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Hill L, Thompson C, Balcombe S, Jain S, He F, Karris-Young M, Martin TCS, Karim A, Bamford L, Deiss R. Effects of a hospital discharge clinic among people with HIV: Lack of early follow-up is associated with 30-day hospital readmission and decreased retention in care. HIV Med 2024; 25:332-342. [PMID: 38012059 DOI: 10.1111/hiv.13577] [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: 07/31/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The transition between inpatient and outpatient care for hospitalized people with HIV represents an opportunity for linkage and re-engagement in care. We evaluated whether attendance at a post-hospitalization visit ('discharge clinic') within 1-2 weeks of discharge would reduce readmissions and improve retention in care (RIC) among people with HIV in San Diego, California, USA. METHODS This was a retrospective cohort study of people with HIV hospitalized between June 2020 and November 2021. Our primary outcome was 30-day readmissions among people with HIV who did or did not attend a discharge clinic visit. Secondary outcomes included the effect of discharge clinic attendance on RIC, along with the impact of attendance at any HIV clinic visit within 30 days of discharge on readmissions and RIC. RESULTS We evaluated 114 people with HIV, of whom 77 (67.5%) and 90 (78.9%) attended a discharge clinic visit or any HIV clinic visit within 30 days of discharge, respectively. Active substance use disorder (SUD) was associated with failing to attend a discharge clinic visit (odds ratio 0.31; 95% confidence interval 0.13-0.77). We observed no significant differences in readmissions between people with HIV who did or did not attend a discharge clinic visit; however, the former had significantly higher 6-month RIC (79.2% vs. 35.1%, p < 0.001). People with HIV attending any HIV clinic visit within 30 days of discharge had significantly fewer 30-day readmissions (8.9% vs. 29.2%, p = 0.02) and better 6-month RIC (75.6% vs. 25%, p < 0.001) than those who did not attend. CONCLUSION Early hospital follow-up care was associated with a reduction in readmissions among people with HIV. Active SUD was a significant barrier to linkage to outpatient follow-up and RIC.
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Affiliation(s)
- Lucas Hill
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
| | - Courtney Thompson
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
| | - Shannon Balcombe
- Department of Pharmacy, University of California, San Diego Health, San Diego, California, USA
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Feng He
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Maile Karris-Young
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
| | - Thomas C S Martin
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
- Veterans Affairs San Diego, San Diego, California, USA
| | - Afsana Karim
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
| | - Laura Bamford
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
| | - Robert Deiss
- UCSD Owen Clinic, Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, USA
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Deiss R, Loreti CV, Gutierrez AG, Filipe E, Tatia M, Issufo S, Ciglenecki I, Loarec A, Vivaldo H, Barra C, Siufi C, Molfino L, Antabak NT. Correction: High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique. PLoS One 2024; 19:e0298877. [PMID: 38330095 PMCID: PMC10852289 DOI: 10.1371/journal.pone.0298877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0250195.].
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3
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Kaplan SR, Rajagopal A, Cachay ER, Deiss R. A case of disseminated coccidioidomycosis and immune reconstitution inflammatory syndrome (IRIS) in a patient with HIV/AIDS. IDCases 2023; 34:e01896. [PMID: 37727860 PMCID: PMC10506086 DOI: 10.1016/j.idcr.2023.e01896] [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: 07/07/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
Coccidioidomycosis is a fungal infection endemic to the southwestern United States and Central/South America, and its range is expanding with the warming climate. People with HIV/AIDS are at increased risk of developing disseminated infection, and furthermore are at risk for developing immune reconstitution inflammatory syndrome (IRIS) if they are initiating or re-initiating anti-retroviral therapy (ART). There have been few cases of coccidioidomycosis-related IRIS reported in the literature, and there is no clear guidance on treatment. We present a case of paradoxical IRIS in a patient with AIDS who clinically improved after initiating corticosteroids.
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Affiliation(s)
- Samantha R. Kaplan
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Amutha Rajagopal
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Edward R. Cachay
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Robert Deiss
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
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4
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Trunfio M, Chaillon A, Beliakova-Bethell N, Deiss R, Letendre SL, Riggs PK, Higgins N, Gianella S. Beyond the Syndemic of Opioid Use Disorders and HIV: The Impact of Opioids on Viral Reservoirs. Viruses 2023; 15:1712. [PMID: 37632053 PMCID: PMC10458944 DOI: 10.3390/v15081712] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
People with HIV are more likely to have opioid use disorder and to be prescribed opioids for chronic pain than the general population; however, the effects of opioids on the immune system and HIV persistence have not been fully elucidated. Opioids may affect HIV reservoirs during their establishment, maintenance, and reactivation by enhancing HIV infectivity and replication due to upregulation of co-receptors and impairment of innate antiviral responses. Opioids may also modulate immune cell functioning and microbial translocation and can reverse viral latency. In this review, we summarize the current findings for and against the modulating effects of opioids on HIV cellular and anatomical reservoirs, highlighting the current limitations that affect in vitro, ex vivo, and in vivo studies in the field. We propose further research targets and potential strategies to approach this topic.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences at Amedeo di Savoia Hospital, University of Turin, 10149 Turin, Italy
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA 92103, USA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - Nadejda Beliakova-Bethell
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
- VA San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, CA 92037, USA
| | - Robert Deiss
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
- VA San Diego Healthcare System and Veterans Medical Research Foundation, La Jolla, CA 92037, USA
- Department of Medicine, Owen Clinic, University of California San Diego (UCSD), San Diego, CA 92037, USA
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego (UCSD), San Diego, CA 92103, USA
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - Niamh Higgins
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92037, USA
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5
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Cachay ER, Gilbert T, Deiss R, Mathews WC. Shared Decision-Making Concerning Anal Cancer Screening in Persons With Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:582-591. [PMID: 35723270 PMCID: PMC10226749 DOI: 10.1093/cid/ciac491] [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: 04/11/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anal high-grade squamous intraepithelial lesion (aHSIL) is the immediate precursor of anal cancer. Anal cytology is a recommended screening test to identify aHSIL among people with human immunodeficiency virus (HIV; PWH). Heterogeneity of risk for invasive anal cancer among PWH suggests the value of a shared decision-making framework regarding screening. METHODS Using a longitudinal HIV cohort with a comprehensive anal cancer screening program, we estimated the adjusted probabilities of having aHSIL on the first anal cytology. We used logistic regression models with inverse probability weighting to account for differential screening in the cohort and to construct a predicted probability nomogram for aHSIL. Sensitivity analysis was performed to estimate aHSIL prevalence corrected for misclassification bias. RESULTS Of 8139 PWH under care between 2007 and 2020, 4105 (49.8%) underwent at least 1 anal cytology test. First-time cytology aHSIL was present in 502 (12.2%) PWH. The adjusted probability of having aHSIL varied from 5% to 18% depending on patient characteristics. Prespecified factors in the aHSIL prediction model included nadir CD4 cell count, ethnicity, race, age, sex, gender identity, and HIV risk factors. The ability of the model to discriminate cytological aHSIL was modest, with an area under the curve of 0.63 (95% confidence interval, .60-.65). CONCLUSIONS PWH are at increased risk for aHSIL and invasive anal cancer. Risk, however, varies by patient characteristics. Individual risk factor profiles predictive of aHSIL can be modeled and operationalized as nomograms to facilitate shared decision-making conversations concerning anal cancer screening.
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Affiliation(s)
- Edward R Cachay
- Department of Medicine, Owen Clinic, University of California–San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California–San Diego, San Diego, California, USA
| | - Tari Gilbert
- Department of Medicine, Owen Clinic, University of California–San Diego, San Diego, California, USA
| | - Robert Deiss
- Department of Medicine, Owen Clinic, University of California–San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California–San Diego, San Diego, California, USA
| | - Wm Christopher Mathews
- Department of Medicine, Owen Clinic, University of California–San Diego, San Diego, California, USA
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6
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Ellis GC, Lanteri CA, Hsieh HC, Graf PCF, Pineda G, Crum-Cianflone NF, Berjohn CM, Sanders T, Maves RC, Deiss R. Coccidioidomycosis Seroincidence and Risk among Military Personnel, Naval Air Station Lemoore, San Joaquin Valley, California, USA 1. Emerg Infect Dis 2022; 28:1842-1846. [PMID: 35997543 PMCID: PMC9423930 DOI: 10.3201/eid2809.220652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective cohort study that tested 2,000 US military personnel for Coccidioides antibodies in a disease-endemic region. The overall incidence of seroconversion was 0.5 cases/100 person-years; 12.5% of persons who seroconverted had illnesses requiring medical care. No significant association was found between demographic characteristics and seroconversion or disease.
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7
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Larson D, Won SH, Ganesan A, Maves RC, Kronmann K, Okulicz JF, Chu X, Schofield C, O’Bryan T, Agan BK, Deiss R. Statin usage and cardiovascular risk among people living with HIV in the U.S. Military HIV Natural History Study. HIV Med 2022; 23:249-258. [PMID: 34704330 PMCID: PMC8847313 DOI: 10.1111/hiv.13195] [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: 09/08/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Using the American College of Cardiology/American Heart Association 2013 atherosclerotic cardiovascular disease (ASCVD) management guidelines, we conducted a retrospective cross-sectional analysis of people living with HIV in the US Military HIV Natural History Study to determine whether individuals were receiving statins when indicated. METHODS Prescription data was taken from Military Health System data. Statin eligibility was defined by ASCVD guidelines. We used the 10-year ASCVD pooled cohorts' equation to evaluate risk for each participant. RESULTS Across all categories, 31.9% (n = 390) of individuals met criteria for statin use, and when adding these subjects to the number of those already receiving statins (n = 96), 62.1% of all eligible subjects (n = 302/486) were actually receiving statin therapy. In multivariable analysis, individuals of African American race [odds ratio (OR) = 0.48, 95% confidence interval (CI): 0.31-0.73] or Hispanic ethnicity (OR = 0.42, 95% CI: 0.19-0.94) were less likely to receive statin prescriptions than white individuals. Individuals with a higher CD4 count (OR = 1.12, 95% CI: 1.05-1.20 per 100 cells/μL]) were significantly more likely to receive a statin prescription. CONCLUSIONS These data highlight discrepancies between ASCVD guidelines and primary care management of people living with HIV (PLWH) in the military health system, along with important racial differences. Targeted interventions are critical to identify and treat appropriate candidates for statin therapy among PLWH in the military and other settings.
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Affiliation(s)
- Derek Larson
- Fort Belvoir Community Hospital, Fort Belvoir, VA,Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Walter Reed National Military Medical Center, Bethesda,
MD
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,Naval Medical Center San Diego, San Diego, CA
| | | | - Jason F. Okulicz
- Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | | | - Thomas O’Bryan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD,Infectious Disease Service, Brooke Army Medical Center, San
Antonio, Texas
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Uniformed
Services University of the Health Sciences, Bethesda, MD,The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc, Bethesda, MD
| | - Robert Deiss
- University of California, San Diego, La Jolla, CA
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8
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Deiss R, Loreti CV, Gutierrez AG, Filipe E, Tatia M, Issufo S, Ciglenecki I, Loarec A, Vivaldo H, Barra C, Siufi C, Molfino L, Tamayo Antabak N. High burden of cryptococcal antigenemia and meningitis among patients presenting at an emergency department in Maputo, Mozambique. PLoS One 2021; 16:e0250195. [PMID: 33901215 PMCID: PMC8075188 DOI: 10.1371/journal.pone.0250195] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis is a leading cause of HIV-related mortality in sub-Saharan Africa, however, screening for cryptococcal antigenemia has not been universally implemented. As a result, data concerning cryptococcal meningitis and antigenemia are sparse, and in Mozambique, the prevalence of both are unknown. METHODS We performed a retrospective analysis of routinely collected data from a point-of-care cryptococcal antigen screening program at a public hospital in Maputo, Mozambique. HIV-positive patients admitted to the emergency department underwent CD4 count testing; those with pre-defined abnormal vital signs or CD4 count ≤ 200 cells/μL received cryptococcal antigen testing and lumbar punctures if indicated. Patients with CM were admitted to the hospital and treated with liposomal amphotericin B and flucytosine; their 12-week outcomes were ascertained through review of medical records or telephone contact by program staff made in the routine course of service delivery. RESULTS Among 1,795 patients screened for cryptococcal antigenemia between March 2018-March 2019, 134 (7.5%) were positive. Of patients with cryptococcal antigenemia, 96 (71.6%) were diagnosed with CM, representing 5.4% of all screened patients. Treatment outcomes were available for 87 CM patients: 24 patients (27.6%) died during induction treatment and 63 (72.4%) survived until discharge; of these, 38 (60.3%) remained in care, 9 (14.3%) died, and 16 (25.3%) were lost-to follow-up at 12 weeks. CONCLUSIONS We found a high prevalence of cryptococcal antigenemia and meningitis among patients screened at an emergency department in Maputo, Mozambique. High mortality during and after induction therapy demonstrate missed opportunities for earlier detection of cryptococcal antigenemia, even as point-of-care screening and rapid assessment in an emergency room offer potential to improve outcomes.
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Affiliation(s)
- Robert Deiss
- Médecins Sans Frontières, Maputo, Mozambique
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, California, United States of America
| | | | | | - Eudoxia Filipe
- HIV Programme, Ministry of Health (MoH), Maputo, Mozambique
| | | | - Sheila Issufo
- HIV Programme, Ministry of Health (MoH), Maputo, Mozambique
| | | | - Anne Loarec
- Médecins Sans Frontières, Maputo, Mozambique
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Richard SA, Schofield C, Colombo R, Fairchok MP, Maves RC, Arnold J, Danaher P, Deiss R, Lalani T, Rajnik M, Millar G, Coles CL, Burgess T. 1512. Influenza vaccine effectiveness wanes over the influenza season: results from five military treatment facilities. Open Forum Infect Dis 2020. [PMCID: PMC7777829 DOI: 10.1093/ofid/ofaa439.1693] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Influenza vaccination can reduce influenza burden, but questions have arisen about the duration of vaccine protection. While the timing of vaccination varies, annual receipt of influenza vaccine is mandated for active duty military personnel. The goal of this analysis is to determine if influenza vaccine effectiveness decreases over time. A secondary goal of this analysis is to determine if repeated influenza vaccination is associated with risk for influenza.
Methods
Otherwise healthy individuals presenting for treatment of acute respiratory infections at 5 military treatment facilities from 2009 to 2018 were enrolled in the Acute Respiratory Infection Consortium (ARIC) study. Individuals with complete demographics, influenza vaccination in the two years prior to illness, and influenza laboratory results were included in this analysis (n=1,273). Multivariate logistic regression was used to calculate the odds of an influenza diagnosis according to time since influenza vaccination, categorized in 90-day periods. The model also included age, race, month of diagnosis, influenza season, and whether the participant received 4+ influenza vaccinations in the past 5 years.
Results
One hundred and ninety-two individuals (15%) had laboratory confirmed influenza (Table 1). Participants were mostly active duty, male, and white. Over half of the participants received 4+ influenza vaccinations in the past 5 years. Participants who were vaccinated 90-179 and 180+ days ago had greater odds of being diagnosed with influenza than did individuals who were vaccinated < 90 days prior to illness onset (Table 2). Participants who were 18-24 years old had lower odds of influenza than individuals in other age groups. Vaccine experience (vaccinated against influenza for at least four of the past five years), race, and ethnicity were not statistically significantly associated with influenza diagnosis.
Table 1. Characteristics of individuals included in the analysis of waning influenza vaccine effectiveness in the ARIC study
Table 2. Multivariate logistic regression results from model using influenza diagnosis as the outcome variable. Also included in the model are season and month of diagnosis.
Conclusion
Influenza vaccination was most effective 14-89 days post-vaccination and effectiveness decreased thereafter. Repeat influenza vaccination, however, was not significantly associated with greater odds of influenza. The waning effectiveness of influenza vaccination indicates additional consideration be given to the timing of vaccination.
Disclaimer
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Rhonda Colombo
- Madigan Army Medical Center, Tacoma, WA, Infectious Disease Clinical Research Program, Bethesda, MD, and Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, Tacoma, Washington
| | | | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | | | | | | | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, and Naval Medical Center Portsmouth, VA, Portsmouth, Virginia
| | - Michael Rajnik
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Gene Millar
- Infectious Disease Clinical Research Program, USU, Rockville, Maryland
| | - Christian L Coles
- Infectious Disease Clinical Research Program, Bethesda, MD, The Henry M. Jackson Foundation, Bethesda, MD, Bethesda, MD
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Ellis GC, Lanteri C, Hsieh HC, Graf P, Sanders T, Maves RC, Deiss R. 1180. Seroincidence and Risk of Coccidioidomycosis Infection Among Active Duty Personnel Stationed at Naval Air Station Lemoore in the San Joaquin Valley of California. Open Forum Infect Dis 2020. [PMCID: PMC7777616 DOI: 10.1093/ofid/ofaa439.1366] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coccidioidomycosis ranges clinically from a self-limited respiratory illness to multi-organ dissemination. Based largely on skin testing from the 1940s, 60% of infections are thought to be asymptomatic. Limited Coccidioides seroincidence data support our understanding of the epidemiology and pathogenicity of this disease.
Methods
This retrospective cohort study tested 2000 U.S. military personnel for Coccidioides exposure after transfer to an endemic region of California between 2011 and 2017. The presence of IgG and IgM anti-Coccidioides antibodies were tested on pre- and post-transfer serum samples from the DoD Serum Repository to establish rates of seroconversion. Medical histories and participant demographics including race/ethnicity and military occupational specialty codes were collected from the electronic medical record and participants were stratified by a history of Coccidioides-specific or general respiratory illness based on ICD9/ICD10 coding.
Results
Thirty of 2000 participants tested newly positive for anti-Coccidioides antibodies after 12 months on station. Seroconversion incidence varied from 0.0-1.32 annually and overall 0.5 per 100 person years. Seroconverters were more frequently diagnosed with coccidioidomycosis or pneumonia than non-converters (p=0.027). No statistically significant association between demographic characteristics and seroconversion or disease was observed. Clinical disease was detected in only three seroconverters (10%).
Incidence Rate of Coccidioidomycosis Infection among Active Duty Stationed at NAS Lemoore, 2011-2017
Seroconversion Status by Cocci/Pneumonia Diagnosis Status
Conclusion
In this study Coccidioides seroincidence was similar to that observed by others, adding longitudinal evidence to epidemiologic assumptions about coccidioidomycosis. A trend toward increasing incidence over the course of the study is consistent with the classification of coccidioidomycosis as an emerging infectious disease. While transmission is typically related to exposure, we did not detect a difference based on military occupational specialty codes. Overall, rates of diagnosed disease in our cohort were lower than the historically-assumed 40% symptomatic rate, although this conclusion is limited by the retrospective nature of the study. Further clinical and epidemiologic coccidioidomycosis research, particularly in broader endemic regions, is warranted.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | - Charlotte Lanteri
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Boyds, Maryland
| | - Hsing-Chuan Hsieh
- Infectious Disease Clinical Research Program, Dept Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences and The Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD
| | - Paul Graf
- Naval Health Research Center, San Diego, CA
| | - Terrel Sanders
- Naval Medical Research Unit Three Ghana Detachment, MARION, South Carolina
| | - Ryan C Maves
- Naval Medical Center San Diego, San Diego, CA and Infectious Disease Clinical Research Program, Bethesda, MD, San DIego, California
| | - Robert Deiss
- University of California, San Diego, San Diego, California
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11
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Noiman A, Macalino G, Won SH, Byrne M, Deiss R, Haw NJ, Ganesan A, Okulicz JF, Schofield C, Lalani T, Maves RC, Wang X, Agan BK, Achatz E, Bradley W, Merritt S, Merritt T, Olsen C, Rhodes C, Sjoberg T, Baker C, Chambers S, Colombo R, Ferguson T, Kunz A, Powers J, Tramont E, Banks S, Illinik L, Kronmann K, Tant R, Cammarata S, Curry J, Kirkland N, Utz G, Price M, Aronson N, Burgess T, Chu X, Estupigan C, Hsieh, Parmelee E, Tribble D, Won S, Ake J, Crowell T, Peel S, Barahona I, Blaylock J, Decker C, Ressner R. Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell". AIDS Patient Care STDS 2020; 34:523-533. [PMID: 33296270 DOI: 10.1089/apc.2020.0095] [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] [Indexed: 11/12/2022] Open
Abstract
Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.
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Affiliation(s)
- Adi Noiman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Morgan Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jason F. Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Christina Schofield
- Division of Infectious Diseases, Madigan Army Medical Center, Joint Base Lewis McChord, Washington, District of Columbia, USA
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California, USA
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
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12
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Joya C, Won SH, Schofield C, Lalani T, Maves RC, Kronmann K, Deiss R, Okulicz J, Agan BK, Ganesan A. Persistent Low-level Viremia While on Antiretroviral Therapy Is an Independent Risk Factor for Virologic Failure. Clin Infect Dis 2020; 69:2145-2152. [PMID: 30785191 DOI: 10.1093/cid/ciz129] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Whether persistent low-level viremia (pLLV) predicts virologic failure (VF) is unclear. We used data from the US Military HIV Natural History Study (NHS), to examine the association of pLLV and VF. METHODS NHS subjects who initiated combination antiretroviral therapy (ART) after 1996 were included if they had 2 or more VLs measured with a lower limit of detection of ≤50 copies/mL. VF was defined as a confirmed VL ≥200 copies/mL or any VL >1000 copies/mL. Participants were categorized into mutually exclusive virologic categories: intermittent LLV (iLLV) (VL of 50-199 copies/mL on <25% of measurements), pLLV (VL of 50-199 copies/mL on ≥25% of measurements), high-level viremia (hLV) (VL of 200-1000 copies/mL), and continuous suppression (all VL <50 copies/mL). Cox proportional hazards models were used to evaluate the association between VF and LLV; hazard ratios and 95% confidence interval (CI) are presented. RESULTS Two thousand six subjects (median age 29.2 years, 93% male, 41% black) were included; 383 subjects (19%) experienced VF. After adjusting for demographics, VL, CD4 counts, ART regimen, prior use of mono or dual antiretrovirals, and time to ART start, pLLV (3.46 [2.42-4.93]), and hLV (2.29 [1.78-2.96]) were associated with VF. Other factors associated with VF include black ethnicity (1.33 [1.06-1.68]) and antiretroviral use prior to ART (1.79 [1.34-2.38]). Older age at ART initiation (0.71 [0.61-0.82]) and non-nucleoside reverse transcriptase inhibitor (0.68 [0.51-0.90]) or integrase strand transfer inhibitor use (0.26 [0.13-0.53]) were protective. CONCLUSION Our data add to the body of evidence that suggests persistent LLV is associated with deleterious virologic consequences.
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Affiliation(s)
- Christie Joya
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Seung Hyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Christina Schofield
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Madigan Army Medical Center, Tacoma, Washington
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland.,Division of Infectious Diseases, Naval Medical Center Portsmouth, Virginia
| | - Ryan C Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Naval Medical Center San Diego, California
| | - Karl Kronmann
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Naval Medical Center Portsmouth, Virginia
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Infectious Disease Service, San Antonio Military Medical Center, Texas
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Division of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
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13
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Agan BK, Ganesan A, Byrne M, Deiss R, Schofield C, Maves RC, Okulicz J, Chu X, O'Bryan T, Lalani T, Kronmann K, Ferguson T, Robb ML, Whitman TJ, Burgess TH, Michael N, Tramont E. The US Military HIV Natural History Study: Informing Military HIV Care and Policy for Over 30 Years. Mil Med 2020; 184:6-17. [PMID: 31778201 DOI: 10.1093/milmed/usy430] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In October 1985, 4 years after the initial descriptions of the acquired immunodeficiency syndrome (AIDS), the U.S. Department of Defense (DoD) began routine screening for human immunodeficiency virus (HIV) infection to prevent infected recruits from exposure to live virus vaccines, implemented routine active-duty force screening to ensure timely care and help protect the walking blood bank, and initiated the U.S. Military HIV Natural History Study (NHS) to develop epidemiologic, clinical, and basic science evidence to inform military HIV policy and establish a repository of data and specimens for future research. Here, we have reviewed accomplishments of the NHS over the past 30 years and sought to describe relevant trends among NHS subjects over this time, with emphasis on combination antiretroviral therapy (cART) use and non-AIDS comorbidities. METHODS Subjects who were prospectively enrolled in the NHS from 1986 through 2015 were included in this analysis. Time periods were classified by decade of study conduct, 1986-1995, 1996-2005, and 2006-2015, which also correlate approximately with pre-, early-, and late-combination ART (cART) eras. Analyses included descriptive statistics and comparisons among decades. We also evaluated mean community log10 HIV viral load (CVL) and CD4 counts for each year. RESULTS A total of 5,758 subjects were enrolled between 1986 and 2015, of whom 92% were male with a median age of 28 years, and 45% were African-American, 42% Caucasian, and 13% Hispanic/other. The proportion of African-Americans remained stable over the decades (45%, 47%, and 42%, respectively), while the proportion of Hispanic/other increased (10%, 13%, and 24%, respectively). The CD4 count at HIV diagnosis has remained high (median 496 cells/uL), while the occurrence of AIDS-defining conditions (excluding low CD4 count) has decreased by decade (36.7%, 5.4%, and 2.9%, respectively). Following the introduction of effective cART in 1996, CVL declined through 2000 as use increased and then plateaued until guidelines changed. After 2004, cART use again increased and CVL declined further until 2012-15 when the vast majority of subjects achieved viral suppression. Non-AIDS comorbidities have remained common, with approximately half of subjects experiencing one or more new diagnoses overall and nearly half of subjects diagnosed between 2006 and 2015, in spite of their relatively young age, shorter median follow-up, and wide use of cART. CONCLUSIONS The US Military HIV NHS has been critical to understanding the impact of HIV infection among active-duty service members and military beneficiaries, as well as producing insights that are broadly relevant. In addition, the rich repository of NHS data and specimens serves as a resource to investigators in the DoD, NIH, and academic community, markedly increasing scientific yield and identifying novel associations. Looking forward, the NHS remains relevant to understanding host factor correlates of virologic and immunologic control, biologic pathways of HIV pathogenesis, causes and consequences of residual inflammation in spite of effective cART, identifying predictors of and potential approaches to mitigation of excess non-AIDS comorbidities, and helping to understand the latent reservoir.
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Affiliation(s)
- Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,Division of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20852
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134
| | - Christina Schofield
- Division of Infectious Diseases, Madigan Army Medical Center, 9040A Jackson Avenue, Joint Base Lewis McChord, WA 98431
| | - Ryan C Maves
- Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817
| | - Thomas O'Bryan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,Division of Infectious Diseases, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Karl Kronmann
- Division of Infectious Diseases, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708
| | - Tomas Ferguson
- Division of Infectious Diseases, Madigan Army Medical Center, 9040A Jackson Avenue, Joint Base Lewis McChord, WA 98431
| | - Merlin L Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda, MD 20817.,U.S. Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Timothy J Whitman
- Division of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20852
| | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Nelson Michael
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Edmund Tramont
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, 5601 Fishers Lane, Bethesda, MD 20892
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14
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Byrne M, Deiss R, Mesner O, Glancey M, Ganesan A, Okulicz J, Kronmann K, Maves R, Schofield C, Agan B, Macalino G. Age, Race, and At-Risk Drinking in an HIV-infected U.S. Military Cohort. Mil Med 2020; 184:e263-e267. [PMID: 30690493 DOI: 10.1093/milmed/usy318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/23/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION There is a high prevalence of at-risk drinking in the U.S. military. Among HIV-infected individuals, alcohol abuse confers additional risk for adverse health outcomes. In the military, however, the characteristics of HIV-infected individuals who engage in high-risk drinking are not well defined. The purpose of this study was to assess risk factors associated with at-risk drinking in an HIV-positive longitudinal cohort of DoD beneficiaries. MATERIALS AND METHODS Annual prevalence of at-risk drinking was calculated for members of the U.S. Military HIV Natural History Study who initiated highly active antiretroviral therapy (HAART) during or after January 2006 through May 2014; each participant completed at least one self-reported alcohol survey within a year of HAART initiation. Univariate and multivariable logistic regression was used to analyze factors associated with at-risk drinking. RESULTS Sixty-six percent of subjects (495/752) reported at-risk drinking on at least one survey after HAART initiation. At-risk drinkers were more likely to be Active Duty compared to Retired (OR 0.65 95% CI [0.46, 0.92]). In multivariate models, Caucasian race (OR 3.30 95% CI [2.31, 4.71]); Hispanic/other race (OR 2.17 95% CI [1.51, 3.14]) and younger age (OR 0.61 per 10 years older, [95%CI 0.49, 0.75]) were significantly associated with at-risk drinking. Single relationship status (OR 1.51 95% CI [1.08, 2.13]) was also associated with at-risk drinking. CONCLUSIONS Consistent with general alcohol consumption patterns in the military, we found a high prevalence of at-risk drinking among individuals with HIV infection, which was associated most closely with young, non-African Americans. Targeting interventions toward this group will be important to reduce at-risk drinking and its potential for HIV-related complications.
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Affiliation(s)
- Morgan Byrne
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.,Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA
| | - Octavio Mesner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.,Currently at Carnegie Mellon University, Pittsburgh, PA
| | - Margaret Glancey
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.,Division of Infectious Diseases, Walter Reed Military Medical Center, Bethesda, MD
| | - Jason Okulicz
- Infectious Disease Service, Brooke Army Medical Center, San Antonio, TX
| | - Karl Kronmann
- Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Ryan Maves
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, CA
| | | | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.,Currently at Marimac Insight, LLC, Simpsonville, MD
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15
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Gilbert L, Wang X, Deiss R, Okulicz J, Maves R, Schofield C, Ferguson T, Whitman T, Kronmann K, Agan B, Ganesan A. Herpes Zoster Rates Continue to Decline in People Living With Human Immunodeficiency Virus but Remain Higher Than Rates Reported in the General US Population. Clin Infect Dis 2019; 69:155-158. [PMID: 30561578 PMCID: PMC6579953 DOI: 10.1093/cid/ciy1041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/28/2018] [Accepted: 12/11/2018] [Indexed: 12/28/2022] Open
Abstract
In the antiretroviral therapy era, herpes zoster incidence continued to decline in people living with HIV (PLWH). However, at 0.9 cases/100 person-years, rates in PLWH are substantially higher than the general US population; emphasizing the needs for studies of the subunit vaccine in PLWH.
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Affiliation(s)
| | - Xun Wang
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Naval Medical Center San Diego, California
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Brooke Army Military Medical Center, Fort Sam Houston, Texas
| | - Ryan Maves
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Naval Medical Center San Diego, California
| | - Christina Schofield
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Madigan Army Medical Center, Tacoma, Washington
| | - Tomas Ferguson
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Tripler Army Medical Center, Honolulu, Hawaii
| | - Timothy Whitman
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Karl Kronmann
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Naval Medical Center Portsmouth, Virginia
| | - Brian Agan
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
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16
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Deiss R, Campbell CDRJ, Watson CWM, Moore RC, Crum-Cianflone NF, Wang X, Ganesan A, Okulicz LCJ, Letendre S, Maves RC, Moore DJ, Agan BK. Posttraumatic Stress Disorder and Neurocognitive Impairment in a U.S. Military Cohort of Persons Living with HIV. Psychiatry 2019; 82:228-239. [PMID: 30925113 PMCID: PMC6766407 DOI: 10.1080/00332747.2019.1586503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 10/27/2022]
Abstract
Objective: Neurocognitive impairment (NCI) is a well-known complication of human immunodeficiency virus (HIV) infection and may be influenced by a number of psychological factors. We examined the relationship between NCI and mental health disorders, including posttraumatic stress disorder (PTSD), in a cohort of 189 active-duty and retired U.S. military men living with HIV. Methods: Participants completed selected modules of the Composite International Diagnostic Interview (CIDI) to ascertain the presence of PTSD, major depressive disorder, and other mental health diagnoses. We also obtained demographic data, including history of head trauma, via personal interview. NCI was assessed with a comprehensive battery of standardized neuropsychological tests. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28 to 43) and median total years of education was 14 (IQR 12 to 16). NCI was diagnosed in 19% of subjects. Individuals with and without a history of PTSD were similar with respect to most HIV-related characteristics; however, the former were significantly more likely to have a prior acquired immunodeficiency syndrome (AIDS) diagnosis. In multivariate analysis, lifetime history of PTSD was independently associated with NCI (odds ration [OR] = 6.12; 95% confidence interval [CI] = 1.85, 20.27), while a history of head of trauma was negatively associated (OR = 0.37 95% CI = 0.15,0.92). Conclusions: Our findings demonstrate that PTSD is an important predictor of NCI in this U.S. military cohort. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders, including PTSD, and prospective studies of the longitudinal relationship between PTSD and NCI, as well as the impact of PTSD treatment on future NCI, are warranted.
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Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD
- Division of Infectious Diseases, Naval Medical Center San Diego. San Diego, CA
| | | | - Caitlin Wei-Ming Watson
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology. San Diego, CA
| | - Raeanne C. Moore
- HIV Neurobehavioral Research Program, University of California, San Diego. San Diego, CA
- Veterans Administration San Diego Health Care System, San Diego, CA. San Diego, CA
| | - Nancy F. Crum-Cianflone
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- Division of Infectious Diseases, Naval Medical Center San Diego. San Diego, CA
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD
- Division of Infectious Diseases. Walter Reed National Military Medical Center. Bethesda, MD
| | - Lt Col Jason Okulicz
- Infectious Disease Service, San Antonio Military Medical Center. Fort Sam Houston, TX
| | - Scott Letendre
- HIV Neurobehavioral Research Program, University of California, San Diego. San Diego, CA
| | - Ryan C. Maves
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- Division of Infectious Diseases, Naval Medical Center San Diego. San Diego, CA
| | - David J. Moore
- HIV Neurobehavioral Research Program, University of California, San Diego. San Diego, CA
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences. Rockville, MD 20852
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda, MD
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Carney B, White J, Xu X, Sunil T, Daniels C, Byrne M, Ganesan A, Deiss R, Macalino G, Agan BK, Okulicz JF. Relationship between depression and risk behaviors in a US Military population with HIV infection. AIDS Care 2019; 31:1152-1156. [PMID: 30917666 DOI: 10.1080/09540121.2019.1595522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluated the relationships between depression trajectories, depression diagnosis and sexual risk behaviors in the US Military HIV Natural History Study. Risk behavior survey data, a coded diagnosis of depression, available Center for Epidemiological Studies Depression measures, and self-reported depressive symptoms (n = 662) were utilized. Latent class analysis created 3 classes of depression trajectories, namely, low depression (LD, n = 378), recent-onset depression (ROD, n = 170), and high depression (HD, n = 114) trajectories. Overall, participants with clinically diagnosed depression were less likely to report often using condoms with new sexual partners in the past 3 months than those who have never been diagnosed with depression (OR 0.15, 95% CI 0.49-2.53). Participants with ROD (OR 0.52, 95% CI 0.28-0.97) and HD (OR 0.48, 95% CI 0.24-0.96) trajectories were less likely to report often using condoms with new sexual partners in the past 3 months than those with LD trajectories. Moreover, those with either ROD (OR 2.13, 95% CI 1.19-3.80) or HD (OR 2.74, 95% CI 1.43-5.24) trajectories were more likely to have had sex with ≥2 new sexual partners in the last 3 months than those with LD trajectories. Continued efforts targeting HIV-infected persons with mental health disorders are warranted to reduce sexual risk behaviors.
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Affiliation(s)
- Brandon Carney
- a Infectious Disease Service , San Antonio Military Medical Center , San Antonio , USA
| | - James White
- b Department of Sociology , University of Texas at San Antonio , San Antonio , USA
| | - Xiaohe Xu
- b Department of Sociology , University of Texas at San Antonio , San Antonio , USA.,c School of Public Administration , Sichuan University , Chengdu , People's Republic of China
| | - Thankam Sunil
- d Institute Disparities Research , University of Texas at San Antonio , San Antonio , USA
| | - Colton Daniels
- b Department of Sociology , University of Texas at San Antonio , San Antonio , USA
| | - Morgan Byrne
- e Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA
| | - Anuradha Ganesan
- e Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA.,f Marimac Insight, LLC , Simpsonville , MD , USA.,g Infectious Disease Clinical Research Program, Department of Preventative Medicine and Biostatistics , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Robert Deiss
- e Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA
| | | | - Brian K Agan
- e Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA
| | - Jason F Okulicz
- a Infectious Disease Service , San Antonio Military Medical Center , San Antonio , USA.,g Infectious Disease Clinical Research Program, Department of Preventative Medicine and Biostatistics , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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Deiss R, Byrne M, Echols SM, Cammarata SM, Potswald L, Gomez E, Curry JA, Garges E, Macalino G, Agan BK, Bavaro MF. Extragenital chlamydia infection among active-duty women in the United States Navy. Mil Med Res 2019; 6:3. [PMID: 30691524 PMCID: PMC6350339 DOI: 10.1186/s40779-019-0193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pharyngeal and anorectal reservoirs of gonorrhea (GC) and chlamydia (CT) are increasingly recognized among heterosexual women. While a number of studies performed at sexually transmitted disease (STD) clinics have found a high prevalence of extragenital GC/CT infection, such screening is typically not offered during routine primary care visits for women. We sought to define the prevalence of and factors associated with extragenital GC/CT among women in the U.S. Navy. METHODS We recruited servicewomen stationed in San Diego, California, between the ages of 18 and 25 who presented for an annual physical exam between January and September, 2017. Nucleic acid amplification testing was performed on swabs collected at endocervical, oropharyngeal and anorectal sites to assess the presence of GC/CT. An anonymous behavioral questionnaire was also administered to characterize sexual risk. Descriptive statistics were used to compare women with and without a prior history of any sexually transmitted infection (STI) (self-report) along with a current GC/CT diagnosis. This study was approved by the Institutional Review Board of the Uniformed Services University of Health Sciences. RESULTS Of the 75 patients who were approached, 60 subjects were enrolled in the study, including white 20 (33.3%), black/African American 18 (31.0%), Hispanic/Latina 13 (21.7%) and Asian/Pacific Islander 9 (15.5%) women. Among all the women, six (10.0%) were diagnosed with CT infection, all via endocervical exam. Of these, five (8.3%) had concurrent anorectal infection, including two cases (3.3%) accompanied by pharyngeal infection. Of the subjects, 15 (25.0%) reported anal intercourse in their most recent sexual encounter, most of which was condomless (13/15, 86.7%). A high number of women who reported sex with a casual male partner (19/45, 42.2%) reported rarely or never using condoms; last, 41.7% consuming at least 3 drinks on a typical drinking day, and one-third of the reported drinking more than once per week. CONCLUSIONS We found a high prevalence of anorectal CT infection, although no infections were detected without concurrent endocervical involvement. Nonetheless, the high prevalence of condomless anal intercourse reported by participants argues for further study and ongoing consideration of extragenital screening among high-risk patients. Behavioral interventions are also warranted given the high prevalence of sexual and related risk factors.
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Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA.,Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Sara M Echols
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Stephanie M Cammarata
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA.,Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Lynda Potswald
- 32nd Street Branch Medical Clinic, Naval Medical Center San Diego, 2450 Craven St, San Diego, CA, 92104, USA
| | - Eduardo Gomez
- 32nd Street Branch Medical Clinic, Naval Medical Center San Diego, 2450 Craven St, San Diego, CA, 92104, USA
| | - Jennifer A Curry
- Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA
| | - Eric Garges
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,Division of Tropical Medical Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA
| | - Grace Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,Marimac Insight, LLC, Simpsonville, MD, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 11300 Rockville Pike, Rockville, MD, 20850, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Mary F Bavaro
- Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Ste 201, San Diego, CA, 92134, USA.
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19
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Ganesan A, Won S, Joya C, Deiss R, Maves R, Kronmann K, Lalani T, Schofield C, Whitman TJ, Okulicz J, Agan B. 571. In a Well-Characterized Cohort with Universal Access to Care and Medications Racial Disparities in HIV Virologic Outcomes Are No Longer Observed. Open Forum Infect Dis 2018. [PMCID: PMC6253896 DOI: 10.1093/ofid/ofy210.579] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background HIV-infected African-Americans [AA] are more likely to experience virologic failure (VF) compared with other ethnic groups. Decreased access to healthcare has been postulated as a potential cause. Using data from the US Military Natural History Study (NHS), we examined the effects of race on VF. The NHS is a longitudinal cohort comprised of Department of Defense (DoD) beneficiaries with unrestricted access to healthcare. Methods We included NHS participants who contributed follow-up after 2001. Demographic characteristics, antiretroviral therapy (ART) history, and serial viral loads (VL) were obtained from the database. Pharmacy records were used to calculate adherence. VF was defined as a VL of 3200 copies/mL on two consecutive measurements or one VL of >1,000 c/mL. A Cox model with time-updated covariates was used to examine the association between race and VF. Results A total of 1,521 subjects contributed follow-up after 2001 (41% AA; 95% male). Median age, CD4 count and VL at ART initiation (AI) were 31.6 years [IQR 26–39], 367 cells/μl [IQR 271–489] and 4.6 log10 copies/mL [IQR 4.0–5.0], respectively. Subjects were followed for a median of 4.8 years [IQR 2.7–7.9], and 13.2% (n = 201) met criteria for VF. Most subjects initiated ART with a non-nucleoside reverse transcriptase inhibitor (NNRTI) (64%), integrase strand transferase inhibitor (InSTI) (15%) or a boosted protease inhibitor (PI) (14%)-based regimen. Results of the adjusted Cox model are in the table below. Conclusion In the NHS, in recent years, AA and Caucasians have similar responses to ART. NNRTI and InsTI use was protective, reinforcing that simpler medications with fewer adverse effects improve outcomes. Unrestricted access to care and modernization of ART should help narrow the disparities observed in virologic outcomes. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Anuradha Ganesan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Seunghyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christie Joya
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Robert Deiss
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Ryan Maves
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Karl Kronmann
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | | | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Brian Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Deiss R, Byrne M, Larson D, Ganesan A, Noiman A, Garges E, Randell K, Okulicz J, Kronmann K, Schofield C, Macalino G, Maves R, Agan B. 601. Prescription Drug Misuse in an HIV-Infected US Military Cohort. Open Forum Infect Dis 2018. [PMCID: PMC6253673 DOI: 10.1093/ofid/ofy210.608] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Prescription drug misuse (PDM) has markedly increased over the last decade and is a significant contributor to the national opioid epidemic. HIV+ individuals are particularly vulnerable to PDM as they experience high levels of chronic pain, anxiety and depression. We examined the prevalence of PDM and associated risk factors among HIV-infected subjects in our cohort. Methods The US Military HIV Natural History Study (NHS) is comprised of HIV+ active duty, retired military personnel and dependents. Since 2014, participants have completed a computerized behavioral survey regarding patterns of drug use and sexual behavior. We specifically queried topics including use of narcotics, benzodiazepines or stimulants without a prescription or use of medications not as prescribed. Logistic regression was used to compare those reporting and not reporting a lifetime history of PDM. Analyses used anonymous data. Results Among 1,558 respondents, 292 (18.7%) reported a history of PDM. The median age of individuals reporting history of PDM was 45 years (interquartile range [IQR] 31–53) compared with individuals without PDM (41 years; IQR 29–35; P = 0.049); the groups did not differ by race, CD4 count or viral load. The prevalence of lifetime PDM was highest among dependent individuals (31.8%), compared with retired (20.6%) or active-duty personnel (15.9%; P = 0.003 for comparison). After adjusting for age and duty status, military officers were significantly less likely to report PDM than enlisted personnel (OR 0.51; IQR 0.31–0.85). Those with a history of PDM were more likely to consume ≥3 alcoholic drinks/day (OR 1.9; IQR 1.4–2.5). In a sub-analysis of active-duty personnel only (median age 30 years), individuals reporting a history of PDM had fewer years since HIV diagnosis (median 2.9 years vs. 3.9 years, P = 0.019). Conclusion We found prevalent PDM among HIV-infected military personnel and beneficiaries, and PDM was associated with at-risk drinking. This is the first estimate of PDM among HIV+ active-duty personnel, and longitudinal studies in similar cohorts will be useful in further characterizing the epidemiology of PDM. The higher prevalence among recently diagnosed active-duty personnel may suggest an increasing scope of PDM in this group, and interventions to decrease PDM are urgently needed. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Robert Deiss
- Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, Maryland
| | - Derek Larson
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Anuradha Ganesan
- Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Adi Noiman
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Garges
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Karl Kronmann
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | | | - Ryan Maves
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, Maryland
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21
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Sanders T, Ellis G, Castrovinci P, Deiss R, Maves R. 1098. Clinical Features and Outcomes of United States Marine Corps Recruits Hospitalized With Shiga Toxin-Producing Escherichia coli Infection and Hemolytic–Uremic Syndrome. Open Forum Infect Dis 2018. [PMCID: PMC6254833 DOI: 10.1093/ofid/ofy210.933] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Shiga toxin-producing Escherichia coli (STEC) is associated with potentially life-threatening dysentery, along with its most feared complication, the hemolytic–uremic syndrome (HUS), occurring in up to 20% of STEC-infected patients. 10–30% of patients may experience chronic renovascular and neurologic sequelae after acute resolution. We describe clinical features and outcomes of a young, male military recruit population hospitalized for STEC infection and HUS in 2017. Methods Between October and November 2017, an STEC outbreak occurred at Marine Corps Recruit Depot San Diego (MCRD-SD) affecting 244 recruits, including 30 who required hospitalization. Polymerase chain reaction and pulsed-field gel electrophoresis of stool culture isolates demonstrated stx2-positive E. coli O157:H7. Thirty recruits required hospitalization; the remaining 214 underwent daily clinical evaluation and laboratory testing at MCRD with daily crystalloid volume expansion until the resolution of dysentery. Results 50% (15/30) of hospitalized recruits developed HUS and were initially managed with volume expansion until the onset of oliguria. Five recruits with severe HUS required hemodialysis; six required intensive critical care unit (ICU) admission; and three suffered from respiratory failure requiring mechanical ventilation. Average length of hospitalization was 10 days. Patients requiring hemodialysis received an average 7.4 days of renal replacement. Three patients experienced encephalopathy with seizures and were managed with levetiracetam and corticosteroids for Stx-induced cerebral edema. One patient received eculizumab, a terminal complement inhibitor approved for atypical HUS, with resolution of seizures and return to his neurocognitive baseline but with persistent electroencephalographic abnormalities. There were no deaths, and all recruits had recovery of renal function. Conclusion This case series represents the largest STEC-HUS outbreak affecting a military population. Rates of HUS and mortality were lower than seen in prior outbreaks, in part due to a high level of baseline health and early detection and management of suspect cases. Early volume expansion and close monitoring of cases may have reduced the risk for HUS progression and long-term renal sequelae. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Terrel Sanders
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | - Graham Ellis
- Medicine, Naval Medical Center San Diego, San Diego, California
| | | | - Robert Deiss
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
- Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Ryan Maves
- Infectious Diseases, Naval Medical Center San Diego, San Diego, California
- Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland
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22
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Ganesan A, Wang X, Blaylock JM, Okulicz J, Waggoner S, Johnson B, Kirkland N, Wimberly V, Garges E, Deiss R. 1500. At Risk Drinking Is Common Among HIV-Infected Department of Defense (DoD) Beneficiaries But Was Not Associated with Prevalent GC/CT Infections. Open Forum Infect Dis 2018. [PMCID: PMC6253503 DOI: 10.1093/ofid/ofy210.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anuradha Ganesan
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland, Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Xun Wang
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Sandra Waggoner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Rockvile, Maryland
| | - Brian Johnson
- Infectious Disease Clinical Research Program, Department of Preventive Medicine, Uniformed Services University, Bethesda, Maryland
| | - Nichol Kirkland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine, Uniformed Services University, Rockville, Maryland
| | - Veronica Wimberly
- Infectious Disease Clinical Research Program, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Rockvile, Maryland
| | - Eric Garges
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Deiss
- Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland
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23
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Jansen N, Daniels C, Sunil TS, Xu X, Cota JM, Byrne M, Ganesan A, Deiss R, Agan B, Okulicz J. 602. Factors Associated With Erectile Dysfunction Diagnosis in HIV-Infected Individuals: A Case–Control Study. Open Forum Infect Dis 2018. [PMCID: PMC6254301 DOI: 10.1093/ofid/ofy210.609] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Nathan Jansen
- Infectious Disease, San Antonio Military Medical Center, Ft Sam Houston, Texas
| | - Colton Daniels
- University of San Antonio/Department of Sociology, San Antonio, Texas
| | - T S Sunil
- University of Texas San Antonio, Department of Sociology, San Antonio, Texas
| | - Xiaohe Xu
- University of Texas San Antonio, Department of Sociology, San Antonio, Texas
| | - Jason M Cota
- University of the Incarnate Word, San Antonio, Texas
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Deiss
- Infectious Diseases Clinical Research Program, Uniformed Services University, Bethesda, Maryland
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Ft Sam Houston, Texas
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Ewers E, Won S, Okulicz J, Ferguson T, Deiss R, Maves R, Kronmann K, Lalani T, Agan B, Whitman TJ, Ganesan A. 2248. Changes in Lipid Profiles for Patients to Tenofovir Alafenamide (TAF)-Containing Regimens: Perspectives from a Military HIV-Positive Cohort. Open Forum Infect Dis 2018. [PMCID: PMC6252728 DOI: 10.1093/ofid/ofy210.1901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Tenofovir alafenamide (TAF) was approved in 2015 for use in HIV-1. TAF decreases risk of renal and bone toxicity compared with tenofovir disproxil fumarate (TDF). Early clinical trials reported median increases in low-density lipoprotein (LDL) of 20–29 and 9–13 mg/dL for total cholesterol (TC) following switch therapy from TDF-containing regimens at 48 weeks, raising concern for increased cardiovascular (CVD) risk over time. We assessed real-world changes in serum lipid concentrations following transition to TAF-containing regimens. Methods Eligible subjects in the U.S. Military Natural History Study, a longitudinal cohort of HIV-infected military beneficiaries, had been switched from TDF to TAF-based regimens, and had pre- and post-switch lipid profiles available. Antiretroviral therapy history, serum lipids, CD4 count and viral load were collected from the study database. Wilcoxon rank-sum test was used to compare lipid profile changes. Results As of January 1, 2018, 408 subjects on TDF switched to TAF; 238 had pre and post lipid profiles. Subjects were primarily male (95%), 45.4% African American, 70% were ≥40 years old at TAF start; 8% had CVD and 10% had diabetes. Changes in lipid profiles and CD4 count are presented in Table 1. No difference was seen when categorized by gender, race, or age. Lipid changes were not seen in subjects switched from an efavirenz (EFV) regimen. Increases in TC, HDL, and LDL were observed in those switched from rilpivirine (RPV) (P = 0.002, P = 0.0404, and P = 0.0296) or elvitegravir (EVG) (P < 0.0001, P = 0.0003, P = 0.0040) regimens. Conclusion We found significant changes in serum lipids, albeit lower than median changes observed in licensing trials. Changes were not observed in those switching from EFV, contrasting with those switching from RPV or EVG. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Evan Ewers
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Seunghyun Won
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | | | - Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Naval Medical Center San Diego, San Diego, California
| | - Ryan Maves
- Naval Medical Center San Diego, San Diego, California
| | - Karl Kronmann
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Brian Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | | | - Anuradha Ganesan
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
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Herrera MC, Konda KA, Leon SR, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD, Deiss R. Do Subjective Alcohol Screening Tools Correlate with Biomarkers Among High-Risk Transgender Women and Men Who Have Sex with Men in Lima, Peru? AIDS Behav 2017; 21:253-261. [PMID: 29043467 PMCID: PMC7392030 DOI: 10.1007/s10461-017-1933-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol abuse can influence sexual risk behavior; however, its measurement is not straightforward. This study compared self-reported alcohol use, via the AUDIT and CAGE, with levels of phosphatidylethanol (Peth), a phospholipid biomarker that forms with chronic, heavy drinking, among high-risk MSM and TW in Lima, Peru. Chi square, Fisher's exact, Wilcoxon ranksum tests compared the instruments. Receiver operating curves determined sensitivity and specificity of the self-reported measures. Among 69 MSM and 17 TW, PEth was positive for 86% (95% CI 77-93%) of participants, while 67% reported binge-drinking in the last 2 weeks. The AUDIT classified 25% as hazardous drinkers while CAGE identified 6% as problem drinkers. Self-reported binge drinking was more sensitive than the AUDIT for PEth positivity (71% vs. 27%, p = 0.022). Among high-risk MSM and TW in Lima, validated, self-report measures of alcohol abuse underestimated biological measures. Further research correlating bio-markers and self-reported alcohol abuse measures is needed.
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Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - B Brown
- Department of Social Medicine and Population Health, UCR School of Medicine, Riverside, CA, USA
| | - G M Calvo
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Center for Interdisciplinary Research in Sexuality, Society, and AIDS, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
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Fairchok M, Chen WJ, Mor D, Schofield C, Arnold J, Danaher P, Deiss R, Lalani T, Rajnik M, Malone L, Grigorenko E, Stalons D, Burgess T, Millar E, Coles C. Clinical Characteristics of Parainfluenza Virus Infection among Healthy Subjects with Influenza-like Illness. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.745] [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: 11/13/2022] Open
Abstract
Abstract
Background
Parainfluenza virus (PIV) is a chief cause of croup. Less is known about the role of PIV in causing influenza-like illness (ILI) among healthy adults and children. We evaluated clinical characteristics of PIV compared with influenza (flu) infection in healthy subjects diagnosed with ILI.
Methods
The Acute Respiratory Infection Consortium (ARIC) conducted an observational, longitudinal study of ILI at five US military treatment facilities from 2009 to 2016. Participants were otherwise healthy military members, retirees, and their dependents. Symptom data were captured prospectively on days 0, 3, and 7 by interview and patient diary. Nasopharyngeal specimens were collected for etiologic determination by multiplex assay (Diatherix Laboratories, LLC.) Severity scores were calculated for upper respiratory, lower respiratory, GI, composite and systemic symptoms
Results
PIV did not account for a large proportion of ILI in our population with 43/961(4.7%) PIV+ vs. 153/961(15.9%) that were flu+. Age < 5 years was associated with increased detection of PIV (10% in <5 years vs. 3.2% in 5–65 years, P < 0.01). Additionally, on multivariable analysis, the presence of a child aged <5 years in the household was associated with an increased risk of PIV detection (OR = 2.58; 95% CI:1.39, 4.80). Sex, geographic location, year of detection, race/ethnicity, smoking status and obesity were all unrelated to PIV detection. Codetections occurred in 8/43 (18.6%) subjects, but codetected viruses did not show any specific pattern, with 5 different viruses found. When comparing demographic characteristics of ILI caused by flu vs. PIV, the only difference was that flu+ subjects were more often ≥5 years (P < 0.01). Comparing symptom profile and severity of adults with PIV + ILI vs. flu+, we found no differences in the presence or severity of 20 symptoms, nor in severity scores for each of the 5 categories. Rates of hospitalization, antibiotic use, or duration of illness were also indistinguishable.
Conclusion
This is one of a few studies to detail the clinical characteristics of PIV presenting as ILI in healthy subjects. PIV is more often detected in young children with ILI. Although PIV was detected 25% as often as flu, it had an indistinguishable clinical course from influenza associated ILI in adults.
Disclosures
L. Malone, diatherix: Employee, Salary. E. Grigorenko, Diatherix Laboratories: Employee, Salary. D. Stalons, Diatherix Laboratories: Employee, Salary.
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Affiliation(s)
- Mary Fairchok
- Pediatrics, Madigan Army Medical Center, Tacoma, Washington,
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry Jackson Foundation, Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Rockville, MD
| | - Deepika Mor
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Rockville, MD
| | | | - John Arnold
- Pediatrics, Naval Medical Center San Diego, San Diego, California
| | - Patrick Danaher
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Naval Medical Center San Diego, San Diego, California
| | - Tahaniyat Lalani
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Michael Rajnik
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | | | | | - Timothy Burgess
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland
| | - Eugene Millar
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christian Coles
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Eickhoff C, Wang X, Deiss R, Okulicz J, O’Bryan T, Maves R, Schofield C, Ferguson T, Whitman TJ, Agan B, Ganesan A. Gonorrhea (GC) and Chlamydia (CT) Infection in a Large, Well-Characterized Military Cohort: Prevalence, Incidence, Site of Infection, and Patient Characteristics. Open Forum Infect Dis 2017. [PMCID: PMC5632171 DOI: 10.1093/ofid/ofx162.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background In the US military, routine extra-genital (EG) GC/CT testing in persons living with HIV was implemented in 2012. This study examines the prevalence/incidence and risk factors associated with genital (GU) and EG GC/CT infections in the US Military HIV Natural History Study (NHS), a cohort of HIV-infected Department of Defense beneficiaries. Methods Since 2012, willing NHS subjects have undergone nucleic acid-based tests (NAAT) to identify anorectal (AR)/ pharyngeal (PH) GC/CT infections. Incident cases had a positive test following an initial negative test. Risk factors for incident GC/CT infections were assessed with a multivariate Cox proportional hazards model. Results A total of 405 GC and 457 CT infections were observed among 1998 subjects (median age 28.7 years, 94% male, 44.1% African-American [AA]); 21% of GC and 18% of CT cases were re-infections. The incidence of AR GC, PH GC, and AR CT increased over time (P = 0.02, P = 0.03 and P = 0.02, respectively). Incident GC infections were associated with younger age [HR 0.61 per 5 year increase (0.57–0.66)], AA ethnicity [HR 1.46 (1.06–2.00)], higher viral load [HR 1.63 per log increase (1.47–1.80)] and a prior history of syphilis [HR 2.20 (1.62–2.99)]. Incident CT infections were associated with younger age [HR 0.7 per 5 year increase (0.66–0.74)], male gender [HR 5.82 (1.86–18.20)], higher viral load [HR 1.61 for each log increase (1.47–1.76)], lower CD4 count [HR 0.86 per 200 cell increase (0.79–0.95)], prior GC [HR 1.55 (1.15–2.08)] and prior syphilis [HR 2.16 (1.67–2.79)]. Conclusion Incident AR GC and CT infections are increasing in the NHS and approximately 20% of infections were repeat infections. The increased incidence is attributable at-least in part to the increased uptake of EG testing. Our study highlights the importance of prevention in positive programs to reduce the risk of HIV transmission. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Christa Eickhoff
- Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Xun Wang
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Robert Deiss
- Naval Medical Center San Diego, San Diego, California
| | - Jason Okulicz
- Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Thomas O’Bryan
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Ryan Maves
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California
| | | | - Tomas Ferguson
- Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii
| | | | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Anuradha Ganesan
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
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Tschopp A, Deiss R, Rotzer M, Wanda S, Thomann B, Schüpbach-Regula G, Meylan M. A matched case-control study comparing udder health, production and fertility parameters in dairy farms before and after the eradication of Bovine Virus Diarrhoea in Switzerland. Prev Vet Med 2017; 144:29-39. [DOI: 10.1016/j.prevetmed.2017.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/04/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
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Deiss R, Selimovic-Hamza S, Seuberlich T, Meylan M. Neurologic Clinical Signs in Cattle With Astrovirus-Associated Encephalitis. J Vet Intern Med 2017; 31:1209-1214. [PMID: 28544318 PMCID: PMC5508366 DOI: 10.1111/jvim.14728] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/20/2017] [Revised: 03/24/2017] [Accepted: 04/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background Evidence of neurotropic astroviruses has been established using novel genetic methods in cattle suffering from viral encephalitis of previously unknown origin. Objectives To describe the clinical signs observed in cattle with astrovirus‐associated encephalitis. Animals Eight cattle (4 cows, 3 heifers, and 1 bull of 4 different breeds) admitted to the Clinic for Ruminants for neurologic disease and 1 cow investigated in the field. Methods Cases were selected based on neuropathologic diagnosis of nonsuppurative encephalitis, positive in situ hybridization result for astrovirus, and availability of the results of physical and neurologic evaluations. Laboratory results were evaluated if available. Results The most frequently observed clinical signs were decreased awareness of surroundings (7), cranial nerve dysfunction (5), and recumbency (5). The cow seen in the field was the only animal that had severe behavioral changes. Cell counts in cerebrospinal fluid (CSF) were increased in 4 animals, and protein concentration was increased in 3 of 5 specimens. In 1 case, the presence of astrovirus could be identified in a CSF sample by reverse transcriptase polymerase chain reaction. Other laboratory abnormalities were nonspecific. Conclusions and Clinical Importance Astrovirus infection may be an important differential diagnosis in cattle with clinical signs of brain disease and should be considered after exclusion of other causes. The clinical and epidemiological relevance of encephalitis associated with astrovirus infection should be further investigated.
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Affiliation(s)
- R Deiss
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - S Selimovic-Hamza
- Division of Neurological Sciences, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - T Seuberlich
- Division of Neurological Sciences, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - M Meylan
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
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30
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Gilbert L, Wang X, Deiss R, Okulicz J, O’Bryan T, Maves R, Lalani T, Schofield C, Ferguson T, Kronmann K, Whitman TJ, Agan B, Ganesan A. Incidence of Herpes Zoster in a Large Cohort of Persons Living with HIV. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Wood S, Byrne M, Deiss R, Okulicz J, O’Bryan T, Schofield C, Ferguson T, Whitman TJ, Agan B, Ganesan A. The Incidence and Risk Factors Associated with Chronic Liver Enzyme Elevation (cLEE) in HIV-Monoinfected Persons. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Schofield C, Chen WJ, Fairchok M, Maves R, Arnold J, Danaher P, Deiss R, Lalani T, Rajnik M, Burgess T, Millar E, Coles C. Epidemiologic Risk, Influenza Subtype, Clinical Severity and Viral Shedding as a Function of Baseline Influenza A Viral Load. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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33
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Deiss R, Bower RJ, Co E, Mesner O, Sanchez JL, Masel J, Ganesan A, Macalino GE, Agan BK. The Association between Sexually Transmitted Infections, Length of Service and Other Demographic Factors in the U.S. Military. PLoS One 2016; 11:e0167892. [PMID: 27936092 PMCID: PMC5148014 DOI: 10.1371/journal.pone.0167892] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 04/04/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Numerous studies have found higher rates of sexually transmitted infections (STIs) among military personnel than the general population, but the cumulative risk of acquiring STIs throughout an individual's military career has not been described. METHODS Using ICD-9 diagnosis codes, we analyzed the medical records of 100,005 individuals from all service branches, divided in equal cohorts (n = 6,667) between 1997 and 2011. As women receive frequent STI screening compared to men, these groups were analyzed separately. Incidence rates were calculated for pathogen-specific STIs along with syndromic diagnoses. Descriptive statistics were used to characterize the individuals within each accession year cohort; repeat infections were censored. RESULTS The total sample included 29,010 females and 70,995 males. The STI incidence rates (per 100 person-years) for women and men, respectively, were as follows: chlamydia (3.5 and 0.7), gonorrhea (1.1 and 0.4), HIV (0.04 and 0.07) and syphilis (0.14 and 0.15). During the study period, 22% of women and 3.3% of men received a pathogen-specific STI diagnosis; inclusion of syndromic diagnoses increased STI prevalence to 41% and 5.5%, respectively. In multivariate analyses, factors associated with etiologic and syndromic STIs among women included African American race, younger age and fewer years of education. In the overall sample, increasing number of years of service was associated with an increased likelihood of an STI diagnosis (p<0.001 for trend). CONCLUSION In this survey of military personnel, we found very high rates of STI acquisition throughout military service, especially among women, demonstrating that STI-related risk is significant and ongoing throughout military service. Lower STI incidence rates among men may represent under-diagnosis and demonstrate a need for enhancing male-directed screening and diagnostic interventions.
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Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
- Naval Medical Center San Diego, San Diego, California, United States of America
- * E-mail:
| | - Richard J. Bower
- Naval Medical Center San Diego, San Diego, California, United States of America
| | - Edgie Co
- William Beaumont Army Medical Center, El Paso, Texas, United States of America
| | - Octavio Mesner
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Jose L. Sanchez
- Armed Forces Health Surveillance Branch, Public Health Division, Defense Health Agency, Silver Spring, Maryland, United States of America
| | - Jennifer Masel
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
- Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Grace E. Macalino
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Brian K. Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
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Macalino G, Kluz N, Rahman N, Byrne M, Sanchez J, Berry-Caban C, Marcum R, Roberts T, Deiss R, Lalani T, Jerse A. Gonococcal Resistance in a Population of At-Risk United States (U.S.) Department of Defense (DoD) Beneficiaries. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Grace Macalino
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nicole Kluz
- Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, Maryland
| | - Nazia Rahman
- Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Morgan Byrne
- Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, Maryland
| | - Jose Sanchez
- Public Health Division, Armed Forces Health Surveillance Branch, Defense Health Agency, Silver Spring, Maryland
| | - Cristobal Berry-Caban
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina
| | - Rodd Marcum
- Madigan Army Medical Center, Tacoma, Washington
| | - Timothy Roberts
- Division of Adolescent Medicine, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Ann Jerse
- Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Pomerantz H, Xu X, White J, Sunil T, Deiss R, Ganesan A, Agan B, Okulicz J. Evaluation of Quantitative Varicella-Zoster Virus Antibody Levels as a Predictor of Zoster Reactivation in HIV-infected Persons. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Heather Pomerantz
- Infectious Diseases, San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Xiaohe Xu
- University of Texas San Antonio, Department of Sociology, San Antonio, TX
| | - James White
- University of Texas San Antonio, Department of Sociology, San Antonio, TX
| | - T.S. Sunil
- Institute for Health Disparities Research, University of Texas at San Antonio, San Antonio, TX
| | | | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Brian Agan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Jason Okulicz
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, TX
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36
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O'Bryan T, Olsen C, Rahman S, Ganesan A, Okulicz J, Lalani T, Deiss R, Agan B. Calculated Globulin Levels Predict Hepatitis B Vaccine Response in Human Immunodeficiency Virus-Infected Persons With Viremic Suppression and High CD4 Cell Count. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas O'Bryan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, Texas
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Chris Olsen
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Syed Rahman
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, Texas
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Byrne M, Kluz N, Sanchez J, Berry-Caban C, Marcum R, Lalani T, Deiss R, Roberts T, Macalino GE. Characterizing Self-Reported Sexual Risk Behaviors and Sexually Transmitted Infections (STIs) Among High Risk Military Population Who Utilize Social Networking Sites to Seek Sexual Partners. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Morgan Byrne
- Infectious Disease Clinical Research Program, Uniformed Services Unifersity of Health Sciences, Rockville, Maryland
| | - Nicole Kluz
- Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, Maryland
| | - Jose Sanchez
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Cristobal Berry-Caban
- Department of Clinical Investigation, Womack Army Medical Center, Fort Bragg, North Carolina
| | - Rodd Marcum
- Madigan Army Medical Center, Tacoma, Washington
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Robert Deiss
- Naval Medical Center San Diego, San Diego, California
| | - Timothy Roberts
- Division of Adolescent Medicine, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Grace E Macalino
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
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38
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O'Bryan T, Freiberg M, Tracy R, Okulicz J, Lalani T, Ganesan A, Deiss R, Agan B. Relationship of Albumin/Globulin Ratio With Biomarkers of Inflammation and Coagulation in HIV-Infected Persons Before and After Combination Antiretroviral Therapy. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas O'Bryan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, Texas
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Matthew Freiberg
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee
| | - Russell Tracy
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, Texas
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Deiss R, Chen WJ, Coles C, Fairchok M, Schofield C, Danaher P, Hansen E, Lalani T, Milzman JO, Mor D, Ridore M, Burgess T, Millar E, Arnold J. Differences in Self-Reported Severity of Symptoms Between Women and Men Experiencing Influenza-Like Illness. Open Forum Infect Dis 2016. [PMCID: PMC7117585 DOI: 10.1093/ofid/ofw172.974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Christian Coles
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mary Fairchok
- Pediatrics, Mary Bridge Children's Hospital, Multicare, Tacoma, Washington
| | | | | | - Erin Hansen
- Naval Health Research Center, San Diego, California
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Jacqueline Owens Milzman
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Deepika Mor
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Rockville, Maryland
| | - Michelande Ridore
- Children's National Medical Center, Washington, District of Columbia
| | - Timothy Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eugene Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Rockville, Maryland
| | - John Arnold
- Naval Medical Center San Diego, San Diego, California
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Macalino G, Wang X, Ganesan A, Deiss R, Lalani T, Schofield C, Okulicz J, Agan B. How Does Changing Sexual Risk Behaviors Impact Incident Sexually Transmitted Infections (STIs) in a Cohort of Human Immunodeficiency Virus (HIV)+ Military Beneficiaries? Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Grace Macalino
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Xun Wang
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
| | | | - Jason Okulicz
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, Texas
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, Maryland
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O'bryan T, Olsen C, Ganesan A, Okulicz J, Lalani T, Deiss R, Agan B. Baseline Albumin/Globulin Ratio Predicted Progression to AIDS Among Persons with Stage 1 HIV Disease in the Pre-Combination Antiretroviral Therapy Era. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas O'bryan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, TX
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Chris Olsen
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, MD
| | - Jason Okulicz
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- San Antonio Military Medical Center, Infectious Disease Service, Fort Sam Houston, TX
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Naval Medical Center Portsmouth, Portsmouth, VA
| | - Robert Deiss
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, CA
| | - Brian Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
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Herrera MC, Konda KA, Leon SR, Deiss R, Brown B, Calvo GM, Salvatierra HJ, Caceres CF, Klausner JD. Impact of alcohol use on sexual behavior among men who have sex with men and transgender women in Lima, Peru. Drug Alcohol Depend 2016; 161:147-54. [PMID: 26896169 PMCID: PMC4807690 DOI: 10.1016/j.drugalcdep.2016.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 09/28/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) may enhance the likelihood of risky sexual behaviors and the acquisition of sexually transmitted infections (STIs). Associations between AUDs with condomless anal intercourse (CAI) and STI/HIV prevalence were assessed among men who have sex with men (MSM) and transgender women (TW) in Lima, Peru. METHODS MSM and TW were eligible to participate based on a set of inclusion criteria which characterized them as high-risk. Participants completed a bio-behavioral survey. An AUDIT score ≥8 determined AUD presence. Recent STI diagnosis included rectal gonorrhea/chlamydia, syphilis, and/or new HIV infection within 6 months. Prevalence ratios (PR) were calculated using Poisson regression. RESULTS Among 312 MSM and 89 TW, 45% (181/401) had an AUD. Among those with an AUD, 164 (91%) were hazardous/harmful drinkers, and 17 (9%) had alcohol dependence. Higher CAI was reported by participants with an AUD vs. without, (82% vs. 72% albeit not significant). Reporting anal sex in two or more risky venues was associated with screening AUD positive vs. not (24% vs. 15%, p=0.001). There was no difference in recent STI/HIV prevalence by AUD status (32% overall). In multivariable analysis, screening AUD positive was not associated with CAI or recent STI/HIV infection. CONCLUSIONS In our sample AUDs were not associated with CAI or new HIV infection/recent STI. However higher prevalence of CAI, alcohol use at last sex, and anal sex in risky venues among those with AUDs suggests that interventions to reduce the harms of alcohol should be aimed toward specific contexts.
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Affiliation(s)
- M C Herrera
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - K A Konda
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - S R Leon
- Partners in Health, Director of Research, Lima, Peru
| | - R Deiss
- Division of Global Public Health, UCSD School of Medicine, San Diego, CA, USA
| | - B Brown
- Division of Clinical Sciences, Center for Healthy Communities, University of California, Riverside, CA, USA
| | - G M Calvo
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - H J Salvatierra
- Alberto Barton Health Center, Health Directorate of Callao, Lima, Peru
| | - C F Caceres
- Unit of Health, Sexuality and Human Development, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J D Klausner
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Deiss R, Marquine M, Crum-Cianflone N, Law F, Wang X, Ganesan A, Okulicz J, Letendre S, Agan B, Moore D. Neurocognitive Impairment Among HIV-Infected Military Beneficiaries: The Impact of Linguistic Background. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deiss R, Mesner O, Bower R, Sanchez J, Co E, Ganesan A, Macalino GE, Agan B. Incidence of Sexually Transmitted Infections (STIs) in the US Military Is Associated With Female Gender, Increasing Length of Service and Non-Deployment. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Glancey M, Agan B, Chu X, Mesner O, Sanchez J, Ganesan A, Deiss R, Macalino G. STI Diagnosis Prior to HIV Infection May Severely Underestimate HIV Risk Among Active Duty Military Members. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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46
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Ganesan A, Mesner O, Deiss R, Okulicz J, Lalani T, Whitman T, O'bryan T, Ferguson T, Macalino G, Agan B. Repeat Syphilis Infections in a Cohort of HIV-Infected Department of Defense Beneficiaries (DoD), A Thirty Year Study (1986–2015). Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perkins M, Deiss R, Lalani T, Bradley WP, Agan B, Whitman T, O'Bryan T, Ferguson T, Okulicz J, Ganesan A. Post-Treatment Control of HIV Infection in an Early Diagnosed Well Characterized Military Cohort of Chronically HIV-1-Infected Subjects. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Troja C, Deiss R, Mesner O, Sanchez JL, Ganesan A, Macalino GE, Agan B. Hepatitis B Virus Infection and Association With Sexually Transmitted Infections Among U.S. Military Personnel. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Berjohn C, Mesner O, Agan B, Okulicz J, Lalani T, Deiss R, Bavaro M, Maves R. Impact of Screening Interval on CD4+ Counts at the Time of Human Immunodeficiency Virus Diagnosis. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Koren M, Wang X, Okulicz J, Blaylock J, Whitman T, Deiss R, O'Bryan T, Lalani T, Agan B, Macalino GE, Ganesan A. The Epidemiology and Risk Factors Associated With Herpes Simplex Virus [HSV]-2 Infections in a Large Well Characterized Cohort of HIV-Infected Patients, 2006-2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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