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Research Interests: Pulmonology, Medicine, Critical Care, Humans, COPD, and 15 moreNursing Homes, Female, Male, Cohort, Medicare, Clinical Sciences, Aged, Mechanical Ventilation, Retrospective Studies, Intensive Care Medicine, Disease Progression, Hospital Mortality, Exacerbation, Patient readmission, and Respiration Artificial
BackgroundDexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone... more
BackgroundDexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.MethodsWe included patients admitted to US Veterans Affairs hospitals between 7 June 2020 and 31 May 2021 within 14 days after a positive test for severe acute respiratory syndrome coronavirus 2. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weighting (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.ResultsOf 19 973 total patients (95% men, median age 71 years, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514 out of 9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472 out of 5954 (75%)...
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Objectives: To determine whether early oral or parenteral corticosteroids compared to no corticosteroids are associated with decreased mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who are not on intensive... more
Objectives: To determine whether early oral or parenteral corticosteroids compared to no corticosteroids are associated with decreased mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who are not on intensive respiratory support (IRS) within 48 hours of admission. Design: Observational cohort study Setting: Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated US national healthcare system Participants: 9,058 patients admitted to a Veterans Affairs Medical Center between June 7, 2020-December 5, 2020 within 14-days after SARS-CoV-2 positive test; exclusion criteria include less than a 48 hour stay, receipt of prior systemic corticosteroids, and no indication of acute medical care for COVID-19. Main outcome measure: 90-day all-cause mortality Results: Of 9,058 total patients (95% men, median age 71 years, 27% black), 6,825 (75%) were not on IRS within 48 hours. Among the 3,025 patients on no oxygen, 598 (20%)...
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Background We ascertained incidence of opportunistic infections (OIs) in people with human immunodeficiency virus (PWH) with cancer undergoing chemotherapy with non-human immunodeficiency virus (HIV) comparators. Methods We identified... more
Background We ascertained incidence of opportunistic infections (OIs) in people with human immunodeficiency virus (PWH) with cancer undergoing chemotherapy with non-human immunodeficiency virus (HIV) comparators. Methods We identified 2106 PWH and 2981 uninfected Veterans with cancer who received at least 1 dose of chemotherapy between 1996 and 2017 from the Veterans Aging Cohort Study. We ascertained incident OIs within 6 months of chemotherapy amongst zoster, cytomegalovirus, tuberculosis, Candida esophagitis, Pneumocystis jirovecii pneumonia (PCP), toxoplasmosis, Cryptococcosis, atypical Mycobacterium infection, Salmonella bacteremia, histoplasmosis, coccidioidomycosis, or progressive multifocal leukoencephalopathy. We used Poisson methods to calculate OI incidence rates by HIV status, stratifying for hematological and nonhematological tumors. We compared OI rates by HIV status, using inverse probability weights of HIV status, further adjusting for PCP prophylaxis. Results We con...
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Background Hospitalization with community‐acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a... more
Background Hospitalization with community‐acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a higher risk of CVD or mortality than individuals uninfected with HIV following hospitalization with CAP. Methods and Results We analyzed data from the Veterans Aging Cohort Study on US veterans admitted with their first episode of CAP from April 2003 through December 2014. We used Cox regression analyses to determine whether HIV status was associated with incident CVD events and mortality from date of admission through 30 days after discharge (30‐day mortality), adjusting for known CVD risk factors. We included 4384 patients (67% [n=2951] PLWH). PLWH admitted with CAP were younger, had less severe CAP, and had fewer CVD risk factors than patients with CAP who were uninfected with HIV. In multivariable‐adjusted analyses, CVD risk was similar in PLWH comp...
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ImportanceSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (Covid-19), an evolving pandemic. Limited data are available characterizing SARS-Cov-2 infection in the United... more
ImportanceSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (Covid-19), an evolving pandemic. Limited data are available characterizing SARS-Cov-2 infection in the United States.ObjectiveTo determine associations between demographic and clinical factors and testing positive for coronavirus 2019 (Covid-19+), and among Covid-19+ subsequent hospitalization and intensive care.Design, Setting, and ParticipantsRetrospective cohort study including all patients tested for Covid-19 between February 8 and March 30, 2020, inclusive. We extracted electronic health record data from the national Veterans Affairs Healthcare System, the largest integrated healthcare system in the United States, on 2,026,227 patients born between 1945 and 1965 and active in care.ExposuresDemographic data, comorbidities, medication history, substance use, vital signs, and laboratory measures. Laboratory tests were analyzed first individually and then grouped into a...
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Research Interests: Medicine and Lung Cancer
Research Interests: Medicine and Lung Cancer
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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... 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...
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As life expectancy of people living with HIV (PLWH) improves in low-income and middle-income countries (LMICs), the spectrum of HIV-related pulmonary complications may reflect a greater burden of chronic lung diseases as in high-income... more
As life expectancy of people living with HIV (PLWH) improves in low-income and middle-income countries (LMICs), the spectrum of HIV-related pulmonary complications may reflect a greater burden of chronic lung diseases as in high-income countries. We determined whether the risk of abnormal spirometry was greater among adolescent compared with adult PLWH at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, and evaluated the role of other cofactors for abnormal spirometry. We prospectively enrolled adolescent and adult PLWH for this cross-sectional study. Data collection included standardized questionnaires, clinical assessment, and prebronchodilator and postbronchodilator spirometry. Adolescents additionally underwent noncontrast chest computed tomography. Multivariable logistic regression determined associations of adolescent age with abnormal spirometry, adjusting for cofactors. Of 427 PLWH, 21 (40%) adolescents and 64 (17%) adults had abnormal spirometry. Among adol...
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No prior studies have addressed the performance of electronic health record (EHR) data to diagnose chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWH), in whom COPD could be more likely to be underdiagnosed or... more
No prior studies have addressed the performance of electronic health record (EHR) data to diagnose chronic obstructive pulmonary disease (COPD) in people living with HIV (PLWH), in whom COPD could be more likely to be underdiagnosed or misdiagnosed, given the higher frequency of respiratory symptoms and smoking compared with HIV-uninfected (uninfected) persons. We determined whether EHR data could improve accuracy of ICD-9 codes to define COPD when compared with spirometry in PLWH vs uninfected, and quantified level of discrimination using the area under the receiver-operating curve (AUC). The development cohort consisted of 350 participants who completed research spirometry in the Examinations of HIV Associated Lung Emphysema (EXHALE) study, a pulmonary substudy of the Veterans Aging Cohort Study. Results were externally validated in 294 PLWH who performed spirometry for clinical indications from the University of Washington (UW) site of the Centers for AIDS Research Network of Int...
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Pneumonia is a complex pulmonary disease in need of new clinical approaches. While triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune... more
Pneumonia is a complex pulmonary disease in need of new clinical approaches. While triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as ARDS and to organ dysfunction beyond the lungs and overextended time-frames after pathogen clearance, some of which increase the risk for subsequent pneumonias. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extra-pulmonary complications from pneumonia. The NHLBI assembled a Working Group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decl...
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With combination-antiretroviral therapy, HIV-infected individuals live longer with an elevated burden of cancer. Given the high prevalence of smoking among HIV-infected populations, we examined the risk of incident cancers attributable to... more
With combination-antiretroviral therapy, HIV-infected individuals live longer with an elevated burden of cancer. Given the high prevalence of smoking among HIV-infected populations, we examined the risk of incident cancers attributable to ever smoking cigarettes. Observational cohort of HIV-infected participants with 270 136 person-years of follow-up in the North American AIDS Cohort Collaboration on Research and Design consortium. Among 52 441 participants, 2306 were diagnosed with cancer during 2000-2015. Estimated hazard ratios and population-attributable fractions (PAF) associated with ever cigarette smoking for all cancers combined, smoking-related cancers, and cancers that were not attributed to smoking. People with cancer were more frequently ever smokers (79%) compared with people without cancer (73%). Adjusting for demographic and clinical factors, cigarette smoking was associated with increased risk of cancer overall [hazard ratios = 1.33 (95% confidence interval: 1.18-1.4...
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Emphysema is one of the most common lung diseases in HIV+ individuals. The pathogenesis of HIV-associated emphysema remains unclear; however, radiographic distribution and earlier age of presentation of emphysema in the lungs of HIV+... more
Emphysema is one of the most common lung diseases in HIV+ individuals. The pathogenesis of HIV-associated emphysema remains unclear; however, radiographic distribution and earlier age of presentation of emphysema in the lungs of HIV+ patients are similar to deficiency of alpha-1 antitrypsin (A1AT), a key elastase inhibitor in the lung. Reduced levels of circulating A1AT have been detected in HIV+ patients, suggesting a potential mechanism for emphysema development. In the present study, we asked if A1AT levels and activity in the bronchoalveolar lavage fluid (BALF) differ in patients with and without HIV and emphysema. A1AT levels were measured by ELISA in plasma and BALF from a cohort of 21 HIV+ and 29 HIV- patients with or without emphysematous changes on chest CT scan. To analyze A1AT function, we measured elastase activity in the BALF and assessed oxidation and polymerization of A1AT by western blotting. Total A1AT was increased in the BALF but not in the plasma of HIV+ compared...
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Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision ( ICD-9) code, V66.7, can identify palliative care services. However, code validity for... more
Patients with heart failure (HF) are at increased risk of unmet palliative care needs. The International Classification of Diseases, Ninth Revision ( ICD-9) code, V66.7, can identify palliative care services. However, code validity for specialist palliative care in the Veterans Health Administration (VHA) has not been determined. To validate the ICD-9 code for specialist palliative care and determine common reasons for specialist palliative care consultation among VHA patients hospitalized with HF. Electronic health record review of data from the Veterans Aging Cohort Study. The sample included 100 patients hospitalized with HF from 2003 to 2012. Data from 50 patients with V66.7 were matched by age, race, site of care, hospital length of stay, intensive care unit admission, and fiscal year of study discharge to 50 patients with HF without V66.7 who had died within a year of hospitalization. We calculated positive and negative predictive values (PPV, NPV), sensitivity, and specificit...
Research Interests: Nursing, Emergency Medicine, Gerontology, Palliative Care, Electronic Health Records, and 15 moreMedicine, Heart Failure, Humans, Hospice, Hospitalization, United States, Female, Male, Aged, Middle Aged, International Classification of Diseases, Adult, Veterans Health, Confidence Interval, and Severity of Illness Index
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HIV infection is associated with impaired lung gas transfer as indicated by a low diffusing capacity (DLCO), but the mechanisms are not well understood. We hypothesized that HIV-associated gas exchange impairment is indicative of... more
HIV infection is associated with impaired lung gas transfer as indicated by a low diffusing capacity (DLCO), but the mechanisms are not well understood. We hypothesized that HIV-associated gas exchange impairment is indicative of system-wide perturbations that could be reflected by alterations in peripheral blood leukocyte (PBL) gene expression. Forty HIV-infected (HIV(+)) and uninfected (HIV(-)) men with preserved versus low DLCO were enrolled. All subjects were current smokers and those with acute illness, lung diseases other than COPD or asthma were excluded. Total RNA was extracted from PBLs and hybridized to whole-genome microarrays. Gene set enrichment analysis (GSEA) was performed between HIV(+) versus HIV(-) subjects with preserved DLCO and those with low DLCO to identify differentially activated pathways. Using pathway-based analyses, we found that in subjects with preserved DLCO, HIV infection is associated with activation of processes involved in immunity, cell cycle, and...
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The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood... more
The prevalence of emphysema is higher among HIV-infected (HIV+) individuals compared to HIV-uninfected persons. While greater tobacco use contributes, HIV-related effects on immunity likely confer additional risk. Low peripheral blood CD4+ to CD8+ T-lymphocyte (CD4/CD8) ratio may reflect chronic inflammation in HIV and may be a marker of chronic lung disease in this population. Therefore, we sought to determine whether the CD4/CD8 ratio was associated with chronic obstructive pulmonary disease (COPD), particularly the emphysema subtype, in a cohort of HIV+ subjects. We performed a cross-sectional analysis of 190 HIV+ subjects enrolled in the Examinations of HIV Associated Lung Emphysema (EXHALE) study. Subjects underwent baseline laboratory assessments, pulmonary function testing and chest computed tomography (CT) analyzed for emphysema severity and distribution. We determined the association between CD4/CD8 ratio and emphysema, and the association between CD4/CD8 ratio and pulmonar...
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HIV infection is independently associated with risk of lung cancer, but few data exist for the relation between longitudinal measurements of immune function and lung-cancer risk in people living with HIV. We followed up participants with... more
HIV infection is independently associated with risk of lung cancer, but few data exist for the relation between longitudinal measurements of immune function and lung-cancer risk in people living with HIV. We followed up participants with HIV from the Veterans Aging Cohort Study for a minimum of 3 years between Jan 1, 1998, and Dec 31, 2012, and used cancer registry data to identify incident cases of lung cancer. The index date for each patient was the later of the date HIV care began or Jan 1, 1998. We excluded patients with less than 3 years' follow-up, prevalent diagnoses of lung cancer, or incomplete laboratory data. We used Cox regression models to investigate the relation between different time-updated lagged and cumulative exposures (CD4 cell count, CD8 cell count, CD4/CD8 ratio, HIV RNA, and bacterial pneumonia) and risk of lung cancer. Models were adjusted for age, race or ethnicity, smoking, hepatitis C virus infection, alcohol use disorders, drug use disorders, and his...
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Author(s): Rodriguez-Barradas, Maria C; Akgun, Kathleen; Brown, Sheldon; Butt, Adeel; Fine, Michael J; Goetz, Matthew Bidwell; Graber, Christopher; Huang, Laurence; Mcginnis, Kathleen; Rimland, David; Justice, Amy C; Crothers, Kristina
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Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for... more
Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya. We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99 percentile of age-appropriate respiratory rates. Logistic regression models adjusted for demographics and HIV severity estimated odds ratios (ORs) for risk of hypoxia and tachypnea associated with potential risk factors. Overall, 11% of adolescents had hypoxia and 55% had tachypnea. Advanced HIV (adjusted OR [aOR] 2.41) and low CD4 (aOR 1.74) were associated with ...
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The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between... more
The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown. To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs. This longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts ...
Research Interests: Hematology, Cardiovascular, Electrocardiography, HIV, Clinical research, and 15 moreCholesterol, Female, Diagnosis, Cocaine, Homo Sapiens, Hiv Infection, Heart Disease, Human immunodeficiency virus, Cells, Coronary Angiography, Adult, Bacteremia, Biological markers, HIV infections, and Coronary Artery Bypass
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Research Interests: Pediatrics, Adolescent, Medicine, Linear models, Multivariate Analysis, and 15 moreProspective studies, Humans, Female, Male, Lung, Aged, Middle Aged, Adult, Quinolines, Azithromycin, Bronchiolitis Obliterans, Hematopoietic Stem Cell Transplantation, Postoperative Complications, Pulmonary function testing, and Fluticasone
Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty (adapted frailty-related phenotype (aFRP)) and... more
Chronic obstructive pulmonary disease (COPD) prevalence is increasing among aging HIV-infected individuals. We determined the association between COPD and self-reported measures of frailty (adapted frailty-related phenotype (aFRP)) and physical limitation (PL), and a clinical biomarker of physiologic frailty (VACS Index) in HIV-infected compared with uninfected individuals. Cross-sectional study of Veterans Aging Cohort Study (VACS) participants between 2002-2012. Pre-frail/aFRP was obtained from self-reported surveys. Pre-frail was defined as 1-2 domains of physical shrinking, exhaustion, slowness and low physical activity; aFRP was defined as ≥3 domains. PL scale was determined from 12 self-reported survey items assessing limitations performing physical activities. VACS Index includes age and laboratory measurements. We used regression models to test for associations between COPD and outcomes in models stratified by HIV status. The sample included 3538 HIV-infected and 3606 uninfe...
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Utilizing the Veterans Aging Cohort Study, the largest HIV cohort in North America, we conducted one of the few comprehensive comparisons of cancer incidence time trends in HIV-infected (HIV+) versus uninfected persons during the... more
Utilizing the Veterans Aging Cohort Study, the largest HIV cohort in North America, we conducted one of the few comprehensive comparisons of cancer incidence time trends in HIV-infected (HIV+) versus uninfected persons during the antiretroviral therapy (ART) era. Prospective cohort study. We followed 44,787 HIV+ and 96,852 demographically-matched uninfected persons during 1997-2012. We calculated age-, sex-, and race/ethnicity-standardized incidence rates (IR) and incidence rate ratios (IRR, HIV+ versus uninfected) over four calendar periods with IR and IRR period trend p-values for cancer groupings and specific cancer types. We observed 3,714 incident cancer diagnoses in HIV+ and 5,760 in uninfected persons. The HIV+ all cancer crude IR increased between 1997-2000 and 2009-2012 (p-trend = 0.0019). However, after standardization, we observed highly significant HIV+ IR declines for all cancer (25% decline; p-trend<0.0001), AIDS-defining cancers (ADC; 55% decline; p-trend<0.0001...
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Previous work found the lung microbiome in healthy HIV-infected subjects was similar to uninfected subjects. We hypothesized lung microbiome from HIV-infected subjects with more advanced disease would differ from an uninfected control... more
Previous work found the lung microbiome in healthy HIV-infected subjects was similar to uninfected subjects. We hypothesized lung microbiome from HIV-infected subjects with more advanced disease would differ from an uninfected control population. To measure the lung microbiome in an HIV-infected population with advanced disease. 16s RNA gene sequencing was performed on acellular bronchoalveolar lavage (BAL) fluid from 30 HIV-infected subjects with advanced disease (baseline mean CD4 count 262 cells/mm3) before and up to three years after starting highly active antiretroviral therapy (HAART) and compared to 22 uninfected controls. The lung microbiome HIV-infected subjects with advanced disease demonstrated decreased alpha diversity (richness and diversity) and greater beta diversity compared to uninfected BAL. Differences improved with HAART, but still persisted up to three years after starting therapy. Population dispersion in the HIV-infected group was significantly greater than in...
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Research Interests: Medicine, Biological Sciences, Humans, COPD, Internal Medicine, and 15 moreAlcoholism, Female, Male, AIDS, Incidence, Middle Aged, Longitudinal Studies, Adult, Chronic obstructive pulmonary disease, Disease Progression, Psychology and Cognitive Sciences, Exacerbation, Medical and Health Sciences, HIV infections, and Pulmonary Disease Chronic Obstructive
Research Interests: Epidemiology, Immunology, Biostatistics, Life Sciences, Medicine, and 15 moreProspective studies, Humans, Female, Male, Lung, Middle Aged, Microbiome, Adult, Mouth, Highly Active Antiretroviral Therapy, Microbiota, Medicine and Health Sciences, Cohort Studies, Medical and Health Sciences, and HIV infections
Background: Although community–acquired pneumonia (CAP) is a leading cause of death in HIV-uninfected older adults, health outcomes among HIV-infected older adults are not well defined. Methods: Associations between HIV infection and... more
Background: Although community–acquired pneumonia (CAP) is a leading cause of death in HIV-uninfected older adults, health outcomes among HIV-infected older adults are not well defined. Methods: Associations between HIV infection and three health outcomes (30-day mortality, hospital readmission within 30 days post-discharge, and hospital length of stay [LOS]) were examined using data from the Veterans Aging Cohort Study Virtual Cohort of male Veterans age ≥50 hospitalized for CAP from 10/1/2002 to 08/31/2010. The association between age and HIV status (using CD4 cell count, viral load, or use of antiretroviral therapy [ART]) and 30-day mortality was assessed with Cox regression. Hospital readmission within 30 days post-discharge was analyzed by logistic regression and LOS by linear regression. All models adjusted for race, smoking status, pulmonary co-morbidity, alcohol and substance abuse. Results: Among the cohort of 117,557 Veterans (80,635 HIV-uninfected and 36,922 HIV-infected ...
Background: HIV infected subjects (HIV+) have a high incidence of pneumococcal disease and vaccination is recommended, but its effectiveness is not established. We evaluated the effect of PV on hospitalization rates for non-PCP pneumonia... more
Background: HIV infected subjects (HIV+) have a high incidence of pneumococcal disease and vaccination is recommended, but its effectiveness is not established. We evaluated the effect of PV on hospitalization rates for non-PCP pneumonia among HIV+ compared to uninfected patients (HIV-) enrolled in the Veterans Aging Cohort 5-site Study. Methods: 700 HIV- and 969 HIV+ participated. Index date was PV date (within 3 y pre- or 2 y post-enrollment) for vaccinated subjects (PV+) and enrollment date for unvaccinated subjects (PV-). The primary outcome was an event of hospitalization for non-PCP pneumonia (Pn). Using survival analysis we determined the hazard ratio (HR) for pneumonia, controlling for age, ethnicity, tobacco use, alcohol disorders, drug use, COPD, prior pneumonia, and among HIV+, CD4 and viral load. Results: HIV- HIV+ PV- PV+ PV- PV+ N (%) 373 (53) 327 (47) 294 (30) 675 (70) Median age 53 y 57 y 49 y 50 y Pn events [n (%)] 5 (1.3) 8 (2.4) 35 (12.0) 56 (8.0) <6 m 1 (0.3) ...
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PURPOSE/AIM Illustrate HIV-related thoracic diseases in the modern era of HAART with radiographic and CT images Elucidate disease pathophysiology with pathologic and clinical correlations CONTENT ORGANIZATION 1. Introduction – Recent... more
PURPOSE/AIM Illustrate HIV-related thoracic diseases in the modern era of HAART with radiographic and CT images Elucidate disease pathophysiology with pathologic and clinical correlations CONTENT ORGANIZATION 1. Introduction – Recent progress and statistics of HIV and HAART 2. HIV-related thoracic diseases – Imaging findings and pathologic correlations a. Immune reconstitution inflammatory syndrome (IRIS) IRIS in the setting of TB, Non-TB mycobacteria, pneumocystis, etc. IRIS in the absence of known residual antigenic load b. COPD / Emphysema in HIV c. Pulmonary hypertension d. Primary lung cancer e. Drug-induced pulmonary diseases and toxicity Diffuse interstitial lung disease, focal consolidations Hypersensitivity reaction, bacterial pneumonia f. Non-infectious pulmonary complications NSIP LIP Lymphoma 3. TB Drug sensitive TB Drug resistant TB Multi-drug resistant TB (MDR-TB) Extremely drug resistant TB (XDR-TB) 4. Conclusion SUMMARY In the modern era, IRIS, COPD, and lung cancer ...
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As antiretroviral treatments prolong life in HIV-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. We determined factors associated with... more
As antiretroviral treatments prolong life in HIV-infected patients, smoking cessation is now a top priority. However, studies of HIV-infected smokers have not been conducted with uninfected controls. We determined factors associated with contemplating smoking cessation and making a prior quit attempt among HIV-infected and uninfected smoking Veterans. Between 2005 and 2007, we identified 1027 HIV-infected and 794 uninfected smokers enrolled in the Veterans Aging Cohort Study (VACS). Stratifying by HIV status, we calculated adjusted odd ratios using logistic regression to identify factors associated with contemplating smoking cessation and making a prior quit attempt. Most participants (66% of HIV-infected vs. 68% of uninfected, p=0.46) were contemplating cessation, and 56% of both groups (p=0.99) had attempted to quit in the last year. In stratified multivariable analyses, HIV-infected smokers with recent pulmonary disease diagnoses were more likely to have made a quit attempt (AOR 4.93, 95% CI=1.41-17.17). Both HIV-infected and uninfected patients with unhealthy alcohol use were less likely to be contemplating cessation (AOR 0.66, 95% CI=0.49-0.90 and 0.71, 95% CI=0.50-1.00). HIV-infected smokers who reported unhealthy alcohol use were also less likely to have made a quit attempt in the last year (AOR 0.68, 95% CI=0.51-0.91). Patient-level interest and motivation are not major barriers to smoking cessation among HIV-infected Veterans. Targeting HIV-infected smokers with a recent pulmonary disease diagnosis may improve sustained smoking cessation. Unhealthy alcohol use appears to be a key modifiable risk factor. Smoking cessation rates may be improved by combining interventions for smoking and alcohol use for HIV-infected patients.