The Female Genital Tract Microbiome Is Associated With Vaginal Antiretroviral Drug Concentrations in Human Immunodeficiency Virus-Infected Women on Antiretroviral Therapy.

Background: The female genital tract (FGT) microbiome may affect vaginal pH and other factors that influence drug movement into the vagina. We examined the relationship between the microbiome and antiretroviral concentrations in the FGT. Methods: Over one menstrual cycle, 20 human immunodeficiency virus (HIV)-infected women virologically suppressed on tenofovir (TFV) disoproxil fumarate/emtricitabine and ritonavir-boosted atazanavir (ATV) underwent serial paired cervicovaginal and plasma sampling for antiretroviral concentrations using high-performance liquid chromatography-tandem mass spectrometry. Analysis of 16S ribosomal RNA gene sequencing of cervicovaginal lavage clustered each participant visit into a unique microbiome community type (mCT). Results: Participants were predominantly African American (95%), with a median age of 38 years. Cervicovaginal lavage sequencing (n = 109) resulted in a low-diversity mCT dominated by Lactobacillus (n = 40), and intermediate-diversity (n = 28) and high-diversity (n = 41) mCTs with abundance of anaerobic taxa. In multivariable models, geometric mean FGT:plasma ratios varied significantly by mCT for all 3 drugs. For both ATV and TFV, FGT:plasma was significantly lower in participant visits with high- and low-diversity mCT groups (all P < .02). For emtricitabine, FGT:plasma was significantly lower in participant visits with low- vs intermediate-diversity mCT groups (P = .002). Conclusions: Certain FGT mCTs are associated with decreased FGT antiretroviral concentrations. These findings are relevant for optimizing antiretrovirals used for biomedical HIV prevention in women.

Preexisting Atrial Fibrillation Associated with Higher Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections: Analysis of the National Inpatient Sample.

Background: The purpose of this study was to investigate the prevalence of preexisting atrial fibrillation (AF) in patients with MRSA-BSI during a three-year period and the impact of preexisting AF on MRSA-BSI outcomes. Methods: This was a retrospective analysis performed using the National Inpatient Sample (NIS) over a three-year period (2016, 2017, 2018) for patients with MRSA-BSI as a principal diagnosis with and without preexisting AF. The primary outcome was mortality with secondary outcomes of acute coronary syndrome, cardiac arrest, cardiogenic shock, endocarditis, respiratory failure, acute kidney injury, length of stay, hospital cost, and patient charge. A univariate and multivariable logistic regression analysis estimated clinical outcomes. Results: Preexisting AF in patients with MRSA-BSI significantly increased the primary outcome of the study, mortality (1.67% vs. 0.66%, p=0.030) with an adjusted odds ratio (AOR) of 1.98 (95% CI, 1.1-3.7). Secondary outcomes showed increased likelihood of cardiac arrest with MRSA-BSI and AF (0.48% vs. 0.2%, p=0.025) with an AOR 3.59 (CI 1.18-11.0), ACS (3.44% vs. 1.21%, p=0.008) with an AOR of 1.81 (CI 1.16-2.80), respiratory failure (8.92% vs. 4.02%, p=0.045) with an AOR 1.39 (CI 1.01-1.91), prolonged LOS (6.4 vs. 5.4 days, p=0.0001), increased hospital cost ($13,374 vs. $11,401, p=0.0001), and increased overall patient charge ($50,091 vs. $43,018, p=0.0001). Secondary outcomes that showed statistical significance included ACS (1,497 (3.44%) vs. 113 (1.21%), p=0.008) with an AOR of 1.81 (CI 1.16-2.80), cardiac arrest (209 (0.48%) vs. 19 (0.2%), p=0.025) with an AOR 3.59 (CI 1.18-11.0), and respiratory failure (3,881 (8.92%) vs. 374 (4.02%), p=0.045 with an AOR 1.39 (CI 1.01-1.91). Conclusions: Preexisting AF is a significant risk factor for mortality in patients admitted for MRSA-BSI and increases risk for cardiac arrest, respiratory failure, and ACS. Considerations should focus on early treatment and source control, especially with AF given the mortality risk, increased hospitalization cost, and prolonged LOS.

Brief Report: PrEP Eligibility Among At-Risk Women in the Southern United States: Associated Factors, Awareness, and Acceptability.

BACKGROUND: Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. SETTING AND METHODS: We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women's Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. RESULTS: Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. CONCLUSIONS: Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.