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137 results on '"Abrams, D I"'

1. Trends in mortality in people with HIV from 1999 to 2020: a multi-cohort collaboration

Author: Tusch, E, Ryom, L, Pelchen-Matthews, A, Mocroft, A, Elbirt, D, Oprea, C, Günthard, H, Staehelin, C, Zangerle, R, Suarez, I, Vehreschild, J, Wit, F, Menozzi, M, d'Arminio Monforte, A, Spagnuolo, V, Pradier, C, Carlander, C, Suanzes, P, Wasmuth, J, Carr, A, Petoumenos, K, Borgans, F, Bonnet, F, De Wit, S, El-Sadr, W, Neesgaard, B, Jaschinski, N, Greenberg, L, Hosein, S, Gallant, J, Vannappagari, V, Young, L, Sabin, C, Lundgren, J, Peters, L, Reekie, J, Calvo, G, Dabis, F, Kirk, O, Law, M, Monforte, A, Morfeldt, L, Reiss, P, Weber, R, Lind-Thomsen, A, Brandt, R, Hillebreght, M, Zaheri, S, Scherrer, A, Schöni-Affolter, F, Rickenbach, M, Tavelli, A, Fanti, I, Leleux, O, Mourali, J, Marec, F, Boerg, E, Thulin, E, Sundström, A, Bartsch, G, Thompsen, G, Necsoi, C, Delforge, M, Fontas, E, Caissotti, C, Dollet, K, Mateu, S, Torres, F, Blance, A, Huang, R, Puhr, R, Laut, K, Kristensen, D, Phillips, A, Kamara, D, Smith, C, Hatleberg, C, Raben, D, Matthews, C, Bojesen, A, Grevsen, A, Powderly, B, Shortman, N, Moecklinghoff, C, Reilly, G, Franquet, X, Smit, C, Ross, M, Fux, C, Morlat, P, Friis-Møller, N, Kowalska, J, Bohlius, J, Bower, M, Fätkenheuer, G, Grulich, A, Sjøl, A, Meidahl, P, Iversen, J, Reiss, C, Hillebregt, M, Prins, J, Kuijpers, T, Scherpbier, H, van der Meer, J, Godfried, M, van der Poll, T, Nellen, F, Geerlings, S, van Vugt, M, Pajkrt, D, Bos, J, Wiersinga, W, van der Valk, M, Goorhuis, A, Hovius, J, van Eden, J, Henderiks, A, van Hes, A, Mutschelknauss, M, Nobel, H, Pijnappel, F, Jurriaans, S, Back, N, Zaaijer, H, Berkhout, B, Cornelissen, M, Schinkel, C, Thomas, X, Ziekenhuis, A, van den Berge, M, Stegeman, A, Baas, S, de Looff, L, Versteeg, D, Ziekenhuis, C, Pronk, M, Ammerlaan, H, De Munnik, E, Jansz, A, Tjhie, J, Wegdam, M, Deiman, B, Scharnhorst, V, van der Plas, A, Weijsenfeld, A, van der Ende, M, De Vries-Sluijs, T, van Gorp, E, Schurink, C, Nouwen, J, Verbon, A, Rijnders, B, Bax, H, van der Feltz, M, Bassant, N, van Beek, J, Vriesde, M, van Zonneveld, L, de Oude-Lubbers, A, van den Berg-Cameron, H, Bruinsma-Broekman, F, de Groot, J, de Man, M, Boucher, C, Koopmans, M, van Kampen, J, Pas, S, Mc–sophia, E, Driessen, G, van Rossum, A, van der Knaap, L, Visser, E, Branger, J, Rijkeboer-Mes, A, de Ven, C, Ziekenhuis, H, Schippers, E, van Nieuwkoop, C, van IJperen, J, Geilings, J, van der Hut, G, Franck, P, van Eeden, A, Brokking, W, Groot, M, Elsenburg, L, Damen, M, Kwa, I, Groeneveld, P, Bouwhuis, J, van den Berg, J, van Hulzen, A, van der Bliek, G, Bor, P, Bloembergen, P, Wolfhagen, M, Ruijs, G, Kroon, F, de Boer, M, Bauer, M, Jolink, H, Vollaard, A, Dorama, W, van Holten, N, Claas, E, Wessels, E, den Hollander, J, Pogany, K, Roukens, A, Kastelijns, M, Smit, J, Smit, E, Struik-Kalkman, D, Tearno, C, Bezemer, M, van Niekerk, T, Pontesilli, O, Lowe, S, Lashof, A, Posthouwer, D, Ackens, R, Schippers, J, Vergoossen, R, Weijenberg-Maes, B, van Loo, I, Havenith, T, Leyten, E, Gelinck, L, van Hartingsveld, A, Meerkerk, C, Wildenbeest, G, Mutsaers, J, Jansen, C, Mulder, J, Vrouenraets, S, Lauw, F, van Broekhuizen, M, Paap, H, Vlasblom, D, Smits, P, Zuiderzee, M, Weijer, S, El Moussaoui, R, Bosma, A, van Vonderen, M, van Houte, D, Kampschreur, L, Dijkstra, K, Faber, S, Weel, J, Kootstra, G, Delsing, C, van der Burg-van de Plas, M, Heins, H, Lucas, E, Kortmann, W, van Twillert, G, Stuart, J, Diederen, B, Pronk, D, van Truijen-Oud, F, van der Reijden, W, Jansen, R, Brinkman, K, van den Berk, G, Blok, W, Frissen, P, Lettinga, K, Schouten, W, Veenstra, J, Brouwer, C, Geerders, G, Hoeksema, K, Kleene, M, van der Meché, I, Spelbrink, M, Sulman, H, Toonen, A, Wijnands, S, Kwa, D, Witte, E, Koopmans, P, Keuter, M, van der Ven, A, ter Hofstede, H, Dofferhoff, A, van Crevel, R, Albers, M, Bosch, M, Grintjes-Huisman, K, Zomer, B, Stelma, F, Rahamat-Langendoen, J, Burger, D, Richter, C, Gisolf, E, Hassing, R, ter Beest, G, van Bentum, P, Langebeek, N, Tiemessen, R, Swanink, C, van Lelyveld, S, Soetekouw, R, Hulshoff, N, van der Prijt, L, van der Swaluw, J, Bermon, N, Herpers, B, Veenendaal, D, Verhagen, D, van Wijk, M, Ziekenhuis, S, van Kasteren, M, Brouwer, A, de Wiel, B, Kuipers, M, Santegoets, R, van der Ven, B, Marcelis, J, Buiting, A, Kabel, P, Bierman, W, Scholvinck, H, Wilting, K, Stienstra, Y, Jonge, H, van der Meulen, P, de Weerd, D, Ludwig-Roukema, J, Niesters, H, Riezebos-Brilman, A, van Leer-Buter, C, Knoester, M, Hoepelman, A, Mudrikova, T, Ellerbroek, P, Oosterheert, J, Arends, J, Barth, R, Wassenberg, M, Schadd, E, van Elst-Laurijssen, D, van Oers-Hazelzet, E, Vervoort, S, van Berkel, M, Schuurman, R, Verduyn-Lunel, F, Wensing, A, Peters, E, van Agtmael, M, Bomers, M, de Vocht, J, Heitmuller, M, Laan, L, Pettersson, A, Vandenbroucke-Grauls, C, Ang, C, Kinderziekenhuis, W, Geelen, S, Wolfs, T, Bont, L, Nauta, N, Bezemer, D, van Sighem, A, Boender, T, de Jong, A, Bergsma, D, Hoekstra, P, de Lang, A, Grivell, S, Jansen, A, Rademaker, M, Raethke, M, Meijering, R, Schnörr, S, de Groot, L, van den Akker, M, Bakker, Y, Claessen, E, El Berkaoui, A, Koops, J, Kruijne, E, Lodewijk, C, Munjishvili, L, Peeck, B, Ree, C, Regtop, R, Ruijs, Y, Rutkens, T, van de Sande, L, Schoorl, M, Timmerman, A, Tuijn, E, Veenenberg, L, van der Vliet, S, Wisse, A, Woudstra, T, Tuk, B, Dupon, M, Gaborieau, V, Lacoste, D, Malvy, D, Mercié, P, Neau, D, Pellegrin, J, Tchamgoué, S, Lazaro, E, Cazanave, C, Vandenhende, M, Vareil, M, Gérard, Y, Blanco, P, Bouchet, S, Breilh, D, Fleury, H, Pellegrin, I, Chêne, G, Thiébaut, R, Wittkop, L, Lawson-Ayayi, S, Gimbert, A, Desjardin, S, Lacaze-Buzy, L, Petrov-Sanchez, V, André, K, Bernard, N, Caubet, O, Caunegre, L, Chossat, I, Courtault, C, Dauchy, F, De Witte, S, Dondia, D, Duffau, P, Dutronc, H, Farbos, S, Faure, I, Ferrand, H, Gerard, Y, Greib, C, Hessamfar, M, Imbert, Y, Lataste, P, Marie, J, Mechain, M, Monlun, E, Ochoa, A, Pistone, T, Raymond, I, Receveur, M, Rispal, P, Sorin, L, Valette, C, Viallard, J, Wille, H, Wirth, G, Lafon, M, Trimoulet, P, Bellecave, P, Tumiotto, C, Haramburu, F, Miremeont-Salamé, G, Blaizeau, M, Decoin, M, Hannapier, C, Lenaud, E, Pougetoux, A, Delveaux, S, D’Ivernois, C, Diarra, F, Uwamaliya-Nziyumvira, B, Palmer, G, Conte, V, Sapparrart, V, Law, C, Moore, R, Edwards, S, Hoy, J, Watson, K, Roth, N, Lau, H, Bloch, M, Baker, D, Cooper, D, O’Sullivan, M, Nolan, D, Guelfi, G, Calvo, C, Domingo, P, Sambeat, M, Gatell, J, Del Cacho, E, Cadafalch, J, Fuster, M, Codina, C, Sirera, G, Vaqué, A, Clumeck, N, Gennotte, A, Gerard, M, Kabeya, K, Konopnicki, D, Libois, A, Martin, C, Payen, M, Semaille, P, Van Laethem, Y, Neaton, C, Krum, E, Thompson, G, Wentworth, D, Luskin-Hawk, R, Telzak, E, Abrams, D, Cohn, D, Markowitz, N, Arduino, R, Mushatt, D, Friedland, G, Perez, G, Tedaldi, E, Fisher, E, Gordin, F, Crane, L, Sampson, J, Baxter, J, Gazzard, B, Horban, A, Karpov, I, Losso, M, Pedersen, C, Ristola, M, Rockstroh, J, Fischer, A, Larsen, J, Podlekareva, D, Cozzi-Lepri, A, Shepherd, L, Schultze, A, Amele, S, Kundro, M, Schmied, B, Wien, P, Vassilenko, A, Mitsura, V, Paduto, D, Florence, E, Vandekerckhove, L, Hadziosmanovic, V, Begovac, J, Machala, L, Jilich, D, Sedlacek, D, Kronborg, G, Benfield, T, Gerstoft, J, Katzenstein, T, Møller, N, Ostergaard, L, Wiese, L, Nielsen, L, Zilmer, K, Smidt, J, Siseklinik, N, Aho, I, Viard, J, Duvivier, C, Schmidt, R, Degen, O, Stellbrink, H, Stefan, C, Goethe, J, Bogner, J, Chkhartishvili, N, Gargalianos, P, Xylomenos, G, Armenis, K, Sambatakou, H, Szlávik, J, Gottfredsson, M, Mulcahy, F, Yust, I, Turner, D, Burke, M, Shahar, E, Hassoun, G, Elinav, H, Haouzi, M, Sthoeger, Z, Esposito, R, Mazeu, I, Mussini, C, Mazzotta, F, Gabbuti, A, Annunziata, O, Vullo, V, Lichtner, M, Zaccarelli, M, Antinori, A, Acinapura, R, Plazzi, M, Lazzarin, A, Castagna, A, Gianotti, N, Galli, M, Ridolfo, A, Rozentale, B, Uzdaviniene, V, Matulionyte, R, Staub, T, Hemmer, R, Ormaasen, V, Maeland, A, Bruun, J, Knysz, B, Gasiorowski, J, Inglot, M, Bakowska, E, Flisiak, R, Grzeszczuk, A, Parczewski, M, Maciejewska, K, Aksak-Was, B, Beniowski, M, Mularska, E, Smiatacz, T, Gensing, M, Jablonowska, E, Malolepsza, E, Wojcik, K, Mozer-Lisewska, I, Caldeira, L, Mansinho, K, Maltez, F, Radoi, R, Panteleev, A, Panteleev, O, Yakovlev, A, Trofimora, T, Khromova, I, Kuzovatova, E, Blokhina, I, Novogrod, N, Borodulina, E, Vdoushkina, E, Jevtovic, D, Tomazic, J, Miró, J, Moreno, S, Rodriguez, J, Clotet, B, Jou, A, Paredes, R, Tural, C, Puig, J, Bravo, I, Gutierrez, M, Mateo, G, Laporte, J, Sonnerborg, A, Brännström, I, Flamholc, L, Cavassini, M, Calmy, A, Furrer, H, Battegay, M, Schmid, P, Kuznetsova, A, Kyselyova, G, Sluzhynska, M, Johnson, A, Simons, E, Johnson, M, Orkin, C, Weber, J, Scullard, G, Clarke, A, Leen, C, Morfeldt, C, Thulin, G, Åkerlund, B, Koppel, K, Karlsson, A, Håkangård, C, Castelli, F, Cauda, R, Perri, G, Iardino, R, Ippolito, G, Marchetti, G, Perno, C, von Schloesser, F, Viale, P, Ceccherini-Silberstein, F, Girardi, E, Caputo, S, Puoti, M, Andreoni, M, Ammassari, A, Balotta, C, Bandera, A, Bonfanti, P, Bonora, S, Borderi, M, Calcagno, A, Calza, L, Capobianchi, M, Cingolani, A, Cinque, P, De Luca, A, Biagio, A, Gori, A, Guaraldi, G, Lapadula, G, Madeddu, G, Maggiolo, F, Marcotullio, S, Monno, L, Nozza, S, Roldan, E, Rossotti, R, Rusconi, S, Santoro, M, Saracino, A, Galli, L, Lorenzini, P, Rodano, A, Shanyinde, M, Carletti, F, Carrara, S, Caro, A, Graziano, S, Petrone, F, Prota, G, Quartu, S, Truffa, S, Giacometti, A, Costantini, A, Barocci, V, Angarano, G, Santoro, C, Suardi, C, Donati, V, Verucchi, G, Minardi, C, Quirino, T, Abeli, C, Manconi, P, Piano, P, Cacopardo, B, Celesia, B, Vecchiet, J, Falasca, K, Pan, A, Lorenzotti, S, Sighinolfi, L, Segala, D, Vichi, F, Cassola, G, Viscoli, C, Alessandrini, A, Bobbio, N, Mazzarello, G, Mastroianni, C, Belvisi, V, Caramma, I, Chiodera, A, Milini, P, Rizzardini, G, Moioli, M, Piolini, R, Salpietro, S, Tincati, C, Puzzolante, C, Abrescia, N, Chirianni, A, Borgia, G, Orlando, R, Bonadies, G, Martino, F, Gentile, I, Maddaloni, L, Cattelan, A, Marinello, S, Cascio, A, Colomba, C, Baldelli, F, Schiaroli, E, Parruti, G, Sozio, F, Magnani, G, Ursitti, M, Cristaudo, A, Baldin, G, Capozzi, M, Cicalini, S, Sulekova, L, Iaiani, G, Latini, A, Mastrorosa, I, Savinelli, S, Vergori, A, Cecchetto, M, Viviani, F, Bagella, P, Rossetti, B, Franco, A, Del Vecchio, R, Francisci, D, Giuli, C, Caramello, P, Orofino, G, Sciandra, M, Bassetti, M, Londero, A, Pellizzer, G, Manfrin, V, Starnini, G, Ialungo, A, Central, C, Dellamonica, P, Bernard, E, Courjon, J, Cua, E, De Salvador-Guillouet, F, Durant, J, Etienne, C, Ferrando, S, Mondain-Miton, V, Naqvi, A, Perbost, I, Pillet, S, Prouvost-Keller, B, Pugliese, P, Rio, V, Risso, K, Roger, P, Aubert, V, Bernasconi, E, Böni, J, Braun, D, Bucher, H, Ciuffi, A, Dollenmaier, G, Egger, M, Elzi, L, Fehr, J, Fellay, J, Haerry, D, Hasse, B, Hirsch, H, Hoffmann, M, Hösli, I, Kahlert, C, Kaiser, L, Keiser, O, Klimkait, T, Kouyos, R, Kovari, H, Ledergerber, B, Martinetti, G, de Tejada, B, Marzolini, C, Metzner, K, Müller, N, Nicca, D, Pantaleo, G, Paioni, P, Rauch, A, Rudin, C, Speck, R, Stöckle, M, Tarr, P, Trkola, A, Vernazza, P, Wandeler, G, Yerly, S, Valk, M, Hutchinson, J, Rupasinghe, D, Han, W, Appoyer, H, Vera, J, Broster, B, Barbour, L, Carney, D, Greenland, L, Coughlan, R, Saint-Pierre, C, Stephan, C, Bucht, M, Chokoshvili, O, Borghi, V, Casabona, J, Miro, J, Lampe, F, Burns, F, Chaloner, C, Muccini, C, Lolatto, R, Sönnerborg, A, Nowak, P, Vesterbacka, J, Mattsson, L, Carrick, D, Stigsäter, K, Kusejko, K, Schulze, N, Franke, B, Rooney, J, Mcnicholl, I, Garges, H, Campo, R, Volny-Anne, A, Dedes, N, Williams, E, Bruguera, A, Volny-Anne, R, Mendão, L, Timiryasova, A, Fursa, O, Jakobsen, M, Kraef, C, Gardizi, M, Andersen, K, Kumar, L, Elsing, T, Shahi, S, Valdenmaiier, O, Bansi-Matharu, L, Byonanebye, D, Bannister, W, Roen, A, Null, N, Tusch, Erich, Ryom, Lene, Pelchen-Matthews, Annegret, Mocroft, Amanda, Elbirt, Daniel, Oprea, Cristiana, Günthard, Huldrych F, Staehelin, Cornelia, Zangerle, Robert, Suarez, Isabelle, Vehreschild, Jörg Janne, Wit, Ferdinand, Menozzi, Marianna, d'Arminio Monforte, Antonella, Spagnuolo, Vincenzo, Pradier, Christian, Carlander, Christina, Suanzes, Paula, Wasmuth, Jan-Christian, Carr, Andrew, Petoumenos, Kathy, Borgans, Frauke, Bonnet, Fabrice, De Wit, Stephane, El-Sadr, Wafaa, Neesgaard, Bastian, Jaschinski, Nadine, Greenberg, Lauren, Hosein, Sean R, Gallant, Joel, Vannappagari, Vani, Young, Lital, Sabin, Caroline, Lundgren, Jens, Peters, Lars, Reekie, Joanne, Monforte, A d’Arminio, Brandt, R Salbøl, Wit, F W N M, Marec, F Le, Laut, K Grønborg, Sabin, C A, Phillips, A N, Kamara, D A, Smith, C J, Hatleberg, C I, Brandt, R S, Grevsen, A L, Lundgren, J D, Fux, C A, Monforte, A d'Arminio, Iversen, J S, Reiss, Central P, Prins, J M, Kuijpers, T W, Scherpbier, H J, van der Meer, J T M, Godfried, M H, Nellen, F J B, Geerlings, S E, Bos, J C, Wiersinga, W J, Hovius, J W, van Hes, A M H, Nobel, H E, Pijnappel, F J J, Back, N K T, Zaaijer, H L, Cornelissen, M T E, Schinkel, C J, Thomas, X V, Ziekenhuis, Admiraal De Ruyter, de Looff, L Hage, Ziekenhuis, Catharina, Pronk, M J H, Ammerlaan, H S M, De Munnik, E S, Jansz, A R, Wegdam, M C A, Weijsenfeld, A M, van der Ende, M E, De Vries-Sluijs, T E M S, van Gorp, E C M, Schurink, C A M, Nouwen, J L, Rijnders, B J A, Bax, H I, van Beek, J E A, van Zonneveld, L M, van den Berg-Cameron, H J, Bruinsma-Broekman, F B, de Man, M de Zeeuw, Boucher, C A B, Koopmans, M P G, van Kampen, J J A, Pas, S D, MC–Sophia, Erasmus, Driessen, G J A, van Rossum, A M C, van der Knaap, L C, de Ven, C J H M Duijf-van, Ziekenhuis, Haga, Schippers, E F, van IJperen, J M, Franck, P F H, Elsenburg, L J M, Kwa, I S, Groeneveld, P H P, Bouwhuis, J W, van den Berg, J F, van Hulzen, A G W, van der Bliek, G L, Bor, P C J, Wolfhagen, M J H M, Ruijs, G J H M, Kroon, F P, de Boer, M G J, Bauer, M P, Vollaard, A M, Claas, E C J, den Hollander, J G, Smit, J V, Lowe, S H, Lashof, A M L Oude, Ackens, R P, van Loo, I H M, Havenith, T R A, Leyten, E M S, Gelinck, L B S, Wildenbeest, G S, Mutsaers, J A E M, Jansen, C L, Mulder, J W, Vrouenraets, S M E, Lauw, F N, van Broekhuizen, M C, Vlasblom, D J, Smits, P H M, Zuiderzee, M C, Bosma, A S, van Vonderen, M G A, van Houte, D P F, Kampschreur, L M, Kootstra, G J, Delsing, C E, Stuart, J W T Cohen, Diederen, B M W, van Truijen-Oud, F A, van der Reijden, W A, van den Berk, G E L, Blok, W L, Frissen, P H J, Lettinga, K D, Schouten, W E M, Brouwer, C J, Geerders, G F, Kleene, M J, van der Meché, I B, Toonen, A J M, Koopmans, P P, van der Ven, A J A M, ter Hofstede, H J M, Dofferhoff, A S M, Bosch, M E W, Grintjes-Huisman, K J T, Zomer, B J, Stelma, F F, Gisolf, E H, Hassing, R J, van Bentum, P H M, Swanink, C M A, van Lelyveld, S F L, van der Prijt, L M M, Herpers, B L, Verhagen, D W M, Ziekenhuis, St Elisabeth, van Kasteren, M E E, Brouwer, A E, de Wiel, B A F M de Kruijf-van, Santegoets, R M W J, Marcelis, J H, Buiting, A G M, Kabel, P J, Bierman, W F W, Wilting, K R, Jonge, H de Groot-de, van der Meulen, P A, de Weerd, D A, Niesters, H G M, van Leer-Buter, C C, Hoepelman, A I M, Ellerbroek, P M, Oosterheert, J J, Arends, J E, Barth, R E, Wassenberg, M W M, Schadd, E M, van Elst-Laurijssen, D H M, van Oers-Hazelzet, E E B, Wensing, A M J, Peters, E J G, van Agtmael, M A, Laan, L M, Pettersson, A M, Vandenbroucke-Grauls, C M J E, Ang, C W, Kinderziekenhuis, Wilhelmina, Geelen, S P M, Wolfs, T F W, Bont, L J, Bezemer, D O, van Sighem, A I, Boender, T S, Rademaker, M J, Pellegrin, J L, Vareil, M O, Dauchy, F A, Receveur, M C, Vandenhende, M A, Viallard, J F, Lafon, Me, Blaizeau, M J, Boerg, Eloïse, Law, Central M, Calvo, Central G, Sambeat, M A, Gennotte, A F, Payen, M C, Neaton, Central J, El-Sadr, W M, Abrams, D I, Crane, L R, Fischer, A H, Larsen, J F, Wien, Pulmologisches Zentrum der Stadt, Mitsura, V M, Møller, N F, Nielsen, L N, Smidt, Jelena, Siseklinik, Nakkusosakond, Viard, J-P, Stellbrink, H J, Goethe, J W, Sthoeger, Z M, Monforte, A D’Arminio, Annunziata, Ospedale S Maria, Blokhina, I N, Novogrod, Nizhny, Gatell, J M, Miró, J M, Rodriguez, J M, Laporte, J M, Johnson, A M, Johnson, M A, Morfeldt, Central L, Perri, G Di, Marchetti, G C, Perno, C F, Caputo, S Lo, Capobianchi, M R, Biagio, A Di, Roldan, E Quiros, Santoro, M M, Caro, A Di, Manconi, P E, Moioli, M C, Ridolfo, A L, Martino, F Di, Cattelan, A M, Ursitti, M A, Sulekova, L Fontanelli, Plazzi, M M, Del Vecchio, R Fontana, Giuli, C Di, Orofino, G C, Roger, P M, Braun, D L, Bucher, H C, Günthard, H F, Hirsch, H H, Kouyos, R D, de Tejada, B Martinez, Metzner, K J, Scherrer, A U, Valk, Marc vd, Han, W Min, Saint-Pierre, C H U, Miro, J M, Wasmuth, J C, Vehreschild, J J, McNicholl, I, Williams, E D, Volny-Anne, R Campo Alain, Dedes, Nikos, Mendão, Luis, Jakobsen, M L, Kumar, L Ramesh, Elsing, T W, null, null, Tusch, E, Ryom, L, Pelchen-Matthews, A, Mocroft, A, 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H, Buiting, A G M, Kabel, P J, Bierman, W F W, Wilting, K R, Jonge, H de Groot-de, van der Meulen, P A, de Weerd, D A, Niesters, H G M, van Leer-Buter, C C, Hoepelman, A I M, Ellerbroek, P M, Oosterheert, J J, Arends, J E, Barth, R E, Wassenberg, M W M, Schadd, E M, van Elst-Laurijssen, D H M, van Oers-Hazelzet, E E B, Wensing, A M J, Peters, E J G, van Agtmael, M A, Laan, L M, Pettersson, A M, Vandenbroucke-Grauls, C M J E, Ang, C W, Kinderziekenhuis, Wilhelmina, Geelen, S P M, Wolfs, T F W, Bont, L J, Bezemer, D O, van Sighem, A I, Boender, T S, Rademaker, M J, Pellegrin, J L, Vareil, M O, Dauchy, F A, Receveur, M C, Vandenhende, M A, Viallard, J F, Lafon, Me, Blaizeau, M J, Boerg, Eloïse, Law, Central M, Calvo, Central G, Sambeat, M A, Gennotte, A F, Payen, M C, Neaton, Central J, El-Sadr, W M, Abrams, D I, Crane, L R, Fischer, A H, Larsen, J F, Wien, Pulmologisches Zentrum der Stadt, Mitsura, V M, Møller, N F, Nielsen, L N, Smidt, Jelena, Siseklinik, Nakkusosakond, Viard, J-P, Stellbrink, H J, Goethe, J W, Sthoeger, Z M, Monforte, A D’Arminio, Annunziata, Ospedale S Maria, Blokhina, I N, Novogrod, Nizhny, Gatell, J M, Miró, J M, Rodriguez, J M, Laporte, J M, Johnson, A M, Johnson, M A, Morfeldt, Central L, Perri, G Di, Marchetti, G C, Perno, C F, Caputo, S Lo, Capobianchi, M R, Biagio, A Di, Roldan, E Quiros, Santoro, M M, Caro, A Di, Manconi, P E, Moioli, M C, Ridolfo, A L, Martino, F Di, Cattelan, A M, Ursitti, M A, Sulekova, L Fontanelli, Plazzi, M M, Del Vecchio, R Fontana, Giuli, C Di, Orofino, G C, Roger, P M, Braun, D L, Bucher, H C, Günthard, H F, Hirsch, H H, Kouyos, R D, de Tejada, B Martinez, Metzner, K J, Scherrer, A U, Valk, Marc vd, Han, W Min, Saint-Pierre, C H U, Miro, J M, Wasmuth, J C, Vehreschild, J J, McNicholl, I, Williams, E D, Volny-Anne, R Campo Alain, Dedes, Nikos, Mendão, Luis, Jakobsen, M L, Kumar, L Ramesh, Elsing, T W, and null, null
Abstract: Background: Mortality among people with HIV declined with the introduction of combination antiretroviral therapy. We investigated trends over time in all-cause and cause-specific mortality in people with HIV from 1999-2020. Methods: Data were collected from the D:A:D cohort from 1999 through January 2015 and RESPOND from October 2017 through 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV (CoDe), were calculated. Poisson regression models were used to assess mortality trends over time. Results: Among 55716 participants followed for a median of 6 years (IQR 3-11), 5263 participants died (crude mortality rate [MR] 13.7/1000 PYFU; 95%CI 13.4-14.1). Changing patterns of mortality were observed with AIDS as the most common cause of death between 1999- 2009 (n = 952, MR 4.2/1000 PYFU; 95%CI 4.0-4.5) and non-AIDS defining malignancy (NADM) from 2010 -2020 (n = 444, MR 2.8/1000 PYFU; 95%CI 2.5-3.1). In multivariable analysis, all-cause mortality declined over time (adjusted mortality rate ratio [aMRR] 0.97 per year; 95%CI 0.96, 0.98), mostly from 1999 through 2010 (aMRR 0.96 per year; 95%CI 0.95-0.97), and with no decline shown from 2011 through 2020 (aMRR 1·00 per year; 95%CI 0·96-1·05). Mortality due all known causes except NADM also declined over the entire follow-up period. Conclusion: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts decreased between 1999 and 2009 and was stable over the period from 2010 through 2020. The decline in mortality rates was not fully explained by improvements in immunologic-virologic status or other risk factors.
Published: 2024

2. Associations between Water-Treatment Methods and Diarrhoea in HIV-Positive Individuals

Author: Eisenberg, J. N. S., Wade, T. J., Hubbard, A., Abrams, D. I., Leiser, R. J., Charles, S., Vu, M., Saha, S., Wright, C. C., Levy, D. A., Jensen, P., and Colford,, J. M.
Published: 2002

3. Cannabis in cancer care

Author: Abrams, D I and Guzman, M
Published: 2015
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4. Response to “The Role of Cannabinoids in Chronic Pain Patients Remains Hazy”

Author: Abrams, D I, Couey, P, Shade, S B, Kelly, M E, and Benowitz, N L
Published: 2012
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5. Cannabinoid-Opioid Interaction in Chronic Pain

Author: Abrams, D I, Couey, P, Shade, S B, Kelly, M E, and Benowitz, N L
Published: 2011
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6. Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study

Author: Abrams, D I, Vizoso, H P, Shade, S B, Jay, C, Kelly, M E, and Benowitz, N L
Published: 2007
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7. CANNABIS IN PAINFUL HIV-ASSOCIATED SENSORY NEUROPATHY: A RANDOMIZED PLACEBO-CONTROLLED TRIAL

Author: Abrams, D I, Jay, C A, Shade, S B, Vizoso, H, Reda, H, Press, S, Kelly, M E, Rowbotham, M C, and Petersen, K L
Published: 2007

8. Defective Polymorphonuclear Leukocyte Chemotaxis in Homosexual Men with Persistent Lymph Node Syndrome

Author: Valone, F. H., Payan, D. G., Abrams, D. I., and Goetzl, E. J.
Published: 1984

9. Interferon and Interleukin-2 Therapy of Kaposi’s Sarcoma

Author: Volberding, P. A., Wofsy, C. B., Abrams, D. I., and Gupta, Sudhir, editor
Published: 1985
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10. Circulating microRNAs in Sera Correlate with Soluble Biomarkers of Immune Activation but Do Not Predict Mortality in ART Treated Individuals with HIV-1 Infection: A Case Control Study

Author: Murray, D. D., Suzuki, K., Law, M., Trebicka, J., Neuhaus, J., Wentworth, D., Johnson, M., Vjecha, M. J., Kelleher, A. D., Emery, S., Aagaard, B., Aragon, E., Arnaiz, J., Borup, L., Clotet, B., Dragsted, U., Fau, A., Gey, D., Grarup, J., Hengge, U., Herrero, P., Jansson, P., Jensen, B., Jensen, K., Juncher, H., Lopez, P., Lundgren, J. D., Matthews, C., Mollerup, D., Pearson, M., Phillips, A., Reilev, S., Tillmann, K., Varea, S., Angus, B., Babiker, A., Cordwell, B., Darbyshire, J., Dodds, W., Fleck, S., Horton, J., Hudson, F., Moraes, Y., Pacciarini, F., Palfreeman, A., Paton, N., Smith, N., Van Hooff, F., Bebchuk, J., Collins, G., Denning, E., Duchene, A., Fosdick, L., Harrison, M., Herman-Lamin, K., Krum, E., Larson, G., Neaton, J., Nelson, R., Quan, K., Quan, S., Schultz, T., Thompson, G., Wyman, N., Carey, C., Chan, F., Cooper, D., Courtney-Rodgers, D., Drummond, F., Harrod, M., Jacoby, S., Kearney, L., Lin, E., Pett, S., Robson, R., Seneviratne, N., Stewart, M., Watts, E., Finley, E., Gordin, F., Sanchez, A., Standridge, B., Belloso, W., Davey, R., Duprez, D., Gatell, J., Hoy, J., Lifson, A., Pederson, C., Perez, G., Price, R., Prineas, R., Rhame, F., Sampson, J., Worley, J., Modlin, J., Beral, V., Chaisson, R., Fleming, T., Hill, C., Kim, K., Murray, B., Pick, B., Seligmann, M., Weller, I., Cahill, K., Fox, L., Luzar, M., Martinez, A., Mcnay, L., Pierson, J., Tierney, J., Vogel, S., Costas, V., Eckstrand, J., Brown, S., Abusamra, L., Angel, E., Aquilia, S., Benetucci, J., Bittar, V., Bogdanowicz, E., Cahn, P., Casiro, A., Contarelli, J., Corral, J., Daciuk, L., David, D., Dobrzanski, W., Duran, A., Ebenrstejin, J., Ferrari, I., Fridman, D., Galache, V., Guaragna, G., Ivalo, S., Krolewiecki, A., Lanusse, I., Laplume, H., Lasala, M., Lattes, R., Lazovski, J., Lopardo, G., Losso, M., Lourtau, L., Lupo, S., Maranzana, A., Marson, C., Massera, L., Moscatello, G., Olivia, S., Otegui, I., Palacios, L., Parlante, A., Salomon, H., Sanchez, M., Somenzini, C., Suarez, C., Tocci, M., Toibaro, J., Zala, C., Agrawal, S., Ambrose, P., Anderson, C., Anderson, J., Baker, D., Beileiter, K., Blavius, K., Bloch, M., Boyle, M., Bradford, D., Britton, P., Brown, P., Busic, T., Cain, A., Carrall, L., Carson, S., Chenoweth, I., Chuah, J., Clark, F., Clemons, J., Clezy, K., Cortissos, P., Cunningham, N., Curry, M., Daly, L., D'Arcy-Evans, C., Del Rosario, R., Dinning, S., Dobson, P., Donohue, W., Doong, N., Downs, C., Edwards, E., Edwards, S., Egan, C., Ferguson, W., Finlayson, R., Forsdyke, C., Foy, L., Franic, T., Frater, A., French, M., Gleeson, D., Gold, J., Habel, P., Haig, K., Hardy, S., Holland, R., Hudson, J., Hutchison, R., Hyland, N., James, R., Johnston, C., Kelly, M., King, M., Kunkel, K., Lau, H., Leamy, J., Lester, D., Leung, J., Lohmeyer, A., Lowe, K., Macrae, K., Magness, C., Martinez, O., Maruszak, H., Medland, N., Miller, S., Murray, J., Negus, P., Newman, R., Ngieng, M., Nowlan, C., Oddy, J., Orford, N., Orth, D., Patching, J., Plummer, M., Price, S., Primrose, R., Prone, I., Ree, H., Remington, C., Richardson, R., Robinson, S., Rogers, G., Roney, J., Roth, N., Russell, D., Ryan, S., Sarangapany, J., Schmidt, T., Schneider, K., Shields, C., Silberberg, C., Shaw, D., Skett, J., Smith, D., Soo, T. M., Sowden, D., Street, A., Tee, B. K., Thomson, J., Topaz, S., Vale, R., Villella, C., Walker, A., Watson, A., Wendt, N., Williams, L., Youds, D., Aichelburg, A., Cichon, P., Gemeinhart, B., Rieger, A., Schmied, B., Touzeau-Romer, V., Vetter, N., Colebunders, R., Clumeck, N., Deroo, A., Kabeya, K., O'Doherty, E., De Wit, S., De Salles Amorim, C., Basso, C., Flint, S., Kallas, E., Levi, G., Lewi, D., Pereira, L., Da Silva, M., Souza, T., Toscano, A., Angel, J., Arsenault, M., Bast, M., Beckthold, B., Bouchard, P., Chabot, I., Clarke, R., Cohen, J., Cote, P., Ellis, M., Gagne, C., Gill, J., Houde, M., Johnston, B., Jubinville, N., Kato, C., Lamoureux, N., Latendre-Paquette, J., Lindemulder, A., Mcneil, A., Mcfarland, N., Montaner, J., Morrisseau, C., O'Neill, R., Page, G., Piche, A., Pongracz, B., Preziosi, H., Puri, L., Rachlis, A., Ralph, E., Raymond, I., Rouleau, D., Routy, J. P., Sandre, R., Seddon, T., Shafran, S., Sikora, C., Smaill, F., Stromberg, D., Trottier, S., Walmsley, S., Weiss, K., Williams, K., Zarowny, D., Baadegaard, B., Andersen, A. B., Boedker, K., Collins, P., Gerstoft, J., Jensen, L., Moller, H., Andersen, P. L., Loftheim, I., Mathiesen, L., Nielsen, H., Obel, N., Pedersen, C., Petersen, D., Jensen, L. P., Black, F. T., Aboulker, J. P., Aouba, A., Bensalem, M., Berthe, H., Blanc, C., Bornarel, D., Bouchaud, O., Boue, F., Bouvet, E., Brancon, C., Breaud, S., Brosseau, D., Brunet, A., Capitant, C., Ceppi, C., Chakvetadze, C., Cheneau, C., Chennebault, J. M., De Truchis, P., Delavalle, A. M., Delfraissy, J. F., Dellamonica, P., Dumont, C., Edeb, N., Fabre, G., Ferrando, S., Foltzer, A., Foubert, V., Gastaut, J. A., Gerbe, J., Girard, P. M., Goujard, C., Hoen, B., Honore, P., Hue, H., Hynh, T., Jung, C., Kahi, S., Katlama, C., Lang, J. M., Le Baut, V., Lefebvre, B., Leturque, N., Levy, Y., Loison, J., Maddi, G., Maignan, A., Majerholc, C., De Boever, C., Meynard, J. L., Michelet, C., Michon, C., Mole, M., Netzer, E., Pialoux, G., Poizot-Martin, I., Raffi, F., Ratajczak, M., Ravaux, I., Reynes, J., Salmon-Ceron, D., Sebire, M., Simon, A., Tegna, L., Tisne-Dessus, D., Tramoni, C., Viard, J. P., Vidal, M., Viet-Peaucelle, C., Weiss, L., Zeng, A., Zucman, D., Adam, A., Arasteh, K., Behrens, G., Bergmann, F., Bickel, M., Bittner, D., Bogner, J., Brockmeyer, N., Darrelmann, N., Deja, M., Doerler, M., Esser, S., Faetkenheuer, G., Fenske, S., Gajetzki, S., Goebel, F., Gorriahn, D., Harrer, E., Harrer, T., Hartl, H., Hartmann, M., Heesch, S., Jakob, W., Jager, H., Klinker, H., Kremer, G., Ludwig, C., Mantzsch, K., Mauss, S., Meurer, A., Niedermeier, A., Pittack, N., Plettenberg, A., Potthoff, A., Probst, M., Rittweger, M., Rockstroh, J., Ross, B., Rotty, J., Rund, E., Ruzicka, T., Schmidt, R., Schmutz, G., Schnaitmann, E., Schuster, D., Sehr, T., Spaeth, B., Staszewski, S., Stellbrink, H. J., Stephan, C., Stockey, T., Stoehr, A., Trein, A., Vaeth, T., Vogel, M., Wasmuth, J., Wengenroth, C., Winzer, R., Wolf, E., Mulcahy, F., Reidy, D., Cohen, Y., Drora, G., Eliezer, I., Godo, O., Kedem, E., Magen, E., Mamorsky, M., Pollack, S., Sthoeger, Z., Vered, H., Yust, I., Aiuti, F., Bechi, M., Bergamasco, A., Bertelli, D., Bruno, R., Butini, L., Cagliuso, M., Carosi, G., Casari, S., Chrysoula, V., Cologni, G., Conti, V., Costantini, A., Corpolongo, A., D'Offizi, G., Gaiottino, F., Di Pietro, M., Esposito, R., Filice, G., Francesco, M., Gianelli, E., Graziella, C., Magenta, L., Martellotta, F., Maserati, R., Mazzotta, F., Murdaca, G., Nardini, G., Nozza, S., Puppo, F., Pogliaghi, M., Ripamonti, D., Ronchetti, C., Rusconi, S., Rusconi, V., Sacchi, P., Silvia, N., Suter, F., Tambussi, G., Uglietti, A., Vechi, M., Vergani, B., Vichi, F., Vitiello, P., Iwamoto, A., Kikuchi, Y., Miyazaki, N., Mori, M., Nakamura, T., Odawara, T., Oka, S., Shirasaka, T., Tabata, M., Takano, M., Ueta, C., Watanabe, D., Yamamoto, Y., Erradey, I., Himmich, H., El Filali, K. M., Blok, W., Van Boxtel, R., Doevelaar, K. B. H., Van Eeden, A., Grijsen, M., Groot, M., Juttmann, J., Kuipers, M., Ligthart, S., Van Der Meulen, P., Lange, J., Langebeek, N., Reiss, P., Richter, C., Schoemaker, M., Schrijnders-Gudde, L., Septer-Bijleveld, E., Sprenger, H., Vermeulen, J., Ten Kate, R., Van De Ven, B., Bruun, J., Kvale, D., Maeland, A., Bakowska, E., Beniowski, M., Boron-Kaczmarska, A., Gasiorowski, J., Horban, A., Inglot, M., Knysz, B., Mularska, E., Parczewski, M., Pynka, M., Rymer, W., Szymczak, A., Aldir, M., Antunes, F., Baptista, C., Da Conceicao Vera, J., Doroana, M., Mansinho, K., Dos Santos, C. R. A., Valadas, E., Vaz Pinto, I., Chia, E., Foo, E., Karim, F., Lim, P. 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D., Allworth, A. M., Anderson, J. S. C., Armishaw, J., Barnes, K., Carr, A., Chiam, A., Chuah, J. C. P., Curry, M. C., Dever, R. L., Donohue, W. A., Doong, N. C., Dwyer, D. E., Dyer, J., Eu, B., Ferguson, V. W., French, M. A. H., Garsia, R. J., Hudson, J. H., Jeganathan, S., Konecny, P., Mccormack, C. L., Mcmurchie, M., Moore, R. J., Moussa, M. B., Piper, M., Read, T., Roney, J. J., Shaw, D. R., Silvers, J., Smith, D. J., Street, A. C., Vale, R. J., Wendt, N. A., Wood, H., Youds, D. W., Zillman, J., Tozeau, V., Dewit, S., De Roo, A., Leonard, P., Lynen, L., Moutschen, M., Pereira, L. C., Souza, T. N. L., Schechter, M., Zajdenverg, R., Almeida, M. M. T. B., Araujo, F., Bahia, F., Brites, C., Caseiro, M. M., Casseb, J., Etzel, A., Falco, G. G., Filho, E. C. J., Flint, S. R., Gonzales, R., Madruga, J. V. R., Passos, L. N., Reuter, T., Sidi, L. C., Toscano, A. L. C., Cherban, E., Conway, B., Dufour, C., Foster, A., Haase, D., Haldane, H., Klein, M., Lessard, B., Martel, A., Martel, C., Paradis, E., Schlech, W., Schmidt, S., Thompson, B., Vezina, S., Reyes, M. J. W., Northland, R., Ostergaard, L., Hergens, L., Loftheim, I. R., Raukas, M., Zilmer, K., Justinen, J., Ristola, M., Landman, R., Abel, S., Abgrall, S., Amat, K., Auperin, L., Barruet, R., Benalycherif, A., Benammar, N., Bentata, M., Besnier, J. M., Blanc, M., Cabie, A., Chavannet, P., Dargere, S., De La Tribonniere, X., Debord, T., Decaux, N., Delgado, J., Dupon, M., Durant, J., Frixon-Marin, V., Genet, C., Gerard, L., Gilquin, J., Jeantils, V., Kouadio, H., Leclercq, P., Lelievre, J. D., Michon, C. P., Nau, P., Pacanowski, J., Piketty, C., Salmon, D., Schmit, J. L., Serini, M. A., Tassi, S., Touam, F., Verdon, R., Weinbreck, P., Yazdanpanah, Y., Yeni, P., Fatkenheuer, G., Bitsch, S., Bogner, J. R., Goebel, F. D., Lehmann, C., Lennemann, T., Wasmuth, J. 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V., Vera, J., Rakhmanova, A., Vinogradova, E., Yakovlev, A., Zakharova, N., Wood, R., Orrel, C., Arnaiz, J. A., Carrillo, R., Dalmau, D., Jordano, Q., Knobel, H., Larrousse, M., Moreno, J. S., Oretaga, E., Pena, J. N., Hirschel, B., Spycher, R., Battegay, M., Bottone, S., Cavassini, M., Christen, A., Furrer, H. J., Gayet-Ageron, A., Genne, D., Hochstrasser, S., Moens, C., Muller, N., Nuesch, R., Ruxrungtham, K., Pumpradit, W., Dangthongdee, S., Kiertiburanakul, S., Klinbuayaem, V., Mootsikapun, P., Nonenoy, S., Piyavong, B., Prasithsirikul, W., Raksakulkarn, P., Gazzard, B. G., Ainsworth, J. G., Angus, B. J., Barber, T. J., Brook, M. G., Care, C. D., Chadwick, D. R., Chikohora, M., Churchill, D. R., Cornforth, D., Dockrell, D. H., Easterbrook, P. J., Fox, P. A., Gomez, P. A., Gompels, M. M., Harris, G. M., Herman, S., Jackson, A. G. A., Jebakumar, S. P. R., Kinghorn, G. R., Kuldanek, K. A., Larbalestier, N., Lumsden, M., Maher, T., Mantell, J., Muromba, L., Orkin, C. M., Peters, S., Peto, T. E. A., Portsmouth, S. D., Rajamanoharan, S., Ronan, Schwenk, A., Slinn, M. A., Stroud, C. J., Thomas, R. C., Wansbrough-Jones, M. H., Whiles, H. J., White, D. J., Williams, E., Williams, G., Youle, M., Abrams, D. I., Acosta, E. A., Adamski, A., Antoniskis, D., Aragon, D. R., Barnett, B. J., Baroni, C., Barron, M., Baxter, J. D., Beers, D., Beilke, M., Bemenderfer, Bernard, A., Besch, C. L., Bessesen, M. T., Bethel, J. T., Blue, S., Blum, J. D., Boarden, S., Bolan, R. K., Borgman, J. B., Brar, I., Braxton, B. K., Bredeek, U. F., Brennan, R., Britt, D. E., Bulgin-Coleman, D., Bullock, E., Campbell, B., Caras, S., Carroll, J., Casey, K. K., Chiang, F., Cindrich, R. B., Cohen, C., Coley, J., Condoluci, D. V., Contreras, R., Corser, J., Cozzolino, J., Crane, L. R., Daley, L., Dandridge, D., D'Antuono, V., Darcourt Rizo Patron, J. G., Dehovitz, J. A., Dejesus, E., Desjardin, J., Dietrich, C., Dolce, A., Erickson, D., Faber, L. L., Falbo, J., Farrough, M. J., Farthing, C. F., Ferrell-Gonzalez, P., Flynn, H., Frank, M., Freeman, K. F., French, N., Friedland, G., Fujita, N., Gahagan, L., Gilson, I., Goetz, M. B., Goodwin, E., Guity, C. K., Gulick, P., Gunderson, E. R., Hale, C. M., Hannah, K., Henderson, H., Hennessey, K., Henry, W. K., Higgins, T., Hodder, S. L., Horowitz, H. W., Howe-Pittman, M., Hubbard, J., Hudson, R., Hunter, H., Hutelmyer, C., Insignares, M. T., Jackson, L., Jenny, L., Johnson, D. L., Johnson, G., Johnson, J., Kaatz, J., Kaczmarski, J., Kagan, S., Kantor, C., Kempner, T., Kieckhaus, K., Kimmel, N., Klaus, B. M., Koeppe, J. R., Koirala, J., Kopka, J., Kostman, J. R., Kozal, M. J., Kumar, A., Lampiris, H., Lamprecht, C., Lattanzi, K. M., Lee, J., Leggett, J., Long, C., Loquere, A., Loveless, K., Lucasti, C. J., Luskin-Hawk, R., Macveigh, M., Makohon, L. H., Markowitz, N. P., Marks, C., Martorell, C., Mcfeaters, E., Mcgee, B., Mcintyre, D. M., Mcmanus, E., Melecio, L. G., Melton, D., Mercado, S., Merrifield, E., Mieras, J. A., Mogyoros, M., Moran, F. M., Murphy, K., Mutic, S., Nadeem, I., Nadler, J. P., Ognjan, A., O'Hearn, M., O'Keefe, K., Okhuysen, P. C., Oldfield, E., Olson, D., Orenstein, R., Ortiz, R., Parpart, F., Pastore-Lange, V., Paul, S., Pavlatos, A., Pearce, D. D., Pelz, R., Peterson, S., Pitrak, D., Powers, S. L., Pujet, H. C., Raaum, J. W., Ravishankar, J., Reeder, J., Reilly, N. A., Reyelt, C., Riddell, J., Rimland, D., Robinson, M. L., Rodriguez, A. E., Rodriguez Derouen, V., Rosmarin, C., Rossen, W. L., Rouff, J. R., Sands, M., Savini, C., Schrader, S., Schulte, M. M., Scott, R., Seedhom, H., Sension, M., Sheblehall, A., Shuter, J., Slater, L. N., Slotten, R., Smith, M., Snap, S., States, D. M., Stringer, G., Summers, K. K., Swanson, K., Sweeton, I. B., Szabo, S., Tedaldi, E. M., Telzak, E. E., Thompson, M. A., Thompson, S., Bong, C. T. H., Vaccaro, A., Vasco, L. M., Vecino, I., Verlinghieri, G. K., Visnegarwala, F., Wade, H., Weis, S. E., Weise, J. A., Weissman, S., Wilkin, M., Witter, J. H., Wojtusic, L., Wright, T. J., Yeh, V., Young, B., Zeana, C., Zeh, J., Savio, E., Vacarezza, M., and Pacheco, Antonio Guilherme
Subjects: Adult, CD4-Positive T-Lymphocytes, Male, General Science & Technology, Anti-HIV Agents, T cell, lcsh:Medicine, Antiretroviral Therapy, HIV Infections, Biology, Essential hypertension, Logistic regression, Malignancy, Acquired immunodeficiency syndrome (AIDS), Clinical Research, Antiretroviral Therapy, Highly Active, microRNA, medicine, Genetics, 2.1 Biological and endogenous factors, Humans, Highly Active, Aetiology, lcsh:Science, Genetic Association Studies, Multidisciplinary, lcsh:R, Case-control study, Middle Aged, medicine.disease, 3. Good health, Circulating MicroRNA, MicroRNAs, medicine.anatomical_structure, Infectious Diseases, Good Health and Well Being, INSIGHT ESPRIT and SMART Study Groups, Immunology, HIV-1, HIV/AIDS, lcsh:Q, Female, Infection, Biomarkers, Biotechnology, Research Article
Abstract: Introduction The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR-145 correlated with nadir CD4+ T cell count. Discussion No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection.
Published: 2015

11. Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study

Author: Mocroft, Amanda, Lundgren, Jens D., Ross, Michael, Law, Matthew, Reiss, Peter, Kirk, Ole, Smith, Colette, Wentworth, Deborah, Neuhaus, Jacqueline, Fux, Christoph A., Moranne, Olivier, Morlat, Phillipe, Johnson, Margaret A., Ryom, Lene, Lundgren, J. D., Powderly, B., Shortman, N., Moecklinghoff, C., Reilly, G., Franquet, X., Sabin, C. A., Phillips, A., Kirk, O., Reiss, P., Weber, R., Pradier, C., Law, M., d'Arminio Monforte, A., Dabis, F., El-Sadr, W. M., De Wit, S., Ryom, L., Kamara, D., Smith, C., Mocroft, A., Tverland, J., Mansfeld, M., Nielsen, J., Raben, D., Salbøl Brandt, R., Rickenbach, M., Fanti, I., Krum, E., Hillebregt, M., Geffard, S., Sundström, A., Delforge, M., Fontas, E., Torres, F., Mcmanus, H., Wright, S., Kjær, J., Sjøl, A., Meidahl, P., Helweg-Larsen, J., Schmidt Iversen, J., Ross, M., Fux, C. A., Morlat, P., Moranne, O., Kesselring, A. M., Kamara, D. A., Friis-Møller, N., Kowalska, J., Sabin, C., Bruyand, M., Bower, M., Fätkenheuer, G., Donald, A., Grulich, A., Prins, J. M., Kuijpers, T. W., Scherpbier, H. J., van der Meer, J. T. M., Wit, F. W. M. N., Godfried, M. H., van der Poll, T., Nellen, F. J. B., Geerlings, S. E., van Vugt, M., Pajkrt, D., Bos, J. C., Wiersinga, W. J., van der Valk, M., Goorhuis, A., Hovius, J. W., van Eden, J., Henderiks, A., van Hes, A. M. H., Mutschelknauss, M., Nobel, H. E., Pijnappel, F. J. J., Westerman, A. M., Jurriaans, S., Back, N. K. T., Zaaijer, H. L., Berkhout, B., Cornelissen, M. T. E., Schinkel, C. J., Thomas, X. V., van den Berge, M., Stegeman, A., Baas, S., Hage de Looff, L., Versteeg, D., Pronk, M. J. H., Ammerlaan, H. S. M., Korsten-Vorstermans, E. M. H. M., de Munnik, E. S., Jansz, A. R., Tjhie, J., Wegdam, M. C. A., Deiman, B., Scharnhorst, V., van der Plas, A., Weijsenfeld, A. M., van der Ende, M. E., de Vries-Sluijs, T. E. M. S., C. M. van Gorp, E., Schurink, C. A. M., Nouwen, J. L., Verbon, A., Rijnders, B. J. A., Bax, H. I., Hassing, R. J., van der Feltz, M., Bassant, N., van Beek, J. E. A., Vriesde, M., van Zonneveld, L. M., de Oude-Lubbers, A., van den Berg-Cameron, H. J., Bruinsma-Broekman, F. B., de Groot, J., de Zeeuw- de Man, M., Broekhoven-Kruijne, M. J., Schutten, M., Osterhaus, A. D. M. E., Boucher, C. A. B., Driessen, G. J. A., van Rossum, A. M. C., van der Knaap, L. C., Visser, E., Branger, J., H. M. Duijf-van de Ven, C. J., Schippers, E. F., van Nieuwkoop, C., Brimicombe, R. W., van IJperen, J. M., van der Hut, G., Franck, P. F. H., van Eeden, A., Brokking, W., Groot, M., Damen, M., Kwa, I. S., Groeneveld, P. H. P., Bouwhuis, J. W., van den Berg, J. F., van Hulzen, A. G. W., van der Bliek, G. L., Bor, P. C. J., Bloembergen, P., Wolfhagen, M. J. H. M., Ruijs, G. J. H. M., van Lelyveld, S. F. L., Soetekouw, R., Hulshoff, N., van der Prijt, L. M. M., Schoemaker, M., Bermon, N., van der Reijden, W. A., Jansen, R., Herpers, B. L., Veenendaal, D., Kroon, F. P., Arend, S. M., de Boer, M. G. J., Bauer, M. P., Jolink, H., Vollaard, A. M., Dorama, W., Moons, C., Claas, E. C. J., Kroes, A. C. M., den Hollander, J. G., Pogany, K., Kastelijns, M., Smit, J. V., Smit, E., Bezemer, M., van Niekerk, T., Pontesilli, O., Lowe, S. H., Oude Lashof, A., Posthouwer, D., Ackens, R. P., Schippers, J., Vergoossen, R., Weijenberg Maes, B., Savelkoul, P. H. M., Loo, I. H., Weijer, S., El Moussaoui, R., Heitmuller, M., Kortmann, W., van Twillert, G., Cohen Stuart, J. W. T., Diederen, B. M. W., Pronk, D., van Truijen-Oud, F. A., Leyten, E. M. S., Gelinck, L. B. S., van Hartingsveld, A., Meerkerk, C., Wildenbeest, G. S., Mutsaers, J. A. E. M., Jansen, C. L., van Vonderen, M. G. A., van Houte, D. P. F., Dijkstra, K., Faber, S., Weel, J., Kootstra, G. J., Delsing, C. E., van der Burg-van de Plas, M., Heins, H., Lucas, E., Brinkman, K., Frissen, P. H. J., Blok, W. L., Schouten, W. E. M., Bosma, A. S., Brouwer, C. J., Geerders, G. 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J., Yeh, V., Young, B., Zeana, C., Zeh, J., Savio, E., Vacarezza, M., University College of London [London] (UCL), University of Copenhagen = Københavns Universitet (KU), University of New South Wales [Sydney] (UNSW), University of Amsterdam [Amsterdam] (UvA), University of Minnesota [Twin Cities] (UMN), University of Minnesota System, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Centre Hospitalier Universitaire de Nice (CHU Nice), Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Med Microbiol, Infect Dis & Infect Prev, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, RS: CAPHRI School for Public Health and Primary Care, RS: CAPHRI - R4 - Health Inequities and Societal Participation, Interne Geneeskunde, Chemical Biology, Mocroft, A, Lundgren, J, Ross, M, Law, M, Reiss, P, Kirk, O, Smith, C, Wentworth, D, Neuhaus, J, Fux, C, Moranne, O, Morlat, P, Johnson, M, Ryom, L, Gori, A, Internal medicine, CCA - Innovative therapy, ICaR - Circulation and metabolism, Medical Microbiology and Infection Prevention, CCA - Disease profiling, CCA - Immuno-pathogenesis, Plastic, Reconstructive and Hand Surgery, Mocroft, Amanda, Lundgren, Jens D., Ross, Michael, Law, Matthew, Reiss, Peter, Kirk, Ole, Smith, Colette, Wentworth, Deborah, Neuhaus, Jacqueline, Fux, Christoph A., Moranne, Olivier, Morlat, Phillipe, Johnson, Margaret A., Ryom, Lene, D:a:d Study, Group, Castagna, Antonella, the Royal Free Hospital Clinic, Cohort, and the, Insight, Smart, and ESPRIT, Study, Clinicum, Department of Medicine, Herrada, Anthony, University of Copenhagen = Københavns Universitet (UCPH), AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health, Other departments, Infectious diseases, Paediatric Infectious Diseases / Rheumatology / Immunology, General Internal Medicine, Center of Experimental and Molecular Medicine, Graduate School, Gastroenterology and Hepatology, Dermatology, ACS - Amsterdam Cardiovascular Sciences, Other Research, Anesthesiology, and Bartlett, John
Subjects: Male, Adult, Age Factors, Anti-HIV Agents, CD4 Lymphocyte Count, Clinical Decision-Making, Comorbidity, Female, HIV, HIV Infections, HIV Seropositivity, Humans, Incidence, Kidney, Middle Aged, Prospective Studies, Renal Insufficiency, Chronic, Risk, Risk Assessment, Sex Factors, urologic and male genital diseases, Biochemistry, 0302 clinical medicine, ANTIRETROVIRAL THERAPY, Adult, Age Factors, Anti-HIV Agents, CD4 Lymphocyte Count, Clinical Decision-Making, Comorbidity, Female, HIV, HIV Infections, HIV Seropositivity, Humans, Incidence, Kidney, Male, Middle Aged, Prospective Studies, Renal Insufficiency, Chronic, Risk, Risk Assessment, Sex Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Age Factor, Chronic, STAGE RENAL-DISEASE, PROTEINURIA, virus diseases, 11 Medical And Health Sciences, General Medicine, ASSOCIATION, 6. Clean water, female genital diseases and pregnancy complications, 3. Good health, HIV/AIDS, Medicine, Infection, psychological phenomena and processes, Human, medicine.medical_specialty, Renal function, NEFROPATIAS, chronic kidney disease, risk score model, 12. Responsible consumption, ESPRIT study group, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Clinical Research, D:A:D study group, Intensive care medicine, medicine (all), Molecular Biology, Royal Free Hospital Clinic Cohort, Prevention, Anti-HIV Agent, medicine.disease, Prospective Studie, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], Immunology, Kidney Disease, PREDICTION, POSITIVE PERSONS, 030232 urology & nephrology, Sex Factor, SDG 3 – Goede gezondheid en welzijn, Medical and Health Sciences, GLOMERULAR-FILTRATION-RATE, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, INSIGHT study group, HIV Infection, LIFE EXPECTANCY, 030212 general & internal medicine, Renal Insufficiency, Prospective cohort study, Framingham Risk Score, Incidence (epidemiology), adult, age factors, anti-hiv agents, CD4 lymphocyte count, clinical decision-making, comorbidity, female, hiv, hiv infections, hiv seropositivity, humans, incidence, kidney, male, middle aged, prospective studies, renal insufficiency, chronic, risk, risk assessment, sex factors, SMART study group, 6.1 Pharmaceuticals, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Patient Safety, Risk assessment, Biotechnology, Research Article, Settore MED/17 - MALATTIE INFETTIVE, NO, A:D study group [D], General & Internal Medicine, Diabetes mellitus, mental disorders, medicine, EXPOSURE, business.industry, Evaluation of treatments and therapeutic interventions, Cell Biology, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, INDIVIDUALS, Good Health and Well Being, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 3121 General medicine, internal medicine and other clinical medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Kidney disease
Abstract: Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7–6.7; median follow-up 6.1 y, range 0.3–9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was −2 (interquartile range –4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0–4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166–3,367); NNTH was 202 (95% CI 159–278) and 21 (95% CI 19–23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506–1462), 88 (95% CI 69–121), and 9 (95% CI 8–10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3–12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6–8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD., Editors’ Summary Background About 35 million people are currently infected with HIV, the virus that causes AIDS. HIV destroys CD4 lymphocytes and other immune system cells, leaving infected individuals susceptible to other infections. HIV infection can be controlled, but not cured, using combination antiretroviral therapy (cART), and, nowadays, the life expectancy of many HIV-positive individuals is similar to that of HIV-negative people. HIV-positive individuals nevertheless experience some illnesses more frequently than HIV-negative people do. For example, up to a third of HIV-positive individuals develop chronic kidney disease (CKD), which is associated with an increased risk of cardiovascular disease and death. Persons with CKD may have an impaired effect of the filtration units in the kidneys that remove waste products and excess water from the blood to make urine, thereby leading to a reduced blood filtration rate (the estimated glomerular filtration rate [eGFR]) and waste product accumulation in the blood. Symptoms of CKD, which rarely occur until the disease is advanced, include tiredness, swollen feet, and frequent urination. Advanced stages of CKD cannot be cured, but its progression can be slowed by, for example, controlling hypertension (high blood pressure) and diabetes (two CDK risk factors) and by adopting a healthy lifestyle. Why Was This Study Done? The burden of CKD may increase among HIV-positive individuals as they age, and clinicians need to know which individuals are at high risk of developing CKD when choosing cART regimens for their patients. In addition, clinicians need to be able to identify those HIV-positive individuals at greatest risk of CKD so that they can monitor them for early signs of kidney disease. Some antiretroviral drugs—for example, tenofovir and atazanavir/ritonavir (a boosted protease inhibitor)—are associated with kidney damage. Clinicians may need to weigh the benefits and risks of giving such potentially nephrotoxic drugs to individuals who already have a high CKD risk. Here, the researchers develop and validate a simple, widely applicable risk score (a risk prediction model) for CKD among HIV-positive individuals and investigate the relationship between CKD and potentially nephrotoxic antiretroviral drugs among individuals with different CKD risk score profiles. What Did the Researchers Do and Find? To develop their CKD risk score, the researchers used clinical and demographic data collected from 17,954 HIV-positive individuals enrolled in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study who had an eGFR > 60 ml/min/1.73 m2 and were not taking a potentially nephrotoxic antiretroviral at baseline. During 103,185 person-years of follow-up, 641 individuals developed CKD. Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease predicted CKD. The researchers included these nine factors in their risk score model (which is available online) and defined three risk groups: low (risk score < 0), medium (risk score 0–4), and high (risk score ≥ 5) risk of CKD development in the next five years. Specifically, there was a 1 in 393, 1 in 47, and 1 in 6 chance of developing CKD in the next five years in the low, medium, and high risk groups, respectively. Because some patients started to use potentially nephrotoxic antiretroviral drugs during follow-up, the researchers were able to use their risk score model to calculate how many patients would have to be treated with one of these drugs for an additional patient to develop CKD over five years in each risk group. This “number needed to harm” (NNTH) for patients starting treatment with tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor was 739, 88, and 9 in the low, medium, and high risk groups, respectively. Finally, the researchers validated the accuracy of their risk score in two independent HIV study groups. What Do These Findings Mean? These findings provide a simple, validated risk score for CKD and indicate that the NNTH when starting potentially nephrotoxic antiretrovirals was low among HIV-positive individuals at the highest risk of CKD (i.e., treating just nine individuals with nephrotoxic antiretroviral drugs will likely lead to an additional case of CKD in five years). Although various aspects of the study, including the lack of data on race, limit the accuracy of these findings, these findings highlight the need for monitoring, screening, and chronic disease prevention to minimize the risk of HIV-positive individuals developing diabetes, hypertension, or cardiovascular disease, or becoming coinfected with hepatitis C, all of which contribute to the CKD risk score. Moreover, the development of a tool for estimating an individual’s five-year risk of developing CKD with or without the addition of potentially nephrotoxic antiretroviral drugs will enable clinicians and patients to weigh the benefits of certain antiretroviral drugs against the risk of CKD and make informed decisions about treatment options. Additional Information Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001809. Information is available from the US National Institute of Allergy and Infectious Diseases on HIV infection and AIDS NAM/aidsmap provides basic information about HIV/AIDS, summaries of recent research findings on HIV care and treatment, and personal stories about living with AIDS/HIV Information is available from Avert, an international AIDS charity, on many aspects of HIV/AIDS, including personal stories about living with HIV/AIDS The World Health Organization provides information on all aspects of HIV/AIDS (in several languages), including its guidelines on the use of ART for treating and preventing HIV infection The UNAIDS World AIDS Day Report 2014 provides up-to-date information about the AIDS epidemic and efforts to halt it The UK National Health Service Choices website provides information for patients on chronic kidney disease, including some personal stories The US National Kidney Foundation, a not-for-profit organization, provides information about chronic kidney disease (in English and Spanish) A tool for calculating the CDK risk score developed in this study is available Additional information about the D:A:D study is available, Amanda Mocroft and colleagues develop and validate a model for determining risk of developing chronic kidney disease for individuals with HIV if treated with different antiretroviral therapies.
Published: 2015
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12. Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Author: Mocroft, A., Lundgren, J. D., Ross, M., Law, M., Reiss, P., Kirk, O., Smith, C., Wentworth, D., Neuhaus, J., Fux, C. A., Moranne, O., Morlat, P., Johnson, M. A., Ryom, L., Powderly, B., Shortman, N., Moecklinghoff, C., Reilly, G., Franquet, X., Sabin, C. A., Phillips, A., Weber, R., Pradier, C., d'Arminio Monforte, A., Dabis, F., El-Sadr, W. M., De Wit, S., Kamara, D., Tverland, J., Mansfeld, M., Nielsen, J., Raben, D., Salbol Brandt, R., Rickenbach, M., Fanti, I., Krum, E., Hillebregt, M., Geffard, S., Sundstrom, A., Delforge, M., Fontas, E., Torres, F., Mcmanus, H., Wright, S., Kjaer, J., Sjol, A., Meidahl, P., Helweg-Larsen, J., Schmidt Iversen, J., Kesselring, A. M., Friis-Moller, N., Kowalska, J., Sabin, C., Bruyand, M., Kamara, D. A., Bower, M., Fatkenheuer, G., Donald, A., Grulich, A., Prins, J. M., Kuijpers, T. W., Scherpbier, H. J., van der Meer, J. T. M., Wit, F. W. M. N., Godfried, M. H., van der Poll, T., Nellen, F. J. B., Geerlings, S. E., van Vugt, M., Pajkrt, D., Bos, J. C., Wiersinga, W. J., van der Valk, M., Goorhuis, A., Hovius, J. W., van Eden, J., Henderiks, A., van Hes, A. M. H., Mutschelknauss, M., Nobel, H. E., Pijnappel, F. J. J., Westerman, A. M., Jurriaans, S., Back, N. K. T., Zaaijer, H. L., Berkhout, B., Cornelissen, M. T. E., Schinkel, C. J., Thomas, X. V., van den Berge, M., Stegeman, A., Baas, S., Hage de Looff, L., Versteeg, D., Pronk, M. J. H., Ammerlaan, H. S. M., Korsten-Vorstermans, E. M. H. M., de Munnik, E. S., Jansz, A. R., Tjhie, J., Wegdam, M. C. A., Deiman, B., Scharnhorst, V., van der Plas, A., Weijsenfeld, A. M., van der Ende, M. E., de Vries-Sluijs, T. E. M. S., C. M. van Gorp, E., Schurink, C. A. M., Nouwen, J. L., Verbon, A., Rijnders, B. J. A., Bax, H. I., Hassing, R. J., van der Feltz, M., Bassant, N., van Beek, J. E. A., Vriesde, M., van Zonneveld, L. M., de Oude-Lubbers, A., van den Berg-Cameron, H. J., Bruinsma-Broekman, F. B., de Groot, J., de Zeeuw- de Man, M., Broekhoven-Kruijne, M. J., Schutten, M., Osterhaus, A. D. M. E., Boucher, C. A. B., Driessen, G. J. A., van Rossum, A. M. C., van der Knaap, L. C., Visser, E., Branger, J., H. M. Duijf-van de Ven C., J., Schippers, E. F., van Nieuwkoop, C., Brimicombe, R. W., van IJperen, J. M., van der Hut, G., Franck, P. F. H., van Eeden, A., Brokking, W., Groot, M., Damen, M., Kwa, I. S., Groeneveld, P. H. P., Bouwhuis, J. W., van den Berg, J. F., van Hulzen, A. G. W., van der Bliek, G. L., Bor, P. C. J., Bloembergen, P., Wolfhagen, M. J. H. M., Ruijs, G. J. H. M., van Lelyveld, S. F. L., Soetekouw, R., Hulshoff, N., van der Prijt, L. M. M., Schoemaker, M., Bermon, N., van der Reijden, W. A., Jansen, R., Herpers, B. L., Veenendaal, D., Kroon, F. P., Arend, S. M., de Boer, M. G. J., Bauer, M. P., Jolink, H., Vollaard, A. M., Dorama, W., Moons, C., Claas, E. C. J., Kroes, A. C. M., den Hollander, J. G., Pogany, K., Kastelijns, M., Smit, J. 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J., Mooka, B., Mamorksy, M. G., Agmon-Levin, N., Karplus, R., Shahar, E., Biglino, A., De Gioanni, M., Montroni, M., Raise, E., Honda, M., Ishisaka, M., Caplinskas, S., Uzdaviniene, V., Schmit, J. C., Mills, G. D., Blackmore, T., Masters, J. A., Morgan, J., Pithie, A., Brunn, J., Ormasssen, V., La Rosa, A., Guerra, O., Espichan, M., Gutierrez, L., Mendo, F., Salazar, R., Knytz, B., Kwiatkowski, J., Castro, R. S., Horta, A., Miranda, A. C., Pinto, I. V., Vera, J., Vinogradova, E., Yakovlev, A., Wood, R., Orrel, C., Arnaiz, J. A., Carrillo, R., Dalmau, D., Jordano, Q., Knobel, H., Larrousse, M., Moreno, J. S., Oretaga, E., Pena, J. N., Spycher, R., Bottone, S., Christen, A., Franc, C., Furrer, H. J., Gayet-Ageron, A., Genne, D., Hochstrasser, S., Moens, C., Nuesch, R., Ruxrungtham, K., Pumpradit, W., Dangthongdee, S., Kiertiburanakul, S., Klinbuayaem, V., Mootsikapun, P., Nonenoy, S., Piyavong, B., Prasithsirikul, W., Raksakulkarn, P., Gazzard, B. G., Ainsworth, J. G., Angus, B. J., Barber, T. J., Brook, M. G., Care, C. D., Chadwick, D. R., Chikohora, M., Churchill, D. R., Cornforth, D., Dockrell, D. H., Easterbrook, P. J., Fox, P. A., Gomez, P. A., Gompels, M. M., Harris, G. M., Herman, S., Jackson, A. G. A., Jebakumar, S. P. R., Kinghorn, G. R., Kuldanek, K. A., Larbalestier, N., Lumsden, M., Maher, T., Mantell, J., Muromba, L., Orkin, C. M., Palfreeman, A. J., Peters, B. S., Peto, T. E. A., Portsmouth, S. D., Rajamanoharan, S., Ronan, A., Schwenk, A., Slinn, M. A., Stroud, C. J., Thomas, R. C., Wansbrough-Jones, M. H., Whiles, H. J., White, D. J., Williams, E., Williams, I. G., Acosta, E. A., Adamski, A., Antoniskis, D., Aragon, D. R., Barnett, B. J., Baroni, C., Barron, M., Baxter, J. D., Beers, D., Beilke, M., Bemenderfer, D., Bernard, A., Besch, C. L., Bessesen, M. T., Bethel, J. T., Blue, S., Blum, J. D., Boarden, S., Bolan, R. K., Borgman, J. B., Brar, I., Braxton, B. K., Bredeek, U. F., Brennan, R., Britt, D. E., Bulgin-Coleman, D., Bullock, D. E., Campbell, B., Caras, S., Carroll, J., Casey, K. K., Chiang, F., Cindrich, R. B., Clark, C., Cohen, C., Coley, J., Condoluci, D. V., Contreras, R., Corser, J., Cozzolino, J., Daley, L., Dandridge, D., D'Antuono, V., Darcourt Rizo Patron, J. G., Dehovitz, J. A., Dejesus, E., Desjardin, J., Dietrich, C., Dolce, E., Erickson, D., Faber, L. L., Falbo, J., Farrough, M. J., Farthing, C. F., Ferrell-Gonzalez, P., Flynn, H., Frank, M., Freeman, K. F., French, N., Fujita, N., Gahagan, L., Gilson, I., Goetz, M. B., Goodwin, E., Guity, C. K., Gulick, P., Gunderson, E. R., Hale, C. M., Hannah, K., Henderson, H., Hennessey, K., Henry, W. K., Higgins, D. T., Hodder, S. L., Horowitz, H. W., Howe-Pittman, M., Hubbard, J., Hudson, R., Hunter, H., Hutelmyer, C., Insignares, M. T., Jackson, L., Jenny, L., Johnson, D. L., Johnson, G., Johnson, J., Kaatz, J., Kaczmarski, J., Kagan, S., Kantor, C., Kempner, T., Kieckhaus, K., Kimmel, N., Klaus, B. M., Koeppe, J. R., Koirala, J., Kopka, J., Kostman, J. R., Kozal, M. J., Kumar, A., Lampiris, H., Lamprecht, C., Lattanzi, K. M., Lee, J., Leggett, J., Long, C., Loquere, A., Loveless, K., Lucasti, C. J., Macveigh, M., Makohon, L. H., Markowitz, N. P., Marks, C., Martorell, C., Mcfeaters, E., Mcgee, B., Mcintyre, D. M., Mcmanus, E., Melecio, L. G., Melton, D., Mercado, S., Merrifield, E., Mieras, J. A., Mogyoros, M., Moran, F. M., Murphy, K., Mutic, S., Nadeem, I., Nadler, J. P., Ognjan, A., O'Hearn, M., O'Keefe, K., Okhuysen, P. C., Oldfield, E., Olson, D., Orenstein, R., Ortiz, R., Parpart, F., Pastore-Lange, V., Paul, S., Pavlatos, A., Pearce, D. D., Pelz, R., Peterson, S., Pitrak, D., Powers, S. L., Pujet, H. C., Raaum, J. W., Ravishankar, J., Reeder, J., Reilly, N. A., Reyelt, C., Riddell, J., Rimland, D., Robinson, M. L., Rodriguez, A. E., Rodriguez-Barradas, M. C., Rodriguez Derouen, V., Rosmarin, C., Rossen, W. L., Rouff, J. R., Sampson, J. H., Sands, M., Savini, C., Schrader, S., Schulte, M. M., Scott, R., Seedhom, H., Sension, M., Sheble-Hall, A., Shuter, J., Slater, L. N., Slotten, R., Smith, M., Snap, S., States, D. M., Stringer, G., Summers, K. K., Swanson, K., Sweeton, I. B., Szabo, S., Telzak, E. E., Thompson, M. A., Thompson, S., Ting Hong Bong, C., Vaccaro, A., Vasco, L. M., Vecino, I., Verlinghieri, G. K., Visnegarwala, F., Wade, B. H., Weis, S. E., Weise, J. A., Weissman, S., Wilkin, A. M., Witter, J. H., Wojtusic, L., Wright, T. J., Yeh, V., Young, B., Zeana, C., Zeh, J., Savio, E., Vacarezza, M., and Cauda R. (ORCID:0000-0002-1498-4229)
Abstract: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7–6.7; median follow-up 6.1 y, range 0.3–9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was −2 (interquartile range –4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0–4, 103 events) and high risk groups (risk score ≥ 5, 505 events)
Published: 2015

13. Integrating cannabis into clinical cancer care.

Author: Abrams, D. I.
Subjects: *CANNABIS (Genus), *SYMPTOMS, *CANCER treatment, *VOMITING, *INSOMNIA
Abstract: Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects. [ABSTRACT FROM AUTHOR]
Published: 2016
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14. Identification of prognostic tumor markers in HIV+ diffuse large B-cell lymphoma (DLBCL).

Author: Chao, C., primary, Silverberg, M., additional, Abrams, D. I., additional, Haque, R., additional, Zha, H. D., additional, Martinez-Maza, O., additional, McGuire, M., additional, Chi, M. D., additional, Castor, B., additional, Xu, L., additional, and Said, J., additional
Published: 2011
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15. Cannabis in painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial

Author: Abrams, D. I., primary, Jay, C. A., additional, Shade, S. B., additional, Vizoso, H., additional, Reda, H., additional, Press, S., additional, Kelly, M. E., additional, Rowbotham, M. C., additional, and Petersen, K. L., additional
Published: 2007
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16. Guidelines for the Design and Conduct of AIDS Clinical Trials

Author: Cotton, D. J., primary, Powderly, W. G., additional, Feinberg, J., additional, Abrams, D. I., additional, Chaisson, R. E., additional, Wheat, L. J., additional, Finkelstein, D. M., additional, Tallman, V., additional, Zimmer, B., additional, Berzon, R., additional, Fogelman, I., additional, and Phair, J., additional
Published: 1993
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17. Bone Marrow Aspiration and Biopsy in Hiv Infection

Author: Calabrese, L. H., primary and Abrams, D. I., additional
Published: 1992
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18. Clinical and virologic effects of recombinant human granulocyte-macrophage colony-stimulating factor in patients receiving chemotherapy for human immunodeficiency virus-associated non-Hodgkin's lymphoma: results of a randomized trial.

Author: Kaplan, L D, primary, Kahn, J O, additional, Crowe, S, additional, Northfelt, D, additional, Neville, P, additional, Grossberg, H, additional, Abrams, D I, additional, Tracey, J, additional, Mills, J, additional, and Volberding, P A, additional
Published: 1991
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19. Epoetin alfa therapy for anaemia in HIV-infected patients: impact on quality of life.

Author: Abrams, Donald I., Steinhart, Corklin, Frascino, Robert, Abrams, D I, Steinhart, C, and Frascino, R
Subjects: ANEMIA, QUALITY of life, HIV, HIGHLY active antiretroviral therapy, AIDS-related complex, AZIDOTHYMIDINE, ANEMIA prevention, ERYTHROPOIETIN, HIV infection complications, HEMATOPOIETIC agents, CLINICAL trials, COMPARATIVE studies, HEMOGLOBINS, HIV infections, RESEARCH methodology, MEDICAL cooperation, RECOMBINANT proteins, RESEARCH, EVALUATION research, ANTI-HIV agents, THERAPEUTICS
Abstract: To evaluate the effect of epoetin alfa on the quality of life (QOL) of HIV-infected patients in the community setting, 221 anaemic (haemoglobin < or = 11 g/dl) HIV-positive patients from community-based treatment centres and physicians' offices were treated with epoetin alfa (100-300 units/kg subcutaneously 3 times a week) in a 4-month, open-label, non-randomized, phase IV trial. Epoetin alfa therapy significantly (P<0.01) increased and maintained haemoglobin levels (mean increase=2.5 g/dl; n=207); the improvement in haemoglobin levels was independent of changes in CD4+ cell counts. Transfusion requirements were also significantly reduced from 20% to 5% of patients (P<0.01). Mean total QOL score measured by the Functional Assessment of HIV Infection (FAHI) scale and Physical Well-Being subscale score improved significantly (P<0.05). QOL improvements associated with increases in haemoglobin were independent of changes in CD4+ counts and baseline anaemia severity. Adverse events observed during epoetin alfa therapy were consistent with HIV disease and not likely due to the drug. Epoetin alfa therapy should be considered a treatment option for HIV-infected patients with mild-to-moderate anaemia. [ABSTRACT FROM AUTHOR]
Published: 2000
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20. AIDS-associated non-Hodgkin's lymphoma in San Francisco.

Author: Kaplan, L D, Abrams, D I, Feigal, E, McGrath, M, Kahn, J, Neville, P, Ziegler, J, and Volberding, P A
Abstract: The characteristics of acquired immunodeficiency syndrome-associated non-Hodgkin's lymphoma in 84 patients diagnosed and treated at San Francisco General Hospital are presented herein. While the majority were high-grade B-cell lymphomas, one cutaneous T-cell and one peripheral T-cell lymphoma were observed. In addition, three other tumors were suspicious for T-cell lymphoma. Sixty-seven percent of patients had stage IV disease, often at unusual sites. Epstein-Barr virus DNA sequences were identified in only five of 15 tumors by dot-blot analysis. Patients were treated with a variety of standard chemotherapeutic regimens, with radiation therapy alone, or with a novel chemotherapy protocol (COMET-A). No significant differences in complete response rates were observed. The most important predictor of survival was the total number of CD4-positive lymphocytes. Other predictors of survival included history of a diagnosis of acquired immunodeficiency syndrome, Karnofsky performance score, and the presence of extranodal disease. Survival was shorter among patients who received higher doses of cyclophosphamide (greater than 1 g/m2), including those treated with the COMET-A regimen. Implications for therapeutic decision making are discussed. [ABSTRACT FROM AUTHOR]
Published: 1989
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21. Oral dextran sulfate (UA001) in the treatment of the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex.

Author: Abrams, Donald I., Kuno, Suchiko, Wong, Roberta, Jeffords, Kevan, Nash, Marti, Mologhan, J.B., Gorter, Robert, Ueno, Ryuji, Abrams, D I, Kuno, S, Wong, R, Jeffords, K, Nash, M, Molaghan, J B, Gorter, R, and Ueno, R
Subjects: DEXTRANASE, HIV, AIDS treatment, AIDS, AIDS-related complex, CLINICAL trials, COMPARATIVE studies, DEXTRAN, DRUG tolerance, DRUG administration, CLINICAL drug trials, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, ORAL drug administration, RESEARCH, EVALUATION research
Abstract: Study Objective: To evaluate the tolerance and safety of oral dextran sulfate (UA001), a potent in-vitro inhibitor of human immunodeficiency virus (HIV) in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex.Design: Unblinded, dose-escalation 8-week trial.Setting: An AIDS outpatient clinic of a university-affiliated municipal hospital.Patients: Thirty-four patients with stage III or IV HIV infection were enrolled. Five patients in six different dosage cohorts completed the study. The population was predominantly homosexual men with persistent generalized lymphadenopathy (stage III).Interventions: Oral dextran sulfate was given three times daily in total daily doses of 900 to 5400 mg for 8 weeks. Patients were monitored for tolerance and toxicity. Immunologic and virologic values were also followed.Measurements and Main Results: Oral dextran sulfate was given without significant side effects. The commonest minor subjective complications were mental hyperexcitability and gastrointestinal complaints. The most frequent laboratory abnormalities were leukopenia and hepatic transaminase elevations. Eleven patients required dose reductions, and therapy was stopped in 4 because of toxicities. The CD4 lymphocyte numbers did not change appreciably. No decline in beta-2 microglobulin levels occurred. The HIV antigen levels were unchanged from baseline. No assay for dextran sulfate plasma levels has yet proven successful.Conclusions: Oral dextran sulfate appears to be well tolerated. No evidence of systemic absorption of the parent compound is available. However, in view of the promising in vitro effects and acceptable toxicity, oral dextran sulfate as a potential antiretroviral agent continues to be studied. [ABSTRACT FROM AUTHOR]
Published: 1989
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22. Antibodies to human T-lymphotropic virus type III and development of the acquired immunodeficiency syndrome in homosexual men presenting with immune thrombocytopenia.

Author: Abrams, Donald I., Kiprov, Dobri D., Goedert, James J., Sarngadharan, M.G., Gallo, Robert C., Volberding, Paul A., Abrams, D I, Kiprov, D D, Goedert, J J, Gallo, R C, and Volberding, P A
Subjects: RETROVIRUS diseases, THROMBOCYTOPENIA, AIDS
Abstract: In 35 homosexual men with isolated thrombocytopenia at initial presentation, who were evaluated and treated between 1982 and 1984, hematologic studies showed immune destruction. In contrast to findings in other autoimmune conditions, T-lymphocyte subsets in these patients were reversed, with a mean helper to suppressor ratio of 0.4 and with an absolute depletion of helper cells to 390/mm3. An enzyme-linked immunosorbent assay detected antibodies to human T-lymphotropic virus type III in 21 of 25 patients tested; Western blot analysis confirmed seropositivity in the other 4 patients, who had borderline findings. Although 19 of 24 patients treated with steroids responded, only 2 achieved sustained normal platelet counts. Ten of fifteen patients who had splenectomy achieved remissions. Three patients treated with steroids or splenectomy developed diagnoses compatible with the acquired immunodeficiency syndrome 16 to 34 months after their initial presentation with thrombocytopenia. These findings indicate that immune thrombocytopenia is part of the clinical spectrum of the acquired immunodeficiency syndrome. [ABSTRACT FROM AUTHOR]
Published: 1986
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23. Vinblastine therapy for Kaposi's sarcoma in the acquired immunodeficiency syndrome.

Author: Volberding, Paul A., Abrams, Donald I., Conant, Marcus, Kaslow, Kathleen, Vranizan, Karen, Ziegler, John, Volberding, P A, Abrams, D I, Conant, M, Kaslow, K, Vranizan, K, and Ziegler, J
Subjects: VINBLASTINE, KAPOSI'S sarcoma, AIDS patients, THERAPEUTICS, AIDS, BLOOD sedimentation, COMPARATIVE studies, DRUG administration, HEMATOCRIT, INFECTION, INTRAVENOUS injections, RESEARCH methodology, MEDICAL cooperation, RESEARCH, EVALUATION research, DISEASE complications
Abstract: Single-agent intravenous vinblastine, 4 to 8 mg/week, was used to treat 38 patients with Kaposi's sarcoma related to the acquired immunodeficiency syndrome. The dose was titrated in relation to the total leukocyte count. Ten patients had an objective response, and 19 had stable disease during therapy. Apart from expected modest neutropenia, toxicity was minimal. A lower response rate was seen in patients with anemia, an elevated erythrocyte sedimentation rate, or any lymphoma-like B symptom. Opportunistic infections were common regardless of type of response but were commoner in patients who did not respond. Vinblastine used in low doses weekly is effective in treating Kaposi's sarcoma related to the acquired immunodeficiency syndrome and has minimal associated toxicities. [ABSTRACT FROM AUTHOR]
Published: 1985
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24. AIDS-related lymphomas: evaluation by abdominal CT.

Author: Nyberg, D A, primary, Jeffrey, R B, additional, Federle, M P, additional, Bottles, K, additional, and Abrams, D I, additional
Published: 1986
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25. AIDS-related lymphadenopathy: the role of biopsy.

Author: Abrams, D I, primary
Published: 1986
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26. Serum 2-Microglobulin Decreases in Patients with AIDS or ARC Treated with Azidothymidine

Author: Jacobson, M. A., primary, Abrams, D. I., additional, Volberding, P. A., additional, Bacchetti, P., additional, Wilber, J., additional, Chaisson, R. E., additional, Crowe, S., additional, Howard, W., additional, and Moss, A., additional
Published: 1989
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27. Relation of Oral Hairy Leukoplakia to Infection with the Human Immunodeficiency Virus and the Risk of Developing AIDS

Author: Greenspan, D., primary, Greenspan, J. S., additional, Hearst, N. G., additional, Pan, L.-Z., additional, Conant, M. A., additional, Abrams, D. I., additional, Hollander, H., additional, and Levy, J. A., additional
Published: 1987
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28. Kaposi sarcoma and lymphadenopathy syndrome: limitations of abdominal CT in acquired immunodeficiency syndrome.

Author: Moon, K L, primary, Federle, M P, additional, Abrams, D I, additional, Volberding, P, additional, and Lewis, B J, additional
Published: 1984
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29. Altered fat distribution in HIV-positive men on nucleoside analog reverse transcriptase inhibitor therapy.

Author: Mulligan K, Tai VW, Algren H, Abrams DI, Leiser RJ, Lo JC, and Schambelan M
Subjects: Adult, Cross-Sectional Studies, HIV Protease Inhibitors adverse effects, HIV Wasting Syndrome, Humans, Male, Retrospective Studies, Adipose Tissue metabolism, Anti-HIV Agents adverse effects, Body Composition, HIV Infections drug therapy, HIV-1, Reverse Transcriptase Inhibitors adverse effects
Abstract: To determine whether HIV infection, the wasting syndrome, or nucleoside analog reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) therapy uniquely affect fat distribution in men, we performed manual regional analysis of total, appendicular, trunk, and central abdominal fat measured by dual-energy X-ray absorptiometry (DEXA). Five groups of study subjects were identified for this cross-sectional analysis: HIV-negative controls (HIV-; N = 44) and four groups of HIV-positive subjects: antiretroviral (ARV)-naive or with limited prior use of NRTIs (ARV-; N = 23); on NRTIs for > or =6 months but PI-naive (NRTI; N = 30); on an NRTI/PI regimen for > or =6 months but with no complaints of abnormal fat distribution (NRTI/PI; N = 26); and those on NRTIs but PI-naive with the wasting syndrome (NRTI/WS; N = 40). Total, appendicular, trunk, and central abdominal fat was significantly lower in NRTI/WS. The ratio of trunk fat to appendicular fat was virtually identical in HIV- and ARV-. This ratio was significantly higher in the NRTI, NRTI/PI, and NRTI/WS groups, and values in these three groups were similar. These cross-sectional data suggest that HIV-infected men receiving NRTIs have an altered pattern of fat distribution, compared with HIV-negative men and HIV-positive men who are not receiving antiretroviral therapy. This effect was independent of the concomitant use of a PI or a diagnosis of the wasting syndrome. We saw no evidence of a unique effect of HIV infection per se on regional fat distribution. Although the fat ratio is increasingly employed, its physiologic significance is unclear. Our results, which have been obtained retrospectively, are intended to provide the impetus for prospective, controlled studies of the interactions among drug and host factors in the development of fat distribution abnormalities.
Published: 2001
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30. Potential interventions for HIV/AIDS wasting: an overview.

Author: Abrams DI
Subjects: Clinical Trials as Topic, Female, Humans, Male, Anabolic Agents therapeutic use, Anti-HIV Agents therapeutic use, Appetite Stimulants therapeutic use, HIV Wasting Syndrome drug therapy, Thalidomide therapeutic use
Abstract: Although the HIV wasting syndrome has become a far less common manifestation of advanced disease since the introduction of highly active therapies, much has been learned about a number of potential therapeutic interventions. HIV wasting therapies are reviewed. The evaluation of some of these treatments for management of body habitus alterations associated with antiretroviral therapies may be appropriate.
Published: 2000
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31. A randomized study of antiretroviral management based on plasma genotypic antiretroviral resistance testing in patients failing therapy. CPCRA 046 Study Team for the Terry Beirn Community Programs for Clinical Research on AIDS.

Author: Baxter JD, Mayers DL, Wentworth DN, Neaton JD, Hoover ML, Winters MA, Mannheimer SB, Thompson MA, Abrams DI, Brizz BJ, Ioannidis JP, and Merigan TC
Subjects: Acquired Immunodeficiency Syndrome blood, Acquired Immunodeficiency Syndrome immunology, Adult, CD4 Lymphocyte Count, Drug Therapy, Combination, Female, Genotype, HIV Infections blood, HIV Infections immunology, HIV Protease Inhibitors therapeutic use, HIV Reverse Transcriptase genetics, HIV-1 isolation & purification, Humans, Male, Mutation, RNA, Viral blood, RNA, Viral genetics, Viral Load, Acquired Immunodeficiency Syndrome drug therapy, Anti-HIV Agents therapeutic use, Drug Resistance, Microbial genetics, HIV Infections drug therapy, HIV-1 genetics
Abstract: Objective: To determine the short-term effects of using genotypic antiretroviral resistance testing (GART) with expert advice in the management of patients failing on a protease inhibitor and two nucleoside reverse transcriptase inhibitors., Design: Prospective randomized controlled trial., Setting: Multicenter community-based clinical trials network., Patients: One-hundred and fifty-three HIV-infected adults with a threefold or greater rise in plasma HIV-1 RNA on at least 16 weeks of combination antiretroviral therapy., Interventions: Randomization was either to a GART group, where genotype interpretation and suggested regimens were provided to clinicians, or to a no-GART group, where treatment choices were made without such input., Main Outcomes Measures: Plasma HIV-1 RNA levels and CD4 cell counts were measured at 4, 8, and 12 weeks following randomization. The primary endpoint was change in HIV-1 RNA levels from baseline to the average of the 4 and 8 week levels., Results: The average baseline CD4 cell count was 230 x 10(6) cells/l and the median HIV-1 RNA was 28,085 copies/ml. At entry, 82 patients were failing on regimens containing indinavir, 51 on nelfinavir, 11 on ritonavir, and nine on saquinavir. HIV-1 RNA, averaged at 4 and 8 weeks, decreased by 1.19 log10 for the 78 GART patients and -0.61 log10 for the 75 no-GART patients (treatment difference: -0.53 log, 95% confidence interval, -0.77 to -0.29; P = 0.00001). Overall, the best virologic responses occurred in patients who received three or more drugs to which their HIV-1 appeared to be susceptible., Conclusion: In patients failing triple drug therapy, GART with expert advice was superior to no-GART as measured by short-term viral load responses.
Published: 2000
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32. Kaposi's sarcoma and central nervous system disease: a real association or an artifact of the control group? Terry Beirn Community Programs for Clinical Research on AIDS.

Author: Eberly LE, Ohman PA, Neaton JD, Price RW, and Abrams DI
Subjects: AIDS Dementia Complex complications, Adult, Female, Humans, Leukoencephalopathy, Progressive Multifocal complications, Lymphoma, AIDS-Related immunology, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Toxoplasmosis, Cerebral complications, AIDS-Related Opportunistic Infections complications, Central Nervous System Diseases complications, HIV Infections complications, Sarcoma, Kaposi complications
Abstract: Objectives: To test the hypothesis that Kaposi's sarcoma (KS) protects against four central nervous system (CNS) diseases in HIV-1-infected individuals., Study Population and Design: The study population of 9404 subjects included participants in Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) protocols who were enrolled between September 1990 and September 1998. This was an observational study., Methods: Proportional hazards regression was used to estimate adjusted relative risks for predictors of four central nervous system diseases. Covariates included occurrence of Kaposi's sarcoma, occurrence of other opportunistic infections or malignancies, baseline CD4+ count, and other baseline characteristics., Results: Among the 5944 participants without progression to AIDS at entry, 451 developed a CNS disease. The adjusted relative risk of any CNS disease for those who developed Kaposi's sarcoma versus those who did not develop any AIDS-defining event was 1.41 [95% confidence interval (CI), 0.98-2.03; P = 0.06]. In contrast, the adjusted relative risk of any CNS disease for those with Kaposi's sarcoma versus those with some other non-Kaposi's sarcoma AIDS-defining event was 0.37 (95% CI, 0.24-0.57; P < 0.0001). Among the 3460 participants with progression to AIDS at entry, the adjusted relative risk of any CNS disease for those with Kaposi's sarcoma versus those with some other non-Kaposi's sarcoma AIDS-defining event was 0.71 (95% CI, 0.40-1.25; P = 0.23)., Conclusions: Our analyses indicate that the risk of CNS disease associated with Kaposi's sarcoma depends strongly on the reference or control group chosen. When compared to individuals with other non-Kaposi's sarcoma AIDS-defining diseases, Kaposi's sarcoma is associated with a lower risk of CNS disease in HIV-1 positive individuals. However, when compared to individuals with no AIDS-defining disease or with a similarly mild AIDS-defining disease such as invasive candidiasis, Kaposi's sarcoma is associated with an equivalent risk of CNS disease.
Published: 2000
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33. Getting on with AIDS.

Author: Abrams DI
Subjects: Disease Progression, Humanism, Humans, Male, Public Sector, Acquired Immunodeficiency Syndrome physiopathology, Acquired Immunodeficiency Syndrome psychology, Television
Published: 1999
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34. Clinical experience and choice of drug therapy for human immunodeficiency virus disease.

Author: Brosgart CL, Mitchell TF, Coleman RL, Dyner T, Stephenson KE, and Abrams DI
Subjects: AIDS-Related Opportunistic Infections prevention & control, Drug Therapy, Combination, Family Practice, HIV Infections complications, Health Care Surveys, Humans, AIDS-Related Opportunistic Infections drug therapy, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Practice Patterns, Physicians', Primary Health Care
Abstract: To determine if providers experienced in the management of human immunodeficiency virus (HIV) disease preferred different treatment regimens than providers with less experience, we analyzed data from a national survey of primary care providers' preferred regimens for the management of 30 HIV-related medical conditions. We mailed questionnaires to 999 correct addresses of providers in > 20 cities in the United States in May 1996. We received 524 responses (response rate, 52%). We found a statistically significant association between the number of HIV-infected patients cared for by the provider and the likelihood that the provider would report prescribing highly active antiretroviral therapy and multidrug combinations for treatment of opportunistic infections. Providers with few HIV-infected patients were substantially less likely to report using new therapeutic regimens or new diagnostic tools. We concluded that the preferred regimens of experienced providers are more likely to be consistent with the latest information on treatment for HIV disease than are those of less experienced providers.
Published: 1999
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35. Community advisory boards: their role in AIDS clinical trials. Terry Beirn Community Programs for Clinical Research on AIDS.

Author: Cox LE, Rouff JR, Svendsen KH, Markowitz M, and Abrams DI
Subjects: Female, Humans, Male, San Francisco, Surveys and Questionnaires, Acquired Immunodeficiency Syndrome, Clinical Trials as Topic standards, Community Health Services organization & administration, Community Participation, Social Work
Abstract: Community-based AIDS research programs were initially federally funded in 1989. Since then, the Terry Beirn Community Programs for Clinical Research on AIDS has mandated that research units develop and maintain community advisory boards to provide advice and communicate community preferences in AIDS research. Seventeen community-based AIDS research units formed community advisory boards (CABs) based on a model developed by the Community Consortium at San Francisco General Hospital. Social workers employed by these AIDS research units surveyed 267 CAB members to ascertain board characteristics and members' perceptions of program activities. Implications for social work and future research are discussed.
Published: 1998
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36. Weight loss as a predictor of survival and disease progression in HIV infection. Terry Beirn Community Programs for Clinical Research on AIDS.

Author: Wheeler DA, Gibert CL, Launer CA, Muurahainen N, Elion RA, Abrams DI, and Bartsch GE
Subjects: Adult, Cohort Studies, Disease Progression, Female, Follow-Up Studies, HIV Infections mortality, Humans, Male, Middle Aged, Risk Factors, Survival Analysis, AIDS-Related Opportunistic Infections epidemiology, HIV Infections physiopathology, Weight Loss
Abstract: Severe weight loss in HIV is associated with decreased length of survival. It is unclear whether mild weight loss is associated with an increased risk of death or opportunistic complications of HIV. Participants in four interventional studies (n = 2382) conducted by a community-based clinical trials network were evaluated for percentage change in weight during their first 4 months in the study. Proportional hazards models were performed for the occurrence of opportunistic complications and death subsequent to the 4-month visit. The relative risk of death and opportunistic complications for those with 5% to 10% weight loss over 4 months was 2.22 (p < .001) and 1.89 (p < .001), respectively, and 1.26 (p < .01) and 1.19 (p < .01) among those who lost 0% to 5% of their body weight, respectively, when compared with those with no weight loss. Among those who lost 5% to 10% of their body weight, the relative risk of individual opportunistic complications increased significantly, including Pneumocystis carinii pneumonia (PCP) (1.61; p < .01), cytomegalovirus (CMV) (2.33; p < .001), and Mycobacterium avium complex (MAC) (1.81; p < .01). As little as 5%t weight loss over a 4-month period is associated with increased risk of death and opportunistic complications in HIV. A weight loss of 5% to 10% is also associated with an increased risk of individual opportunistic complications.
Published: 1998
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37. Medical marijuana: tribulations and trials.

Author: Abrams DI
Subjects: Clinical Trials as Topic, Humans, Pilot Projects, San Francisco, Cannabis therapeutic use, HIV Wasting Syndrome therapy, Phytotherapy
Abstract: Widespread use of smoked marijuana in the San Francisco Bay Area as a treatment for HIV-related anorexia and weight loss, as well as nausea related to prescribed therapy, prompted the design of a clinical trial to evaluate the safety and effectiveness of this controlled substance. The Community Consortium--the Bay Area's community-based HIV clinical trials organization--designed a first pilot evaluation of smoked marijuana compared to oral tetrahydrocannabinol (THC, synthesized as dronabinol or Marinol) in 1993. A legal source of marijuana could not be identified. Two subsequent applications to the National Institutes of Health were submitted in 1996 and 1997. During the intervening period, increasing numbers of people with HIV infection were obtaining marijuana for "medicinal use" from local Cannabis Buyer's Clubs. In November 1996, California voters endorsed the medical use of marijuana by approving Proposition 215. The federal government's attempt to oppose the voters' mandate led to public outrage. Organized medicine demanded more studies into marijuana's potential use as medicine. The consortium's 1997 proposal to evaluate the potential interaction between THC and widely-prescribed protease inhibitors was positively received. Funding and study-required marijuana cigarettes have been obtained from the National Institute of Drug Abuse, and the first subjects are being enrolled in the trial. When politically sensitive research proposals include sound science, they can prevail if investigators are willing to persist.
Published: 1998
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38. Nurses' attitudes and beliefs toward assisted suicide in AIDS.

Author: Leiser RJ, Mitchell TF, Hahn J, Slome L, and Abrams DI
Subjects: Attitude to Death, Educational Status, Ethics, Nursing, Female, Humans, Male, Religion and Medicine, San Francisco, Surveys and Questionnaires, Acquired Immunodeficiency Syndrome nursing, Acquired Immunodeficiency Syndrome psychology, Attitude of Health Personnel, Nurses psychology, Suicide, Assisted psychology
Abstract: This report of a 1995 survey presents data regarding nurses' attitudes and beliefs about assisted suicide in AIDS. The authors surveyed 428 nurses working at facilities serving AIDS patients in the San Francisco Bay Area, using an anonymous, self-administered questionnaire. They received 215 responses (50%). There was a high level of agreement with statements that place assisted suicide in the context of humane action to relieve suffering. An AIDS diagnosis did not change respondents' attitudes toward assisted suicide, although many nurses said that the relentless suffering and specific nature of the AIDS epidemic did influence their thinking.
Published: 1998
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39. A randomized, placebo-controlled trial of the safety and efficacy of oral ganciclovir for prophylaxis of cytomegalovirus disease in HIV-infected individuals. Terry Beirn Community Programs for Clinical Research on AIDS.

Author: Brosgart CL, Louis TA, Hillman DW, Craig CP, Alston B, Fisher E, Abrams DI, Luskin-Hawk RL, Sampson JH, Ward DJ, Thompson MA, and Torres RA
Subjects: Administration, Oral, Adolescent, Adult, Antiviral Agents adverse effects, Double-Blind Method, Female, Ganciclovir adverse effects, Humans, Male, Treatment Outcome, AIDS-Related Opportunistic Infections prevention & control, Antiviral Agents administration & dosage, Cytomegalovirus, Cytomegalovirus Infections prevention & control, Ganciclovir administration & dosage
Abstract: Objective: Evaluate safety and efficacy of oral ganciclovir (GCV) for preventing cytomegalovirus (CMV) disease in HIV-infected persons at high risk for CMV disease., Design: Double-blind, placebo-controlled, randomized clinical trial in primary care clinics and private practice offices specializing in the care of people with HIV. Interventions were oral GCV (1000 mg three times/day) or placebo. Protocol amendment allowed switch to open-label oral GCV. Main outcome measures were confirmed CMV retinal or gastrointestinal mucosal disease, and death. The study enrolled 994 people co-infected with CMV and HIV, with at least one CD4 count recorded < 100 x 10(6) cells/l., Results: At study completion (15 months median follow-up), CMV event rates in the oral GCV and control groups were 13.1 and 14.6 per 100 person years, respectively, a hazard ratio (HR) of 0.92 [95% confidence interval (CI), 0.65-1.27; P = 0.6]. At protocol amendment event rates were 12.7 and 15.0, respectively (HR, 0.85; 95% CI, 0.56-1.30; P = 0.45). At study completion, event rates for death were 26.6 and 32.0 (HR, 0.84; P = 0.09), and at protocol amendment were 18.9 and 19.6 (HR, 0.95; P = 0.78), respectively. At protocol amendment for the CMV endpoint, the oral GCV treatment effect was associated with baseline use of didanosine (ddI). For patients taking ddI at randomization, HR was 7.48 (P = 0.02). For patients not taking ddI, HR was 0.62 (P = 0.04). These HR were statistically different (P = 0.0006)., Conclusions: In our study, 3 g/day oral GCV did not significantly reduce CMV disease incidence, but there was a suggestion of a death-rate reduction. Furthermore, results suggest that oral GVC decreased risk of CMV disease in patients not prescribed ddI, and increased risk in those prescribed ddI. For the CMV endpoint, our study differs markedly from the only similar study, although for the death endpoint, a combined analysis of studies indicated significant reduction in death rate.
Published: 1998
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40. Not all is dead in HIV-1 graveyard.

Author: Grant RM and Abrams DI
Subjects: DNA, Viral isolation & purification, Drug Resistance, HIV Infections diagnosis, HIV-1 genetics, Humans, Prognosis, Anti-HIV Agents therapeutic use, HIV Infections blood, HIV Infections drug therapy, HIV-1 isolation & purification, HIV-1 physiology, Virus Latency
Published: 1998
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41. Genotypic-resistance assays and antiretroviral therapy.

Author: Deeks SG and Abrams DI
Subjects: Codon genetics, Costs and Cost Analysis, Drug Resistance, Microbial genetics, Genome, Viral, Genotype, Humans, Microbial Sensitivity Tests economics, Microbial Sensitivity Tests methods, Mutation genetics, Predictive Value of Tests, Protease Inhibitors therapeutic use, Virus Replication genetics, Anti-HIV Agents therapeutic use, HIV genetics, HIV Infections drug therapy
Published: 1997
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42. Physician-assisted suicide and patients with human immunodeficiency virus disease.

Author: Slome LR, Mitchell TF, Charlebois E, Benevedes JM, and Abrams DI
Subjects: California, Data Collection, Female, Humans, Intention, Logistic Models, Male, Multivariate Analysis, Social Change, Acquired Immunodeficiency Syndrome, Attitude of Health Personnel, Health Knowledge, Attitudes, Practice, Physicians psychology, Suicide, Assisted statistics & numerical data
Abstract: Background: Data are limited on the attitudes and practices of physicians regarding assisting the suicide of patients with human immunodeficiency virus (HIV) disease., Methods: Between November 1994 and January 1995, we used an anonymous, self-administered questionnaire to survey all 228 physicians in the Community Consortium, an association of providers of health care to patients infected with HIV in the San Francisco Bay area. The responses were compared with those in a 1990 survey of consortium physicians. Physician-assisted suicide was defined as "a physician providing a sufficient dose of narcotics to enable a patient to kill himself." Respondents were to "assume that the patient is a mentally competent, severely ill individual facing imminent death.", Results: One hundred eighteen of the questionnaires were evaluated. Respondents reported a mean of 7.9 "direct" and 13.7 "indirect" requests from patients for assistance. In responses based on a case vignette, 48 percent of the physicians said they would be likely or very likely to grant the request of a patient with the acquired immunodeficiency syndrome (AIDS) for assistance in a suicide, as compared with 28 percent of the respondents in 1990. Asked to estimate the number of times they had granted the request of a patient with AIDS for assistance in committing suicide, 53 percent said they had done so at least once (mean number of times, 4.2; median, 1.0; range, 0 to 100). In a multivariate analysis, factors positively associated with having, in fact, assisted a suicide were having had a higher number of patients with AIDS who had died, a higher number of indirect requests from patients for assistance, a stated gay, lesbian, or bisexual orientation on the part of the physician, and a higher "intention to assist" score (as calculated from the physician's responses to the case vignette)., Conclusions: Within a group of physicians caring for patients with HIV disease, the acceptance of assisted suicide increased between 1990 and 1995. A majority of respondents in 1995 said they had granted a request for assisted suicide from a patient with AIDS at least once.
Published: 1997
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43. The role of critical care nurses in euthanasia and assisted suicide.

Author: Leiser RJ, Mitchell TF, Hahn JA, and Abrams DI
Subjects: Critical Care, Data Collection, Humans, San Francisco, United States, Nurses statistics & numerical data, Suicide, Assisted statistics & numerical data
Published: 1996

44. Pilot randomized controlled trial of Chinese herbal treatment for HIV-associated symptoms.

Author: Burack JH, Cohen MR, Hahn JA, and Abrams DI
Subjects: Adult, Double-Blind Method, Female, Follow-Up Studies, Humans, Interviews as Topic, Male, Pilot Projects, Quality of Life, Treatment Outcome, Drugs, Chinese Herbal therapeutic use, HIV Infections drug therapy
Abstract: We wished to determine the short-term safety and efficacy of a Chinese medicinal herb preparation in treating symptoms of human immunodeficiency virus (HIV) infection in a 12-week randomized, double-blind, placebo-controlled clinical trial in a University-affiliated acquired immunodeficiency syndrome (AIDS) clinic at a public general hospital. Thirty adults with symptomatic HIV infection, no previous AIDS-defining diagnosis, and CD4+ counts of 0.200-0.499 x 10(9)/L (200-499/mm3) received 28 tablets each day of either a standardized oral preparation of 31 Chinese herbs or a cellulose placebo. Primary outcome measures were changes in life satisfaction, perceived health, and number and severity of symptoms. Other outcomes included adherence, and changes in weight, CD4+ count, depression, anxiety, physical and social function, and mental health. Two placebo- and no herb-treated subjects had mild adverse events (AE). Subjects on both arms reported taking 94% of prescribed tablets. No differences between treatment groups reached the p < 0.05 level. Life satisfaction improved in herb-treated [+0.86, 95% confidence interval (CI): +0.29, +1.43] but not in placebo-treated subjects (+0.20, 95% CI -0.35, + 0.75). Number of symptoms was reduced in subjects receiving herbs (-2.2, 95% CI -4.1, -0.3) but not in those receiving placebo (-0.3, 95% CI -3.2, +2.7). There were trends toward greater improvements among herb-treated subjects on all symptom subscales except dermatologic. Believing that one was receiving herbs was strongly associated with reporting that the treatment had helped (p < 0.005), but not with changes in life satisfaction or symptoms. There were improvements in life satisfaction and symptoms among subjects receiving the herbal therapy. Whether Chinese herbs are effective in the management of symptomatic HIV infection can be adequately addressed only by larger trials of longer duration.
Published: 1996
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45. Current therapeutic options for Kaposi's sarcoma.

Author: Abrams DI
Subjects: Antineoplastic Agents administration & dosage, Antiretroviral Therapy, Highly Active methods, Antiretroviral Therapy, Highly Active statistics & numerical data, Drug Delivery Systems methods, Drug Delivery Systems statistics & numerical data, Humans, Sarcoma, Kaposi diagnosis, Sarcoma, Kaposi virology, Sarcoma, Kaposi drug therapy
Abstract: Treatment options for patients with acquired immune deficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) have changed very little over the past decade. Research has been hampered by the absence of an accepted staging system for KS and the lack of a uniform definition of response. New advances in understanding the pathogenesis of KS, particularly the role of angiogenesis and growth factors, may help in the future development of additional therapies. At present, available options include radiation therapy, chemotherapy, and biologic response modifiers. Improved delivery systems for existing chemotherapeutic agents may help to target more effective doses to KS lesions and to prevent certain dose-limiting side effects. Our goal should be to recommit ourselves to finding ways to improve the survival of patients with AIDS-related KS, not j ust to deliver cosmetic or palliative treatments.
Published: 1996

46. Off-label drug use in human immunodeficiency virus disease.

Author: Brosgart CL, Mitchell T, Charlebois E, Coleman R, Mehalko S, Young J, and Abrams DI
Subjects: AIDS-Related Opportunistic Infections drug therapy, Drug Approval, Drug Labeling, Drug Prescriptions economics, Humans, Practice Patterns, Physicians' statistics & numerical data, Primary Health Care statistics & numerical data, Reimbursement Mechanisms, United States, Drug Prescriptions statistics & numerical data, Drug Utilization Review statistics & numerical data, HIV Infections drug therapy, HIV-1
Abstract: We wished to determine the extent to which drugs used to treat HIV disease and its clinical manifestations are prescribed for conditions other than those listed on the U.S. Food and Drug Administration's approved drug label, how such "off-label" use varies by patient characteristics and type of HIV-related medical condition, and the extent to which physicians alter the way they treat HIV-related conditions because of reimbursement problems associated with off-label drug use. We surveyed 1,530 primary care providers for people with HIV disease between February and May 1993. A three-part survey instrument was used to obtain data on the drugs prescribed for the last three patients with HIV disease treated by the provider, the preferred choice of therapy for 32 specific HIV-related conditions, and the extent to which providers faced reimbursement problems regarding the use of drugs for off-label indications. Three drug compendia were used as cited sources of off-label drug uses. In all, 387 (32%) evaluable surveys were returned, yielding data on 1,148 patients. The majority (81%) of patients received at least one drug off-label, and almost half (40%) of all reported drug therapy was off-label. Most off-label drug use was for treatment and prevention of HIV-related opportunistic infections, which frequently represented the community standard of practice (e.g., trimethoprim/sulfamethoxazole for prevention of Pneumocystis carinii pneumonia), or the de facto standard of practice when no licensed therapies were available (e.g., drugs for treatment of Mycobacterium avium complex, MAC). More than 75% of off-label usage was cited in at least one of the three authoritative medical compendia. The use of drugs for off-label indications in HIV care is common and frequently represents community standards of care. Reliance on drug compendia for support of off-label drug use accounts for the majority of such uses, although many legitimate off-label uses may not be included because of compendia publication lag. The prevalence of off-label drug use in routine clinical practice and the development of newer and more costly drugs for treatment of HIV and its medical complications argues for the articulation of an explicit national reimbursement policy for off-label uses of prescription drugs so that medically appropriate therapies will be available to those with insurance in a rational, consistent way.
Published: 1996
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47. Response of CD4 lymphocytes and clinical consequences of treatment using ddI or ddC in patients with advanced HIV infection.

Author: Goldman AI, Carlin BP, Crane LR, Launer C, Korvick JA, Deyton L, and Abrams DI
Subjects: Biomarkers, CD4 Lymphocyte Count, Disease Progression, Follow-Up Studies, HIV Infections immunology, HIV Infections mortality, HIV Infections physiopathology, Humans, Regression Analysis, Survival Rate, Treatment Outcome, Antiviral Agents therapeutic use, CD4-Positive T-Lymphocytes immunology, Didanosine therapeutic use, HIV Infections drug therapy, HIV-1, Zalcitabine therapeutic use
Abstract: The value of CD4 lymphocyte counts as a surrogate marker in persons with advanced human immunodeficiency virus infection during antiretroviral treatment was assessed using longitudinal models and data from the Terry Beirn Community Programs for Clinical Research on AIDS didanosine/zalcitabine trial of 467 HIV-infected patients. Patients with AIDS or two CD4 counts of < or = 300 who fulfilled specific criteria for zidovudine intolerance or failure were randomized to receive either 500 mg didanosine (ddl) daily or 2.25 mg zalcitabine (ddC) per day. Absolute CD4 counts were recorded at study entry and at as many as four visits. Patients were followed for clinical disease progression and survival. At 2 months, the difference in mean CD4 count from baseline was +15.4 cells/mm3 in the ddI group but -1.3 cells/mm3 in the ddC group. Patients assigned to ddI had a greater chance of a CD4 response at 2 months than those on ddC, yet only those in the ddC group with a response showed significant improvement in progression of disease or survival compared with ddC nonresponders, ddI responders, and ddI nonresponders (p = 0.03). We conclude that a CD4 response does not necessarily correlate with improved outcome and is therefore not a useful surrogate marker in these patients.
Published: 1996
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48. Continuous low-dose interferon-alpha therapy for HIV-related immune thrombocytopenic purpura.

Author: Northfelt DW, Charlebois ED, Mirda MI, Child C, Kaplan LD, and Abrams DI
Subjects: Adult, Antiviral Agents administration & dosage, Antiviral Agents adverse effects, CD4 Lymphocyte Count, CD4-Positive T-Lymphocytes immunology, Cohort Studies, Female, HIV Infections immunology, Humans, Injections, Subcutaneous, Interferon alpha-2, Interferon-alpha administration & dosage, Interferon-alpha adverse effects, Male, Platelet Count, Purpura, Thrombocytopenic, Idiopathic etiology, Recombinant Proteins, Self Administration, Antiviral Agents therapeutic use, HIV Infections complications, HIV-1, Interferon-alpha therapeutic use, Purpura, Thrombocytopenic, Idiopathic therapy
Abstract: Our objective was to examine the efficacy and toxicity of continuous, low-dose interferon-alpha therapy for human immunodeficiency virus-related immune thrombocytopenic purpura (HIV-ITP) in a Phase II clinical trial overseen by a community-based consortium of physicians conducting clinical trials in HIV-related diseases. Sixteen patients with HIV-ITP defined by prospective clinical criteria were enrolled; the majority had failed other therapies for HIV-ITP. Baseline and serial measurements were made of platelet counts, complete blood counts, serum chemistries, platelet-associated immunoglobulin, and CD4+ T-lymphocyte counts; subjective symptoms and bleeding were recorded. Three million units of interferon-alpha 2b were self-administered by subcutaneous injection every Monday, Wednesday, and Friday for 16 weeks. Thirteen participants were evaluable for response. One obtained a complete response, eight had partial responses, and four had no response to interferon-alpha therapy. The mean absolute platelet count of the group rose from 15.5 x 10(9)/L at baseline to 47.3 x 10(9)/L at 2 weeks and remained in this range for the duration of the study. CD4+ T-lymphocyte counts and serum chemistries did not change significantly during therapy. Ability to detect platelet-associated immunoglobulin did not change in a predictable manner in relation to platelet count response. Hematologic toxicity was limited to one episode of granulocytopenia, which resolved after a lowering of zidovudine dosage. Subjective toxicities were mild and tolerable, and minor bleeding problems improved in all participants so affected. Low-dose, continuous therapy with interferon-alpha resulted in meaningful increases in the platelet counts of the majority of study participants with HIV-ITP. Interferon-alpha was safe and tolerable for most participants with HIV-ITP at the dosage and schedule employed in this study. Interferon-alpha for clinically significant thrombocytopenia and who have failed to respond to zidovudine.
Published: 1995

49. Considerations in choice of a clinical endpoint for AIDS clinical trials. Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).

Author: Neaton JD, Wentworth DN, Rhame F, Hogan C, Abrams DI, and Deyton L
Subjects: AIDS-Related Opportunistic Infections, Acquired Immunodeficiency Syndrome epidemiology, Disease Progression, Humans, Survival Analysis, Treatment Outcome, Acquired Immunodeficiency Syndrome drug therapy, Clinical Trials as Topic statistics & numerical data, Data Interpretation, Statistical, Models, Statistical
Abstract: In most clinical trials of antiretroviral therapy for patients infected with HIV, the major outcome variable has been the combined clinical endpoint of any new or recurrent AIDS defining event. We review features of combined endpoints and use data from the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) to evaluate this outcome measure in terms of relevance, diagnostic certainty and sensitivity. We conclude that this endpoint is not relevant because: (i) the 19 different events constituting the combined endpoint are equally weighted in analyses even though they vary considerably in terms of risk of death; and (ii) events after the first are ignored, thus the event profile of patients is not taken into account in making treatment comparisons. We also conclude that power may be low with use of this endpoint if treatments under study do not have an immediate impact on disease progression, if some events which occur soon after randomization represent a disease process that has already begun to incubate, or if treatment differences for the various events constituting the combined endpoint are differentially effected by treatment. Since the ease and certainty of diagnosis of each of the 19 events also vary, we recommend that survival be the primary endpoint of antiretroviral trials, and that all opportunistic events experienced by patients, not just the first, be collected and summarized. Trial reports should include comparisons of incidence of each event by treatment group so that readers can rank events as they please. A single summary measure which considers severity and the entire event profile, as described here, would also be useful for assessing the impact of treatments on quality of life. Further research on approaches for weighting and combining multiple outcome measures is needed.
Published: 1994
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50. Treatment options in zidovudine intolerance or failure.

Author: Abrams DI
Subjects: Acquired Immunodeficiency Syndrome mortality, Adult, Didanosine toxicity, Female, Follow-Up Studies, Humans, Male, Survival Rate, Time Factors, Treatment Failure, Zalcitabine toxicity, Zidovudine adverse effects, Acquired Immunodeficiency Syndrome drug therapy, Didanosine therapeutic use, Zalcitabine therapeutic use, Zidovudine therapeutic use
Abstract: Aim: To compare the efficacy and safety of didanosine and zalcitabine in patients who could not tolerate zidovudine or who had failed to respond adequately., Patients and Methods: A multicentre, randomly allocated, open-label clinical trial was set up with 230 patients treated with didanosine and 237 treated with zalcitabine. All had previously been treated unsuccessfully with zidovudine. The patients were followed for at least 1 year, with an average of 16 months., Results: Disease progression or death occurred in 157 patients taking didanosine and 152 taking zalcitabine. There appeared to be a slight trend in favour of survival in the latter group., Conclusions: There is an urgent need for more effective and better tolerated antiretroviral agents in the treatment of HIV infection. Zalcitabine is at least as effective as didanosine and may provide a survival advantage in patients treated unsuccessfully with zidovudine.
Published: 1994
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