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HIV Seropositivity: HELP
Articles from University of Pennsylvania
Based on 32 articles published since 2008

These are the 32 published articles about HIV Seropositivity that originated from University of Pennsylvania during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2
1 Review Molecular Diagnosis of TB in the HIV Positive Population. 2014

Vittor, Amy Y / Garland, Joseph M / Gilman, Robert H. ·Department of Infectious Disease, University of Florida Emerging Pathogens Institute, Gainesville, FL. · Department of Infectious Disease, University of Pennsylvania, Jonathan Lax Center/Philadelphia FIGHT, Philadelphia, PA. · Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: rgilman@jhsph.edu. ·Ann Glob Health · Pubmed #25960097.

ABSTRACT: BACKGROUND: Tuberculosis (TB) remains a major contributor to morbidity and mortality in HIV-positive individuals, causing 1.1 million incident cases and 0.32 million deaths in 2012. Diagnosis of TB is particularly challenging in HIV-coinfected individuals, due to a high frequency of smear-negative disease, atypical presentations, and extrapulmonary TB. OBJECTIVE: The aim of this article was to review the current literature on molecular diagnostics for TB with an emphasis on the performance of these diagnostic tests in the HIV-positive population. METHODS: We searched the PubMed database using at least one of the terms TB, HIV, diagnostics, Xpert MTB/RIF, nucleic acid amplification tests, drug susceptibility testing, RNA transcription, and drew on World Health Organization publications. FINDINGS: With increased focus on reducing TB prevalence worldwide, a new set of tools for diagnosing the disease have emerged. Molecular tools such as Xpert MTB/RIF and line-probe assays are now in use or are being rolled out in many regions. The diagnostic performance of these and other molecular assays are discussed here as they pertain to the HIV-positive population. CONCLUSIONS: Molecular diagnostics offer a useful addition and at times, alternative, to traditional culture methods for the diagnosis of TB. However, most of these tests suffer from decreased accuracy in the HIV-positive population.

2 Review Allowing HIV-positive organ donation: ethical, legal and operational considerations. 2013

Mgbako, O / Glazier, A / Blumberg, E / Reese, P P. ·University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. ·Am J Transplant · Pubmed #23758835.

ABSTRACT: Case reports of kidney transplantation using HIV-positive (HIV+) donors in South Africa and advances in the clinical care of HIV+ transplant recipients have drawn attention to the legal prohibition of transplanting organs from HIV+ donors in the United States. For HIV+ transplant candidates, who face high barriers to transplant access, this prohibition violates beneficence by placing an unjustified limitation on the organ supply. However, transplanting HIV+ organs raises nonmaleficence concerns given limited data on recipient outcomes. Informed consent and careful monitoring of outcome data should mitigate these concerns, even in the rare circumstance when an HIV+ organ is intentionally transplanted into an HIV-negative recipient. For potential donors, the federal ban on transplanting HIV+ organs raises justice concerns. While in practice there are a number of medical criteria that preclude organ donation, only HIV+ status is singled out as a mandated exclusion to donation under the National Organ Transplant Act (NOTA). Operational objections could be addressed by adapting existing approaches used for organ donors with hepatitis. Center-specific outcomes should be adjusted for HIV donor and recipient status. In summary, transplant professionals should advocate for eliminating the ban on HIV+ organ donation and funding studies to determine outcomes after transplantation of these organs.

3 Clinical Trial Sequential Vacc-4x and romidepsin during combination antiretroviral therapy (cART): Immune responses to Vacc-4x regions on p24 and changes in HIV reservoirs. 2017

Tapia, G / Højen, J F / Ökvist, M / Olesen, R / Leth, S / Nissen, S K / VanBelzen, D J / O'Doherty, U / Mørk, A / Krogsgaard, K / Søgaard, O S / Østergaard, L / Tolstrup, M / Pantaleo, G / Sommerfelt, M A. ·Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, BH10-527, CH-1011 Lausanne, Switzerland. · Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark. · Bionor Pharma AS, P.O.Box 1477 Vika, NO-0116 Oslo, Norway. · University of Pennsylvania, Philadelphia, 19104 PA, USA. · Bionor Pharma AS, P.O.Box 1477 Vika, NO-0116 Oslo, Norway. Electronic address: ms@bionorpharma.com. ·J Infect · Pubmed #28917661.

ABSTRACT: OBJECTIVES: The REDUC clinical study Part B investigated Vacc-4x/rhuGM-CSF therapeutic vaccination prior to HIV latency reversal using romidepsin. The main finding was a statistically significant reduction from baseline in viral reservoir measurements. Here we evaluated HIV-specific functional T-cell responses following Vacc-4x/rhuGM-CSF immunotherapy in relation to virological outcomes on the HIV reservoir. METHODS: This study, conducted in Aarhus, Denmark, enrolled participants (n = 20) with CD4>500 cells/mm RESULTS: The frequency of participants with CD8+ T-cell proliferation assay positivity was 8/16 (50%) at baseline, 11/15 (73%) post-vaccination, 6/14 (43%) during romidepsin, and 9/15 (60%)post-romidepsin. Participants with CD8+ T-cell proliferation assay positivity post-vaccination showed reductions in total HIV DNA post-vaccination (p = 0.006; q = 0.183), post-latency reversal (p = 0.005; q = 0.183), and CA-RNA reductions post-vaccination (p = 0.015; q = 0.254). Participants (40%) were defined as proliferation 'Responders' having ≥2-fold increase in assay positivity post-baseline. Robust ELISpot baseline responses were found in 87.5% participants. No significant changes were observed in the proportion of polyfunctional CD8+ T-cells to HIV CONCLUSIONS: In this 'shock and kill' approach supported by therapeutic vaccination, CD8+ T-cell proliferation represents a valuable means to monitor functional immune responses as part of the path towards functional HIV cure.

4 Clinical Trial Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers. 2012

Brawner, B M / Gomes, M M / Jemmott, L S / Deatrick, J A / Coleman, C L. ·Center for Health Equity Research, School of Nursing, University of Pennsylvania, Philadelphia, USA. brawnerb@nursing.upenn.edu ·AIDS Care · Pubmed #22292603.

ABSTRACT: Clinically depressed and nondepressed African-American adolescent females aged 13-19 years (N=131) were interviewed and surveyed to determine the relationship between depression and HIV risk-related sexual behaviors. Narratives indicate that the psychopathology of depression may create situations where the target population could become exposed to HIV. Specifically, depressed participants described feelings of loneliness, isolation, and wanting somebody to "comfort them" as aspects of depression that affect the decisions they make about sex and relationships. In essence, sex was viewed as a stress reliever, an anti-depressant and a way to increase self-esteem. They shared that even if they did not feel like having sex, they might just "git it over wit" so their partners would stop asking. Some also discussed financial and emotional stability offered by older, more sexually experienced partners. These age-discordant relationships often translated into trusting that their partners knew what was best for their sexual relationships (i.e., having unprotected sex). Sixty-nine percent (n=88) of the sample reported engaging in sexual activity. Given their mean age (16 ± 1.9 years) participants had been sexually active for 2 ± 1.8 years. The adolescents reported an average of 2 ± 1.8 sexual partners within the past three months. Depressed participants reported a higher frequency of having ever had sex (78% vs. 59%, χ(2)=5.236, p=0.022), and had a higher mean number of sexual partners (2 vs. 1, t=-2.023, p= 0.048) and sexual encounters under the influence of drugs and alcohol (8 vs. 2, t=-3.078, p=0.005) in the past three months. The results of this study can guide the modification and/or development of tailored HIV/sexually transmitted infection (STI) prevention programs. The findings provide explicit, psychologically and culturally relevant information regarding the interaction between depression, self-medicating behaviors and risk for HIV/STIs among clinically depressed African-American adolescent females.

5 Article Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM). 2017

Merchant, Roland C / Romanoff, Justin / Clark, Melissa A / Liu, Tao / Rosenberger, Joshua G / Bauermeister, Jose / Mayer, Kenneth H. ·1 Department of Emergency Medicine and Department of Epidemiology, Alpert Medical School and the School of Public Health, Brown University, Providence, RI, USA. · 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA. · 3 Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA, USA. · 4 Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA. · 5 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. · 6 Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA. ·Am J Mens Health · Pubmed #28691552.

ABSTRACT: The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered.

6 Article Predictors of Depression among Seropositive Batswana Men and Women: A Descriptive Correlational Study. 2016

Coleman, Christopher Lance. ·University of Pennsylvania School of Nursing, Philadelphia, PA. Electronic address: colemanc@nursing.upenn.edu. ·Arch Psychiatr Nurs · Pubmed #27888968.

ABSTRACT: The purpose of this descriptive correlational study was to describe predictors of depressive symptoms among N=70 seropositive Botswana men and women residing in Gaborne, Botswana. A demographic questionnaire, the Center for Epidemiologic Studies Depression Scale, (CESD-D), and the SF-36 [Quality of life] were administered. The questionnaires were translated and back translated in Setswana and administered by Batswana men and women. The results of the regression analyses resulted in two calculated models. In the first Model energy/fatigue explained 46% of the variance in depressive symptoms (P=.000), and in the second Model energy/fatigue and role limitations on emotional well-being explained 50% of the variance in depressive symptoms respectively. The study findings underscore the need for mental health services for seropositive Batswana men and women.

7 Article Pre-Exposure Prophylaxis (PrEP) for Safer Conception Among Serodifferent Couples: Findings from Healthcare Providers Serving Patients with HIV in Seven US Cities. 2016

Finocchario-Kessler, Sarah / Champassak, Sofie / Hoyt, Mary Jo / Short, William / Chakraborty, Rana / Weber, Shannon / Levison, Judy / Phillips, Joanne / Storm, Deborah / Anderson, Jean. ·1 Department of Family Medicine, University of Kansas Medical Center , Kansas City, Kansas. · 2 Health Services and Outcomes Research, Children's Mercy Hospital , Kansas City, Missouri. · 3 François-Xavier Bagnoud Center, School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey. · 4 Division of Infectious Diseases, Perelman Schools of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania. · 5 Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia . · 6 HIVE, University of California San Francisco , San Francisco, California. · 7 Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas. · 8 Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions , Baltimore, Maryland. ·AIDS Patient Care STDS · Pubmed #26824425.

ABSTRACT: Pre-exposure prophylaxis (PrEP) can reduce the risk of HIV transmission among serodifferent couples trying to conceive, yet provider knowledge, attitudes, and experience utilizing PrEP for this purpose are largely unexamined. Trained interviewers conducted phone interviews with healthcare providers treating patients with HIV in seven cities (Atlanta, Baltimore, Houston, Kansas City, Newark, Philadelphia, and San Francisco, N = 85 total). Quantitative and qualitative data were analyzed to describe experience, concerns, and perceived barriers to prescribing PrEP for safer conception. Providers (67.1% female, 43 mean years of age, 70.4% white, 10 mean years treating HIV+ patients, 56% in academic vs. community facilities, 62.2% MD) discussed both benefits and concerns of PrEP for safer conception among serodifferent couples. Only 18.8% of providers reported experience prescribing PrEP, 74.2% were willing to prescribe it under ideal circumstances, and 7.0% were not comfortable prescribing PrEP. Benefits included added protection and a greater sense of control for the HIV-negative partner. Concerns were categorized as clinical, system-level, cost, or behavioral. Significant differences in provider characteristics existed across sites, but experience with PrEP for safer conception did not, p = 0.14. Despite limited experience, most providers were open to recommending PrEP for safer conception as long as patients understood the range of concerns and could make informed decisions. Strategies to identify and link serodifferent couples to PrEP services and clinical guidance specific to PrEP for safer conception are needed.

8 Article Evaluating the potential impact of a mobile telemedicine system on coordination of specialty care for patients with complicated oral lesions in Botswana. 2016

Tesfalul, Martha / Littman-Quinn, Ryan / Antwi, Cynthia / Ndlovu, Siphiwo / Motsepe, Didintle / Phuthego, Motsholathebe / Tau, Boitumelo / Mohutsiwa-Dibe, Neo / Kovarik, Carrie. ·Doris Duke Clinical Research Fellowship, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. ·  Health Informatics and Telemedicine, Botswana-UPenn Partnership, Gaborone, Botswana Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. ·  Health Informatics and Telemedicine, Botswana-UPenn Partnership, Gaborone, Botswana. · Department of Clinical Services, Botswana Ministry of Health, Gaborone, Botswana. · Department of Dermatology, Princess Marina Hospital, Gaborone, Botswana. · Department of Oral Medicine, Princess Marina Hospital, Gaborone, Botswana. ·  Health Informatics and Telemedicine, Botswana-UPenn Partnership, Gaborone, Botswana Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA carrie.kovarik@uphs.upenn.edu. ·J Am Med Inform Assoc · Pubmed #26510877.

ABSTRACT: Mobile telemedicine involves the use of mobile device (e.g., cell phones, tablets) technology to exchange information to assist in the provision of patient care. Throughout the world, mobile telemedicine initiatives are increasing in number and in scale, but literature on their impact on patient outcomes in low-resource areas is limited. This study explores the potential impact of a mobile oral telemedicine system on the oral health specialty referral system in Botswana. Analysis of 26 eligible cases from June 2012 to July 2013 reveals high diagnosis concordance between dental officers and oral health specialists at 91.3% (21/23) but significant management plan discordance at 64.0% (16/25), over two-thirds of which involved the specialists disagreeing with the referring clinicians about the need for a visit to a specialist. These findings suggest mobile telemedicine can optimize the use of insights and skills of specialists remotely in regions where they are scarce.

9 Article Fistulizing Epstein-Barr virus-positive plasmablastic lymphoma in an HIV-positive man. 2016

Rangel, J / Novoa, R / Morrison, C / Frank, D / Kovarik, C. ·Kaiser Permanente, Department of Dermatology, Sacramento, CA, U.S.A. · Stanford University, Department of Pathology, Department of Dermatology, Stanford, CA, U.S.A. · Baylor College of Medicine, Department of Surgery, Houston, TX, U.S.A. · Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, U.S.A. · Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, U.S.A. ·Br J Dermatol · Pubmed #26286218.

ABSTRACT: Plasmablastic lymphoma (PBL) is an unusual subtype of non-Hodgkin lymphoma recently classified as a diffuse immunoblastic lymphoma with a plasma-cell immunophenotype. Originally described in the oral cavity of HIV-positive patients, it has also been recognized to occur rarely at other sites. We describe a previously unreported fistulizing presentation of Epstein-Barr virus (EBV)-positive PBL, reviewing its association with HIV-1 infection and its importance as an AIDS-defining malignancy.

10 Article Treatment Failures and Excess Mortality Among HIV-Exposed, Uninfected Children With Pneumonia. 2015

Kelly, Matthew S / Wirth, Kathleen E / Steenhoff, Andrew P / Cunningham, Coleen K / Arscott-Mills, Tonya / Boiditswe, Sefelani C / Patel, Mohamed Z / Shah, Samir S / Finalle, Rodney / Makone, Ishmael / Feemster, Kristen A. ·Botswana-UPenn Partnership, Gaborone, Botswana Divisions of Global Health Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina. · Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. · Botswana-UPenn Partnership, Gaborone, Botswana Divisions of Global Health Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia. · Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina. · Botswana-UPenn Partnership, Gaborone, Botswana Perelman School of Medicine, University of Pennsylvania, Philadelphia. · Botswana-UPenn Partnership, Gaborone, Botswana. · University of Botswana School of Medicine, Gaborone. · Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Ohio. · Divisions of Global Health Perelman School of Medicine, University of Pennsylvania, Philadelphia. · Ministry of Health, Gaborone, Botswana. · Divisions of Global Health Infectious Diseases, The Children's Hospital of Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia. ·J Pediatric Infect Dis Soc · Pubmed #26582879.

ABSTRACT: BACKGROUND: Human immunodeficiency virus (HIV)-exposed, uninfected (HIV-EU) children are at increased risk of infectious illnesses and mortality compared with children of HIV-negative mothers (HIV-unexposed). However, treatment outcomes for lower respiratory tract infections among HIV-EU children remain poorly defined. METHODS: We conducted a hospital-based, prospective cohort study of N = 238 children aged 1-23 months with pneumonia, defined by the World Health Organization. Children were recruited within 6 hours of presentation to a tertiary hospital in Botswana. The primary outcome--treatment failure at 48 hours--was assessed by an investigator blinded to HIV exposure status. RESULTS: Median age was 6.0 months; 55% were male. One hundred fifty-three (64%) children were HIV-unexposed, 64 (27%) were HIV-EU, and 20 (8%) were HIV-infected; the HIV exposure status of 1 child could not be established. Treatment failure at 48 hours occurred in 79 (33%) children, including in 36 (24%) HIV-unexposed, 30 (47%) HIV-EU, and 12 (60%) HIV-infected children. In multivariable analyses, HIV-EU children were more likely to fail treatment at 48 hours (risk ratio [RR]: 1.83, 95% confidence interval [CI]: 1.27-2.64, P = .001) and had higher in-hospital mortality (RR: 4.31, 95% CI: 1.44-12.87, P = .01) than HIV-unexposed children. Differences in outcomes by HIV exposure status were observed only among children under 6 months of age. HIV-EU children more frequently received treatment with a third-generation cephalosporin, but this did not reduce the risk of treatment failure in this group. CONCLUSIONS: HIV-EU children with pneumonia have higher rates of treatment failure and in-hospital mortality than HIV-unexposed children during the first 6 months of life. Treatment with a third-generation cephalosporins did not improve outcomes among HIV-EU children.

11 Article AIDS Panic in the Twenty-First Century: The Tenuous Legal Status of HIV-Positive Persons in America. 2015

Cockerill, Richard G / Wahlert, Lance. ·Mayo Medical School, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA. rcockerill@mednet.ucla.edu. · Perelman School of Medicine, Department of Medical Ethics and Health Policy, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA, 19104, USA. ·J Bioeth Inq · Pubmed #26160604.

ABSTRACT: Thirty-four states criminalize HIV in some way, whether by mandating disclosure of one's HIV status to all sexual partners or by deeming the saliva of HIV-positive persons a "deadly weapon." In this paper, we argue that HIV-specific criminal laws are rooted in historical prejudice against HIV-positive persons as a class. While purporting to promote public health goals, these laws instead legally sanction discrimination against a class of persons.

12 Article Superior outcomes in HIV-positive kidney transplant patients compared with HCV-infected or HIV/HCV-coinfected recipients. 2015

Sawinski, Deirdre / Forde, Kimberly A / Eddinger, Kevin / Troxel, Andrea B / Blumberg, Emily / Tebas, Pablo / Abt, Peter L / Bloom, Roy D. ·Department of Medicine, Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · 1] Department of Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA [2] Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · 1] Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA [2] Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Medicine, Division of Infectious Disease, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. · Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. ·Kidney Int · Pubmed #25807035.

ABSTRACT: The prerequisite for an 'undetectable' HIV viral load has restricted access to transplantation for HIV-infected kidney recipients. However, HCV-infected recipients, owing to the historic limitations of HCV therapy in patients with renal disease, are commonly viremic at transplant and have universal access. To compare the effect of HIV, HCV, and HIV/HCV coinfection on kidney transplant patient and allograft outcomes, we performed a retrospective study of kidney recipients transplanted from January 1996 through December 2013. In multivariable analysis, patient (hazard ratio 0.90, 95% confidence interval 0.66-1.24) and allograft survival (0.60, 40-0.88) in 492 HIV patients did not differ significantly from the 117,791 patient-uninfected reference group. This was superior to outcomes in both the 5605 patient HCV group for death (1.44, 1.33-1.56) and graft loss (1.43, 1.31-1.56), as well as the 147 patient HIV/HCV coinfected group for death (2.26, 1.45-3.52) and graft loss (2.59, 1.60-4.19). HIV infection did not adversely affect recipient or allograft survival and was associated with superior outcomes compared with both HCV infection and HIV/HCV coinfection in this population. Thus, pretransplant viral eradication and/or immediate posttransplant eradication should be studied as potential strategies to improve posttransplant outcomes in HCV-infected kidney recipients.

13 Article Cost-effectiveness of interventions to prevent HIV and STDs among women: a randomized controlled trial. 2014

Ruger, Jennifer Prah / Abdallah, Arbi Ben / Ng, Nora Y / Luekens, Craig / Cottler, Linda. ·University of Pennsylvania Perleman School of Medicine, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA, jenpr@upenn.edu. ·AIDS Behav · Pubmed #24699712.

ABSTRACT: Injection drug use is a leading transmission route of HIV and STDs, and disease prevention among drug users is an important public health concern. This study assesses cost-effectiveness of behavioral interventions for reducing HIV and STDs infections among injection drug-using women. Cost-effectiveness analysis was conducted from societal and provider perspectives for randomized trial data and Bernoullian model estimates of infections averted for three increasingly intensive interventions: (1) NIDA's standard intervention (SI); (2) SI plus a well woman exam (WWE); and (3) SI, WWE, plus four educational sessions (4ES). Trial results indicate that 4ES was cost-effective relative to WWE, which was dominated by SI, for most diseases. Model estimates, however, suggest that WWE was cost-effective relative to SI and dominated 4ES for all diseases. Trial and model results agree that WWE is cost-effective relative to SI per hepatitis C infection averted ($109 308 for in trial, $6 016 in model) and per gonorrhea infection averted ($9 461 in trial, $14 044 in model). In sensitivity analysis, trial results are sensitive to 5 % change in WWE effectiveness relative to SI for hepatitis C and HIV. In the model, WWE remained cost-effective or cost-saving relative to SI for HIV prevention across a range of assumptions. WWE is cost-effective relative to SI for preventing hepatitis C and gonorrhea. WWE may have similar effects as the costlier 4ES.

14 Article Reliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study. 2014

Azfar, Rahat S / Lee, Robert A / Castelo-Soccio, Leslie / Greenberg, Martin S / Bilker, Warren B / Gelfand, Joel M / Kovarik, Carrie L. ·Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia. · Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego. · Department of Dermatology, University of Pennsylvania, Philadelphia. · Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia. · Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia. ·JAMA Dermatol · Pubmed #24622778.

ABSTRACT: IMPORTANCE: Mobile teledermatology may increase access to care. OBJECTIVE: To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist. MAIN OUTCOMES AND MEASURES: We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis. RESULTS: The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively. CONCLUSIONS AND RELEVANCE: Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.

15 Article Examining the relationship between alcohol use and high-risk sex practices in a population of women with high HIV incidence despite high levels of HIV-related knowledge. 2014

Zetola, Nicola M / Modongo, Chawangwa / Olabiyi, Bisayo / Ramogola-Masire, Doreen / Collman, Ronald G / Chao, Li-Wei. ·Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, , Philadelphia, Pennsylvania, USA. ·Sex Transm Infect · Pubmed #24431186.

ABSTRACT: OBJECTIVES: Alcohol use has been linked to risky sexual behaviour and it has been identified as an important modifiable factor to prevent HIV infection. However, the evidence of a link between alcohol use and risky sexual behaviour is mixed. In this paper, we examine the role of alcohol use in sexual risk taking among women in Botswana. METHODS: Participants were recruited by stratified proportional random sampling and were administered a survey interview that collected information on HIV/AIDS knowledge, risky sexual behaviour and alcohol use. Logistic regression and bivariate probit analyses were used to examine the association between alcohol use and high-risk sexual behaviour. RESULTS: 239 women were interviewed. 168 (70%) had high levels of HIV/AIDS knowledge. We found no significant protective effect of good HIV/AIDS knowledge over high-risk sex behaviour (adjusted OR 0.74, 95% CI 0.38 to 1.42). However, alcohol use before sex was associated with high-risk sex behaviour (adjusted OR 3.04, 95% CI 1.11 to 6.45). However, bivariate probit analysis that simultaneously estimates risky sexual behaviour and alcohol use revealed an insignificant association between alcohol use and risky sex, highlighting the potential presence of other unobserved individual factors that are associated with alcohol use and risky sex. CONCLUSIONS: Knowledge about HIV may not be sufficient to decrease risky sexual behaviour. Alcohol consumption was associated with an increased probability of high-risk sexual intercourse. However, the relationship between alcohol use and risky sex may also be a marker of a third omitted variable (such as overall risk-taking propensity). Further research is needed to identify factors associated with alcohol use and high-risk sex.

16 Article Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. 2014

Jemmott, John B / Heeren, G Anita / Sidloyi, Lulama / Marange, C Show / Tyler, Joanne C / Ngwane, Zolani. ·Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, jjemmott@asc.upenn.edu. ·AIDS Behav · Pubmed #24310931.

ABSTRACT: When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.

17 Article Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men. 2013

Mateen, Farrah J / Post, Wendy S / Sacktor, Ned / Abraham, Alison G / Becker, James T / Smith, Bryan R / Detels, Roger / Martin, Eileen / Phair, John P / Shinohara, Russell T / Anonymous370775. ·From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston · Departments of International Health (F.J.M., N.S.), and Epidemiology (W.S.P., A.G.A.), Bloomberg School of Public Health, and Department of Medicine, Division of Cardiology (W.S.P.), the Johns Hopkins University, Baltimore · Department of Neurology (N.S., B.R.S.), the Johns Hopkins Hospital, Baltimore, MD · Departments of Neurology, Psychiatry, and Psychology (J.T.B.), University of Pittsburgh, PA · Department of Epidemiology, School of Public Health (R.D.), and Department of Medicine, School of Medicine (R.D.), University of California, Los Angeles · Department of Psychiatry (E.M.), Rush University Medical Center, Chicago · Feinberg School of Medicine (J.P.P.), Division of Infectious Diseases, Northwestern University, Chicago, IL · and Department of Biostatistics and Epidemiology (R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. ·Neurology · Pubmed #24212385.

ABSTRACT: OBJECTIVE: To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men. METHODS: The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, FRS-S were calculated 10 years before the stroke event and assessed according to HIV status. RESULTS: A total of 114 stroke events occurred, including 57 HIV+ and 37 HIV- participants with first-ever strokes and 19 fatal strokes. The incidence of first-ever stroke was 1.7/1,000 person-years among HIV- and 3.3/1,000 person-years among HIV+ participants. Among those with strokes, HIV+ participants were younger than HIV- participants (median age 51.3 vs 61.8 years, p < 0.0001). For these men with stroke, the average 10-year risk of stroke was higher for HIV- MSM (6.6% [range 3%-26%] vs 4.9% for HIV+ MSM [range 0%-15%], p < 0.04). Traditional risk factors for stroke were similar among the Framingham cohort and the MACS HIV+ and HIV- participants. CONCLUSIONS: FRS-S prediction was systematically different in HIV+ vs HIV- men with stroke events. The FRS-S underestimates the long-term risk of stroke in HIV+ men.

18 Article Behind the cascade: analyzing spatial patterns along the HIV care continuum. 2013

Eberhart, Michael G / Yehia, Baligh R / Hillier, Amy / Voytek, Chelsea D / Blank, Michael B / Frank, Ian / Metzger, David S / Brady, Kathleen A. ·*AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA; †Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; ‡Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; §University of Pennsylvania School of Design, Philadelphia, PA; ‖Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and ¶Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and #Treatment Research Institute, Philadelphia, PA. ·J Acquir Immune Defic Syndr · Pubmed #24126447.

ABSTRACT: BACKGROUND: Successful HIV treatment as prevention requires individuals to be tested, aware of their status, linked to and retained in care, and virally suppressed. Spatial analysis may be useful for monitoring HIV care by identifying geographic areas with poor outcomes. METHODS: Retrospective cohort of 1704 people newly diagnosed with HIV identified from Philadelphia's Enhanced HIV/AIDS Reporting System in 2008-2009, with follow-up to 2011. Outcomes of interest were not linked to care, not linked to care within 90 days, not retained in care, and not virally suppressed. Spatial patterns were analyzed using K-functions to identify "hot spots" for targeted intervention. Geographic components were included in regression analyses along with demographic factors to determine their impact on each outcome. RESULTS: Overall, 1404 persons (82%) linked to care; 75% (1059/1404) linked within 90 days; 37% (526/1059) were retained in care; and 72% (379/526) achieved viral suppression. Fifty-nine census tracts were in hot spots, with no overlap between outcomes. Persons residing in geographic areas identified by the local K-function analyses were more likely to not link to care [adjusted odds ratio 1.76 (95% confidence interval: 1.30 to 2.40)], not link to care within 90 days (1.49, 1.12-1.99), not be retained in care (1.84, 1.39-2.43), and not be virally suppressed (3.23, 1.87-5.59) than persons not residing in the identified areas. CONCLUSIONS: This study is the first to identify spatial patterns as a strong independent predictor of linkage to care, retention in care, and viral suppression. Spatial analyses are a valuable tool for characterizing the HIV epidemic and treatment cascade.

19 Article Improved immunogenicity with high-dose seasonal influenza vaccine in HIV-infected persons: a single-center, parallel, randomized trial. 2013

McKittrick, Noah / Frank, Ian / Jacobson, Jeffrey M / White, C Jo / Kim, Deborah / Kappes, Rosemarie / DiGiorgio, Carol / Kenney, Thomas / Boyer, Jean / Tebas, Pablo. ·University of Pennsylvania, Philadelphia, PA 19104, USA. ·Ann Intern Med · Pubmed #23277897.

ABSTRACT: BACKGROUND: HIV-infected persons have less robust antibody responses to influenza vaccines. OBJECTIVE: To compare the immunogenicity of high-dose influenza vaccine with that of standard dosing in HIV-positive participants. DESIGN: Randomized, double-blind, controlled trial. (ClinicalTrials.gov: NCT01262846) SETTING: The MacGregor Clinic of the Hospital of the University of Pennsylvania, Philadelphia, from 27 October 2010 to 27 March 2011. PARTICIPANTS: HIV-infected persons older than 18 years. INTERVENTION: Participants were randomly assigned to receive either a standard dose (15 mcg of antigen per strain) or a high dose (60 mcg/strain) of the influenza trivalent vaccine. MEASUREMENTS: The primary end point was the rate of seroprotection, defined as antibody titers of 1:40 or greater on the hemagglutination inhibition assay 21 to 28 days after vaccination. The primary safety end point was frequency and intensity of adverse events. Secondary end points were seroconversion rate (defined as a greater than 4-fold increase in antibody titers) and the geometric mean antibody titer. RESULTS: 195 participants enrolled, and 190 completed the study (93 in the standard-dose group and 97 in the high-dose group). The seroprotection rates after vaccination were higher in the high-dose group for the H1N1 (96% vs. 87%; treatment difference, 9 percentage points [95% CI, 1 to 17 percentage points]; P = 0.029), H3N2 (96% vs. 92%; treatment difference, 3 percentage points [CI, -3 to 10 percentage points]; P = 0.32), and influenza B (91% vs. 80%; treatment difference, 11 percentage points [CI, 1 to 21 percentage points]; P = 0.030) strains. Both vaccines were well-tolerated, with myalgia (19%), malaise (14%), and local pain (10%) the most frequent adverse events. LIMITATIONS: The effectiveness of the vaccine in preventing clinical influenza was not evaluated. The number of participants with CD4 counts less than 0.200 × 109 cells/L was limited. CONCLUSION: HIV-infected persons reach higher levels of influenza seroprotection if vaccinated with the high-dose trivalent vaccine than with the standard-dose. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases and Center for AIDS Research of the University of Pennsylvania.

20 Article Depression and stigma in high-risk youth living with HIV: a multi-site study. 2012

Tanney, Mary R / Naar-King, Sylvie / MacDonnel, Karen / Anonymous4920729. ·The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Tanney@email.chop.edu ·J Pediatr Health Care · Pubmed #22726715.

ABSTRACT: INTRODUCTION: This study explored the relationship between depression, stigma, and risk behaviors in a multi-site study of high-risk youth living with HIV (YLH) in the United States. METHODS: All youth met screening criteria for either problem level substance use, current sexual risk, and/or suboptimal HIV medication adherence. Problem level substance use behavior was assessed with the CRAFFT, a six-item adolescent screener. A single item was used to screen for current sexual risk and for an HIV medication adherence problem. Stigma and depression were measured via standard self-report measures. RESULTS: Multiple regression analysis revealed that behavioral infection, older age, more problem behaviors, and greater stigma each contributed to the prediction of higher depression scores in YLH. Associations between depression, stigma, and problem behaviors are discussed. More than half of the youth in this study scored at or above the clinical cut-off for depression. Results highlight the need for depression-focused risk reduction interventions that address stigma in YLH. DISCUSSION: Study outcomes suggest that interventions are needed to address stigma and depression, not only among youth living with HIV, but in the communities in which they live.

21 Article Blocking HIV's attack. 2012

June, Carl / Levine, Bruce. ·University of Pennsylvania Perelman School of Medicine, USA. ·Sci Am · Pubmed #22375323.

ABSTRACT: -- No abstract --

22 Article Rapid psychosocial function screening test identified treatment failure in HIV+ African youth. 2012

Lowenthal, Elizabeth / Lawler, Kathy / Harari, Nurit / Moamogwe, Lesedi / Masunge, Japhter / Masedi, Motshodi / Matome, Bolefela / Seloilwe, Esther / Gross, Robert. ·General Pediatrics, Children's Hospital of Philadelphia, PA, USA. lowenthale@email.chop.edu ·AIDS Care · Pubmed #22292411.

ABSTRACT: Psychosocial dysfunction in older children and adolescents is common and may lead to nonadherence to HIV treatments. Poor adherence leads to HIV treatment failure and the development of resistant virus. In resource-limited settings where treatment options are typically limited to only one or two available lines of therapy, identification of individuals at highest risk of failure before failure occurs is of critical importance. Rapid screening tools for psychosocial dysfunction may allow for identification of those children and adolescents who are most likely to benefit from limited psychosocial support services targeted at preventing HIV treatment failure. The Pediatric Symptom Checklist (PSC) is used in high resource settings for rapid identification of at-risk youth. In 692 HIV-infected treated children (ages of 8-< 17 years) in Botswana, having a high score on the PSC was associated with having virologic failure (OR 1.7, 95% CI: 1.1-2.6). The PSC may be a useful screening tool in pediatric HIV.

23 Article Impact of transitioning from HIV clinical trials to routine medical care on clinical outcomes and patient perceptions. 2012

Yehia, Baligh R / Long, Judith A / Stearns, Cordelia R / French, Benjamin / Tebas, Pablo / Frank, Ian. ·Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA. byehia@upenn.edu ·AIDS Care · Pubmed #22106980.

ABSTRACT: Participation in antiretroviral therapy clinical trials (ART-RCTs) offers many advantages including access to new drugs, close monitoring, and cost savings. These same benefits may pose a risk to patients ending ART-RCTs and returning to routine care; as they may experience changes to their drug regimen, decreased monitoring, and new out-of-pocket costs. We aimed to evaluate this transition and determine its effects on viral outcomes and patient perceptions. A retrospective cohort was assembled from participants of naïve ART-RCTs at the University of Pennsylvania between 1 January 2000 and 31 December 2009. Data were collected in the 12 months prior to and after trial completion. Multivariable logistic regression was used to evaluate viral failure rates and to identify factors associated with viral failure. Qualitative interviews were held with a subset of patients. Content analysis was used to identify thematic differences between patients with viral failure and those with viral suppression. In total, 116 patients enrolled in 5 ART-RCTs from 2000 to 2009. Viral failure was observed in 39 patients (34%). Nonwhites, high enrollment CD4 count, and trial completion in 1999-2002 were risk factors for failure. Patients transitioning from ART-RCTs to routine care had a 20% increased odds of failure (Adjusted Odds Ratio 1.20 (95% CI [0.37, 3.88])). Nine patients with viral suppression and three with viral failure in the year after trail completion were interviewed. Suppressed patients were more eager to continue trial participation, nervous about leaving the trial, and felt prepared to return to routine care. In contrast, those with viral failure were less concerned about the transition. These findings suggest that the posttrial period may be a vulnerable time for patients. Patients without a healthy fear of transitioning from ART-RCTs to routine care may be at increased risk of viral failure. Focus should be given to assisting patients during this transition.

24 Article Images in clinical medicine. Human papillomavirus lesions of the oral cavity. 2011

Stoopler, Eric T / Balasubramaniam, Ramesh. ·University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA. ·N Engl J Med · Pubmed #22030005.

ABSTRACT: -- No abstract --

25 Article Strategies to enhance linkages between care for HIV/AIDS in jail and community settings. 2011

Draine, Jeffrey / Ahuja, Divya / Altice, Frederick L / Arriola, Kimberly Jacob / Avery, Ann K / Beckwith, Curt G / Booker, Cristina A / Ferguson, Ann / Figueroa, Hayley / Lincoln, Thomas / Ouellet, Lawrence J / Porterfield, Jeffrey / Spaulding, Anne C / Tinsley, Melinda J. ·School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA. jdraine@sp2.upenn.edu ·AIDS Care · Pubmed #21347900.

ABSTRACT: The policies of mass incarceration and the expansion of the criminal justice system in the USA over the last 40 years have weighed heavily on individuals and communities impacted by drug use and HIV disease. Though less than ideal, jails provide a unique opportunity to diagnose, treat and implement effective interventions. The role of jails in HIV detection, treatment, and continuity of care, however, has yet to be systematically examined. This paper reviews the service strategies and contexts for 10 demonstration sites funded to develop innovative methods for providing care and treatment to HIV-infected individuals in jail settings who are returning to their communities. The sites have implemented varied intervention strategies; each set in unique policy and service system contexts. Collaboration among agencies and between systems to implement these interventions is viewed as particularly challenging undertakings. We anticipate the sites will collectively serve 700-1000 individuals across the duration of the initiative. In this paper, we review the service contexts and strategies developed by the 10 sites. The individual and multi-site evaluations aim to provide new data on testing, treatment, and community linkages from jails that will further develop our knowledge base on effective intervention strategies in these settings.