people with HIV (PWH) on ART in Switzerland. In addition to established risk factors, the use of tenofovir alafenamide was associated with hepatic steatosis.
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Affiliation(s)
- Carlotta Riebensahm
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Annalisa Berzigotti
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hepatology, Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Bernard Surial
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Huldrych F Günthard
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Kiener LM, Schwendener CL, Jafflin K, Meier A, Reber N, Schärli Maurer S, Muggli F, Gültekin N, Huber BM, Merten S, Deml MJ, Tarr PE. Vaccine hesitancy and HPV vaccine uptake among male and female youth in Switzerland: a cross-sectional study. BMJ Open 2022; 12:e053754. [PMID: 35450894 PMCID: PMC9024257 DOI: 10.1136/bmjopen-2021-053754] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Identifying factors associated with human papillomavirus (HPV) vaccine uptake is essential for designing successful vaccination programmes. We aimed to examine the association between vaccine hesitancy (VH) and HPV vaccine uptake among male and female youth in Switzerland. DESIGN With a cross-sectional study, an interview-based questionnaire was used to collect information on sociodemographic factors, vaccination records and to measure the prevalence of VH using the Youth Attitudes about Vaccines scale (YAV-5), a modified version of the Parent Attitudes about Childhood Vaccinations survey instrument. SETTING AND PARTICIPANTS Eligible male and female participants, 15-26 years of age, were recruited through physicians' offices and military enlistment in all three language regions of Switzerland. Of 1001 participants, we included 674 participants with a vaccination record available (415 males and 259 females) in this study. PRIMARY AND SECONDARY OUTCOME MEASURES The outcome was uptake for HPV vaccine (having received ≥1 dose of HPV vaccine). Covariates were VH, sex, age and other sociodemographics. RESULTS 151 (58%) female and 64 (15%) male participants received ≥1 dose of HPV vaccine. 81 (31%) female and 92 (22%) male participants were VH (YAV-5-Score >50). The odds for being unvaccinated were higher for VH women than non-VH women, adjusted OR=4.90 (95% CI 2.53 to 9.50), but similar among VH and non-VH men, OR=1.90 (95% CI 0.84 to 4.31). The odds for being unvaccinated were lower for younger men (born on or after 1 July 2002) than older men (born before 1 July 2002), OR=0.34 (95% CI 0.14 to 0.81), but we found no association between age and vaccine uptake for female youth, OR=0.97 (95% CI 0.48 to 1.97). CONCLUSIONS VH was associated with lower HPV vaccine uptake in female youth but not male youth in our study population in Switzerland. Our findings suggest that issues other than VH contribute to HPV underimmunisation in male youth in Switzerland.
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Affiliation(s)
- Laura M Kiener
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Corina L Schwendener
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Audrey Meier
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Noah Reber
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Franco Muggli
- Rekrutierungszentrum Monte Ceneri, Schweizer Armee, Monte Ceneri, Switzerland
| | - Nejla Gültekin
- Kompetenzzentrum für Militär- und Katastrophenmedizin, Eidgenössisches Departement für Verteidigung, Bevölkerungsschutz und Sport VBS Schweizer Armee, Ittigen, Switzerland
| | - Benedikt M Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Michael J Deml
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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15
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Ebi SJ, Deml MJ, Jafflin K, Buhl A, Engel R, Picker J, Häusler J, Wingeier B, Krüerke D, Huber BM, Merten S, Tarr PE. Parents' vaccination information seeking, satisfaction with and trust in medical providers in Switzerland: a mixed-methods study. BMJ Open 2022; 12:e053267. [PMID: 35228281 PMCID: PMC8886431 DOI: 10.1136/bmjopen-2021-053267] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this study was to better understand parental trust in and satisfaction with information sources and medical providers regarding decision making about childhood vaccines. SETTING The study was part of a Swiss national research programme investigating vaccine hesitancy and underimmunisation. PARTICIPANTS We conducted qualitative interviews with 37 providers and 30 parents, observed 34 vaccination consultations, and then conducted quantitative surveys with 130 providers (both complementary and alternative medicine (CAM) oriented and biomedically oriented) and 1390 parents. MAIN OUTCOME MEASURES Participants' vaccination information sources used in their decision-making process, parents' trust in and satisfaction with these sources and providers. RESULTS Based on the Parent Attitudes about Childhood Vaccines scale, we considered 501 parents as vaccine-hesitant (VH) and 889 parents as non-VH. Whereas both groups mentioned providers as the most trusted source of information, VH-parents were less likely to mention paediatricians (N=358 (71%) vs N=755 (85%)) and public health authorities (N=101 (20%) vs N=333 (37%)) than non-VH-parents. VH-parents were more likely to have consulted another provider (N=196 (39%) vs N=173 (19%)) than non-VH-parents, to express less satisfaction with both their primary (N=342 (82%) vs N=586 (91%)) and other providers (N=82 (42%) vs N=142 (82%)) and less trust in their primary (N=368 (88%) vs N=632 (98%)) and other providers (N=108 (55%) vs N=146 (84%)). VH-parents were less likely to be satisfied with their biomedical primary provider than non-VH-parents (100 (69%) vs 467 (91%)). However, when the primary provider was CAM-oriented, there were similar levels of satisfaction among both groups (237 (89%) VH-parents vs 118 (89%) non-VH-parents). All differences were significant (p<0.05). CONCLUSIONS While the provider remains the main information source, VH parents turn to additional sources and providers, which is likely related to VH parents being rather dissatisfied with and distrusting in obtained information and their provider. ETHICS The local ethics committee (Ethikkommission Nordwest- und Zentralschweiz, EKNZ; project ID number 2017-00725) approved the study.
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Affiliation(s)
- Selina Jana Ebi
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Michael J Deml
- Department of Sociology, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
| | - Kristen Jafflin
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andrea Buhl
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Rebecca Engel
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Picker
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Häusler
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Benedikt M Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Philip E Tarr
- Medizinische Universitätsklinik Kantonsspital Baselland, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
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16
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Hachfeld A, Atkinson A, Stute P, Calmy A, Tarr PE, Darling K, Babouee Flury B, Polli C, Sultan-Beyer L, Abela IA, Aebi-Popp K. Women with HIV transitioning through menopause: Insights from the Swiss HIV Cohort Study (SHCS). HIV Med 2022; 23:417-425. [PMID: 35194949 PMCID: PMC9306735 DOI: 10.1111/hiv.13255] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to assess prevalence and age at menopause, identify factors associated with early menopause and explore the provision and utilization of healthcare in women living with HIV in Switzerland. Methods This was a retrospective Swiss HIV Cohort Study analysis from January 2010 to December 2018. Descriptive statistics to characterise the population and menopause onset. Logistic regression analysis to identify risk factors for early menopause. Results Of all women in the SHCS, the proportion of postmenopausal women tripled from 11.5% (n = 274) in 2010 to 36.1% (n = 961) in 2018. The median age at menopause was 50 years. Early menopause (< 45 years) occurred in 115 (10.2%) women and premature ovarian insufficiency (POI) (< 40 years) in 23 (2%) women. Early menopause was associated with black ethnicity (52.2% vs. 21.6%, p < 0.001), but not with HIV acquisition mode, CDC stage, viral suppression, CD4 cell count, hepatitis C, smoking or active drug use. While 92% of the postmenopausal women underwent a gynaecological examination during the 36 months before menopause documentation, only 27% received a bone mineral density measurement within 36 months after the last bleed and 11% were on hormone replacement therapy at the time of menopause documentation. Conclusions The median age of women living with HIV at menopause is around 2 years lower than that reported for HIV‐negative women in Switzerland. HIV care providers need to adapt their services to the requirements of the increasing number of women living with HIV transitioning through menopause. They should be able to recognize menopause‐associated symptoms and improve access to bone mineral density measurement as well as hormone replacement therapy.
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Affiliation(s)
- Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Petra Stute
- Departement of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexandra Calmy
- Department of Infectious Diseases University Hospital Geneva, Geneva, Switzerland
| | - Philip E Tarr
- Department of Infectious Diseases, University Hospital Basel, Bruderholz, Switzerland
| | - Katharine Darling
- Department of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Christian Polli
- Department of Obstetrics and Gynecology, Regional Hospital, Lugano, Switzerland
| | - Leila Sultan-Beyer
- Department of Obstetrics and Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Irene A Abela
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zürich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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Tepekule B, Kusejko K, Zeeb M, Tarr PE, Calmy A, Battegay M, Furrer H, Cavassini M, Bernasconi E, Notter J, Günthard HF, Nemeth J, Kouyos RD. Impact of Latent Tuberculosis Infection on the Incidence of Type 2 Diabetes Mellitus in HIV-Infected Participants in the Swiss HIV Cohort Study. J Infect Dis 2022; 225:2229-2234. [PMID: 35172332 DOI: 10.1093/infdis/jiac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/04/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
While an increased risk of active and latent tuberculosis infection (LTBI) in people with type-2 diabetes (DM) has been demonstrated, it is less well characterized whether LTBI is associated with an increased risk of developing DM. We investigated the link between LTBI and DM in people living with HIV (PHIV) in the Swiss HIV Cohort Study via time-dependent cox proportional hazards models. We found that LTBI significantly increased the risk of developing DM (HR=1.47), which was robust across different adjustment and censoring techniques. Our results thus suggest that LTBI may be associated with an increased risk of developing DM.
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Affiliation(s)
- Burcu Tepekule
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Marius Zeeb
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital, Lausanne, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Julia Notter
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Johannes Nemeth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
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18
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Schwendener CL, Kiener LM, Jafflin K, Rouached S, Juillerat A, Meier V, Schärli Maurer S, Muggli F, Gültekin N, Baumann A, Debergh M, Gruillot C, Huber B, Merten S, Buhl A, Deml MJ, Tarr PE. HPV vaccine awareness, knowledge and information sources among youth in Switzerland: a mixed methods study. BMJ Open 2022; 12:e054419. [PMID: 35105636 PMCID: PMC8808397 DOI: 10.1136/bmjopen-2021-054419] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We aimed to provide a detailed characterisation of human papillomavirus (HPV) vaccine awareness, knowledge and information sources in the HPV vaccine decision-making process of youth, both male and female, in Switzerland. DESIGN With a mixed-method study design, we conducted quantitative questionnaires and qualitative interviews, which lasted 20-45 min. SETTING AND PARTICIPANTS We recruited participants, 15-26 years of age, in physicians' offices, in a local sexual health clinic, and during military enlistment. We administered quantitative questionnaires to 997 youth participants (585 male, 412 female) and conducted qualitative interviews with 31 youth (17 male, 14 female). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed HPV vaccine awareness, knowledge, information sources and vaccination status. RESULTS In the study's quantitative component, 108 (20%) male and 262 (65%) female participants had received ≥1 dose of HPV vaccine. 697 (70%) participants were knowledgeable about the HPV vaccine. Females were more likely to be knowledgeable than males (342/412 (83%) vs 355/585 (61%); p<0.01). Younger participants in the sample compared with older participants were more likely to be aware of HPV vaccine (135/148 (91%) vs 695/849 (82%); p<0.01). The three most mentioned information sources were school health programmes (442 (53%)), healthcare providers (190 (23%)) and participants' social networks (163 (20%)). Overall, 554/710 (78%) participants had a female-gendered perception of HPV vaccine, a finding which was further supported and explained by qualitative data. CONCLUSIONS Despite a male HPV vaccine recommendation being made >4 years prior to the data collection, HPV vaccine knowledge was higher among females than males, and a female-gendered perception of HPV vaccine remains prevalent. Internet and social media were minor HPV vaccine information sources. Study findings demonstrate that HPV knowledge matters for HPV vaccine uptake and suggest that we should improve HPV information quality and access for youth, particularly by tailoring knowledge campaigns to young men.
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Affiliation(s)
- Corina L Schwendener
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Laura M Kiener
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sarah Rouached
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Juillerat
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Vincent Meier
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Franco Muggli
- Rekrutierungszentrum Monte Ceneri, Swiss Armed Forces, Bern, Switzerland
| | - Nejla Gültekin
- Eidgenössisches Departement für Verteidigung, Bevölkerungsschutz und Sport VBS Schweizer Armee, Swiss Armed Forces, Bern, Switzerland
| | - Aron Baumann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Marlyse Debergh
- Institute of Sociological Research, University of Geneva, Geneva, Geneva, Switzerland
| | - Catherine Gruillot
- PROFA Consultation de santé sexuelle - planning familial, Renens, Switzerland
| | - Benedikt Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andrea Buhl
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Michael J Deml
- Institute of Sociological Research, University of Geneva, Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Basel, Switzerland
- University of Basel, Basel, Switzerland
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19
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Deml MJ, Buhl A, Huber BM, Burton‐Jeangros C, Tarr PE. Trust, affect, and choice in parents' vaccination decision-making and health-care provider selection in Switzerland. Sociol Health Illn 2022; 44:41-58. [PMID: 34747500 PMCID: PMC9299032 DOI: 10.1111/1467-9566.13388] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/30/2021] [Accepted: 10/05/2021] [Indexed: 06/01/2023]
Abstract
This article examines the relationships between biomedicine, complementary and alternative medicine (CAM) and parents' vaccination decision-making in Switzerland. Our empirical evidence sheds light on an understudied phenomenon-parents switching from one doctor to another provider (often one offering CAM services) around issues that arise during vaccination consultations. This is important to understand since CAM is used by 25%-50% of the Swiss population and is integrated into the Swiss health-care system when offered by biomedically trained medical doctors with additional CAM training. Qualitative data gathered from in-depth semi-structured interviews with parents (N = 30) and ethnographic observations of vaccination consultations (N = 16 biomedical consultations, N = 18 CAM consultations) demonstrate how there was not always a clear-cut, direct relationship between (non)vaccination and parents' use of CAM and/or biomedicine. Borrowing from Hirschman (Exit, voice, and loyalty: Responses to decline in firms, organizations, and states, Harvard Univ. Press, 1970), we frame our analysis by using the concepts of exit, voice and loyalty to describe parents' provider selection and vaccination decision-making process, although only four families in the sample described switching solely because of vaccination-related issues. Findings add to vaccine decision-making literature by describing and analysing the underdiscussed provider-switching phenomenon and by demonstrating the importance of parents' experiences of trust, affect and choice in vaccination consultations as they pursue the best health outcomes for their children.
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Affiliation(s)
- Michael J. Deml
- Institute of Sociological ResearchDepartment of SociologyUniversity of GenevaGenevaSwitzerland
- Division of Social and Behavioural SciencesSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Andrea Buhl
- Swiss Tropical and Public Health Institute (Swiss TPH)BaselSwitzerland
- University of BaselBaselSwitzerland
| | - Benedikt M. Huber
- Department of PediatricsFribourg Cantonal HospitalFribourgSwitzerland
| | | | - Philip E. Tarr
- University of BaselBaselSwitzerland
- University Department of MedicineKantonsspital BasellandUniversity of BaselBruderholzSwitzerland
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Jusufoska M, Abreu de Azevedo M, Tolic J, Deml MJ, Tarr PE. "Vaccination needs to be easy for the people, right ?": a qualitative study of the roles of physicians and pharmacists regarding vaccination in Switzerland. BMJ Open 2021; 11:e053163. [PMID: 34921081 PMCID: PMC8685942 DOI: 10.1136/bmjopen-2021-053163] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Vaccination in pharmacies has been a key component of national vaccination strategies to facilitate vaccination access. Qualitative data on the perspectives of professional stakeholders on vaccination in pharmacies and on the professional relations of pharmacists with physicians regarding increasing immunisation rates is limited. We conducted a qualitative study in Switzerland. The main aim was to gain further insight into professional stakeholders' perspectives on vaccination counselling and administration conducted in pharmacies, and to further understand their views on physicians' and pharmacists' roles in increasing immunisation rates. DESIGN We conducted semistructured qualitative interviews. We coded and analysed transcripts using thematic analysis. SETTING Face-to-face interviews took place in German-speaking and French-speaking regions of Switzerland. PARTICIPANTS We interviewed 14 key vaccination stakeholders including health authorities, heads of pharmacy management and professional association boards. All participants had a background in medicine or pharmacy. RESULTS Three main themes emerged from the qualitative data: (1) Participants viewed pharmacists as competent to provide vaccination counselling and administration based on their university training; (2) interprofessional cooperation between physicians and pharmacists on vaccination topics is limited and should be improved; and (3) pharmacists play an important role in increasing immunisation rates by facilitating vaccination access and through provision of vaccination counselling. CONCLUSION By providing vaccination counselling and administering vaccines, pharmacists play an important public health role. Healthcare policies and health authorities should encourage more involvement of pharmacists and encourage interprofessional cooperation between physicians and pharmacists in order to improve vaccination counselling and increase immunisation rates.
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Affiliation(s)
- Meliha Jusufoska
- University Department of Pharmaceutical Sciences, University of Basel, Basel, Basel-Stadt, Switzerland
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland Medizinische Universitätsklinik Standort Bruderholz, Binningen, Switzerland
| | - Marta Abreu de Azevedo
- University Department of Pharmaceutical Sciences, University of Basel, Basel, Basel-Stadt, Switzerland
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland Medizinische Universitätsklinik Standort Bruderholz, Binningen, Switzerland
| | - Josipa Tolic
- University Department of Pharmaceutical Sciences, University of Basel, Basel, Basel-Stadt, Switzerland
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland Medizinische Universitätsklinik Standort Bruderholz, Binningen, Switzerland
| | - Michael J Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
- School of Public Health & Family Medicine, Division of Social and Behavioural Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Philip E Tarr
- University Dept. of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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21
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Schoepf IC, Thorball CW, Ledergerber B, Kootstra NA, Reiss P, Raffenberg M, Engel T, Braun DL, Hasse B, Thurnheer C, Marzolini C, Seneghini M, Bernasconi E, Cavassini M, Buvelot H, Arribas JR, Kouyos RD, Fellay J, Günthard HF, Tarr PE. Telomere Length Declines In Persons Living With HIV Before Antiretroviral Therapy Start But Not After Viral Suppression: A Longitudinal Study Over >17 Years. J Infect Dis 2021; 225:1581-1591. [PMID: 34910812 DOI: 10.1093/infdis/jiab603] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In people living with HIV (PWH), long-term telomere length (TL) change without/with suppressive antiretroviral therapy (ART) and the contribution of genetic background to TL are incompletely understood. METHODS We measured TL change in peripheral blood mononuclear cells by quantitative PCR in 107 Swiss HIV Cohort Study participants with longitudinal samples available both before and during suppressive ART. We applied mixed effects multi-level regression to obtain uni-/multivariable estimates for longitudinal TL dynamics including age, sex, and CD4:CD8 ratio. We assessed the effect of individual antiretrovirals and of an individual TL-polygenic risk score (TL-PRS; based on 239 single nucleotide polymorphisms) on TL in 798 additional participants from our previous longitudinal studies. RESULTS During untreated HIV infection (median observation, 7.7 [interquartile range, IQR, 4.7-11] years), TL declined significantly (median -2.12%/year; IQR, -3.48% to -0.76%/year; p=0.002). During suppressive ART (median observation, 9.8 [IQR, 7.1-11.1] years), there was no evidence of TL decline or increase (median +0.54%/year; IQR, -0.55% to +1.63%/year; p=0.329). TL-PRS contributed to TL change (global p=0.019) but particular antiretrovirals did not (all p>0.15). DISCUSSION In PWH, TL is associated with an individual polygenic risk score. TL declined significantly during untreated chronic HIV infection but no TL change occurred during suppressive ART.
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Affiliation(s)
- Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Hepatology, Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Switzerland
| | | | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health and Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Marieke Raffenberg
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tanja Engel
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Internal Medicine, Kantonsspital Uri, Altdorf, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Christine Thurnheer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Marco Seneghini
- Division of Infectious Diseases, Kantonsspital St Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Hélène Buvelot
- Division of Infectious Disease, Geneva University Hospital, Switzerland
| | - José R Arribas
- HIV/AIDS and Infectious Diseases Research Group , Department of Internal Medicine, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, CHUV, University of Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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22
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Olarewaju VO, Jafflin K, Deml MJ, Gültekin N, Muggli F, Schärli S, Gruillot C, Kloetzer A, Huber BM, Merten S, Tarr PE. The Youth Attitudes about Vaccines (YAV-5) scale: adapting the parent attitudes about childhood vaccines short scale for use with youth in German, French, and Italian in Switzerland, exploratory factor analysis and mokken scaling analysis. Hum Vaccin Immunother 2021; 17:5183-5190. [PMID: 34752179 DOI: 10.1080/21645515.2021.1980314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
No validated measures of vaccine hesitancy (VH) for youth vaccination currently exist. We adapted the Parent Attitudes about Childhood Vaccines survey (PACV-15) for use in youth to create the version Youth Attitudes about Vaccines survey (YAV-14 and YAV-5), then translated it into three languages (German, French, and Italian). We administered the YAV-14 to 1,003 youth aged 15-26 years in Switzerland. We used exploratory factor analysis and Mokken scale analysis to explore the psychometric properties, Cronbach's alpha to investigate the reliability for the YAV-14 and the YAV-5, but we only report results of the YAV-5 analysis here. We determined construct validity by logistic regression of the association between youth VH as measured by the YAV-5 and non-receipt of the first human papillomavirus (HPV) vaccine dose. EFA produced a single scale in German and French while two factors were obtained in Italian. All language versions fit the Mokken scale models with medium-scale strength. There was a significant association between VH and HPV vaccine non-receipt for the full sample (odds ratio (OR); 1.93, 95% confidence interval (CI); 1.31-2.85). Language-stratified analyses found a significant association between VH and non-immunization in the German-language sample. Our results demonstrate that the German version of YAV-5 is a valid and reliable scale for identifying vaccine hesitant youth regardless of sex, and the French version is a valid and reliable scale for identifying vaccine hesitant female youth. Further validation is needed for Italian and French-speaking male youth.
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Affiliation(s)
- Victoria O Olarewaju
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Michael J Deml
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defense, Civil Protection and Sport, Bern, Switzerland
| | - Franco Muggli
- Centro di Reclutamento Monte Ceneri, Esercito Svizzero, Rivera, Switzerland
| | - Susanna Schärli
- Rekrutierungszentrum Aarau, Schweizer Armee, Aarau, Switzerland
| | - Catherine Gruillot
- Profa Consultation de Santé Sexuelle - Planning Familial, Renens, Switzerland
| | - Andrea Kloetzer
- University of Basel, Basel, Switzerland.,University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Benedikt M Huber
- Department of Pediatrics, Hfr Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Philip E Tarr
- University of Basel, Basel, Switzerland.,University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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23
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Olarewaju VO, Jafflin K, Deml MJ, Zimmermann C, Sonderegger J, Preda T, Staub H, Kwiatkowski M, Kloetzer A, Huber BM, Merten S, Tarr PE. Application of the Parent Attitudes about Childhood Vaccines (PACV) survey in three national languages in Switzerland: Exploratory factor analysis and Mokken scale analysis. Hum Vaccin Immunother 2021; 17:2652-2660. [PMID: 33760690 PMCID: PMC8475569 DOI: 10.1080/21645515.2021.1894894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/12/2021] [Accepted: 02/19/2021] [Indexed: 01/24/2023] Open
Abstract
Vaccine hesitancy (VH) is a complex and context-specific phenomenon that is linked to under-immunization and poses challenges to immunization programs. The Parent Attitudes about Childhood Vaccines (PACV) is an instrument developed to measure VH. We translated the PACV into three languages (German, French and Italian) and administered it to 1388 Swiss parents. We used exploratory factor analysis (EFA) to confirm the scale sub-domains, Cronbach's alpha to assess internal consistency reliability, and Mokken scale analysis (MSA), to explore unidimensionality of each language version. We determined to construct validity by linking parental PACV score to children's immunization status for the first dose of measles vaccine. For the 15-item PACV, EFA extracted three sub-domains in German and French and four sub-domains in Italian. Cronbach's alpha was >0.8 across the three languages, and MSA produced a 13-item German, 14-item French, and 11-item Italian PACV. EFA and MSA of the short version PACV extracted a single factor and scale with Cronbach's alpha >0.7 in all three language versions. VH was significantly associated with non-timely receipt of the first dose of measles in all languages (odds ratio of 20.7, 21.3, and 8.3 for German, French, and Italian languages, respectively). The translated and revised PACV-15 versions are valid and reliable instruments for VH measurement. The structure and reliability of the short version of the PACV was as good as the long version. Our results suggest that the PACV can be used to measure parental VH outside the US in the validated languages.
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Affiliation(s)
- Victoria O. Olarewaju
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Michael J. Deml
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Clara Zimmermann
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
| | - Joanna Sonderegger
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
| | - Thierry Preda
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
| | - Hanna Staub
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
| | - Marek Kwiatkowski
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Kloetzer
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
| | - Benedikt M. Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Philip E. Tarr
- University of Basel, Basel, Switzerland
- University Department of Medicine, University of Basel, Bruderholz, Switzerland
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24
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Livio F, Deutschmann E, Moffa G, Rrustemi F, Stader F, Elzi L, Braun DL, Calmy A, Hachfeld A, Cavassini M, Tarr PE, Wissel K, Battegay M, Marzolini C. Analysis of inappropriate prescribing in elderly patients of the Swiss HIV Cohort Study reveals gender inequity. J Antimicrob Chemother 2021; 76:758-764. [PMID: 33279997 DOI: 10.1093/jac/dkaa505] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of inappropriate prescribing observed in geriatric medicine has not been thoroughly evaluated in people ageing with HIV. We determined the prevalence of and risk factors for inappropriate prescribing in individuals aged ≥75 years enrolled in the Swiss HIV Cohort Study. METHODS Retrospective review of medical records was performed to gain more insights into non-HIV comorbidities. Inappropriate prescribing was screened using the Beers criteria, the STOPP/START criteria and the Liverpool drug-drug interactions (DDIs) database. RESULTS For 175 included individuals, the median age was 78 years (IQR 76-81) and 71% were male. The median number of non-HIV comorbidities was 7 (IQR 5-10). The prevalence of polypharmacy and inappropriate prescribing was 66% and 67%, respectively. Overall, 40% of prescribing issues could have deleterious consequences. Prescribing issues occurred mainly with non-HIV drugs and included: incorrect dosage (26%); lack of indication (21%); prescription omission (drug not prescribed although indicated) (17%); drug not appropriate in elderly individuals (18%) and deleterious DDIs (17%). In the multivariable logistic regression, risk factors for prescribing issues were polypharmacy (OR: 2.5; 95% CI: 1.3-4.7), renal impairment (OR: 2.7; 95% CI: 1.4-5.1), treatment with CNS-active drugs (OR: 2.1; 95% CI: 1.1-3.8) and female sex (OR: 8.3; 95% CI: 2.4-28.1). CONCLUSIONS Polypharmacy and inappropriate prescribing are highly prevalent in elderly people living with HIV. Women are at higher risk than men, partly explained by sex differences in the occurrence of non-HIV comorbidities and medical care. Medication reconciliation and periodic review of prescriptions by experienced physicians could help reduce polypharmacy and inappropriate prescribing in this vulnerable, growing population.
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Affiliation(s)
- Françoise Livio
- Service of Clinical Pharmacology, University Hospital Lausanne, Lausanne, Switzerland
| | - Elisabeth Deutschmann
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | | | - Felix Stader
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Basel, Switzerland
| | - Kerstin Wissel
- Division of Infectious Diseases and Hospital Epidemiology, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Catia Marzolini
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
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25
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Schoepf IC, Thorball CW, Ledergerber B, Engel T, Raffenberg M, Kootstra NA, Reiss P, Hasse B, Marzolini C, Thurnheer C, Seneghini M, Bernasconi E, Cavassini M, Buvelot H, Kouyos R, Günthard HF, Fellay J, Tarr PE. Coronary Artery Disease-associated and Longevity-associated Polygenic Risk Scores for Prediction of Coronary Artery Disease Events in Persons Living with HIV: The Swiss HIV Cohort Study. Clin Infect Dis 2021; 73:1597-1604. [PMID: 34091660 DOI: 10.1093/cid/ciab521] [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: 03/19/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is in part genetically determined. Aging is accentuated in people with HIV (PLWH). It is unknown whether genetic CAD event prediction in PLWH is improved by applying individual polygenic risk scores (PRS) and by considering genetic variants associated with successful aging and longevity. METHODS In Swiss HIV Cohort Study participants of self-reported European descent, we determined univariable and multivariable odds ratios (OR) for CAD events, based on traditional CAD risk factors, adverse antiretroviral exposures, and different validated genome-wide PRS. PRS were built from CAD-associated single nucleotide polymorphisms (SNPs), longevity-associated SNPs, or both. RESULTS We included 269 cases with CAD events between 2000-2017 (Median age 54 years, 87% male, 82% with suppressed HIV RNA) and 567 event-free controls. Clinical (i.e. traditional and HIV-related) risk factors, and PRS built from CAD-associated SNPs, longevity-associated SNPs, or both, each contributed independently to CAD events (p<0.001). Participants with the most unfavorable clinical risk factor profile (top quintile) had adjusted CAD-OR=17.82 (8.19-38.76), compared to participants in the bottom quintile. Participants with the most unfavorable CAD-PRS (top quintile) had adjusted CAD-OR=3.17 (1.74-5.79), compared to the bottom quintile. After adding longevity-associated SNPs to the CAD-PRS, participants with the most unfavorable genetic background (top quintile) had adjusted CAD-OR=3.67 (2.00-6.73), compared to the bottom quintile. CONCLUSIONS In Swiss PLWH, CAD prediction based on traditional and HIV-related risk factors was superior to genetic CAD prediction based on longevity- and CAD-associated PRS. Combining traditional, HIV-related and genetic risk factors provided the most powerful CAD prediction.
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Affiliation(s)
- Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja Engel
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Marieke Raffenberg
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health an Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Christine Thurnheer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Seneghini
- Division of Infectious Diseases, Kantonsspital St Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale Lugano, University of Geneva and Università della Svizzera italiana, Lugano, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hélène Buvelot
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Roger Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Zurich, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Zurich, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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26
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Surial B, Mugglin C, Calmy A, Cavassini M, Günthard HF, Stöckle M, Bernasconi E, Schmid P, Tarr PE, Furrer H, Ledergerber B, Wandeler G, Rauch A. Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study. Ann Intern Med 2021; 174:758-767. [PMID: 33721521 DOI: 10.7326/m20-4853] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain. OBJECTIVE To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF. DESIGN Cohort study. SETTING 5 university hospitals, affiliated hospitals, and private physicians in Switzerland. PARTICIPANTS 4375 adults living with HIV who received TDF-containing ART for 6 months or longer. MEASUREMENTS Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests. RESULTS 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months. LIMITATION Short follow-up, small subgroup analyses, and potential residual confounding. CONCLUSION Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels. PRIMARY FUNDING SOURCE Swiss National Science Foundation.
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Affiliation(s)
- Bernard Surial
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Catrina Mugglin
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Alexandra Calmy
- Geneva University Hospital, University of Geneva, Geneva, Switzerland (A.C.)
| | - Matthias Cavassini
- University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland (M.C.)
| | - Huldrych F Günthard
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Marcel Stöckle
- University Hospital Basel, University of Basel, Basel, Switzerland (M.S.)
| | - Enos Bernasconi
- Regional Hospital of Lugano, University of Geneva, and University of Southern Switzerland, Lugano, Switzerland (E.B.)
| | - Patrick Schmid
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland (P.S.)
| | - Philip E Tarr
- and Kantonsspital Baselland, University of Basel, Basel, Switzerland (P.E.T.)
| | - Hansjakob Furrer
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Bruno Ledergerber
- University Hospital Zurich, University of Zurich, Zurich, Switzerland (H.F.G., B.L.)
| | - Gilles Wandeler
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
| | - Andri Rauch
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (B.S., C.M., H.F., G.W., A.R.)
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27
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Kusejko K, Salazar-Vizcaya L, Braun DL, Tarr PE, Bernasconi E, Doco-Lecompte T, Cavassini M, Schmid P, Du Pasquier R, Hauser C, Günthard HF, Kouyos RD. Self-reported Neurocognitive Impairment in People Living With Human Immunodeficiency Virus (HIV): Characterizing Clusters of Patients With Similar Changes in Self-reported Neurocognitive Impairment, 2013-2017, in the Swiss HIV Cohort Study. Clin Infect Dis 2021; 71:637-644. [PMID: 31504323 DOI: 10.1093/cid/ciz868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/04/2019] [Accepted: 09/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Self-reported neurocognitive impairment (SRNI) in people living with human immunodeficiency virus type 1 (HIV-1) infection is frequent. We use longitudinal information on SRNI in the Swiss HIV Cohort Study (SHCS) to identify and characterize groups of patients with persisting SRNI over time. METHODS We included all SHCS patients who were assessed for SRNI during at least 5 visits spanning at least 2.5 years in 2013-2017. We first compared patients with SRNI to those without SRNI over the whole study period. Second, we used a hierarchical cluster algorithm to identify groups of patients with similar changes of SRNI over time. In both analyses, we studied clinical and demographic factors potentially influencing SRNI. RESULTS In total, 79 683 questionnaires of 11 029 patients contained information about SRNI, and 8545 of 11 029 (77.5%) patients had longitudinal information. The overall percentage of patients with SRNI decreased from 19.6% in 2013 to 10.7% in 2017. Compared to patients in the cluster with low-level SRNI over time, patients in the cluster with high-level persisting SRNI more often had a prior opportunistic infection of the central nervous system (CNS) (odds ratio [OR], 3.7; P < .001), imperfect adherence to antiretroviral therapy (ART) (OR, 2.8; P < .001), and depression (OR, 1.9; P < .001). CONCLUSIONS Although overall SRNI is decreasing in the SHCS, there is a group of patients with persisting SRNI over time. Past opportunistic infections of the CNS, imperfect adherence to ART, and depression were associated most with persisting SRNI. Patients with these characteristics should be preferentially tested for neurocognitive impairment.Although overall self-reported neurocognitive impairment (SRNI) is decreasing in the Swiss HIV Cohort Study, there is a group of patients with persisting SRNI over time, characterized by more past opportunistic infections of the central nervous system, imperfect adherence to antiretroviral therapy, and depression.
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Affiliation(s)
- Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Luisa Salazar-Vizcaya
- Clinic for Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Thanh Doco-Lecompte
- Department of Infectious Diseases, HIV Unit, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Renaud Du Pasquier
- Department of Clinical Neurosciences, Service of Neurology, Neuroimmunology Unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Christoph Hauser
- Clinic for Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Kovari H, Surial B, Tarr PE, Cavassini M, Calmy A, Schmid P, Bernasconi E, Rauch A, Wandeler G, Ledergerber B. Changes in alanine aminotransferase levels after switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) in HIV-positive people without viral hepatitis in the Swiss HIV Cohort Study. HIV Med 2021; 22:623-628. [PMID: 33880839 DOI: 10.1111/hiv.13106] [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] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We previously demonstrated an association between tenofovir disoproxil fumarate (TDF) and chronic liver enzyme elevation in the D:A:D study. The objective of the study was to assess changes in alanine aminotransferase (ALT) levels after switching from TDF to tenofovir alafenamide (TAF). METHODS We included Swiss HIV Cohort Study participants who switched from TDF to TAF with two or more ALT values in the 24 months before and two or more values in the 24 months after replacing TDF with TAF. Individuals with replicating viral hepatitis were excluded. Uni- and multivariable linear mixed models were used to explore changes in ALT values associated with switching from TDF to TAF, and to assess potential modifying effects. RESULTS A total of 1712 participants were included, contributing 6169 ALT values before and 5482 after switching. Median (interquartile range, IQR) age was 50 (42-57) years, and 75% were male. Median (IQR) ALT was 28 (22-38) U/L before and 24 (19-32) U/L after replacing TDF with TAF. ALT values decreased by 3.7 U/L (95% confidence interval: 3.2-4.2) after the switch. The median drop was larger in patients with chronic ALT elevation (defined as two or more elevated values for ≥ 6 months) compared with patients with normal ALT values (17.8 vs. 3.3 U/L, P < 0.001). We did not identify any major effect modifications of the ALT change with any of the potential variables studied. CONCLUSIONS Replacing TDF with TAF in HIV-monoinfected people led to a significant decrease in ALT values. Findings were not significantly affected by known risk factors for hepatotoxicity.
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Affiliation(s)
- H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
| | - B Surial
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - P E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - M Cavassini
- Division of Infectious Diseases, University Hospital, Lausanne, Switzerland
| | - A Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - P Schmid
- Division of Infectious Diseases, Cantonal Hospital, St Gall, Switzerland
| | - E Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, Lugano, Switzerland
| | - A Rauch
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Berne, Berne, Switzerland
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Zurich, Switzerland
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Raffenberg M, Engel T, Schoepf IC, Kootstra NA, Reiss P, Braun DL, Thorball CW, Fellay J, Kouyos RD, Ledergerber B, Günthard HF, Tarr PE. Impact of Delaying Antiretroviral Treatment during Primary HIV Infection on Telomere Length. J Infect Dis 2021; 224:1775-1784. [PMID: 33822976 DOI: 10.1093/infdis/jiab186] [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: 12/15/2020] [Accepted: 03/31/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Telomere length (TL) shortens during aging, HIV-seroconversion and untreated chronic HIV infection. It is unknown whether early antiretroviral therapy (ART) start is associated with less TL shortening during primary HIV infection (PHI). METHODS We measured TL in peripheral blood mononuclear cells by quantitative PCR in participants of the Zurich PHI Study with samples available for >6 years. We obtained uni-/multivariable estimates from mixed-effects models and evaluated the association of delaying ART start or interrupting ART with baseline and longitudinal TL. RESULTS In 105 participants with PHI (median age 36 years, 9% women), median ART delay was 25, 42, and 60 days, respectively, in the 1 st (shortest), 2 nd, and 3 rd (longest) ART delay tertile. First ART delay tertile was associated with longer baseline TL (p for trend=0.034), and longer TL over 6 years, but only with continuous ART (p<0.001), not if ART was interrupted >12 months (p=0.408). In multivariable analysis, participants in the 2 nd and 3 rd ART delay tertile had 17.6% (5.4-29.7%; p=0.004) and 21.5% (9.4-33.5%; p<0.001) shorter TL, after adjustment for age, with limited effect modification by clinical variables. DISCUSSION In PHI, delaying ART start for even a matter of weeks was associated with significant and sustained TL shortening.
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Affiliation(s)
- Marieke Raffenberg
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Tanja Engel
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Internal Medicine, Kantonsspital Uri, Altdorf, Switzerland
| | - Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health and Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Dominique L Braun
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland
| | - Christian W Thorball
- EPFL School of Life Sciences and Swiss Institute of Bioinformatics; Lausanne, Switzerland.,Precision Medicine Unit, CHUV, University of Lausanne, Switzerland
| | - Jacques Fellay
- EPFL School of Life Sciences and Swiss Institute of Bioinformatics; Lausanne, Switzerland.,Precision Medicine Unit, CHUV, University of Lausanne, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Darling KEA, Locatelli I, Benghalem N, Nadin I, Calmy A, Gutbrod K, Hauser C, Brugger P, Hasse B, Kovari H, Kunze U, Stoeckle M, Fux C, Rossi S, Di Benedetto C, Früh S, Schmid P, Tarr PE, Daeppen JB, Du Pasquier R, Cavassini M. Alcohol consumption and neurocognitive deficits in people with well-treated HIV in Switzerland. PLoS One 2021; 16:e0246579. [PMID: 33651794 PMCID: PMC7924787 DOI: 10.1371/journal.pone.0246579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively. Results Most participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function. Conclusions In this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway.
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Affiliation(s)
| | - Isabella Locatelli
- Division of Biostatistics and Quantitative Methods, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Benghalem
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Isaure Nadin
- Department of Clinical Neurosciences, Laboratory of Neuroimmunology, Research Centre of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandra Calmy
- HIV Unit, Infectious Diseases Division, Medicine Specialties Department, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland
| | - Christoph Hauser
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Brugger
- Department of Neuropsychology, Neurology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Ursi Kunze
- Memory Clinic, Felix Platter Hospital, University Centre for Medicine of Aging, Basel, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christophe Fux
- Infectious Diseases and Hospital Epidemiology Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, Lugano Regional Hospital, Lugano, Switzerland
| | | | - Severin Früh
- Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Philip E. Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - Jean-Bernard Daeppen
- Service of Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Service of Neurology, Department of clinical neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
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Dietrich LG, Barceló C, Thorball CW, Ryom L, Burkhalter F, Hasse B, Furrer H, Weisser M, Steffen A, Bernasconi E, Cavassini M, de Seigneux S, Csajka C, Fellay J, Ledergerber B, Tarr PE. Contribution of Genetic Background and Data Collection on Adverse Events of Anti-human Immunodeficiency Virus (HIV) Drugs (D:A:D) Clinical Risk Score to Chronic Kidney Disease in Swiss HIV-infected Persons With Normal Baseline Estimated Glomerular Filtration Rate. Clin Infect Dis 2021; 70:890-897. [PMID: 30953057 DOI: 10.1093/cid/ciz280] [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] [Received: 01/18/2019] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In human immunodeficiency virus (HIV), the relative contribution of genetic background, clinical risk factors, and antiretrovirals to chronic kidney disease (CKD) is unknown. METHODS We applied a case-control design and performed genome-wide genotyping in white Swiss HIV Cohort participants with normal baseline estimated glomerular filtration rate (eGFR >90 mL/minute/1.73 m2). Univariable and multivariable CKD odds ratios (ORs) were calculated based on the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) score, which summarizes clinical CKD risk factors, and a polygenic risk score that summarizes genetic information from 86 613 single-nucleotide polymorphisms. RESULTS We included 743 cases with confirmed eGFR drop to <60 mL/minute/1.73 m2 (n = 144) or ≥25% eGFR drop to <90 mL/minute/1.73 m2 (n = 599), and 322 controls (eGFR drop <15%). Polygenic risk score and D:A:D score contributed to CKD. In multivariable analysis, CKD ORs were 2.13 (95% confidence interval [CI], 1.55-2.97) in participants in the fourth (most unfavorable) vs first (most favorable) genetic score quartile; 1.94 (95% CI, 1.37-2.65) in the fourth vs first D:A:D score quartile; and 2.98 (95% CI, 2.02-4.66), 1.70 (95% CI, 1.29-2.29), and 1.83 (95% CI, 1.45-2.40), per 5 years of exposure to atazanavir/ritonavir, lopinavir/ritonavir, and tenofovir disoproxil fumarate, respectively. Participants in the first genetic score quartile had no increased CKD risk, even if they were in the fourth D:A:D score quartile. CONCLUSIONS Genetic score increased CKD risk similar to clinical D:A:D score and potentially nephrotoxic antiretrovirals. Irrespective of D:A:D score, individuals with the most favorable genetic background may be protected against CKD.
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Affiliation(s)
- Léna G Dietrich
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz
| | - Catalina Barceló
- Division of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne
| | - Christian W Thorball
- Swiss Institute of Bioinformatics, Lausanne.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Lene Ryom
- Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Felix Burkhalter
- University Department of Medicine and Nephrology Service, Kantonsspital Baselland, University of Basel, Bruderholz
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Lugano
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Lugano
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Lugano
| | - Ana Steffen
- Division of Infectious Diseases, Kantonsspital St Gallen, Lugano
| | | | | | - Sophie de Seigneux
- Division of Nephrology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland
| | - Chantal Csajka
- Division of Clinical Pharmacology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne
| | - Jacques Fellay
- Swiss Institute of Bioinformatics, Lausanne.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Lugano
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz
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Kovari H, Calmy A, Doco-Lecompte T, Nkoulou R, Marzel A, Weber R, Kaufmann PA, Buechel RR, Ledergerber B, Tarr PE. Antiretroviral Drugs Associated With Subclinical Coronary Artery Disease in the Swiss Human Immunodeficiency Virus Cohort Study. Clin Infect Dis 2021; 70:884-889. [PMID: 30958888 DOI: 10.1093/cid/ciz283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) events have been associated with certain antiretroviral therapy (ART) agents. In contrast, the influence of ART on subclinical atherosclerosis is not clear. The study objective was to assess the association between individual ART agents and the prevalence and extent of subclinical CAD. METHODS Coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) were performed in ≥45-year-old Swiss Human Immunodeficiency Virus Cohort Study participants. The following subclinical CAD endpoints were analyzed separately: CAC score >0, any plaque, calcified plaque, noncalcified/mixed plaque, segment involvement score (SIS), and segment severity score (SSS). Logistic regression models calculated by inverse probability of treatment weights (IPTW) were used to explore associations between subclinical CAD and cumulative exposure to the 10 most frequently used drugs. RESULTS There were 403 patients who underwent CCTA. A CAC score >0 was recorded in 188 (47%), any plaque in 214 (53%), calcified plaque in 151 (38%), and noncalcified/mixed plaque in 150 (37%) participants. A CAC score >0 was negatively associated with efavirenz (IPTW adjusted odds ratio per 5 years 0.73, 95% confidence interval [CI] 0.56-0.96), tenofovir disoproxil fumarate (0.68, 95% CI 0.49-0.95), and lopinavir (0.64, 95% CI 0.43-0.96). Any plaque was negatively associated with tenofovir disoproxil fumarate (0.71, 95% CI 0.51-0.99). Calcified plaque was negatively associated with efavirenz (0.7, 95% CI 0.57-0.97). Noncalcified/mixed plaque was positively associated with abacavir (1.46, 95% CI 1.08-1.98) and negatively associated with emtricitabine (0.67, 95% CI 0.46-0.99). For SSS and SIS, we found no association with any drug. CONCLUSIONS An increased risk of noncalcified/mixed plaque was only found in patients exposed to abacavir. Emtricitabine was negatively associated with noncalcified/mixed plaque, while tenofovir disoproxil fumarate and efavirenz were negatively associated with any plaque and calcified plaque, respectively.
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Affiliation(s)
- Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University of Geneva, Switzerland
| | | | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, Switzerland
| | - Philip E Tarr
- Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Dietrich LG, Thorball CW, Ryom L, Burkhalter F, Hasse B, Thurnheer MC, Weisser M, Schmid P, Bernasconi E, Darling KEA, Buvelot H, Fellay J, Ledergerber B, Tarr PE. Rapid Progression of Kidney Dysfunction in People Living With HIV: Use of Polygenic and Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Risk Scores. J Infect Dis 2020; 223:2145-2153. [PMID: 33151293 DOI: 10.1093/infdis/jiaa695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/06/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In people with human immunodeficiency virus (PWH), it is unknown whether genetic background associates with rapid progression of kidney dysfunction (ie, estimated glomerular filtration rate [eGFR] decrease of >5mL/min/1.73m2 per year for ≥3 consecutive years). METHODS We obtained univariable and multivariable hazard ratios (HR) for rapid progression, based on the clinical D:A:D chronic kidney disease (CKD) risk score, antiretroviral exposures, and a polygenic risk score based on 14 769 genome-wide single nucleotide polymorphisms in white Swiss HIV Cohort Study participants. RESULTS We included 225 participants with rapid progression and 3378 rapid progression-free participants. In multivariable analysis, compared to participants with low D:A:D risk, participants with high risk had rapid progression (HR = 1.82 [95% CI, 1.28-2.60]). Compared to the first (favorable) polygenic risk score quartile, participants in the second, third, and fourth (unfavorable) quartiles had rapid progression (HR = 1.39 [95% CI, 0.94-2.06], 1.52 [95% CI, 1.04-2.24], and 2.04 [95% CI, 1.41-2.94], respectively). Recent exposure to tenofovir disoproxil fumarate was associated with rapid progression (HR = 1.36 [95% CI, 1.06-1.76]). DISCUSSION An individual polygenic risk score is associated with rapid progression in Swiss PWH, when analyzed in the context of clinical and antiretroviral risk factors.
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Affiliation(s)
- Léna G Dietrich
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Surgery and Traumatology, Gesundheitszentrum Fricktal, Rheinfelden, Switzerland
| | - Christian W Thorball
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Lene Ryom
- Center of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Felix Burkhalter
- University Department of Medicine and Nephrology Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, Lugano, Switzerland
| | - Kathrine E A Darling
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hélène Buvelot
- Division of Infectious Disease, Geneva University Hospital, Geneva, Switzerland
| | - Jacques Fellay
- Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Tarr PE, Ledergerber B, Calmy A, Doco-Lecompte T, Schoepf IC, Marzel A, Weber R, Kaufmann PA, Nkoulou R, Buechel RR, Kovari H. Longitudinal Progression of Subclinical Coronary Atherosclerosis in Swiss HIV-Positive Compared With HIV-Negative Persons Undergoing Coronary Calcium Score Scan and CT Angiography. Open Forum Infect Dis 2020; 7:ofaa438. [PMID: 33134415 PMCID: PMC7585327 DOI: 10.1093/ofid/ofaa438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023] Open
Abstract
Background People with HIV (HIV+) may have increased cardiovascular event rates compared with HIV-negative (HIV-) persons. Cross-sectional data from the United States and Switzerland, based on coronary artery calcium scan (CAC) and coronary computed tomography angiography (CCTA), suggest, respectively, increased and similar prevalence of subclinical atherosclerosis in HIV+ vs HIV- persons. Methods We repeated CAC/CCTA in 340 HIV+ and 90 HIV- study participants >2 years after baseline CAC/CCTA. We assessed the association of HIV infection, Framingham risk score (FRS), and HIV-related factors with the progression of subclinical atherosclerosis. Results HIV+ were younger than HIV- participants (median age, 52 vs 56 years; P < .01) but had similar median 10-year FRS (8.9% vs 9.0%; P = .82); 94% had suppressed HIV viral load. In univariable and multivariable analyses, FRS was associated with the incidence rate ratio (IRR) of new subclinical atherosclerosis at the follow-up CAC/CCTA, but HIV infection was not: any plaque (adjusted IRR for HIV+ vs HIV- participants, 1.21; 95% CI, 0.62–2.35), calcified plaque (adjusted IRR for HIV+ vs HIV- participants, 1.06; 95% CI, 0.56–2), noncalcified/mixed plaque (adjusted IRR for HIV+ vs HIV- participants, 1.24; 95% CI, 0.69–2.21), and high-risk plaque (adjusted IRR for HIV+ vs HIV- participants, 1.46; 95% CI, 0.66–3.20). Progression of CAC score between baseline and follow-up CAC/CCTA was similar in HIV+ (median annualized change [interquartile range {IQR}], 0.41 [0–10.19]) and HIV- participants (median annualized change [IQR], 2.38 [0–16.29]; P = .11), as was progression of coronary segment severity score (HIV+: median annualized change [IQR], 0 [0–0.47]; HIV-: median annualized change [IQR], 0 [0–0.52]; P = .10) and coronary segment involvement score (HIV+: median annualized change [IQR], 0 [0–0.45]; HIV-: median annualized change [IQR], 0 [0–0.41]; P = .25). Conclusions In this longitudinal CAC/CCTA study from Switzerland, Framingham risk score was associated with progression of subclinical atherosclerosis, but HIV infection was not.
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Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Division of Infectious Diseases, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Thanh Doco-Lecompte
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Isabella C Schoepf
- University Department of Medicine and Division of Infectious Diseases, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Deml MJ, Tarr PE. Ambiguity in Swiss vaccine mandate legislation. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Swiss Epidemics Act 2016 foresees no vaccine mandates in routine settings. Only in certain settings can the federal government, after consulting with Swiss cantons, “declare vaccinations mandatory for risk groups, persons at threat of particular exposure, and persons exercising certain activities once a serious danger has been established.” Parliament proposed this Act in March 2012 arguing that recent infectious disease outbreaks required stronger preparedness plans clearly delineating responsibilities of the Confederation, cantons, and third parties. Swiss naturopath Trappitsch gathered >75,000 signatures to launch a referendum contesting the law. Main criticisms dealt with ambiguous language around mandates, infringement upon individual liberty, and fear of an overreaching federal government. Nevertheless, the Swiss populace voted to pass the law (60% in favor) in September 2013.
Methods
Qualitative interviews with key informants (N = 5 public health officials-PHO) and analysis of press coverage of the legislation/referendum allow for an investigation of the ambiguity of the mandate language and the referendum's consequences on this issue in public discourses.
Results
Several PHOs/politicians stated during the referendum that “nobody would be vaccinated against their will” and implied that the law would apply, for example, to non-vaccinated healthcare professionals who could be transferred to different care units to protect patients. Such specificities never appeared in the law. Ambiguous language around mandates served as a point of contention around which vaccination critics united and gained political traction. Such criticisms put State actors in the position of needing to more clearly articulate their perspectives.
Conclusions
With neighboring countries enacting vaccine mandate policies (France, Italy, Germany) in response to resurgence in measles cases, current legislative language leaves the question of mandates open to interpretation
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Affiliation(s)
- M J Deml
- Swiss Tropical and Public Health Institute, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, University of Basel, Basel, Switzerland
- NRP74 Vaccine Hesitancy, Swiss National Research Program, Bern, Switzerland
| | - P E Tarr
- University of Basel, University of Basel, Basel, Switzerland
- Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, Bruderholz, Switzerland
- NRP74 Vaccine Hesitancy, Swiss National Research Program, Bern, Switzerland
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Engel T, Raffenberg M, Schoepf IC, Kootstra NA, Reiss P, Thorball CW, Hasse B, Hirzel C, Wissel K, Roth JA, Bernasconi E, Darling KEA, Calmy A, Fellay J, Kouyos RD, Günthard HF, Ledergerber B, Tarr PE. Telomere Length, Traditional Risk Factors, HIV-related Factors and Coronary Artery Disease Events in Swiss Persons Living with HIV. Clin Infect Dis 2020; 73:e2070-e2076. [PMID: 32725240 DOI: 10.1093/cid/ciaa1034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 03/16/2020] [Accepted: 07/18/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Leukocyte telomere length (TL) shortens with age and is associated with coronary artery disease (CAD) events in the general population. Persons living with HIV (PLWH) may have accelerated atherosclerosis and shorter TL than the general population. It is unknown whether TL is associated with CAD in PLWH. METHODS We measured TL by quantitative PCR in white Swiss HIV Cohort Study participants. Cases had a first CAD event during 01.01.2000-31.12.2017. We matched 1-3 PLWH controls without CAD events on sex, age, and observation time. We obtained univariable and multivariable odds ratios (OR) for CAD from conditional logistic regression analyses. RESULTS We included 333 cases (median age 54 years; 14% women; 83% with suppressed HIV RNA) and 745 controls. Median time (interquartile range) of TL measurement was 9.4 (5.9-13.8) years prior to CAD event. Compared to the 1st (shortest) TL quintile, participants in the 5th (longest) TL quintile had univariable and multivariable CAD event OR=0.56 (95% confidence interval, 0.35-0.91) and OR=0.54 (0.31-0.96). Multivariable OR for current smoking was 1.93 (1.27-2.92), dyslipidemia OR=1.92 (1.41-2.63), and for recent abacavir, cumulative lopinavir, indinavir, and darunavir exposure was OR=1.82 (1.27-2.59), OR=2.02 (1.34-3.04), OR=3.42 (2.14-5.45), and OR=1.66 (1.00-2.74), respectively. The TL-CAD association remained significant when adjusting only for Framingham risk score, when excluding TL outliers, and when adjusting for CMV-seropositivity, HCV-seropositivity, time spent with detectable HIV viremia, and injection drug use. CONCLUSION In PLWH, TL measured >9 years before, is independently associated with CAD events after adjusting for multiple traditional and HIV-related factors.
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Affiliation(s)
- Tanja Engel
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Internal Medicine, Kantonsspital Uri, Altdorf, Switzerland
| | - Marieke Raffenberg
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland.,Department of Intensive Care Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Neeltje A Kootstra
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Peter Reiss
- Department of Global Health and Division of Infectious Disease, Amsterdam University Medical Centers, University of Amsterdam, and Amsterdam Institute for Global Health and Dvelopment, Amsterdam, The Netherlands
| | - Christian W Thorball
- EPFL School of Life Sciences and Swiss Institute of Bioinformatics; Lausanne, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Kerstin Wissel
- Division of Infectious Diseases, Kantonsspital St. Gallen, Switzerland
| | - Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale, Lugano, Switzerland
| | | | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Fellay
- EPFL School of Life Sciences and Swiss Institute of Bioinformatics; Lausanne, Switzerland.,Precision Medicine Unit, CHUV, University of Lausanne, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases, University Hospital Zurich, University of Zurich, Switzerland
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Tramèr L, Mertz KD, Huegli R, Hinic V, Jost L, Burkhalter F, Wirz S, Tarr PE. Intra-Abdominal Nocardiosis-Case Report and Review of the Literature. J Clin Med 2020; 9:jcm9072141. [PMID: 32645935 PMCID: PMC7408857 DOI: 10.3390/jcm9072141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 01/04/2023] Open
Abstract
Nocardiosis is primarily an opportunistic infection affecting immunosuppressed individuals, in whom it most commonly presents as pulmonary infection and sometimes cerebral abscesses. Isolated abdominal or retroperitoneal nocardiosis is rare. Here, we report the second case, to our knowledge, of isolated abdominal nocardiosis due to Nocardia paucivorans and provide a comprehensive review of intra-abdominal nocardiosis. The acquisition of abdominal nocardiosis is believed to occur via hematogenous spreading after pulmonary or percutaneous inoculation or possibly via direct abdominal inoculation. Cases of Nocardia peritonitis have been reported in patients on peritoneal dialysis. Accurate diagnosis of abdominal nocardiosis requires histological and/or microbiological examination of appropriate, radiologically or surgically obtained biopsy specimens. Malignancy may initially be suspected when the patient presents with an abdominal mass. Successful therapy usually includes either percutaneous or surgical abscess drainage plus prolonged combination antimicrobial therapy.
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Affiliation(s)
- Lucas Tramèr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
| | | | - Rolf Huegli
- Department of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101 Bruderholz, Switzerland;
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Lorenz Jost
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Oncology Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Felix Burkhalter
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Nephrology Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Sebastian Wirz
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Infectious Diseases Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Philip E. Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Infectious Diseases Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
- Correspondence: ; Tel.: +41-61-436-2212; Fax: +41-61-436-3670
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Young J, Scherrer AU, Calmy A, Tarr PE, Bernasconi E, Cavassini M, Hachfeld A, Vernazza P, Günthard HF, Bucher HC. The comparative effectiveness of NRTI-sparing dual regimens in emulated trials using observational data from the Swiss HIV Cohort Study. Antivir Ther 2020; 24:343-353. [PMID: 30985290 DOI: 10.3851/imp3310] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Nucleoside (or nucleotide) reverse transcriptase inhibitors (NRTIs) cause side effects in some patients, prompting the use of either partly or fully NRTI-sparing regimens. METHODS We used data from the Swiss HIV Cohort Study to estimate the effectiveness of two new dolutegravir dual regimens relative to the alternative NRTI-sparing dual regimens that our clinicians used previously. We emulated two trials by propensity score matching case patients on the dolutegravir regimen with control patients on an alternative regimen. We analysed the case control sets using a Bayesian Cox model and estimated effectiveness as the percentage still on their trial regimen without virological failure at 48 weeks. RESULTS In a comparison of partly NRTI-sparing regimens, 58 cases treated with dolutegravir were matched to 17 controls treated with boosted darunavir (both with lamivudine or emtricitabine). The estimated difference in effectiveness was 15% (95% credible interval [CrI] 2-33) and 12% (95% CrI 0-26) in two sequential analyses 1 year apart. In a comparison of fully NRTI-sparing regimens, 54 cases treated with dolutegravir were matched to 32 controls treated with raltegravir (both with boosted darunavir). The estimated difference in effectiveness was 9% (95% CrI -1-21) and 5% (95% CrI -4-15) in the two sequential analyses. CONCLUSIONS Estimates of relative effectiveness suggest that both dolutegravir regimens are not inferior to these alternative regimens. All four regimens seem suitable for patients needing an NRTI-sparing regimen: there were few virological failures and few treatment changes due to toxicity.
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Affiliation(s)
- Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra U Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Philip E Tarr
- Infectious Diseases Service, University Department of Medicine, Cantonal Hospital Baselland, University of Basel, Bruderholz, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Barceló C, Guidi M, Thorball CW, Hammer C, Chaouch A, Scherrer AU, Hasse B, Cavassini M, Furrer H, Calmy A, Haubitz S, Bernasconi E, Buclin T, Fellay J, Tarr PE, Csajka C. Impact of Genetic and Nongenetic Factors on Body Mass Index and Waist-Hip Ratio Change in HIV-Infected Individuals Initiating Antiretroviral Therapy. Open Forum Infect Dis 2020; 7:ofz464. [PMID: 31988971 PMCID: PMC6974740 DOI: 10.1093/ofid/ofz464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
Abstract
Objective There is limited data on abdominal obesity and the influence of genetics on weight change after antiretroviral therapy (ART) initiation. We assessed body mass index (BMI) and waist hip ration (WHR) change over time in the Swiss HIV Cohort study (SHCS). Methods Mixed-effects models characterizing BMI and WHR change over time in 1090 SHCS participants initiating ART between 2005 and 2015 were developed and used to quantify the influence of demographics, clinical factors, and genetic background. Results Individuals with CD4 nadir <100 cells/µL gained 6.4 times more BMI than individuals with ≥200, and 2.8 times more WHR than individuals with ≥100 (P < .001) during the first 1.5 and 2.5 years after ART initiation, respectively. The risk of being overweight or obese after 1.5 years increased with CD4 nadir <100 cells/µL compared to 100–199 (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.63–2.74) and ≥200 (OR, 1.69; 95% CI, 1.26–2.32), persisting after 10 years of ART. The risk of abdominal obesity after 2.5 years increased with CD4 nadir <100 compared to ≥100 (OR, 1.35; 95% CI, 1.17–1.54 [in men]; OR, 1.36; 95% CI, 1.18–1.57 [in women]), persisting after 10 years of ART. No significant differences were found across antiretroviral drug classes or genetic scores. Conclusions The risk of general and abdominal obesity increased with CD4 nadir <100 cells/µL. Based on our results, including the genetic background would not improve obesity predictions in HIV-infected individuals.
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Affiliation(s)
- Catalina Barceló
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland
| | - Monia Guidi
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland.,Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Christian W Thorball
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Christian Hammer
- Department of Cancer Immunology, Genentech, South San Francisco, CA, USA.,Department of Human Genetics, Genentech, South San Francisco, CA, USA
| | - Aziz Chaouch
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, HIV/AIDS Unit, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sebastian Haubitz
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital, Lugano, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Switzerland
| | - Chantal Csajka
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Lausanne, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Metral M, Nadin I, Locatelli I, Tarr PE, Calmy A, Kovari H, Brugger P, Cusini A, Gutbrod K, Schmid P, Schwind M, Kunze U, Di Benedetto C, Pignatti R, Du Pasquier R, Darling K, Cavassini M. How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population? HIV Med 2019; 21:342-348. [PMID: 31883203 PMCID: PMC7216878 DOI: 10.1111/hiv.12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 12/30/2022]
Abstract
Objectives Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated. Results Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001). Conclusions The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.
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Affiliation(s)
- M Metral
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - I Nadin
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland.,Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - I Locatelli
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - P E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - A Calmy
- HIV Unit, Infectious Diseases Division, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - P Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Division of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St Gallen, St Gallen, Switzerland
| | - M Schwind
- Neurology Clinic, St. Gallen, Switzerland
| | - U Kunze
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - C Di Benedetto
- Infectious Diseases Unit, Lugano Regional Hospital, Lugano, Switzerland
| | - R Pignatti
- Department of Neurology, Neurocentre of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - R Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - Kea Darling
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Tarr PE, Ledergerber B, Calmy A, Doco-Lecompte T, Marzel A, Weber R, Kaufmann PA, Nkoulou R, Buechel RR, Kovari H. Subclinical coronary artery disease in Swiss HIV-positive and HIV-negative persons. Eur Heart J 2019; 39:2147-2154. [PMID: 29590332 DOI: 10.1093/eurheartj/ehy163] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/06/2018] [Indexed: 12/31/2022] Open
Abstract
Aims HIV-positive persons have increased cardiovascular event rates but data on the prevalence of subclinical atherosclerosis compared with HIV-negative persons are not uniform. We assessed subclinical atherosclerosis utilizing coronary artery calcium (CAC) scoring and coronary computed tomography angiography (CCTA) in 428 HIV-positive participants of the Swiss HIV Cohort Study and 276 HIV-negative controls concurrently referred for clinically indicated CCTA. Methods and results We assessed the association of HIV infection, cardiovascular risk profile, and HIV-related factors with subclinical atherosclerosis in univariable and multivariable analyses. HIV-positive participants (median duration of HIV infection, 15 years) were younger than HIV-negative participants (median age 52 vs. 56 years; P < 0.01) but had similar median 10-year Framingham risk scores (9.0% vs. 9.7%; P = 0.40). The prevalence of CAC score >0 (53% vs. 56.2%; P = 0.42) and median CAC scores (47 vs. 47; P = 0.80) were similar, as was the prevalence of any, non-calcified/mixed, and high-risk plaque. In multivariable adjusted analysis, HIV-positive participants had a lower prevalence of calcified plaque than HIV-negative participants [36.9% vs. 48.6%, P < 0.01; adjusted odds ratio (aOR) 0.57; 95% confidence interval (CI) 0.40-0.82; P < 0.01], lower coronary segment severity score (aOR 0.72; 95% CI 0.53-0.99; P = 0.04), and lower segment involvement score (aOR 0.71, 95% CI 0.52-0.97; P = 0.03). Advanced immunosuppression was associated with non-calcified/mixed plaque (aOR 1.97; 95% CI 1.09-3.56; P = 0.02). Conclusion HIV-positive persons in Switzerland had a similar degree of non-calcified/mixed plaque and high-risk plaque, and may have less calcified coronary plaque, and lower coronary atherosclerosis involvement and severity scores than HIV-negative persons with similar Framingham risk scores.
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Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Thanh Doco-Lecompte
- Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - René Nkoulou
- Division of Cardiology, University Hospital Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Rämistr. 100, University of Zurich, 8091 Zurich, Switzerland
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Deml MJ, Jafflin K, Merten S, Huber B, Buhl A, Frau E, Mettraux V, Sonderegger J, Kliem P, Cattalani R, Krüerke D, Pfeiffer C, Burton-Jeangros C, Tarr PE. Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme. BMJ Open 2019; 9:e032218. [PMID: 31678955 PMCID: PMC6830664 DOI: 10.1136/bmjopen-2019-032218] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017-2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient-provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents. METHODS AND ANALYSIS Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15-26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations. ETHICS AND DISSEMINATION The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations.
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Affiliation(s)
- Michael J Deml
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kristen Jafflin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benedikt Huber
- Department of Pediatrics, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Andrea Buhl
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Eleonora Frau
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Valérie Mettraux
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Joanna Sonderegger
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Paulina Kliem
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Rachele Cattalani
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | | | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Philip E Tarr
- University of Basel, Basel, Switzerland
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
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Deml MJ, Notter J, Kliem P, Buhl A, Huber BM, Pfeiffer C, Burton-Jeangros C, Tarr PE. “We treat humans, not herds!”: A qualitative study of complementary and alternative medicine (CAM) providers’ individualized approaches to vaccination in Switzerland. Soc Sci Med 2019; 240:112556. [DOI: 10.1016/j.socscimed.2019.112556] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 08/30/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
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Métral M, Darling K, Locatelli I, Nadin I, Santos G, Brugger P, Kovari H, Cusini A, Gutbrod K, Tarr PE, Calmy A, Lecompte TD, Assal F, Monsch A, Kunze U, Stoeckle M, Schwind M, Schmid P, Pignatti R, Di Benedetto C, Du Pasquier R, Cavassini M. The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile. HIV Med 2019; 21:30-42. [PMID: 31589807 PMCID: PMC6916574 DOI: 10.1111/hiv.12795] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
Objectives The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study. Methods The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV‐associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z‐score means) were performed. Results Most patients (942; 96.2%) had viral loads < 50 HIV‐1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV‐associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non‐Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration. Conclusions In this large sample of aging people living with HIV with well‐controlled infection in Switzerland, baseline HIV‐associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.
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Affiliation(s)
- M Métral
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Kea Darling
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - I Locatelli
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - I Nadin
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.,Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - G Santos
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - P Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - H Kovari
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - A Calmy
- HIV Unit, Infectious Diseases Division, Medicine Department, University Hospital of Geneva, Geneva, Switzerland
| | - T D Lecompte
- HIV Unit, Infectious Diseases Division, Medicine Department, University Hospital of Geneva, Geneva, Switzerland
| | - F Assal
- Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - A Monsch
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - U Kunze
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - M Stoeckle
- Infectious Diseases Unit, Basel, Switzerland
| | - M Schwind
- Neurology Clinic, St Gallen, Switzerland
| | - P Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St Gallen, St Gallen, Switzerland
| | - R Pignatti
- Department of Neurology, Neurocentre of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - C Di Benedetto
- Infectious Diseases Unit, Lugano Regional Hospital, Lugano, Switzerland
| | - R Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Schoepf IC, Buechel RR, Kovari H, Hammoud DA, Tarr PE. Subclinical Atherosclerosis Imaging in People Living with HIV. J Clin Med 2019; 8:jcm8081125. [PMID: 31362391 PMCID: PMC6723163 DOI: 10.3390/jcm8081125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/18/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
In many, but not all studies, people living with HIV (PLWH) have an increased risk of coronary artery disease (CAD) events compared to the general population. This has generated considerable interest in the early, non-invasive detection of asymptomatic (subclinical) atherosclerosis in PLWH. Ultrasound studies assessing carotid artery intima-media thickness (CIMT) have tended to show a somewhat greater thickness in HIV+ compared to HIV−, likely due to an increased prevalence of cardiovascular (CV) risk factors in PLWH. Coronary artery calcification (CAC) determination by non-contrast computed tomography (CT) seems promising to predict CV events but is limited to the detection of calcified plaque. Coronary CT angiography (CCTA) detects calcified and non-calcified plaque and predicts CAD better than either CAC or CIMT. A normal CCTA predicts survival free of CV events over a very long time-span. Research imaging techniques, including black-blood magnetic resonance imaging of the vessel wall and 18F-fluorodeoxyglucose positron emission tomography for the assessment of arterial inflammation have provided insights into the prevalence of HIV-vasculopathy and associated risk factors, but their clinical applicability remains limited. Therefore, CCTA currently appears as the most promising cardiac imaging modality in PLWH for the evaluation of suspected CAD, particularly in patients <50 years, in whom most atherosclerotic coronary lesions are non-calcified.
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Affiliation(s)
- Isabella C Schoepf
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Helen Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, 8091 Zurich, Switzerland
| | - Dima A Hammoud
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
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Affiliation(s)
- Philip E Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Michael J Deml
- Swiss Tropical and Public Health Institute, Basel and University of Basel, Switzerland
| | - Benedikt M Huber
- Centre for Integrative Paediatrics, Department of Paediatrics, Fribourg Hospital HFR, and Faculty of Science and Medicine, University of Fribourg, Switzerland
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Hachfeld A, Darling K, Calmy A, Ledergerber B, Weber R, Battegay M, Wissel K, Di Benedetto C, Fux CA, Tarr PE, Kouyos R, Ruggia LS, Furrer HJ, Wandeler G. Why do sub-Saharan Africans present late for HIV care in Switzerland? HIV Med 2019; 20:418-423. [PMID: 31062497 DOI: 10.1111/hiv.12727] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Late presentation (LP) to HIV care disproportionally affects individuals from sub-Saharan Africa (SSA). We explored the reasons for late presentation to care among this group of patients in the Swiss HIV Cohort Study. METHODS The prevalence of LP was compared between patients from Western Europe (WE) and those from SSA enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face-to-face interviews. RESULTS The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P < 0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P = 0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P = 0.73). Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P < 0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P = 0.001). Late presenters from SSA more frequently reported 'not knowing about anonymous testing possibilities' (46.4% versus 27.3%, respectively; P = 0.04) and 'fear about negative reaction in relatives' (39.3% versus 21.7%, respectively; P = 0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA. CONCLUSIONS The majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear-related issues are important drivers for LP in this population.
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Affiliation(s)
- A Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - K Darling
- Department of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - A Calmy
- Department of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - B Ledergerber
- Department of Infectious Diseases, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R Weber
- Department of Infectious Diseases, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Battegay
- Department of Infectious Diseases, University Hospital Basel and University of Basel, Basel, Switzerland
| | - K Wissel
- Department of Infectious Diseases, Cantonal Hospital, St. Gallen, Switzerland
| | - C Di Benedetto
- Department of Infectious Diseases, Regional Hospital, Lugano, Switzerland
| | - C A Fux
- Department of Infectious Diseases, Cantonal Hospital Aargau, Aargau, Switzerland
| | - P E Tarr
- Department of Infectious Diseases, Kantonsspital Baselland and University of Basel, Basel, Switzerland
| | - R Kouyos
- Department of Infectious Diseases, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - L S Ruggia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - H J Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - G Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Diaco ND, Strickler C, Giezendanner S, Wirz SA, Tarr PE. Systematic De-escalation of Successful Triple Antiretroviral Therapy to Dual Therapy with Dolutegravir plus Emtricitabine or Lamivudine in Swiss HIV-positive Persons. EClinicalMedicine 2018; 6:21-25. [PMID: 31193647 PMCID: PMC6537552 DOI: 10.1016/j.eclinm.2018.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/01/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies increasingly suggest that the efficacy of certain dual antiretroviral therapy (ART) combinations is equal to triple ART. Increasing concerns among HIV-positive patients and physicians in Switzerland include ART cost and long-term ART safety and toxicity, i.e. taking only as many ART agents as necessary. The aims of this retrospective analysis are to report on the de-escalation of our entire clinic population of eligible patients with well-controlled HIV-infection to dolutegravir-containing dual ART. METHODS Starting in March 2015, we systematically considered the de-escalation of eligible patients to either dolutegravir/emtricitabine or dolutegravir/lamivudine, by discontinuing tenofovir disoproxil fumarate or abacavir. We report on the virological efficacy, tolerability and patient satisfaction ≥ 48 weeks after de-escalation. FINDINGS Of 106 HIV-positive patients followed in our clinic, 70 patients were de-escalated. Three returned to triple ART (insomnia after dolutegravir start, n = 2; new wish for single tablet regimen, n = 1). All de-escalated patients and all who continued triple ART had suppressed HIV viremia at last follow-up and were satisfied with their ART regimen, except for one patient who had virological failure after ART discontinuation in the setting of major depression. The most common reasons to not de-escalate included hepatitis B co-infection (n = 6), physician's concern about ART adherence (n = 6), patient reluctance to switch from a single tablet to a 2-tablet regimen (n = 7), patient satisfied with current ART (n = 5) and others (n = 12). INTERPRETATION ART de-escalation to dolutegravir/FTC or dolutegravir/3TC is possible in the majority of patients virologically suppressed on triple ART, and may effectively address patient and physician concerns about long-term safety and cost of ART.
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Affiliation(s)
- Natascha D. Diaco
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Claudio Strickler
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | | | - Sebastian A. Wirz
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
| | - Philip E. Tarr
- University Department of Medicine and Infectious Diseases Service, Kantonsspital Baselland, University of Basel, Bruderholz, Switzerland
- Corresponding author at: University Dept. of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland.
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Bibert S, Wójtowicz A, Taffé P, Tarr PE, Bernasconi E, Furrer H, Günthard HF, Hoffmann M, Kaiser L, Osthoff M, Fellay J, Cavassini M, Bochud PY. Interferon lambda 3/4 polymorphisms are associated with AIDS-related Kaposi's sarcoma. AIDS 2018; 32:2759-2765. [PMID: 30234607 DOI: 10.1097/qad.0000000000002004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Kaposi's sarcoma, the most common AIDS-related cancer, represents a major public concern in resource-limited countries. Single nucleotide polymorphisms within the Interferon lambda 3/4 region (IFNL3/4) determine the expression, function of IFNL4, and influence the clinical course of an increasing number of viral infections. OBJECTIVES To analyze whether IFNL3/4 variants are associated with susceptibility to AIDS-related Kaposi's sarcoma among MSM enrolled in the Swiss HIV Cohort Study (SHCS). METHODS The risk of developing Kaposi's sarcoma according to the carriage of IFNL3/4 SNPs rs8099917 and rs12980275 and their haplotypic combinations was assessed by using cumulative incidence curves and Cox regression models, accounting for relevant covariables. RESULTS Kaposi's sarcoma was diagnosed in 221 of 2558 MSM Caucasian SHCS participants. Both rs12980275 and rs8099917 were associated with an increased risk of Kaposi's sarcoma (cumulative incidence 15 versus 10%, P = 0.01 and 16 versus 10%, P = 0.009, respectively). Diplotypes predicted to produce the active P70 form (cumulative incidence 16 versus 10%, P = 0.01) but not the less active S70 (cumulative incidence 11 versus 10%, P = 0.7) form of IFNL4 were associated with an increased risk of Kaposi's sarcoma, compared with those predicted not to produce IFNL4. The associations remained significant in a multivariate Cox regression model after adjustment for age at infection, combination antiretroviral therapy, median CD4+ T-cell count nadir and CD4+ slopes (hazard ratio 1.42, 95% confidence interval 1.06-1.89, P = 0.02 for IFLN P70 versus no IFNL4). CONCLUSION This study reports for the first time an association between IFNL3/4 polymorphisms and susceptibility to AIDS-related Kaposi's sarcoma.
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Affiliation(s)
| | | | - Patrick Taffé
- Institute for Social and Preventive Medicine, University (IUMSP), Lausanne University Hospital, Lausanne
| | - Philip E Tarr
- Department of Medicine, Kantonspital Baselland, University of Basel, Bruderholz
| | - Enos Bernasconi
- Division of Infectious diseases, Regional hospital of Lugano, Lugano
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich
- Institute of Medical Virology, University of Zurich, Zurich
| | - Matthias Hoffmann
- Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen
| | - Laurent Kaiser
- Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University Hospital of Geneva and Medical School, University of Geneva, Geneva
| | - Michael Osthoff
- Division of Infectious Diseases and Hospital Epidemiology and Department of Internal Medicine, University Hospital Basel, Basel
| | - Jacques Fellay
- Global Health Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne
- Precision Medicine unit, Lausanne University Hospital, Lausanne, Switzerland
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Torgerson PR, Schweiger A, Deplazes P, Pohar M, Reichen J, Ammann RW, Tarr PE, Halkic N, Müllhaupt B. Corrigendum to "Alveolar echinococcosis: From a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years" [J Hepatol 49 (2008) 72-77]. J Hepatol 2018; 69:1208. [PMID: 30206019 DOI: 10.1016/j.jhep.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Paul R Torgerson
- Institute of Parasitology, University of Zürich, CH-8057 Zürich, Switzerland
| | - Alexander Schweiger
- Institute of Parasitology, University of Zürich, CH-8057 Zürich, Switzerland
| | - Peter Deplazes
- Institute of Parasitology, University of Zürich, CH-8057 Zürich, Switzerland
| | - Maja Pohar
- Department of Medical Informatics, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia
| | - Jürg Reichen
- Institute of Clinical Pharmacology, University of Bern, CH-3010 Bern, Switzerland
| | - Rudolf W Ammann
- Gastroenterology and Hepatology, University Hospital of Zürich, Rämistrasse 100, Zürich CH-8091, Switzerland
| | - Philip E Tarr
- Infectious Diseases, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
| | - Nermin Halkic
- Surgery Services, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
| | - Beat Müllhaupt
- Gastroenterology and Hepatology, University Hospital of Zürich, Rämistrasse 100, Zürich CH-8091, Switzerland; Swiss HBP Center, University Hospital of Zürich, Rämistrasse 100, Zürich CH-8091, Switzerland.
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