Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke cigarett... more Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke cigarettes. Large surveys show that 16.9%–37.3% of PLWH are never smokers compared to 57.5% of US adults. Similar proportions of PLWH and general population adults describe themselves as ex-smokers (20.3% vs 21.9% respectively). Little research has been done to characterize PLWH non-smokers. In this study, we compared a group of well characterized PLWH ex-smokers (i.e., no cigarettes for at least 5 years) to PLWH never smokers with the aim of developing a clearer understanding of the characteristics of these groups and the differences between them. Design Cross-sectional interview study employing audio computer-assisted self-interview (ACASI). Setting Comprehensive HIV care center in New York City. Participants In 2018–2019, we recruited a sample of PLWH never smokers (N = 54) and long-term ex-smokers (no cigarettes for at least 5 years, N = 36). Non-smoking status of participants was verified b...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2022
BACKGROUND Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately tri... more BACKGROUND Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately triple the rate of the general adult population and are less successful in their quit attempts than other smokers. This randomized trial tested whether a novel web-based cessation program for PWH yielded higher cigarette quit rates compared to a control program. SETTING Two urban HIV care sites in NYC and Baltimore. METHODS Between 2016 and 2020, 506 PWH were randomized to either Positively Smoke Free on the Web (PSFW+; N=255), a multimodal platform, interactive web intervention hosted within an online social network to support quitting among PWH who smoke, and an attention-matched web-based control intervention (American Heart Association Getting Healthy; AHA; N=251). All participants were offered 12 weeks of nicotine patch. Our primary outcome was biochemically-confirmed exhaled carbon monoxide (ECO)<10 parts per million (ppm) seven-day point prevalence abstinence at 6-months. RESULTS Participants were middle-aged (mean 50.2 yrs; range 23-73), 57% male, and 19% Latinx, 83% Black, 13% White. At 6-months, a significantly greater percentage of PSFW+ participants (14.9%) achieved biochemically confirmed seven-day point prevalence abstinence in intent-to-treat analysis compared to 8.8% of AHA participants (O.R. =1.82 [95% C.I. =1.04-3.18], P=.03). CONCLUSIONS PSFW+ is a promising cessation intervention composed of empirically-tested content and real-time social support through an online social network that was found to promote abstinence. This digital approach has broad reach and scalability, can be easily integrated into comprehensive HIV care, and represents an advance in the fight against tobacco use among PWH.
More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacc... more More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacco cigarettes. Among those on antiretroviral therapy, smoking decreases life expectancy more than human immunodeficiency virus (HIV) itself. Most PWH who smoke want to quit, but tobacco dependence treatment has not been widely integrated into HIV care. This article summarizes the epidemiology of tobacco use among PWH, health consequences of tobacco use and benefits of cessation in PWH, and studies of treatment for tobacco dependence among the general population and among PWH. We provide practical guidance for providers to treat tobacco dependence among PWH. A 3-step Ask-Advise-Connect framework includes asking about tobacco use routinely during clinical encounters, advising about tobacco cessation with emphasis on the benefits of cessation, and actively connecting patients to cessation treatments, including prescription of pharmacotherapy (preferably varenicline) and direct connection to ...
Summary There is an urgent need for prospective clinical trials in HIV-associated lung cancer to ... more Summary There is an urgent need for prospective clinical trials in HIV-associated lung cancer to improve understanding of lung cancer pathogenesis and to optimize patient care. Several clinical trials are in progress to address questions in cancer biology, screening, and treatment for this significant cause of mortality in persons with HIV infection.
Background. Persons with HIV (PWH) smoke cigarettes at much higher rates than the general populat... more Background. Persons with HIV (PWH) smoke cigarettes at much higher rates than the general population in the US, and smoking is now the leading cause of death in US PWH. Efforts to control the tobacco use epidemic in PWH have met with limited success, and the factors associated with successful cessation are not well delineated. There is a particular dearth of knowledge regarding PWH ex-smokers who have successfully quit smoking cigarettes for the long term. Methods. We pooled data from three separate sources of PWH smokers and ex-smokers (reporting complete abstinence for ≥ one year with biochemical verification at the time of data collection) from New York City, collected sociodemographic and behavioral information from them in structured interviews, and obtained their DNA samples. Univariate and rigorous multivariate analytic strategies were employed to determine the sociobehavioral and genetic factors that distinguished PWH smokers from ex-smokers. Results. We compared 142 current...
BACKGROUND Smoking-related illnesses are the leading cause of death among people with HIV (PWH). ... more BACKGROUND Smoking-related illnesses are the leading cause of death among people with HIV (PWH). Yet, there are few effective evidence-based interventions that help PWH quit smoking. The group-based program Positively Smoke Free is a biobehavioral cessation intervention for PWH with a growing evidence base. This study builds on prior work of Positively Smoke Free and addresses numerous weaknesses of prior trials for this population. We describe the Positively Quit Trial, a randomized controlled trial comparing a videoconferencing delivered Positively Smoke Free intervention to an attention-matched condition, assessing cessation over a 1-year period. METHODS This attention-matched, randomized (1:1) controlled trial compares Positively Smoke Free Video-Groups to an updated version of Healthy Relationship Video-Groups. Participants are PWH, aged 18 years and older, who smoke at least one cigarette per day. All are offered nicotine replacement therapy patches and given brief advice to quit. Participants are enrolled in 12 group sessions focusing on either smoking cessation for PWH or broader topics regarding living healthy with HIV; in both conditions, Social Cognitive Theory is the guiding theoretical framework. Participants complete assessments at baseline, days 42, 90, 180, and 360; self-reported abstinence is verified with a video-observed cheek swab sent to a lab and tested for cotinine. PRIMARY OUTCOMES Biochemically confirmed 7-day point prevalence smoking abstinence at day 360 is the primary outcome. Cost per quit, sustained abstinence at various timepoints, and biochemical confirmed abstinence at three and six months are secondary outcomes. Effects of smoking cessation on CD4 and virologic suppression are also explored.
Journal of Clinical and Translational Science, 2020
OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The ro... more OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The role that HIV status, by levels of immune function and viral load, has on survival from lung cancer is not fully understood. The study’s objectives were to assess 1) the association of HIV with survival in non-small cell lung cancer (NSCLC) and 2) prognostic factors in PLWH with NSCLC. METHODS/STUDY POPULATION: Participants were from a cohort of lung cancer patients diagnosed between 2004-2017 in the Bronx, NY, with vital status ascertainment at least annually. We compared survival from NSCLC diagnosis between HIV-negative patients (HIV-, N = 2881) and PLWH (N = 88), using Cox regression, accounting for clinical and sociodemographic factors including smoking status. In three separate comparisons to HIV-, PLWH were dichotomized by CD4 count (<200 vs. ≥200 cells/μL), CD4/CD8 ratio (median, <0.43 vs. ≥0.43) and HIV viral load (VL) suppression (<75 vs. ≥75 copies/mL). In PLWH only, we...
Colonization of human nasal mucosa with Staphylococcus aureus sets the stage for subsequent syste... more Colonization of human nasal mucosa with Staphylococcus aureus sets the stage for subsequent systemic infection. This study characterizes S. aureus adhesion to nasal mucosa in vitro and investigates the interaction of S. aureus with human nasal mucin. S. aureus binding to cell-associated and cell-free mucus was greater than to nonmucin-coated epithelial cells. Scanning electron microscopy of S. aureus incubated with human nasal mucosal tissue showed minimal binding to ciliated respiratory epithelium. In a solid-phase assay, S. aureus bound to purified human nasal mucin-coated wells significantly more than to bovine serum albumin-coated microtiter wells. Binding to mucin was saturable in a dose- and time-dependent fashion. Staphylococcal adherence to human nasal mucin was inhibited by bovine submaxillary mucin but not by fibrinogen. Pretreatment of mucin with periodate but not with pronase reduced adherence. Trypsin treatment of the bacteria significantly reduced adherence to mucin. 1...
Background Cigarette smoking is common among persons living with HIV (PLWH) in the United States.... more Background Cigarette smoking is common among persons living with HIV (PLWH) in the United States. It is the leading cause of mortality in this group, and efforts to promote cessation have been largely unsuccessful. Methods From 2015 to 2017, we performed a randomized controlled trial of Positively Smoke Free–Mobile (PSF-M) versus standard care. PSF-M is a mobile Web site that offers a 42-day text message-based quit-smoking program with smartphone features including quit-day selection/calendar, educational/motivational videos, and HELP button for cravings. Results One hundred individuals enrolled, 48 were randomized to PSF-M (mean age = 45 years, 54% male, 81% black, 31% Latino) and 52 to the standard care condition. All participants were offered a 3-month supply of nicotine patches. Participants randomized to the mobile intervention visited the PSF-M home page a mean of 83 times, viewed 5.6/8 videos, logged in on 13 of 42 possible days, and received 131 texts. Among them, 77% tapped...
Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to h... more Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to health care providers, and hundreds of millions of minutes ridesharing (e.g., with Uber or Lyft). From July to October 2017, we recruited rideshare users (e.g., Uber or Lyft) to participate in a survey about health messaging during rides. Responses were collected anonymously on tablet devices. We interviewed 170 ridesharers and assessed their interest in health messaging delivered during rides. Participants ranged from 19 to 79 years of age, and most (87%) reported using their smartphones to search for health information. More than 70% expressed interest in health messaging during rides, and 55% of current smokers expressed interest in quit-smoking messaging. The most popular of suggested health topics included healthy eating (61.8%), exercise (60.6%), and weight loss (40.0%), and the preferred message formats were video (33.5%), smartphone apps (33.5%), and online social network (25.3%)....
Journal of acquired immune deficiency syndromes (1999), Jan 6, 2018
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally.... more Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. Both cigarette smoking and HIV have been identified as independent risk factors for COPD. We used data from the Strategic Timing of Antiretroviral Treatment (START) Pulmonary Substudy to quantify the impact of smoking on rate of lung function decline in HIV. We included START Pulmonary Substudy participants who contributed at least two good quality spirometry measures during the study. Slope of forced expiratory volume in 1 second (FEV1) was estimated using a repeated measures model adjusted for treatment group (immediate vs. deferred treatment arm of START), age, sex, race, baseline COPD, and region. Of 1,026 START Pulmonary Substudy participants, 915 (89%) were included in this analysis. Median follow up time was 3.9 years. Smokers and non-smokers were similar in baseline age (median 36 y), but smokers were more likely to be white, male, and from Europe/Israel/Australia. Smokers had f...
Journal of the International Association of Providers of AIDS Care
Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World H... more Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World Health Organization guidelines for HIV-naive patients, has been limited in resource-constrained settings. The aim of this study was to evaluate the effectiveness of zidovudine-(ZDV) versus TDF-based HAART in the Yi minority region of Sichuan Province, China at a single HIV treatment center. The primary end point was the attainment of an HIV viral load <50 copies/mL. Secondary end points included change in CD4 level, adverse reactions, mortality, and sustained virologic suppression. Of the 361 total participants, recipients of TDF-based HAART were more likely to achieve viral load <50 copies/mL (60% versus 46%, odds ratio [OR] = 1.7, P = .016) as well as sustained virologic suppression (61% versus 28%, OR = 3.4, P = .001). Tenofovir (adjusted odds ratio [ORadj] = 1.71, P = .025) and female sex (ORadj = 1.93, P = .003) were identified as independent predictors of achieving HIV viral l...
Left ventricular assist devices (LVADs) have been successfully used in patients with heart failur... more Left ventricular assist devices (LVADs) have been successfully used in patients with heart failure. However, LVADs may trigger immune activation, leading to higher frequencies of autoantibodies. We describe the clinical, epidemiological, and laboratory characteristics of LVAD recipients with false positive hepatitis C (FPHC) serology among 39 consecutive adult LVAD recipients who bridged to heart transplantation from January 2007 to January 2013 at Montefiore Medical Center. FPHC patients were identified as those with post-LVAD positive hepatitis C ELISA antibody tests and negative confirmatory testing with hepatitis C RNA PCR and/or radioimmunoblot assay. Ten (26%) patients previously seronegative for hepatitis C were found to have FPHC after device placement. Of the 39 patients, 32 had HeartMate II devices. The mean age at LVAD placement was 55 years. FPHC correlated with older age at the time of LVAD implantation and with receipt of packed red blood cell transfusions, but not wit...
Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke cigarett... more Background and Aims Approximately half of persons living with HIV (PLWH) in the US smoke cigarettes. Large surveys show that 16.9%–37.3% of PLWH are never smokers compared to 57.5% of US adults. Similar proportions of PLWH and general population adults describe themselves as ex-smokers (20.3% vs 21.9% respectively). Little research has been done to characterize PLWH non-smokers. In this study, we compared a group of well characterized PLWH ex-smokers (i.e., no cigarettes for at least 5 years) to PLWH never smokers with the aim of developing a clearer understanding of the characteristics of these groups and the differences between them. Design Cross-sectional interview study employing audio computer-assisted self-interview (ACASI). Setting Comprehensive HIV care center in New York City. Participants In 2018–2019, we recruited a sample of PLWH never smokers (N = 54) and long-term ex-smokers (no cigarettes for at least 5 years, N = 36). Non-smoking status of participants was verified b...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2022
BACKGROUND Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately tri... more BACKGROUND Persons with HIV (PWH) in the United States (US) smoke cigarettes at approximately triple the rate of the general adult population and are less successful in their quit attempts than other smokers. This randomized trial tested whether a novel web-based cessation program for PWH yielded higher cigarette quit rates compared to a control program. SETTING Two urban HIV care sites in NYC and Baltimore. METHODS Between 2016 and 2020, 506 PWH were randomized to either Positively Smoke Free on the Web (PSFW+; N=255), a multimodal platform, interactive web intervention hosted within an online social network to support quitting among PWH who smoke, and an attention-matched web-based control intervention (American Heart Association Getting Healthy; AHA; N=251). All participants were offered 12 weeks of nicotine patch. Our primary outcome was biochemically-confirmed exhaled carbon monoxide (ECO)<10 parts per million (ppm) seven-day point prevalence abstinence at 6-months. RESULTS Participants were middle-aged (mean 50.2 yrs; range 23-73), 57% male, and 19% Latinx, 83% Black, 13% White. At 6-months, a significantly greater percentage of PSFW+ participants (14.9%) achieved biochemically confirmed seven-day point prevalence abstinence in intent-to-treat analysis compared to 8.8% of AHA participants (O.R. =1.82 [95% C.I. =1.04-3.18], P=.03). CONCLUSIONS PSFW+ is a promising cessation intervention composed of empirically-tested content and real-time social support through an online social network that was found to promote abstinence. This digital approach has broad reach and scalability, can be easily integrated into comprehensive HIV care, and represents an advance in the fight against tobacco use among PWH.
More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacc... more More than 40% of people with human immunodeficiency virus (PWH) in the United States smoke tobacco cigarettes. Among those on antiretroviral therapy, smoking decreases life expectancy more than human immunodeficiency virus (HIV) itself. Most PWH who smoke want to quit, but tobacco dependence treatment has not been widely integrated into HIV care. This article summarizes the epidemiology of tobacco use among PWH, health consequences of tobacco use and benefits of cessation in PWH, and studies of treatment for tobacco dependence among the general population and among PWH. We provide practical guidance for providers to treat tobacco dependence among PWH. A 3-step Ask-Advise-Connect framework includes asking about tobacco use routinely during clinical encounters, advising about tobacco cessation with emphasis on the benefits of cessation, and actively connecting patients to cessation treatments, including prescription of pharmacotherapy (preferably varenicline) and direct connection to ...
Summary There is an urgent need for prospective clinical trials in HIV-associated lung cancer to ... more Summary There is an urgent need for prospective clinical trials in HIV-associated lung cancer to improve understanding of lung cancer pathogenesis and to optimize patient care. Several clinical trials are in progress to address questions in cancer biology, screening, and treatment for this significant cause of mortality in persons with HIV infection.
Background. Persons with HIV (PWH) smoke cigarettes at much higher rates than the general populat... more Background. Persons with HIV (PWH) smoke cigarettes at much higher rates than the general population in the US, and smoking is now the leading cause of death in US PWH. Efforts to control the tobacco use epidemic in PWH have met with limited success, and the factors associated with successful cessation are not well delineated. There is a particular dearth of knowledge regarding PWH ex-smokers who have successfully quit smoking cigarettes for the long term. Methods. We pooled data from three separate sources of PWH smokers and ex-smokers (reporting complete abstinence for ≥ one year with biochemical verification at the time of data collection) from New York City, collected sociodemographic and behavioral information from them in structured interviews, and obtained their DNA samples. Univariate and rigorous multivariate analytic strategies were employed to determine the sociobehavioral and genetic factors that distinguished PWH smokers from ex-smokers. Results. We compared 142 current...
BACKGROUND Smoking-related illnesses are the leading cause of death among people with HIV (PWH). ... more BACKGROUND Smoking-related illnesses are the leading cause of death among people with HIV (PWH). Yet, there are few effective evidence-based interventions that help PWH quit smoking. The group-based program Positively Smoke Free is a biobehavioral cessation intervention for PWH with a growing evidence base. This study builds on prior work of Positively Smoke Free and addresses numerous weaknesses of prior trials for this population. We describe the Positively Quit Trial, a randomized controlled trial comparing a videoconferencing delivered Positively Smoke Free intervention to an attention-matched condition, assessing cessation over a 1-year period. METHODS This attention-matched, randomized (1:1) controlled trial compares Positively Smoke Free Video-Groups to an updated version of Healthy Relationship Video-Groups. Participants are PWH, aged 18 years and older, who smoke at least one cigarette per day. All are offered nicotine replacement therapy patches and given brief advice to quit. Participants are enrolled in 12 group sessions focusing on either smoking cessation for PWH or broader topics regarding living healthy with HIV; in both conditions, Social Cognitive Theory is the guiding theoretical framework. Participants complete assessments at baseline, days 42, 90, 180, and 360; self-reported abstinence is verified with a video-observed cheek swab sent to a lab and tested for cotinine. PRIMARY OUTCOMES Biochemically confirmed 7-day point prevalence smoking abstinence at day 360 is the primary outcome. Cost per quit, sustained abstinence at various timepoints, and biochemical confirmed abstinence at three and six months are secondary outcomes. Effects of smoking cessation on CD4 and virologic suppression are also explored.
Journal of Clinical and Translational Science, 2020
OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The ro... more OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The role that HIV status, by levels of immune function and viral load, has on survival from lung cancer is not fully understood. The study’s objectives were to assess 1) the association of HIV with survival in non-small cell lung cancer (NSCLC) and 2) prognostic factors in PLWH with NSCLC. METHODS/STUDY POPULATION: Participants were from a cohort of lung cancer patients diagnosed between 2004-2017 in the Bronx, NY, with vital status ascertainment at least annually. We compared survival from NSCLC diagnosis between HIV-negative patients (HIV-, N = 2881) and PLWH (N = 88), using Cox regression, accounting for clinical and sociodemographic factors including smoking status. In three separate comparisons to HIV-, PLWH were dichotomized by CD4 count (<200 vs. ≥200 cells/μL), CD4/CD8 ratio (median, <0.43 vs. ≥0.43) and HIV viral load (VL) suppression (<75 vs. ≥75 copies/mL). In PLWH only, we...
Colonization of human nasal mucosa with Staphylococcus aureus sets the stage for subsequent syste... more Colonization of human nasal mucosa with Staphylococcus aureus sets the stage for subsequent systemic infection. This study characterizes S. aureus adhesion to nasal mucosa in vitro and investigates the interaction of S. aureus with human nasal mucin. S. aureus binding to cell-associated and cell-free mucus was greater than to nonmucin-coated epithelial cells. Scanning electron microscopy of S. aureus incubated with human nasal mucosal tissue showed minimal binding to ciliated respiratory epithelium. In a solid-phase assay, S. aureus bound to purified human nasal mucin-coated wells significantly more than to bovine serum albumin-coated microtiter wells. Binding to mucin was saturable in a dose- and time-dependent fashion. Staphylococcal adherence to human nasal mucin was inhibited by bovine submaxillary mucin but not by fibrinogen. Pretreatment of mucin with periodate but not with pronase reduced adherence. Trypsin treatment of the bacteria significantly reduced adherence to mucin. 1...
Background Cigarette smoking is common among persons living with HIV (PLWH) in the United States.... more Background Cigarette smoking is common among persons living with HIV (PLWH) in the United States. It is the leading cause of mortality in this group, and efforts to promote cessation have been largely unsuccessful. Methods From 2015 to 2017, we performed a randomized controlled trial of Positively Smoke Free–Mobile (PSF-M) versus standard care. PSF-M is a mobile Web site that offers a 42-day text message-based quit-smoking program with smartphone features including quit-day selection/calendar, educational/motivational videos, and HELP button for cravings. Results One hundred individuals enrolled, 48 were randomized to PSF-M (mean age = 45 years, 54% male, 81% black, 31% Latino) and 52 to the standard care condition. All participants were offered a 3-month supply of nicotine patches. Participants randomized to the mobile intervention visited the PSF-M home page a mean of 83 times, viewed 5.6/8 videos, logged in on 13 of 42 possible days, and received 131 texts. Among them, 77% tapped...
Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to h... more Americans spend trillions of minutes in cars annually, tens of billions of minutes traveling to health care providers, and hundreds of millions of minutes ridesharing (e.g., with Uber or Lyft). From July to October 2017, we recruited rideshare users (e.g., Uber or Lyft) to participate in a survey about health messaging during rides. Responses were collected anonymously on tablet devices. We interviewed 170 ridesharers and assessed their interest in health messaging delivered during rides. Participants ranged from 19 to 79 years of age, and most (87%) reported using their smartphones to search for health information. More than 70% expressed interest in health messaging during rides, and 55% of current smokers expressed interest in quit-smoking messaging. The most popular of suggested health topics included healthy eating (61.8%), exercise (60.6%), and weight loss (40.0%), and the preferred message formats were video (33.5%), smartphone apps (33.5%), and online social network (25.3%)....
Journal of acquired immune deficiency syndromes (1999), Jan 6, 2018
Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally.... more Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability globally. Both cigarette smoking and HIV have been identified as independent risk factors for COPD. We used data from the Strategic Timing of Antiretroviral Treatment (START) Pulmonary Substudy to quantify the impact of smoking on rate of lung function decline in HIV. We included START Pulmonary Substudy participants who contributed at least two good quality spirometry measures during the study. Slope of forced expiratory volume in 1 second (FEV1) was estimated using a repeated measures model adjusted for treatment group (immediate vs. deferred treatment arm of START), age, sex, race, baseline COPD, and region. Of 1,026 START Pulmonary Substudy participants, 915 (89%) were included in this analysis. Median follow up time was 3.9 years. Smokers and non-smokers were similar in baseline age (median 36 y), but smokers were more likely to be white, male, and from Europe/Israel/Australia. Smokers had f...
Journal of the International Association of Providers of AIDS Care
Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World H... more Tenofovir (TDF)-based highly active antiretroviral therapy (HAART), as recommended by the World Health Organization guidelines for HIV-naive patients, has been limited in resource-constrained settings. The aim of this study was to evaluate the effectiveness of zidovudine-(ZDV) versus TDF-based HAART in the Yi minority region of Sichuan Province, China at a single HIV treatment center. The primary end point was the attainment of an HIV viral load <50 copies/mL. Secondary end points included change in CD4 level, adverse reactions, mortality, and sustained virologic suppression. Of the 361 total participants, recipients of TDF-based HAART were more likely to achieve viral load <50 copies/mL (60% versus 46%, odds ratio [OR] = 1.7, P = .016) as well as sustained virologic suppression (61% versus 28%, OR = 3.4, P = .001). Tenofovir (adjusted odds ratio [ORadj] = 1.71, P = .025) and female sex (ORadj = 1.93, P = .003) were identified as independent predictors of achieving HIV viral l...
Left ventricular assist devices (LVADs) have been successfully used in patients with heart failur... more Left ventricular assist devices (LVADs) have been successfully used in patients with heart failure. However, LVADs may trigger immune activation, leading to higher frequencies of autoantibodies. We describe the clinical, epidemiological, and laboratory characteristics of LVAD recipients with false positive hepatitis C (FPHC) serology among 39 consecutive adult LVAD recipients who bridged to heart transplantation from January 2007 to January 2013 at Montefiore Medical Center. FPHC patients were identified as those with post-LVAD positive hepatitis C ELISA antibody tests and negative confirmatory testing with hepatitis C RNA PCR and/or radioimmunoblot assay. Ten (26%) patients previously seronegative for hepatitis C were found to have FPHC after device placement. Of the 39 patients, 32 had HeartMate II devices. The mean age at LVAD placement was 55 years. FPHC correlated with older age at the time of LVAD implantation and with receipt of packed red blood cell transfusions, but not wit...
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Papers by Jonathan Shuter