Hospitalization Rates and Reasons Among HIV Elite Controllers and Persons With Medically Controlled HIV Infection.

BACKGROUND: Elite controllers spontaneously suppress human immunodeficiency virus (HIV) viremia but also demonstrate chronic inflammation that may increase risk of comorbid conditions. We compared hospitalization rates and causes among elite controllers to those of immunologically intact persons with medically controlled HIV. METHODS: For adults in care at 11 sites from 2005 to 2011, person-years with CD4 T-cell counts ≥350 cells/mm(2) were categorized as medical control, elite control, low viremia, or high viremia. All-cause and diagnostic category-specific hospitalization rates were compared between groups using negative binomial regression. RESULTS: We identified 149 elite controllers (0.4%) among 34 354 persons in care. Unadjusted hospitalization rates among the medical control, elite control, low-viremia, and high-viremia groups were 10.5, 23.3, 12.6, and 16.9 per 100 person-years, respectively. After adjustment for demographic and clinical factors, elite control was associated with higher rates of all-cause (adjusted incidence rate ratio, 1.77 [95% confidence interval, 1.21-2.60]), cardiovascular (3.19 [1.50-6.79]) and psychiatric (3.98 [1.54-10.28]) hospitalization than was medical control. Non-AIDS-defining infections were the most common reason for admission overall (24.1% of hospitalizations) but were rare among elite controllers (2.7%), in whom cardiovascular hospitalizations were most common (31.1%). CONCLUSIONS: Elite controllers are hospitalized more frequently than persons with medically controlled HIV and cardiovascular hospitalizations are an important contributor.

A Community-Based Pre-Exposure Prophylaxis Telehealth Program Focused on Latinx Sexual Minority Men.

Latinx sexual minority men (LSMM) face multilevel barriers to accessing HIV pre-exposure prophylaxis (PrEP). To address these barriers, we designed and implemented community-based organization (CBO)-PrEP, a collaborative community-based telehealth PrEP program for LSMM. We designed this PrEP delivery program through a collaborative process involving staff from local CBOs and a primary care-based HIV prevention program. Staff met weekly over a 3-month period to establish protocols for referrals, obtaining insurance coverage, and navigation to appointments and laboratory testing. To assess feasibility, we extracted electronic medical record data including demographics and clinical outcomes of PrEP care. Between December 2020 and May 2023, 102 individuals were referred to CBO-PrEP of which 85 had Hispanic/Latino as their ethnicity in their medical records; out of 102 individuals, 72 (70.6%) were scheduled for an initial appointment. Out of 72 individuals scheduled for an appointment, 58 (80.6%) were seen by a health care provider a median of 7.5 days after referral [interquartile range (IQR), 2-19]; 48 (82.6%) of initial appointments were through telemedicine, 10 (17.2%) were seen in person. Of the 48 patients who had a telehealth appointment, 36 (75%) underwent initial laboratory testing and 42 (87.5) were prescribed PrEP; all 10 patients who were seen in person underwent laboratory testing and were prescribed PrEP. PrEP prescriptions were received in a median of 17.5 days (IQR 4.5-33.5) after referral. CBO-PrEP successfully engaged LSMM, a population that is often hard to reach. Expanding collaborative approaches with CBOs could have a significant impact on improving PrEP uptake for LSMM and other priority populations.

Clinical Outcomes and Inflammatory Markers by HIV Serostatus and Viral Suppression in a Large Cohort of Patients Hospitalized With COVID-19.

BACKGROUND: Limited data exist about clinical outcomes and levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus and by HIV viral suppression. SETTING: Large tertiary care health system in the Bronx, NY, USA. METHODS: We conducted a retrospective cohort study of 4613 SARS-CoV-2 PCR-positive patients admitted between March 10, 2020, and May 11, 2020. We examined in-hospital intubation, acute kidney injury (AKI), hospitalization length, and in-hospital mortality by HIV serostatus, and by HIV-viral suppression and CD4 counts among people living with HIV (PLWH) using adjusted competing risks regression. We also compared immune and inflammatory marker levels by HIV serostatus and viral suppression. RESULTS: Most patients were either non-Hispanic Black (36%) or Hispanic (37%); 100/4613 (2.2%) were PLWH, among whom 15 had detectable HIV viral load. PLWH compared to patients without HIV had increased intubation rates (adjusted hazard ratio 1.73 [95% CI: 1.12 to 2.67], P = 0.01). Both groups had similar rates of AKI, length of hospitalization, and death. No (0%) virally unsuppressed PLWH were intubated or died, versus 21/81 (26%, P = 0.04) and 22/81 (27%, P = 0.02) of virally suppressed PLWH, respectively. Among PLWH, higher CD4 T-cell counts were associated with increased intubation rates. C-reactive protein, IL-6, neutrophil counts, and ferritin levels were similar between virally suppressed PLWH and patients without HIV, but significantly lower for unsuppressed PLWH (all P < 0.05). CONCLUSIONS: PLWH had increased risk of intubation but similarly frequent rates of AKI and in-hospital death as those without HIV. Findings of no intubations or deaths among PLWH with unsuppressed HIV viral load warrant further investigation.

HIV Prevention and Treatment in the Context of the COVID-19 in the Bronx, New York: Implications for Practice and Research.

New York City has been one of the major epicenters of the coronavirus disease (COVID-19) pandemic, experiencing among the highest case rates, hospitalizations, and deaths globally. The Bronx borough in New York City, which has been disproportionately impacted by HIV, has also experienced significant disparities in COVID-19. In this perspective, we discuss the disruptions faced by our community and primary-care based HIV programs at Montefiore Health System in the Bronx in the context of the COVID-19 pandemic. We discuss how the COVID-19 pandemic has impacted our HIV prevention and treatment programs, the resulting adaptations to clinical care, and the implications for practice and future research.

A syphilis control intervention targeting black and Hispanic men who have sex with men.

UNLABELLED: There are no documented syphilis control efforts targeting Black and Hispanic men who have sex with men (MSM) despite recent syphilis outbreaks among MSM and the disparate burden of syphilis among minorities. METHODS: A syphilis control intervention, named the DL STATS PARTY, was designed to promote syphilis testing among minority MSM, through a sexual health and general well-being framework. RESULTS: Of the 461 MSM with complete intake data, the average age was 27.0, 44.7% were Black, 42.7% were Hispanic, 67.9% had sex with two or more partners in the previous six months, and 28.4% reported sex with a female in the previous six months. Although Blacks accessed fewer overall services and physically invasive services, race/ethnicity was not a factor in choosing to be tested for syphilis. CONCLUSION: The DL STATS PARTY promoted syphilis testing among at-risk Black and Hispanic MSM. The program conforms to the CDC Recommended Steps to Mobilizing the Community to Address Syphilis and has the potential to be an example for other U.S. metropolitan areas.

Buprenorphine treatment in an urban community health center: what to expect.

BACKGROUND: Despite new opportunities to expand buprenorphine treatment for opioid dependence, use of this treatment modality has been limited. Physicians may question their ability to successfully treat opioid-dependent patients with buprenorphine in a primary care setting. We describe a buprenorphine treatment program and treatment outcomes in an urban community health center. METHODS: We conducted retrospective chart reviews on the first 41 opioid-dependent patients treated with buprenorphine/naloxone. The primary outcome was 90-day retention in treatment. RESULTS: Patients' mean age was 46 years, 70.7% were male, 58.8% Hispanic, 31.7% black, 57.5% unemployed, and 70.0% used heroin prior to treatment. Twenty-nine (70.7%) patients were retained in treatment at day 90. Compared to those not retained, patients retained in treatment were more likely to have used street methadone (0% versus 37.9%) and less likely to have used opioid analgesics (54.6% versus 20.7%) and alcohol (50.0% versus 13.8%) prior to treatment. Of the 25 patients with urine toxicology tests, 24% tested positive for opioids. CONCLUSIONS: Buprenorphine treatment for opioid dependence in an urban community health center resulted in a 90-day retention rate of 70.7%. Type of substance use prior to treatment appeared to be associated with retention. These findings can help guide program development.

Increased Antiretroviral Therapy Use and Virologic Suppression in the Bronx in the Context of Multiple HIV Prevention Strategies.

Multiple population-based HIV prevention strategies from national, state, local, and institutional levels have been implemented in the Bronx, which has one of the highest HIV prevalences in the U.S. We examined changes in antiretroviral therapy (ART) use and associated outcomes between 2007 and 2014 among patients seen at one of >20 outpatient clinics affiliated with the largest Bronx HIV care provider. Among eligible HIV-infected patients age ≥13 years, we examined annual trends in ART use, mean HIV RNA level, and virologic suppression (<200 copies/ml) overall and among prespecified subgroups. In a subset with suppressed HIV RNA at the end of each year, we determined the percentage whose levels remained suppressed within the next year. Regression models assessed disparities in outcomes. Among 7,196 patients (median age 50, 47% Hispanic, 45% black), we identified consistent increases over time in the percent prescribed ART (78% in 2007 to 93% in 2014) and with virologic suppression (58% to 80%), as mean HIV RNA decreased (351 to 73 copies/ml) (all p < .001). Sustained virologic suppression improved markedly beginning in 2011, coinciding with local test-and-treat initiatives and adoption of expanded treatment guidelines. While disparities among population groups were most pronounced for sustained virologic suppression, those aged 13-24 fared relatively poorly for all outcomes examined (e.g., rate ratio 0.57 for virologic suppression, 95% confidence interval 0.52-0.62, vs. age 65+). Population-wide HIV prevention strategies coincided with improvements in virologic suppression among most population groups. However, more attention is needed to address continued disparities in the HIV care continuum among young people.

Cigarette smoking and lesbian and bisexual women in the Bronx.

This study investigated the prevalence of cigarette smoking, smoking patterns, and smoking cessation efforts of Black and Hispanic lesbian and bisexual women from a poor, urban community. One-on-one interviews were conducted with a convenience sample of 130 self-identified Black and Hispanic lesbian and bisexual women from the Bronx, NY. Bivariate statistics were used to determine differences between Black and Hispanic respondents in smoking prevalence, frequency, desire to quit, and impact on family unit. Fifty-five percent of Black respondents and sixty-two percent of Hispanic respondents were current smokers. Hispanics were more likely than Blacks to have a partner (p < 0.04), 2 or more children (p < 0.05), and an asthmatic in their household (p < 0.02). Hispanics were less likely than Blacks to have ever attempted to quit (p < 0.04) and to have made a serious attempt to quit in the past year (p < 0.02). Culturally sensitive interventions are needed to help Hispanic lesbian and bisexual women move from the pre-contemplative to action stage of quitting. The large proportion of current smokers requires greater access to effective smoking cessation tools.