1,721 results on '"Fiellin, David A."'
Search Results
2. Assessing Research Activity and Capacity of Community-Based Organizations: Development and Pilot Testing of an Instrument
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Humphries, Debbie L., Carroll-Scott, Amy, Mitchell, Leif, Tian, Terry, Choudhury, Shonali, and Fiellin, David A.
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- 2015
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3. The MATE Act: Progress for substance use education, but is checking a box enough?
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Morford, Kenneth L., Tetrault, Jeanette M., and Fiellin, David A.
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- 2024
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4. Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy
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Cartwright, Emily J, Pierret, Chloe, Minassian, Caroline, Esserman, Denise A, Tate, Janet P, Goetz, Matthew B, Bhattacharya, Debika, Fiellin, David A, Justice, Amy C, Re, Vincent Lo, and Rentsch, Christopher T
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Emerging Infectious Diseases ,Infectious Diseases ,Hepatitis ,Chronic Liver Disease and Cirrhosis ,Alcoholism ,Alcohol Use and Health ,Substance Misuse ,Liver Disease ,Hepatitis - C ,Digestive Diseases ,Infection ,Good Health and Well Being ,United States ,Male ,Humans ,Middle Aged ,Hepacivirus ,Antiviral Agents ,Alcoholism ,Hepatitis C ,Chronic ,Sustained Virologic Response ,Cohort Studies ,Retrospective Studies ,Hepatitis C ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceSome payers and clinicians require alcohol abstinence to receive direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection.ObjectiveTo evaluate whether alcohol use at DAA treatment initiation is associated with decreased likelihood of sustained virologic response (SVR).Design, setting, and participantsThis retrospective cohort study used electronic health records from the US Department of Veterans Affairs (VA), the largest integrated national health care system that provides unrestricted access to HCV treatment. Participants included all patients born between 1945 and 1965 who were dispensed DAA therapy between January 1, 2014, and June 30, 2018. Data analysis was completed in November 2020 with updated sensitivity analyses performed in 2023.ExposureAlcohol use categories were generated using responses to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses for alcohol use disorder (AUD): abstinent without history of AUD, abstinent with history of AUD, lower-risk consumption, moderate-risk consumption, and high-risk consumption or AUD.Main outcomes and measuresThe primary outcome was SVR, which was defined as undetectable HCV RNA for 12 weeks or longer after completion of DAA therapy. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% CIs of SVR associated with alcohol category.ResultsAmong 69 229 patients who initiated DAA therapy (mean [SD] age, 62.6 [4.5] years; 67 150 men [97.0%]; 34 655 non-Hispanic White individuals [50.1%]; 28 094 non-Hispanic Black individuals [40.6%]; 58 477 individuals [84.5%] with HCV genotype 1), 65 355 (94.4%) achieved SVR. A total of 32 290 individuals (46.6%) were abstinent without AUD, 9192 (13.3%) were abstinent with AUD, 13 415 (19.4%) had lower-risk consumption, 3117 (4.5%) had moderate-risk consumption, and 11 215 (16.2%) had high-risk consumption or AUD. After adjustment for potential confounding variables, there was no difference in SVR across alcohol use categories, even for patients with high-risk consumption or AUD (OR, 0.95; 95% CI, 0.85-1.07). There was no evidence of interaction by stage of hepatic fibrosis measured by fibrosis-4 score (P for interaction = .30).Conclusions and relevanceIn this cohort study, alcohol use and AUD were not associated with lower odds of SVR. Restricting access to DAA therapy according to alcohol use creates an unnecessary barrier to patients and challenges HCV elimination goals.
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- 2023
5. Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial
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Edelman, E Jennifer, Dziura, James, Deng, Yanhong, DePhilippis, Dominick, Fucito, Lisa M, Ferguson, Tekeda, Bedimo, Roger, Brown, Sheldon, Marconi, Vincent C, Goetz, Matthew Bidwell, Rodriguez-Barradas, Maria C, Simberkoff, Michael S, Molina, Patricia E, Weintrob, Amy C, Maisto, Stephen A, Paris, Manuel, Justice, Amy C, Bryant, Kendall J, and Fiellin, David A
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Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Behavioral and Social Science ,Alcoholism ,Alcohol Use and Health ,Comparative Effectiveness Research ,Clinical Trials and Supportive Activities ,Prevention ,Substance Misuse ,7.1 Individual care needs ,Management of diseases and conditions ,Good Health and Well Being ,Humans ,Cohort Studies ,Pandemics ,COVID-19 ,Alcohol Drinking ,HIV Infections ,Randomized Controlled Trials as Topic ,Multicenter study ,Randomized controlled trial ,Algorithms ,HIV ,Alcohol ,Contingency management ,Motivational enhancement therapy ,Medical and Health Sciences ,General Clinical Medicine ,Public Health ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundAlthough unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial.MethodsPWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described.ConclusionsThe FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH.Clinicaltrialsgov identifier: NCT03089320.
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- 2023
6. Implementing a pharmacist-integrated collaborative model of medication treatment for opioid use disorder in primary care: study design and methodological considerations
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McLeman, Bethany, Gauthier, Phoebe, Lester, Laurie S., Homsted, Felicity, Gardner, III, Vernon, Moore, Sarah K., Joudrey, Paul J., Saldana, Lisa, Cochran, Gerald, Harris, Jacklyn P., Hefner, Kathryn, Chongsi, Edward, Kramer, Kimberly, Vena, Ashley, Ottesen, Rebecca A., Gallant, Tess, Boggis, Jesse S., Rao, Deepika, Page, Marjorie, Cox, Nicholas, Iandiorio, Michelle, Ambaah, Ekow, Ghitza, Udi, Fiellin, David A., and Marsch, Lisa A.
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- 2024
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7. Efficacy of alcohol reduction interventions among people with HIV as evaluated by self-report and a phosphatidylethanol (PEth) outcome: protocol for a systematic review and individual participant data meta-analysis
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Kane, Jeremy C, Allen, Isabel, Fatch, Robin, Scheffler, Aaron, Emenyonu, Nneka, Puryear, Sarah B, Chirayil, Priya, So-Armah, Kaku, Kahler, Christopher W, Magidson, Jessica F, Conroy, Amy A, Edelman, E Jennifer, Woolf-King, Sarah, Parry, Charles, Kiene, Susan M, Chamie, Gabriel, Adong, Julian, Go, Vivian F, Cook, Robert L, Muyindike, Winnie, Morojele, Neo, Blokhina, Elena, Krupitsky, Evgeny, Fiellin, David A, and Hahn, Judith A
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Substance Misuse ,Sexually Transmitted Infections ,Alcoholism ,Alcohol Use and Health ,Clinical Research ,Infectious Diseases ,Behavioral and Social Science ,Clinical Trials and Supportive Activities ,HIV/AIDS ,Health and social care services research ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,8.4 Research design and methodologies (health services) ,Prevention of disease and conditions ,and promotion of well-being ,Mental health ,Cardiovascular ,Good Health and Well Being ,Humans ,Self Report ,Alcohol Drinking ,Glycerophospholipids ,Ethanol ,HIV Infections ,Systematic Reviews as Topic ,Meta-Analysis as Topic ,substance misuse ,HIV & AIDS ,clinical trials ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
IntroductionUnhealthy alcohol use is associated with a range of adverse outcomes among people with HIV (PWH). Testing the efficacy and promoting the availability of effective interventions to address unhealthy alcohol use among PWH is thus a priority. Alcohol use outcomes in intervention studies are often measured by self-report alone, which can lead to spurious results due to information biases (eg, social desirability). Measuring alcohol outcomes objectively through biomarkers, such as phosphatidylethanol (PEth), in addition to self-report has potential to improve the validity of intervention studies. This protocol outlines the methods for a systematic review and individual participant data meta-analysis that will estimate the efficacy of interventions to reduce alcohol use as measured by a combined categorical self-report/PEth variable among PWH and compare these estimates to those generated when alcohol is measured by self-report or PEth alone.Methods and analysisWe will include randomised controlled trials that: (A) tested an alcohol intervention (behavioural and/or pharmacological), (B) enrolled participants 15 years or older with HIV; (C) included both PEth and self-report measurements, (D) completed data collection by 31 August 2023. We will contact principal investigators of eligible studies to inquire about their willingness to contribute data. The primary outcome variable will be a combined self-report/PEth alcohol categorical variable. Secondary outcomes will include PEth alone, self-report alone and HIV viral suppression. We will use a two-step meta-analysis and random effects modelling to estimate pooled treatment effects; I2 will be calculated to evaluate heterogeneity. Secondary and sensitivity analyses will explore treatment effects in adjusted models and within subgroups. Funnel plots will be used to explore publication bias.Ethics and disseminationThe study will be conducted with deidentified data from completed randomised controlled trials and will be considered exempt from additional ethical approval. Results will be disseminated through peer-reviewed publications and international scientific meetings.Prospero registration numberCRD42022373640.
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- 2023
8. The opioid use disorder core outcomes set (OUD-COS) for treatment research: findings from a Delphi consensus study.
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Karnik, Niranjan, Marsden, John, McCluskey, Connor, Boley, Randy, Bradley, Katharine, Campbell, Cynthia, Curtis, Megan, Fiellin, David, Ghitza, Udi, Hefner, Kathryn, Hser, Yih-Ing, McHugh, R, McPherson, Sterling, Mooney, Larissa, Moran, Landhing, Murphy, Sean, Schwartz, Robert, Shmueli-Blumberg, Dikla, Shulman, Matisyahu, Stephens, Kari, Watkins, Katherine, Weiss, Roger, and Wu, Li-Tzy
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Core outcomes set ,Delphi consensus ,US National Institute on Drug Abuse ,efficacy and effectiveness research ,opioid treatment cascade ,opioid use disorder ,Analgesics ,Opioid ,Consensus ,Delphi Technique ,Humans ,Opioid-Related Disorders ,Outcome Assessment ,Health Care ,Research Design ,United States - Abstract
BACKGROUND AND AIM: There is no gold-standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD-COS). DESIGN: Four-round, e-Delphi expert panel consensus study and plenary research group discussion and targeted consultation. SETTING: United States. PARTICIPANTS: A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the networks affiliated clinical and community sites and the NIDA Centre for the CTN. MEASUREMENTS: From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on-line questionnaire to rank items with defined specification on a 9-point scale for importance, with a standard 70% consensus criterion. FINDINGS: After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient-reported (global impression of improvement and incident non-fatal overdose); one clinician-reported (illicit/non-medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). CONCLUSIONS: An e-Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research.
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- 2022
9. Buprenorphine-naloxone vs. extended-release naltrexone for opioid use disorder in individuals with and without criminal legal involvement: A secondary analysis of the X:BOT randomized controlled trial
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Balter, Dylan Rose, Puglisi, Lisa B., Dziura, James, Fiellin, David A., and Howell, Benjamin A.
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- 2024
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10. Long-Term Treatment of Opioid Use Disorder with Medications
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Wolfgang, Aaron S., primary, Weimer, Melissa B., additional, Na, Peter J., additional, Fiellin, David A., additional, and Muvvala, Srinivas B., additional
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- 2023
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11. Receipt of opioid use disorder treatments prior to fatal overdoses and comparison to no treatment in Connecticut, 2016–17
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Heimer, Robert, Black, Anne C., Lin, Hsiuju, Grau, Lauretta E., Fiellin, David A., Howell, Benjamin A., Hawk, Kathryn, D’Onofrio, Gail, and Becker, William C.
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- 2024
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12. Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years
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Davy-Mendez, Thibaut, Napravnik, Sonia, Eron, Joseph J, Cole, Stephen R, van Duin, David, Wohl, David A, Hogan, Brenna C, Althoff, Keri N, Gebo, Kelly A, Moore, Richard D, Silverberg, Michael J, Horberg, Michael A, Gill, M John, Mathews, W Christopher, Klein, Marina B, Colasanti, Jonathan A, Sterling, Timothy R, Mayor, Angel M, Rebeiro, Peter F, Buchacz, Kate, Li, Jun, Nanditha, Ni Gusti Ayu, Thorne, Jennifer E, Nijhawan, Ank, Berry, Stephen A, Benson, Constance A, Bosch, Ronald J, Kirk, Gregory D, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Montaner, Julio SG, Salters, Kate, Lima, Viviane D, Sereda, Paul, Trigg, Jason, Rodriguez, Benigno, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Rabkin, Charles, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, oanne, Hunter-Mellado, Robert F, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Mathews, William C, Kitahata, Mari M, Crane, Heidi M, Haas, David, Rebeiro, Peter, Turner, Megan, Tate, Janet, Dubrow, Robert, Fiellin, David, Gange, Stephen J, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, You, Bin, Hogan, Brenna, Zhang, Jinbing, and Jing, Jerry
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Biomedical and Clinical Sciences ,Clinical Sciences ,Infectious Diseases ,Sexually Transmitted Infections ,Clinical Research ,Anti-HIV Agents ,CD4 Lymphocyte Count ,Canada ,Cohort Studies ,Female ,HIV Infections ,Hospitalization ,Humans ,Male ,Viral Load ,HIV/AIDS ,6.1 Pharmaceuticals ,HIV ,hospitalization ,CD4 lymphocyte count ,sustained virologic response ,cohort studies ,North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Biological sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundPersons with HIV (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.MethodsIn six US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (Years 2-5) and long-term (Years 6-11) suppression and lowest pre-suppression CD4 count 500 cells/μL had an aIRR of 1.44 during early suppression (95% CI 1.01-2.06), and 1.67 (1.03-2.72) during long-term suppression. Among patients with lowest pre-suppression CD4 ≥200 (56%), patients with current CD4 351-500 versus >500 cells/μL had an aIRR of 1.22 (0.93-1.60) during early suppression and 2.09 (1.18-3.70) during long-term suppression.ConclusionsVirologically suppressed patients with lower CD4 counts experienced higher hospitalization rates, and could potentially benefit from targeted clinical management strategies.
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- 2021
13. Outcomes of Patients with Opioid-Related Diagnoses in Acute Coronary Syndrome: a National Inpatient Sample-Based Analysis
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Kim, Yeunjung, Pacor, Justin M., Do, Albert, Brennan, Joseph, Fiellin, David A., and Edelman, E. Jennifer
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- 2023
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14. Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015
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Davy-Mendez, Thibaut, Napravnik, Sonia, Hogan, Brenna C, Althoff, Keri N, Gebo, Kelly A, Moore, Richard D, Horberg, Michael A, Silverberg, Michael J, Gill, M John, Crane, Heidi M, Marconi, Vincent C, Bosch, Ronald J, Colasanti, Jonathan A, Sterling, Timothy R, Mathews, W Christopher, Mayor, Angel M, Nanditha, Ni Gusti Ayu, Buchacz, Kate, Li, Jun, Rebeiro, Peter F, Thorne, Jennifer E, Nijhawan, Ank, van Duin, David, Wohl, David A, Eron, Joseph J, Berry, Stephen A, Benson, Constance A, Kirk, Gregory D, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Carey, John T, Rodriguez, Benigno, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Rabkin, Charles, Klein, Marina B, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Hunter-Mellado, Robert F, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Mathews, William C, Kitahata, Mari M, Haas, David, Rebeiro, Peter, Turner, Megan, Tate, Janet, Dubrow, Robert, Fiellin, David, Gange, Stephen J, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, and You, Bin
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Medical Microbiology ,Sexually Transmitted Infections ,Aging ,Infectious Diseases ,Prevention ,HIV/AIDS ,Infection ,Good Health and Well Being ,Acquired Immunodeficiency Syndrome ,Anti-HIV Agents ,CD4 Lymphocyte Count ,Canada ,Comorbidity ,HIV Infections ,Hospitalization ,Humans ,Risk Factors ,United States ,Viral Load ,HIV ,hospitalization ,cohort studies ,North American AIDS Cohort Collaboration on Research and Design of IeDEA ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Biological sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundTo assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015.MethodsIn 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL.ResultsAmong 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories.ConclusionsAmong PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.
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- 2021
15. Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis.
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Hahn, Judith A, Murnane, Pamela M, Vittinghoff, Eric, Muyindike, Winnie R, Emenyonu, Nneka I, Fatch, Robin, Chamie, Gabriel, Haberer, Jessica E, Francis, Joel M, Kapiga, Saidi, Jacobson, Karen, Myers, Bronwyn, Couture, Marie Claude, DiClemente, Ralph J, Brown, Jennifer L, So-Armah, Kaku, Sulkowski, Mark, Marcus, Gregory M, Woolf-King, Sarah, Cook, Robert L, Richards, Veronica L, Molina, Patricia, Ferguson, Tekeda, Welsh, David, Piano, Mariann R, Phillips, Shane A, Stewart, Scott, Afshar, Majid, Page, Kimberly, McGinnis, Kathleen, Fiellin, David A, Justice, Amy C, Bryant, Kendall, and Saitz, Richard
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alcohol ,individual participant data meta-analysis ,phosphatidylethanol ,sensitivity ,individual participant data meta‐ ,analysis ,Substance Abuse ,Liver Disease ,Alcoholism ,Alcohol Use and Health ,Clinical Research ,Digestive Diseases ,Oral and gastrointestinal ,Clinical Sciences ,Neurosciences ,Psychology - Abstract
BackgroundObjective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption.MethodsWe identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score.ResultsOne third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables.ConclusionsAmong people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.
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- 2021
16. Perspectives on and experiences of emergency department–initiated buprenorphine among clinical pharmacists: A multi-site qualitative study
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Justen, Marissa, Edelman, E. Jennifer, Chawarski, Marek, Coupet, Edouard, Jr, Cowan, Ethan, Lyons, Michael, Owens, Patricia, Martel, Shara, Richardson, Lynne, Rothman, Richard, Whiteside, Lauren, O'Connor, Patrick G., Zahn, Evan, D'Onofrio, Gail, Fiellin, David A., and Hawk, Kathryn F.
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- 2023
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17. Core outcomes set for research on the treatment of opioid use disorder (COS-OUD): the National Institute on Drug Abuse Clinical Trials Network protocol for an e-Delphi consensus study.
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Karnik, Niranjan, Campbell, Cynthia, Curtis, Megan, Fiellin, David, Ghitza, Udi, Hefner, Kathryn, Hser, Yih-Ing, McHugh, R, Murphy, Sean, McPherson, Sterling, Moran, Landhing, Mooney, Larissa, Wu, Li-Tzy, Shmueli-Blumberg, Dikla, Shulman, Matisyahu, Schwartz, Robert, Stephens, Kari, Watkins, Katherine, and Marsden, John
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Consensus ,Core outcome set ,E-Delphi survey ,Opioid use disorder ,Outcome reporting ,Patient-reported outcomes ,Adolescent ,Adult ,Aged ,Consensus ,Delphi Technique ,Endpoint Determination ,Female ,Humans ,Male ,Middle Aged ,National Institute on Drug Abuse (U.S.) ,Opioid-Related Disorders ,Research Design ,Treatment Outcome ,United States ,Young Adult - Abstract
BACKGROUND: A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core outcome set (COS) is a minimum set of outcome measures that are recommended for all studies of a particular condition. The National Drug Abuse Treatment Clinical Trials Network (CTN) Core Outcome Set for OUD (COS-OUD) is a development study to identify core constructs, meaningful outcomes, and their optimal measurement for all efficacy and effectiveness studies of OUD treatment and service delivery. METHODS/DESIGN: Overseen by an expert workgroup, a modified, stepwise, e-Delphi methodology will be used to gain consensus among a panel of clinical practitioners and researchers involved in the treatment of OUD, who are members of the CTN. Sequential rounds of anonymous, online questionnaires will be used to identify, rate the importance of, and refine a core outcome set. A consensus threshold will be achieved if at least 70% of the panel rate the measure as critical for inclusion in the COS-OUD. Where consensus is not reached or there are suggestions for new measures, these will be brought forward to a further round of review prior to a consensus meeting. Products from this study will be communicated via peer-reviewed scientific journals and conferences. DISCUSSION: This initiative will develop a COS for OUD intervention trials, treatment studies, and service delivery and will support the pooling of research and clinical practice data and efforts to develop measurement-based care within the OUD treatment cascade. TRIAL REGISTRATION: http://www.comet-initiative.org/Studies/Details/1579.
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- 2021
18. Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence?
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Williams, Emily C, McGinnis, Kathleen A, Rubinsky, Anna D, Matson, Theresa E, Bobb, Jennifer F, Lapham, Gwen T, Edelman, E Jennifer, Satre, Derek D, Catz, Sheryl L, Richards, Julie E, Bryant, Kendall J, Marshall, Brandon DL, Kraemer, Kevin L, Crystal, Stephen, Gordon, Adam J, Skanderson, Melissa, Fiellin, David A, Justice, Amy C, and Bradley, Katharine A
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Clinical Research ,Aging ,Behavioral and Social Science ,HIV/AIDS ,Substance Misuse ,Alcoholism ,Alcohol Use and Health ,Infectious Diseases ,Prevention ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Good Health and Well Being ,Aged ,Alcohol Drinking ,Anti-Retroviral Agents ,Cohort Studies ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Middle Aged ,HIV ,ART ,Antiretroviral therapy ,Adherence ,Alcohol use ,Public Health and Health Services ,Social Work ,Public Health - Abstract
Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH). Dynamic longitudinal associations are understudied. Veterans Aging Cohort Study (VACS) data 2/1/2008-7/31/16 were used to fit linear regression models estimating changes in adherence (% days with ART medication fill) associated with changes in alcohol use based on annual clinically-ascertained AUDIT-C screening scores (range - 12 to + 12, 0 = no change) adjusting for demographics and initial adherence. Among 21,275 PLWH (67,330 observations), most reported no (48%) or low-level (39%) alcohol use initially, with no (55%) or small (39% ≤ 3 points) annual change. Mean initial adherence was 86% (SD 21%), mean annual change was - 3.1% (SD 21%). An inverted V-shaped association was observed: both increases and decreases in AUDIT-C were associated with greater adherence decreases relative to stable scores [p
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- 2021
19. Implementing Programs to Initiate Buprenorphine for Opioid Use Disorder Treatment in High-Need, Low-Resource Emergency Departments: A Nonrandomized Controlled Trial
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McCormack, Ryan P., Rotrosen, John, Gauthier, Phoebe, D’Onofrio, Gail, Fiellin, David A., Marsch, Lisa A., Novo, Patricia, Liu, David, Edelman, E. Jennifer, Farkas, Sarah, Matthews, Abigail G., Mulatya, Caroline, Salazar, Dagmar, Wolff, Jeremy, Knight, Randolph, Goodman, William, Williams, Joseph, and Hawk, Kathryn
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- 2023
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20. Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial
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Edelman, E. Jennifer, Dziura, James, Deng, Yanhong, DePhilippis, Dominick, Fucito, Lisa M., Ferguson, Tekeda, Bedimo, Roger, Brown, Sheldon, Marconi, Vincent C., Goetz, Matthew Bidwell, Rodriguez-Barradas, Maria C., Simberkoff, Michael S., Molina, Patricia E., Weintrob, Amy C., Maisto, Stephen A., Paris, Manuel, Justice, Amy C., Bryant, Kendall J., and Fiellin, David A.
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- 2023
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21. Spironolactone as a potential new pharmacotherapy for alcohol use disorder: convergent evidence from rodent and human studies
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Farokhnia, Mehdi, Rentsch, Christopher T., Chuong, Vicky, McGinn, M. Adrienne, Elvig, Sophie K., Douglass, Eliza A., Gonzalez, Luis A., Sanfilippo, Jenna E., Marchette, Renata C. N., Tunstall, Brendan J., Fiellin, David A., Koob, George F., Justice, Amy C., Leggio, Lorenzo, and Vendruscolo, Leandro F.
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- 2022
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22. Association of Immunosuppression and Human Immunodeficiency Virus (HIV) Viremia With Anal Cancer Risk in Persons Living With HIV in the United States and Canada
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Hernández-Ramírez, Raúl U, Qin, Li, Lin, Haiqun, Leyden, Wendy, Neugebauer, Romain S, Althoff, Keri N, Hessol, Nancy A, Achenbach, Chad J, Brooks, John T, Gill, M John, Grover, Surbhi, Horberg, Michael A, Li, Jun, Mathews, W Christopher, Mayor, Angel M, Patel, Pragna, Rabkin, Charles S, Rachlis, Anita, Justice, Amy C, Moore, Richard D, Engels, Eric A, Silverberg, Michael J, Dubrow, Robert, Benson, Constance A, Bosch, Ronald J, Kirk, Gregory D, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Buchacz, Kate, Gebo, Kelly A, Rodriguez, Benigno, Thorne, Jennifer E, Rabkin, Charles, Margolick, Joseph B, Jacobson, Lisa P, D’Souza, Gypsyamber, Klein, Marina B, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Hunter-Mellado, Robert F, Deeks, Steven G, Martin, Jeffrey N, Saag, Michael S, Mugavero, Michael J, Willig, James, Mathews, William C, Eron, Joseph J, Napravnik, Sonia, Kitahata, Mari M, Crane, Heidi M, Drozd, Daniel R, Sterling, Timothy R, Haas, David, Rebeiro, Peter, Turner, Megan, Fiellin, David, Gange, Stephen J, Anastos, Kathryn, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, and You, Bin
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Medical Microbiology ,Biomedical and Clinical Sciences ,Immunology ,Digestive Diseases ,Prevention ,Sexually Transmitted Infections ,Cancer ,Infectious Diseases ,Clinical Research ,HIV/AIDS ,2.1 Biological and endogenous factors ,Aetiology ,Infection ,Good Health and Well Being ,Anus Neoplasms ,CD4 Lymphocyte Count ,Canada ,HIV ,HIV Infections ,Humans ,Immunosuppression Therapy ,United States ,Viral Load ,Viremia ,HIV infection ,CD4+T-cell count ,HIV-1 RNA viral load ,anal cancer ,risk ,North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS ,CD4+ T-cell count ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundPeople living with human immunodeficiency virus (HIV; PLWH) have a markedly elevated anal cancer risk, largely due to loss of immunoregulatory control of oncogenic human papillomavirus infection. To better understand anal cancer development and prevention, we determined whether recent, past, cumulative, or nadir/peak CD4+ T-cell count (CD4) and/or HIV-1 RNA level (HIV RNA) best predict anal cancer risk.MethodsWe studied 102 777 PLWH during 1996-2014 from 21 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. Using demographics-adjusted, cohort-stratified Cox models, we assessed associations between anal cancer risk and various time-updated CD4 and HIV RNA measures, including cumulative and nadir/peak measures during prespecified moving time windows. We compared models using the Akaike information criterion.ResultsCumulative and nadir/peak CD4 or HIV RNA measures from approximately 8.5 to 4.5 years in the past were generally better predictors for anal cancer risk than their corresponding more recent measures. However, the best model included CD4 nadir (ie, the lowest CD4) from approximately 8.5 years to 6 months in the past (hazard ratio [HR] for
- Published
- 2020
23. Concordance between controlled substance receipt and post-mortem toxicology in opioid-detected overdose deaths: A statewide analysis
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Howell, Benjamin A., Black, Anne C., Grau, Lauretta E., Lin, Hsiu-Ju, Greene, Christina, Lee, Hana, Heimer, Robert, Hawk, Kathryn E., D’Onofrio, Gail, Fiellin, David A., and Becker, William C.
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- 2023
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24. Urine Toxicology Profiles of Emergency Department Patients with Untreated Opioid Use Disorder: A Multi-Site View: ED UDS Profiles
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Cowan, Ethan, Perrone, Jeanmarie, Dziura, James, Edelman, E. Jennifer, Hawk, Kathryn, Herring, Andrew, McCormack, Ryan, Murphy, Alexandra, Phadke, Manali, Fiellin, David A., and D'Onofrio, Gail
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- 2023
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25. Bridging the Gap: Dual Fellowship Training in Addiction Medicine and Digestive Diseases
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Haque, Lamia Y. and Fiellin, David A.
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- 2022
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26. Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain
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Rossi, Raiza, primary, Cutter, Christopher J., additional, Beitel, Mark, additional, Covelli, Mikah, additional, Fiellin, David A., additional, Kerns, Robert D., additional, Vassilieva, Svetlana, additional, Olabisi, Deborah, additional, and Barry, Declan T., additional
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- 2024
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27. The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV
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Lauckner, Carolyn, Walthers, Justin, Stuck, Jennifer, Bryant, Kendall, Edelman, E. Jennifer, Fiellin, David A., Hansen, Nathan B., Kahler, Christopher W., Magill, Molly, Mastroleo, Nadine R., and Maisto, Stephen A.
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- 2022
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28. HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV.
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Williams, Emily C, McGinnis, Kathleen A, Tate, Janet P, Matson, Theresa E, Rubinsky, Anna D, Bobb, Jennifer F, Lapham, Gwen T, Edelman, E Jennifer, Catz, Sheryl L, Satre, Derek D, Bryant, Kendall J, Marshall, Brandon DL, Kraemer, Kevin L, Bensley, Kara M, Richards, Julie E, Skanderson, Melissa, Justice, Amy C, Fiellin, David A, and Bradley, Katharine A
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Research ,Alcoholism ,Alcohol Use and Health ,Prevention ,Substance Misuse ,Infectious Diseases ,HIV/AIDS ,Stroke ,Oral and gastrointestinal ,Cardiovascular ,Good Health and Well Being ,Aged ,Alcohol Drinking ,Alcoholism ,Cohort Studies ,Ethnicity ,Female ,Follow-Up Studies ,HIV Infections ,Humans ,Male ,Middle Aged ,Racial Groups ,Severity of Illness Index ,Veterans ,HIV ,alcohol ,HIV disease severity ,VACS Index ,alcohol use ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundAlcohol use influences HIV disease severity through multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied.SettingNational Veterans Health Administration.MethodsPairs of AUDIT-C screens within 9-15 months (February 1, 2008-September 30, 2014) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0-270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (-12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures.ResultsAmong 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0 to 134, change scores ranged from -65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (P < 0.001). Among those with stable alcohol use (AUDIT-C change ≤ │1│ point), VACS Index 2.0 improvements ranged 0.36-0.60 points. For those with maximum AUDIT-C increase (change from 0 to 12), VACS Index 2.0 worsened 3.74 points (95% CI: -4.71 to -2.78); for those with maximum AUDIT-C decrease (change from 12 to 0), VACS Index 2.0 changed minimally [-0.60 (95% CI: -1.43 to 0.23)].ConclusionsIn this national sample, improvement in HIV severity was generally greatest among those with stable alcohol use (primarily those with no use).
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- 2019
29. Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas
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Bensley, Kara M, McGinnis, Kathleen A, Fortney, John, Chan, KC Gary, Dombrowski, Julia C, Ornelas, India, Edelman, E Jennifer, Goulet, Joseph L, Satre, Derek D, Justice, Amy C, Fiellin, David A, and Williams, Emily C
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Health Services and Systems ,Public Health ,Health Sciences ,Prevention ,HIV/AIDS ,Substance Misuse ,Clinical Research ,Rural Health ,Alcoholism ,Alcohol Use and Health ,Behavioral and Social Science ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Alcoholism ,Cohort Studies ,Female ,HIV Infections ,Humans ,Male ,Middle Aged ,Prevalence ,Rural Population ,Urban Population ,Veterans ,alcohol use ,HIV ,rural ,urban ,veterans ,Nursing ,Public Health and Health Services ,Health services and systems ,Public health ,Development studies - Abstract
BackgroundFor people living with HIV (PLWH), alcohol use is harmful and may be influenced by unique challenges faced by PLWH living in rural areas. We describe patterns of alcohol use across rurality among PLWH.MethodsVeterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD-9 codes for HIV or AIDS) who completed AUDIT-C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT-C > 0] and alcohol use disorder [AUD; ICD-9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT-C risk categories: lower- [1-3 men/1-2 women], moderate- [4-5 men/3-5 women], higher- 6-7]), and severe-risk [8-12], and heavy episodic drinking (HED; ≥1 past-year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census-defined region.FindingsAmong 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%-54.7%) in urban, 49.6% (46.9%-52.3%) in large rural, and 50.6% (48.3%-52.9%) in small rural areas (P < .01). Predicted prevalence of AUD was 14.4% (14.0%-14.8%) in urban, 11.8% (10.0%-13.5%) in large rural, and 12.3% (10.8%-13.8%) in small rural areas (P < .01). Approximately 12% and 25% had higher- or severe-risk drinking and HED, respectively, but neither differed across rurality.ConclusionThough some variation across rurality and region was observed, alcohol-related interventions are needed for PLWH across all geographic locations.
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- 2019
30. Association of immunosuppression and HIV viraemia with non-Hodgkin lymphoma risk overall and by subtype in people living with HIV in Canada and the USA: a multicentre cohort study
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Hernández-Ramírez, Raúl U, Qin, Li, Lin, Haiqun, Leyden, Wendy, Neugebauer, Romain S, Althoff, Keri N, Achenbach, Chad J, Hessol, Nancy A, D'Souza, Gypsyamber, Gebo, Kelly A, Gill, M John, Grover, Surbhi, Horberg, Michael A, Li, Jun, Mathews, W Christopher, Mayor, Angel M, Park, Lesley S, Rabkin, Charles S, Salters, Kate, Justice, Amy C, Moore, Richard D, Engels, Eric A, Silverberg, Michael J, Dubrow, Robert, AIDS, North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate, Betts, Adrian, Brooks, John T, Freeman, Aimee M, Van Rompaey, Stephen E, Burchell, Ann, Yip, Benita, You, Bin, Hogan, Brenna, Grasso, Chris, Hogg, Robert S, Benson, Constance A, Drozd, Daniel R, Sterling, Timothy R, Haas, David, Humes, Elizabeth, Crane, Heidi M, Willig, James, Eron, Joseph J, Martin, Jeffrey N, Saag, Michael S, Jing, Jerry, Zhang, Jinbing, Lindsay, Joanne, Hunter-Mellado, Robert F, Deeks, Steven G, Zhu, Julia, Montaner, Julio SG, McReynolds, Justin, Gabler, Karyn, Buchacz, Kate, Rodriguez, Benigno, Thorne, Jennifer E, Margolick, Joseph B, Anastos, Kathryn, Jacobson, Lisa P, Klein, Marina B, Kroch, Abigail, Morton, Liz, Turner, Megan, Fiellin, David, Gange, Stephen J, Mugavero, Michael J, Harrigan, P Richard, Rebeiro, Peter, Bosch, Ronald J, Kirk, Gregory D, Mayer, Kenneth H, McKaig, Rosemary G, Coburn, Sally, Napravnik, Sonia, Kitahata, Mari M, Lober, William B, and Lee, Jennifer S
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Oncology and Carcinogenesis ,Sexually Transmitted Infections ,Hematology ,Prevention ,Lymphoma ,Rare Diseases ,Cancer ,Infectious Diseases ,Lymphatic Research ,HIV/AIDS ,Aetiology ,2.1 Biological and endogenous factors ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,CD4 Lymphocyte Count ,Canada ,Cohort Studies ,Female ,HIV Infections ,Humans ,Immune Tolerance ,Lymphoma ,Non-Hodgkin ,Male ,Middle Aged ,Risk Assessment ,United States ,Viral Load ,Young Adult ,North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS ,Medical and Health Sciences ,Biomedical and clinical sciences ,Health sciences - Abstract
BackgroundResearch is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype.MethodsWe studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion.FindingsOf 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months;
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- 2019
31. One Size Fits (n)One: The Influence of Sex, Age, and Sexual Human Immunodeficiency Virus (HIV) Acquisition Risk on Racial/Ethnic Disparities in the HIV Care Continuum in the United States
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Desir, Fidel A, Lesko, Catherine R, Moore, Richard D, Horberg, Michael A, Wong, Cherise, Crane, Heidi M, Silverberg, Michael, Thorne, Jennifer E, Rachlis, Beth, Rabkin, Charles, Mayor, Angel M, Mathews, William C, Althoff, Keri N, Benson, Constance A, Bosch, Ronald J, Fenway, Gregory D Kirk, Boswell, Stephen, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Buchacz, Kate, Brooks, John T, Gebo, Kelly A, Carey, John T, Rodriguez, Benigno, Silverberg, Michael J, Margolick, Joseph B, Jacobson, Lisa P, D’Souza, Gypsyamber, Klein, Marina B, Kroch, Abigail, Burchell, Ann, Rachlis, Anita, Cupido, Patrick, Lindsay, Joanne, Hunter-Mellado, Robert F, Gill, M John, Deeks, Steven G, Martin, Jeffrey N, Patel, Pragna, Saag, Michael S, Mugavero, Michael J, Willig, James, Eron, Joseph J, Napravnik, Sonia, Kitahata, Mari M, Drozd, Daniel R, Sterling, Timothy R, Haas, David, Rebeiro, Peter, Turner, Megan, Bebawy, Sally, Rogers, Ben, Justice, Amy C, Dubrow, Robert, Fiellin, David, Gange, Stephen J, Anastos, Kathryn, McKaig, Rosemary G, Freeman, Aimee M, Lent, Carol, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, You, Bin, Hogan, Brenna, Zhang, Jinbing, and Jing, Jerry
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Biomedical and Clinical Sciences ,Clinical Sciences ,HIV/AIDS ,Clinical Research ,Behavioral and Social Science ,Infectious Diseases ,Sexual and Gender Minorities (SGM/LGBT*) ,Health Disparities ,Sexually Transmitted Infections ,Minority Health ,Infection ,Adolescent ,Adult ,Cohort Studies ,Continuity of Patient Care ,Ethnicity ,Female ,HIV Infections ,Homosexuality ,Male ,Humans ,Male ,Middle Aged ,Racial Groups ,Risk Factors ,Sexual Behavior ,United States ,Viral Load ,Young Adult ,HIV care continuum ,racial/ethnic disparities ,key populations ,North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) Region of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundThe United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood.MethodsWe estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014.ResultsAmong women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites.ConclusionsRacial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.
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- 2019
32. Medical Intensive Care Unit Admission Among Patients With and Without HIV, Hepatitis C Virus, and Alcohol-Related Diagnoses in the United States
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Rentsch, Christopher T, Tate, Janet P, Steel, Tessa, Butt, Adeel A, Gibert, Cynthia L, Huang, Laurence, Pisani, Margaret, Soo Hoo, Guy W, Crystal, Stephen, Rodriguez-Barradas, Maria C, Brown, Sheldon T, Freiberg, Matthew S, Graber, Christopher J, Kim, Joon W, Rimland, David, Justice, Amy C, Fiellin, David A, Crothers, Kristina A, and Akgün, Kathleen M
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Liver Disease ,Hepatitis - C ,Hepatitis ,Chronic Liver Disease and Cirrhosis ,HIV/AIDS ,Infectious Diseases ,Substance Misuse ,Digestive Diseases ,Clinical Research ,Alcoholism ,Alcohol Use and Health ,Emerging Infectious Diseases ,Aetiology ,2.2 Factors relating to the physical environment ,Infection ,Good Health and Well Being ,Adult ,Alcohol Drinking ,Alcohol-Related Disorders ,Coinfection ,Female ,HIV Infections ,Hepatitis C ,Humans ,Intensive Care Units ,Male ,Middle Aged ,Patient Admission ,Retrospective Studies ,Risk Factors ,United States ,intensive care units ,HIV ,hepatitis C ,alcoholism ,electronic health records ,veterans ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundHIV, hepatitis C virus (HCV), and alcohol-related diagnoses (ARD) independently contribute increased risk of all-cause hospitalization. We sought to determine annual medical intensive care unit (MICU) admission rates and relative risk of MICU admission between 1997 and 2014 among people with and without HIV, HCV, and ARD, using data from the largest HIV and HCV care provider in the United States.SettingVeterans Health Administration.MethodsAnnual MICU admission rates were calculated among 155,550 patients in the Veterans Aging Cohort Study by HIV, HCV, and ARD status. Adjusted rate ratios and 95% confidence intervals (CIs) were estimated with Poisson regression. Significance of trends in age-adjusted admission rates were tested with generalized linear regression. Models were stratified by calendar period to identify shifts in MICU admission risk over time.ResultsCompared to HIV-/HCV-/ARD- patients, relative risk of MICU admission decreased among HIV-mono-infected patients from 61% (95% CI: 1.56 to 1.65) in 1997-2009% to 21% (95% CI: 1.16 to 1.27) in 2010-2014, increased among HCV-mono-infected patients from 22% (95% CI: 1.16 to 1.29) in 1997-2009% to 54% (95% CI: 1.43 to 1.67) in 2010-2014, and remained consistent among patients with ARD only at 46% (95% CI: 1.42 to 1.50). MICU admission rates decreased by 48% among HCV-uninfected patients (P-trend
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- 2019
33. Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare.
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Williams, Emily C, McGinnis, Kathleen A, Edelman, E Jennifer, Matson, Theresa E, Gordon, Adam J, Marshall, Brandon DL, Bryant, Kendall J, Rubinsky, Anna D, Lapham, Gwen T, Satre, Derek D, Richards, Julie E, Catz, Sheryl L, Fiellin, David A, Justice, Amy C, and Bradley, Katharine A
- Subjects
Humans ,HIV Infections ,Anti-HIV Agents ,Viral Load ,Retrospective Studies ,Alcohol Drinking ,Health Behavior ,Middle Aged ,Veterans ,Continuity of Patient Care ,United States ,Female ,Male ,Medication Adherence ,Alcohol ,Antiretroviral therapy ,Care continuum ,HIV ,Treatment cascade ,Viral suppression ,Substance Misuse ,Infectious Diseases ,Behavioral and Social Science ,Brain Disorders ,Clinical Research ,HIV/AIDS ,Health Services ,Alcoholism ,Alcohol Use and Health ,Infection ,Oral and gastrointestinal ,Good Health and Well Being ,Public Health and Health Services ,Social Work ,Public Health - Abstract
We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008-9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA
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- 2019
34. Provider verification of electronic health record receipt and nonreceipt of direct-acting antivirals for the treatment of hepatitis C virus infection
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Rentsch, Christopher T, Cartwright, Emily J, Gandhi, Neel R, Brown, Sheldon T, Rodriguez-Barradas, Maria C, Goetz, Matthew Bidwell, Marconi, Vincent C, Gibert, Cynthia L, Re, Vincent Lo, Fiellin, David A, Justice, Amy C, and Tate, Janet P
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Digestive Diseases ,Chronic Liver Disease and Cirrhosis ,Emerging Infectious Diseases ,Infectious Diseases ,Clinical Research ,Hepatitis ,Hepatitis - C ,Liver Disease ,Infection ,Good Health and Well Being ,Aged ,Antiviral Agents ,Drug Prescriptions ,Electronic Health Records ,Female ,Hepatitis C ,Chronic ,Humans ,Male ,Middle Aged ,Pharmacoepidemiology ,Pharmacy ,United States ,United States Department of Veterans Affairs ,Veterans ,Veterans Health ,Antivirals ,Direct-acting antiviral ,Hepatitis C ,Observational data ,Validation ,Medical and Health Sciences ,Epidemiology ,Biomedical and clinical sciences ,Health sciences - Abstract
PurposePharmacoepidemiologic studies using electronic health record data could serve an important role in assessing safety and effectiveness of direct-acting antiviral therapy for chronic hepatitis C virus (HCV) infection, but the validity of these data needs to be determined. We evaluated the accuracy of pharmacy fill records in the national Veterans Health Administration (VA) Corporate Data Warehouse (CDW) as compared to facility-level electronic health record.MethodsPatients prescribed a direct-acting antiviral regimen at five VA sites between 2014 and 2016 were randomly selected and reviewed. A random sample of patients with chronic HCV infection without evidence of HCV treatment during the study period also underwent chart review. We calculated positive predictive value and negative predictive value overall and by site.ResultsOf the 501 patients who received a total of 2416 prescriptions, 494 were validated using data extracted from CDW 6 months after the study period, yielding a positive predictive value of 98.6% (95% confidence interval, 97.6%-99.6%). Of the 100 patients with chronic HCV infection without prescriptions for HCV treatment, 99 were confirmed not to have received antiviral treatment (negative predictive value, 99.0%; 95% confidence interval, 97.1%-100%).ConclusionsThese findings provide assurance to researchers who use national VA CDW data for retrospective cohort studies that the CDW contains accurate information on HCV therapies in the modern treatment era.
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- 2018
35. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study
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Morford, Kenneth L., Muvvala, Srinivas B., Chan, Philip A., Cornman, Deborah H., Doernberg, Molly, Porter, Elizabeth, Virata, Michael, Yager, Jessica E., Fiellin, David A., and Edelman, E. Jennifer
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- 2022
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36. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV
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Wyse, Jessica J., McGinnis, Kathleen A., Edelman, E. Jennifer, Gordon, Adam J., Manhapra, Ajay, Fiellin, David A., Moore, Brent A., Korthuis, P. Todd, Kennedy, Amy J., Oldfield, Benjamin J., Gaither, Julie R., Gordon, Kirsha S., Skanderson, Melissa, Barry, Declan T., Bryant, Kendall, Crystal, Stephen, Justice, Amy C., and Kraemer, Kevin L.
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- 2022
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37. Change in Alcohol Use Based on Self-Report and a Quantitative Biomarker, Phosphatidylethanol, in People With HIV
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McGinnis, Kathleen A., Tate, Janet P., Bryant, Kendall J., Justice, Amy C., O’Connor, Patrick G., Rodriguez-Barradas, Maria C., Crystal, Stephen, Cutter, Christopher J., Hansen, Nathan B., Maisto, Stephen A., Marconi, Vincent C., Williams, Emily C., Cook, Robert L., Gordon, Adam J., Gordon, Kirsha S., Eyawo, Oghenowede, Edelman, E. Jennifer, and Fiellin, David A.
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- 2022
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38. Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV
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Kennedy, Amy J., McGinnis, Kathleen A., Merlin, Jessica S., Edelman, E. Jennifer, Gordon, Adam J., Korthuis, P. Todd, Skanderson, Melissa, Williams, Emily C., Wyse, Jessica, Oldfield, Benjamin, Bryant, Kendall, Justice, Amy, Fiellin, David A., and Kraemer, Kevin L.
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- 2022
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39. Gender and alcohol use
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Matson, Theresa E, McGinnis, Kathleen A, Rubinsky, Anna D, Frost, Madeline C, Czarnogorski, Maggie, Bryant, Kendall J, Edelman, E Jennifer, Satre, Derek D, Catz, Sheryl L, Bensley, Kara M, Fiellin, David A, Justice, Amy C, and Williams, Emily C
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Substance Misuse ,Alcoholism ,Alcohol Use and Health ,Infectious Diseases ,Clinical Research ,HIV/AIDS ,Infection ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Alcoholism ,CD4 Lymphocyte Count ,Continuity of Patient Care ,Female ,HIV Infections ,Humans ,Male ,Medication Adherence ,Middle Aged ,Prevalence ,Retrospective Studies ,Sex Factors ,United States ,Veterans ,Viral Load ,alcohol drinking ,continuity of patient care ,HIV ,social determinants of health ,veterans ,viral load ,women ,Biological Sciences ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Virology ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectivesTo investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans.DesignRetrospective cohort.MethodsVeterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 cells/μl or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA
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- 2018
40. Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort
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Williams, Emily C, McGinnis, Kathleen A, Bobb, Jennifer F, Rubinsky, Anna D, Lapham, Gwen T, Skanderson, Melissa, Catz, Sheryl L, Bensley, Kara M, Richards, Julie E, Bryant, Kendall J, Edelman, E Jennifer, Satre, Derek D, Marshall, Brandon DL, Kraemer, Kevin L, Blosnich, John R, Crystal, Stephen, Gordon, Adam J, Fiellin, David A, Justice, Amy C, and Bradley, Katharine A
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Alcoholism ,Alcohol Use and Health ,Substance Misuse ,HIV/AIDS ,Infectious Diseases ,Clinical Research ,Oral and gastrointestinal ,Stroke ,Good Health and Well Being ,Adult ,Aged ,Aging ,Alcohol Drinking ,Female ,HIV Infections ,Humans ,Longitudinal Studies ,Male ,Middle Aged ,Severity of Illness Index ,Veterans ,HIV ,CD4 ,Viral load ,Alcohol use ,Alcohol use disorders ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Biochemistry and cell biology ,Pharmacology and pharmaceutical sciences ,Epidemiology - Abstract
BackgroundAmong groups of persons living with HIV (PLWH), high-risk drinking trajectories are associated with HIV severity. Whether changes in individuals' alcohol use are associated with changes in HIV severity over the same period is unknown.MethodsVeterans Aging Cohort Study (VACS) data from VA's EHR (2/1/2008-9/30/2016) identified AUDIT-C screens for all PLWH. Pairs of AUDIT-C screens within 9-15 months were included if CD4 and/or viral load (VL) was measured within 9 months after baseline and follow-up AUDIT-Cs. Linear regression assessed change in HIV severity (CD4 and logVL) associated with AUDIT-C change adjusted for confounders. Mean changes in HIV severity were estimated for each AUDIT-C change value. For all measures of change, positive values indicate improvements (lower drinking and improved HIV severity).ResultsAmong PLWH, 21,999 and 22,143 were eligible for CD4 and VL analyses, respectively. Most had non- or low-level drinking and stable consumption over time (mean AUDIT-C change = .08, SD = 1.91). HIV severity improved over time [mean CD4 change = 20.5 (SD 180.8); mean logVL change = 0.12 (SD 0.71)]. AUDIT-C changes were associated non-linearly with changes in CD4 (p = 0.03) and logVL (p
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- 2018
41. Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States
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Wong, Cherise, Gange, Stephen J, Moore, Richard D, Justice, Amy C, Buchacz, Kate, Abraham, Alison G, Rebeiro, Peter F, Koethe, John R, Martin, Jeffrey N, Horberg, Michael A, Boyd, Cynthia M, Kitahata, Mari M, Crane, Heidi M, Gebo, Kelly A, Gill, M John, Silverberg, Michael J, Palella, Frank J, Patel, Pragna, Samji, Hasina, Thorne, Jennifer, Rabkin, Charles S, Mayor, Angel, Althoff, Keri N, Freeman, Aimee M, Cescon, Angela, Rachlis, Anita R, Rogers, Ben, Rodriguez, Benigno, Grasso, Chris, Benson, Constance A, Drozd, Daniel R, Fiellin, David, Haas, David, Kirk, Gregory D, Willig, James, Globerman, Jason, Brooks, John T, Eron, Joseph J, Montaner, Julio SG, Gabler, Karyn, Anastos, Kathryn, Mayer, Kenneth H, Jacobson, Lisa P, Kopansky-Giles, Madison, Klein, Marina B, Turner, Megan, Mugavero, Michael J, Saag, Michael S, Harrigan, P Richard, Dubrow, Robert, Hunter-Mellado, Robert F, Hogg, Robert S, Bosch, Ronald J, McKaig, Rosemary G, Bebawy, Sally, Rourke, Sean B, Napravnik, Sonia, Boswell, Stephen, and Sterling, Timothy R
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Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Sexually Transmitted Infections ,Cardiovascular ,Infectious Diseases ,Clinical Research ,HIV/AIDS ,Good Health and Well Being ,Adult ,Age Factors ,Black People ,Cohort Studies ,Diabetes Mellitus ,Type 2 ,Female ,HIV ,HIV Infections ,Heterosexuality ,Homosexuality ,Male ,Humans ,Hypercholesterolemia ,Hypertension ,Longitudinal Studies ,Male ,Middle Aged ,Multimorbidity ,Renal Insufficiency ,Chronic ,Sexual and Gender Minorities ,United States ,White People ,multimorbidity ,age-associated conditions ,aging ,North American AIDS Cohort Collaboration on Research and Design ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundAge-associated conditions are increasingly common among persons living with human immunodeficiency virus (HIV) (PLWH). A longitudinal investigation of their accrual is needed given their implications on clinical care complexity. We examined trends in the co-occurrence of age-associated conditions among PLWH receiving clinical care, and differences in their prevalence by demographic subgroup.MethodsThis cohort study was nested within the North American AIDS Cohort Collaboration on Research and Design. Participants from HIV outpatient clinics were antiretroviral therapy-exposed PLWH receiving clinical care (ie, ≥1 CD4 count) in the United States during 2000-2009. Multimorbidity was irreversible, defined as having ≥2: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures.ResultsAmong 22969 adults, 79% were male, 36% were black, and the median baseline age was 40 years (interquartile range, 34-46 years). Between 2000 and 2009, multimorbidity prevalence increased from 8.2% to 22.4% (Ptrend < .001). Adjusting for age, this trend was still significant (P < .001). There was no difference by sex, but blacks were less likely than whites to have multimorbidity (aPR, 0.87; 95% CI, .77-.99). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR, 1.16; 95% CI, 1.01-1.34). Hypertension and hypercholesterolemia most commonly co-occurred.ConclusionsMultimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.
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- 2018
42. Alcohol and Mortality
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Eyawo, Oghenowede, McGinnis, Kathleen A, Justice, Amy C, Fiellin, David A, Hahn, Judith A, Williams, Emily C, Gordon, Adam J, Marshall, Brandon DL, Kraemer, Kevin L, Crystal, Stephen, Gaither, Julie R, Edelman, E Jennifer, Bryant, Kendall J, and Tate, Janet P
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Emerging Infectious Diseases ,Clinical Research ,Infectious Diseases ,Alcoholism ,Alcohol Use and Health ,Substance Misuse ,Digestive Diseases ,Liver Disease ,Hepatitis - C ,Chronic Liver Disease and Cirrhosis ,Hepatitis ,HIV/AIDS ,Prevention ,2.2 Factors relating to the physical environment ,Aetiology ,Infection ,Good Health and Well Being ,Adult ,Aged ,Aged ,80 and over ,Alcoholism ,Biomarkers ,Female ,Glycerophospholipids ,HIV Infections ,Humans ,Longitudinal Studies ,Male ,Middle Aged ,Self Report ,HIV ,HCV ,alcohol ,mortality ,AUDIT-C ,phosphatidylethanol ,VACS Project team ,Clinical Sciences ,Public Health and Health Services ,Virology - Abstract
BackgroundUnhealthy alcohol use may be particularly detrimental among individuals living with HIV and/or hepatitis C virus (HCV), and is often under-reported. Direct biomarkers of alcohol exposure may facilitate improved detection of alcohol use.MethodsWe evaluated the association of alcohol exposure determined by both self-report [Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)] and a direct biomarker [phosphatidylethanol (PEth)], with mortality among HIV-infected and HIV-uninfected in the Veterans Aging Cohort Study-Biomarker Cohort. We considered PEth
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- 2018
43. Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures
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Kim, Junghwan, primary, Lee, Jinhyung, additional, Thornhill, Thomas A., additional, Dennett, Julia, additional, Lu, Haidong, additional, Howell, Benjamin, additional, Grau, Lauretta E., additional, Fiellin, David A., additional, Heimer, Robert, additional, and Gonsalves, Gregg, additional
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- 2024
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44. Psychiatric comorbidity and order of condition onset among patients seeking treatment for chronic pain and opioid use disorder
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Barry, Declan T., Beitel, Mark, Cutter, Christopher J., Fiellin, David A., Madden, Lynn M., Lipkind, Nathan, Bollampally, Pooja, Liong, Christopher, and Schottenfeld, Richard S.
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- 2021
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45. Emergency department patients with untreated opioid use disorder: A comparison of those seeking versus not seeking referral to substance use treatment
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Coupet, Edouard, Jr, D’Onofrio, Gail, Chawarski, Marek, Edelman, E.J., O’Connor, Patrick G., Owens, Patricia, Martel, Shara, Fiellin, David A., Cowan, Ethan, Richardson, Lynne, Huntley, Kristen, Whiteside, Lauren K., Lyons, Michael S., Rothman, Richard E., Pantalon, Michael, and Hawk, Kathryn
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- 2021
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46. Hospitalisations for non-fatal overdose among people with a history of opioid dependence in New South Wales, Australia, 2001–2018: Findings from the OATS retrospective cohort study
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Jones, Nicola R., Hickman, Matthew, Larney, Sarah, Nielsen, Suzanne, Ali, Robert, Murphy, Thomas, Dobbins, Timothy, Fiellin, David A., and Degenhardt, Louisa
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- 2021
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47. Cancer-Attributable Mortality Among People With Treated Human Immunodeficiency Virus Infection in North America
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Engels, Eric A, Yanik, Elizabeth L, Wheeler, Willian, Gill, M John, Shiels, Meredith S, Dubrow, Robert, Althoff, Keri N, Silverberg, Michael J, Brooks, John T, Kitahata, Mari M, Goedert, James J, Grover, Surbhi, Mayor, Angel M, Moore, Richard D, Park, Lesley S, Rachlis, Anita, Sigel, Keith, Sterling, Timothy R, Thorne, Jennifer E, Pfeiffer, Ruth M, Benson, Constance A, Bosch, Ronald J, Kirk, Gregory D, Boswell, Stephen, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Buchacz, Kate, Gebo, Kelly A, Carey, John T, Rodriguez, Benigno, Horberg, Michael A, Rabkin, Charles, Jacobson, Lisa P, D’Souza, Gypsyamber, Klein, Marina B, Rourke, Sean B, Rachlis, Anita R, Globerman, Jason, Kopansky-Giles, Madison, Hunter-Mellado, Robert F, Deeks, Steven G, Martin, Jeffrey N, Patel, Pragna, Saag, Michael S, Mugavero, Michael J, Willig, James, Eron, Joseph J, Napravnik, Sonia, Crane, Heidi M, Drozd, Daniel R, Haas, David, Rebeiro, Peter, Turner, Megan, Bebawy, Sally, Rogers, Ben, Justice, Amy C, Fiellin, David, Gange, Stephen J, Anastos, Kathryn, McKaig, Rosemary G, Freeman, Aimee M, Lent, Carol, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Abraham, Alison G, Lau, Bryan, Zhang, Jinbing, and Jing, Jerry
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Lung ,Sexually Transmitted Infections ,Hematology ,Lymphatic Research ,HIV/AIDS ,Infectious Diseases ,Cancer ,Lymphoma ,Rare Diseases ,Lung Cancer ,2.1 Biological and endogenous factors ,2.4 Surveillance and distribution ,Aetiology ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,CD4 Lymphocyte Count ,Female ,HIV Infections ,Humans ,Male ,Middle Aged ,Neoplasms ,North America ,Proportional Hazards Models ,Retrospective Studies ,Viral Load ,Young Adult ,HIV ,AIDS ,cancer ,mortality ,aging ,North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS ,North American AIDS Cohort Collaboration on Research and Design of the International Epidemiologic Databases to Evaluate AIDS ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundCancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts.MethodsWe evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load.ResultsThere were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts
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- 2017
48. Risk of End-Stage Liver Disease in HIV-Viral Hepatitis Coinfected Persons in North America From the Early to Modern Antiretroviral Therapy Eras
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Klein, Marina B, Althoff, Keri N, Jing, Yuezhou, Lau, Bryan, Kitahata, Mari, Re, Vincent Lo, Kirk, Gregory D, Hull, Mark, Kim, H Nina, Sebastiani, Giada, Moodie, Erica EM, Silverberg, Michael J, Sterling, Timothy R, Thorne, Jennifer E, Cescon, Angela, Napravnik, Sonia, Eron, Joe, Gill, M John, Justice, Amy, Peters, Marion G, Goedert, James J, Mayor, Angel, Thio, Chloe L, Cachay, Edward R, Moore, Richard, Research and Design of IeDEA, for the North American AIDS Cohort Collaboration on, Benson, Constance A, Bosch, Ronald J, Boswell, Stephen, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Samji, Hasina, Brooks, John T, Buchacz, Kate, Gebo, Kelly A, Moore, Richard D, Rodriguez, Benigno, Horberg, Michael A, Jacobsonc, Lisa P, D'Souza, Gypsyamber, Rourke, Sean B, Burchell, Ann N, Rachlis, Anita R, Hunter-Mellado, Robert F, Mayor, Angel M, Deeks, Steven G, Martin, Jeffrey N, Patel, Pragna, Saag, Michael S, Mugavero, Michael J, Willig, James, Eron, Joseph J, Kitahata, Mari M, Crane, Heidi M, Drozd, Daniel R, Haas, David, Bebawy, Sally, Turner, Megan, Justice, Amy C, Dubrow, Robert, Fiellin, David, Gange, Stephen J, Anastos, Kathryn, McKaig, Rosemary G, Freeman, Aimee M, Lent, Carol, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, and Abraham, Alison G
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Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Hepatitis ,Emerging Infectious Diseases ,Chronic Liver Disease and Cirrhosis ,Hepatitis - C ,Digestive Diseases ,Liver Disease ,Hepatitis - B ,Sexually Transmitted Infections ,Infectious Diseases ,HIV/AIDS ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Infection ,Good Health and Well Being ,Adult ,Aged ,Alcohol Drinking ,Anti-HIV Agents ,Canada ,Cohort Studies ,Coinfection ,End Stage Liver Disease ,Female ,HIV Infections ,Hepatitis B ,Hepatitis C ,Humans ,Incidence ,Male ,Middle Aged ,Risk Factors ,United States ,HIV ,hepatitis C virus ,hepatitis B virus ,coinfection ,end-stage liver disease ,North American AIDS Cohort Collaboration on Research and Design of IeDEA ,North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundHuman immunodeficiency virus (HIV)-infected patients coinfected with hepatitis B (HBV) and C (HCV) viruses are at increased risk of end-stage liver disease (ESLD). Whether modern antiretroviral therapy has reduced ESLD risk is unknown.MethodsTwelve clinical cohorts in the United States and Canada participating in the North American AIDS Cohort Collaboration on Research and Design validated ESLD events from 1996 to 2010. ESLD incidence rates and rate ratios according to hepatitis status adjusted for age, sex, race, cohort, time-updated CD4 cell count and HIV RNA were estimated in calendar periods corresponding to major changes in antiretroviral therapy: early (1996-2000), middle (2001-2005), and modern (2006-2010) eras.ResultsAmong 34 119 HIV-infected adults followed for 129 818 person-years, 380 incident ESLD outcomes occurred. ESLD incidence (per 1000 person-years) was highest in triply infected (11.57) followed by HBV- (8.72) and HCV- (6.10) coinfected vs 1.27 in HIV-monoinfected patients. Adjusted incidence rate ratios (95% confidence intervals) comparing the modern to the early antiretroviral era were 0.95 (.61-1.47) for HCV, 0.95 (.40-2.26) for HBV, and 1.52 (.46-5.02) for triply infected patients. Use of antiretrovirals dually activity against HBV increased over time. However, in the modern era, 35% of HBV-coinfected patients were not receiving tenofovir. There was little use of HCV therapy.ConclusionsDespite increasing use of antiretrovirals, no clear reduction in ESLD risk was observed over 15 years. Treatment with direct-acting antivirals for HCV and wider use of tenofovir-based regimens for HBV should be prioritized for coinfected patients.
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- 2016
49. Impact of behavioral and medication treatment for alcohol use disorder on changes in HIV-related outcomes among patients with HIV: A longitudinal analysis
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McGinnis, Kathleen A., Skanderson, Melissa, Edelman, E. Jennifer, Gordon, Adam J., Korthuis, P. Todd, Oldfield, Benjamin, Williams, Emily C., Wyse, Jessica, Bryant, Kendall, Fiellin, David A., Justice, Amy C., and Kraemer, Kevin L.
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- 2020
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50. Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study
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Doolittle, Benjamin R., McGinnis, Kathleen, Ransome, Yusuf, Fiellin, David, and Justice, Amy
- Published
- 2021
- Full Text
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