SARS-CoV-2 Antiviral Prescribing Gaps Among Nonhospitalized High-Risk Adults.

Within a multistate clinical cohort, SARS-CoV-2 antiviral prescribing patterns were evaluated from April 2022-June 2023 among nonhospitalized patients with SARS-CoV-2 with risk factors for severe COVID-19. Among 3247 adults, only 31.9% were prescribed an antiviral agent (87.6% nirmatrelvir/ritonavir, 11.9% molnupiravir, 0.5% remdesivir), highlighting the need to identify and address treatment barriers.

Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke.

ABSTRACT: Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.

Cancer Incidence and Cancer Screening Practices Among a Cohort of Persons Receiving HIV Care in Washington, DC.

In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and receipt of screening among persons actively enrolled in the DC Cohort, a longitudinal observational cohort of PLWH, between 2011 and 2017. Cancer screening eligibility was determined based on age, sex, smoking history and co-morbidity data available and published national guidelines. The incidence rate of NADCs was 12.1 (95% CI 10.7, 13.8) and ADCs 1.6 (95% CI 0.6, 4.6) per 1000 person-years. The most common incident NADCs were breast 2.6 (95% CI 0.5,1 2.1), prostate 2.3 (95% CI 1.2, 4.3), and non-melanoma skin 1.2 (95% CI 0.6, 2.3) incident diagnoses/cases per 1000 person-years. Among cohort sites where receipt of cancer screening was assessed, less than 60% of eligible participants had any ascertained anal HPV, breast, cervical, colorectal, hepatocellular carcinoma, or lung cancer screening. In this cohort of PLWH, there were more incident NADCs versus ADCs in contrast to earlier cohort studies where ADCs predominated. Despite a large eligible population there were low rates of screening. Implementation of cancer screening is an important component of care among PLWH.

Receipt of HIV prevention interventions is more common in community-based clinics than in primary care or acute care settings for Black men who have sex with men in the District of Columbia.

Characterization of structural barriers that impede the receipt of HIV prevention and care services is critical to addressing the HIV epidemic among Black men who have sex with men (BMSM). This study investigated the utilization of HIV prevention and general care services among a non-clinic-based sample of BMSM who reported at least one structural barrier to engagement in care. Proportions of participants who had received HIV prevention services and general care services in different settings were compared using Fisher's exact test and correlates of service receipt were assessed using logistic regression. Among 75 BMSM, 60% had accessed a community-based clinic, 21% had accessed a primary care setting, and 36% had accessed an acute care setting in the last 6 months. Greater proportions of participants who had accessed community-based clinics received HIV prevention services during these visits (90%) compared to those who had accessed primary care (53%) and acute care (44%) settings (p = .005). Opportunities for BMSM to receive HIV prevention interventions differed by care setting. Having access to health care did not necessarily facilitate the uptake of HIV prevention interventions. Further investigation of the structurally rooted reasons why BMSM are often unable to access HIV prevention services is warranted.

Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States.

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

Body composition changes during androgen deprivation therapy for prostate cancer: a 2-year prospective study.

BACKGROUND: Little is known about the long-term impact of androgen deprivation therapy (ADT) on body composition in men with prostate cancer. We compared body composition parameters in men with non-metastatic prostate cancer on or not on therapy with healthy, age-matched controls at baseline and monitored changes over a 2-year period. METHODS: We measured body fat mass and lean body mass in 81 men with prostate cancer on no ADT, 43 men on acute ADT (less than 6 months), 67 men on chronic ADT (more than 6 months) and 53 age-matched healthy controls. Measurements were performed every 6 months for 2 years. RESULTS: Men with prostate cancer on acute ADT (mean 3 months) had significant gains in body fat mass [1499.56+/-322.28g (mean+/-S.E.) after 12 months, 2167.15+/-676.45g after 24 months, p<0.01 for both] and losses in lean body mass (929.74+/-296.36g after 12 months, 1785.81+/-501.31g after 24 months, p<0.01 for both) over 2 years. Men on chronic ADT (mean 31 months) had smaller but still significant body composition changes over 24 months. Changes in body composition in men on no ADT were small and healthy controls had no significant changes. CONCLUSIONS: Men with prostate cancer on ADT have significant gains in body fat mass and losses lean body mass over 2 years. These changes are most pronounced with initiation of ADT.

Physical function changes in prostate cancer patients on androgen deprivation therapy: a 2-year prospective study.

OBJECTIVES: To investigate the influence of androgen deprivation therapy (ADT) in men with nonmetastatic prostate cancer. METHODS: We conducted a 2-year controlled, prospective study. Twenty-three men on 6 months or longer of ADT (chronic), 12 men on less than 6 months of ADT (acute), and 13 men not on ADT (healthy controls or prostate cancer patients not on ADT) were studied. We used validated, objective tests for physical and visual-motor function and dual X-ray absorptiometry for body composition at baseline and at 24 months. RESULTS: We found the baseline percentage of body fat increased and baseline percentage of lean mass decreased with duration of ADT (P <0.002 across groups for both). After 24 months, men on chronic ADT had significant declines in lean body mass percentage (P = 0.058) and increases in body fat percentage (P = 0.029). Men on acute ADT had smaller but still significant differences in body composition at baseline and similar trends at 24 months. At baseline, men on chronic ADT had longer chair rise times than men on no ADT (P = 0.073) or acute ADT (P = 0.035). Four-meter walk velocities at 24 months were slower in men on acute (P = 0.006) and chronic ADT (P <0.001). CONCLUSIONS: Declines in lean body mass and increases in body fat percentage over 2 years are observed in men on ADT. Lower body physical function performance is reduced in men on chronic ADT. Changes in body composition and physical function should be considered in men on long-term ADT.