Prevalence of and Risk Factors for Prediabetes in Patients Infected With HIV.

BACKGROUND: The use of highly active antiretroviral therapy (HAART) has resulted in a dramatic decrease in morbidity and mortality in HIV-infected patients. Components of HAART (e.g., protease inhibitors and nucleoside reverse transcriptase inhibitors), as well as HIV infection itself, can have significant effects on developing new-onset diabetes. The goals of this study were to determine the prevalence of prediabetes and to assess risk factors associated with prediabetes in a cohort of HIV-infected patients. METHODS: This is a retrospective, cross-sectional study of 249 HIV-infected patients in an outpatient multidisciplinary HIV clinic in a university hospital. Patients with prediabetes were identified and compared with patients without prediabetes. The association between the prevalence of prediabetes and risk factors was analyzed. RESULTS: Among 249 HIV-infected patients, the mean age was 46.3 years, and 54% were male. Prevalence of prediabetes was approximately 30%, and BMI ≥30 kg/m2 was found to be a significant risk factor for developing prediabetes. CONCLUSION: A high prevalence of prediabetes was observed in this cohort of HIV-infected patients. Interventions targeting HIV-infected patients with increased risk of prediabetes, especially individuals with a high BMI, is needed.

Promoting Anti-Racism in Clinical Practice: Lessons Learned in the Process of Removing the Race Coefficient from the Estimated Glomerular Filtration Rate Algorithm.

Background: Promoting anti-racism in medicine entails naming racism as a contributor to health inequities and being intentional about changing race-based practices in health care. Unscientific assumptions about race have led to the proliferation of race-based coefficients in clinical algorithms. Identifying and eliminating this practice is a critical step to promoting anti-racism in health care. The New York City Department of Health and Mental Hygiene (NYC-DOHMH) formed the Coalition to End Racism in Clinical Algorithms (CERCA), a health system consortium charged with eliminating clinical practices and policies that perpetuate racism. Objective: This article describes the process by which an academic medical center guided by the NYC-DOHMH tackled race-based clinical algorithms. Methods: Multiple key interested parties representing department chairs, hospital leaders, researchers, legal experts, and clinical pathologists were convened. A series of steps ensued, including selecting a specific clinical algorithm to address, conducting key informant interviews, reviewing relevant literature, reviewing clinical data, and identifying alternative and valid algorithms. Key Outcomes: Given the disproportionately higher rates of chronic kidney disease risk factors, estimated glomerular filtration rate (eGFR) was prioritized for change. Key informant interviews revealed concerns about the clinical impact that removing race from the equation would have on patients, potential legal implications, challenges of integrating revised algorithms in practice, and aligning this change in clinical practice with medical education. This collaborative process enabled us to tackle these concerns and successfully eliminate race as a coefficient in the eGFR algorithm. Conclusions: CERCA serves as a model for developing academic and public health department partnerships that advance health equity and promote anti-racism in practice. Lessons learned can be adapted to identify, review, and remove the use of race as a coefficient from other clinical guidelines.

The positive affect, promoting Positive Engagement, and Adherence for Life (APPEAL) feasibility trial: Design and rationale.

OBJECTIVE: To describe development of the Positive Affect, Promoting Positive Engagement, and Adherence for Life (APPEAL) program. METHOD: APPEAL is intended to increase HIV medication adherence through promotion of positive affect, and was developed through an iterative process involving 6 focus groups (N = 34) that elicited feedback on intervention content, followed by an individually administered prepilot of the entire intervention (N = 7). RESULTS: Participants provided feedback on important potential moderator variables, including depression, on mode of intervention administration, and on anticipated barriers and benefits to participation. Insights gained were used to finalize study procedures in preparation for a feasibility trial. For the feasibility trial, a total of 80 participants who, in the past 6 months have had at least one plasma HIV RNA >200 copies/mL, will be randomized to receive APPEAL or standard of care (N = 40 per group). Intervention group participants will receive 3 monthly, individually administered sessions, and all participants will have their medication adherence monitored and complete structured interviews at baseline and at 3 and 6 months. CONCLUSION: The APPEAL program is innovative in that it focuses on promoting self-regulation of positive emotions, an understudied approach to promoting chronic disease self-management behaviors such as HIV medication adherence. Findings from the feasibility trial will gauge suitability of the APPEAL intervention and evaluation methods for subsequent testing in a confirmatory trial and will examine changes in positive affect, the primary mechanism of change targeted in the intervention. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Use of aspirin and statins for the primary prevention of myocardial infarction and stroke in patients with human immunodeficiency virus infection.

This retrospective, cross-sectional study evaluated whether HIV-infected patients received aspirin and statins for the primary prevention of myocardial infarction and stroke. Among the 258 patients included, 50.4% (n = 130/258) of the patients had a high risk of myocardial infarction and 14% (n = 36/258) of stroke. Overall, 43.1% (n = 56/130) and 50% (n = 18/36) of the patients were prescribed aspirin for the primary prevention of myocardial infarction and stroke, respectively. Among the patients who required statin therapy, 42.5% (n = 34/80) and 37.1% (n = 13/35) of patients received it for the primary prevention of myocardial infarction and stroke, respectively. The patients who had hypertension (odds ratio 3.8, 95% confidence interval 1.5-10.9) and diabetes mellitus (odds ratio 5.6, 95% confidence interval 2.6-12.4) were more likely to receive aspirin. Interventions are needed to improve provider awareness of the use of aspirin and statins in the primary prevention of myocardial infarction and stroke in HIV-infected patients.

Immune reconstitution after potent antiretroviral therapy in AIDS patients with progressive multifocal leukoencephalopathy.

Neurological disease is the initial manifestation of acquired immunodeficiency syndrome (AIDS) in 10-20% of patients with HIV infection. Progressive multifocal leukoencephalopathy (PML) predominantly involves the cerebral hemispheres, with a small subset of patients having lesions predominantly or exclusively confined to the cerebellum. The radiological features of PML are typically non-inflammatory. As a result of potent antiretroviral therapy (ART), however, inflammatory lesions are becoming more common in HIV-infected individuals and are due, in part, to immune reconstitution that occurs in recipients of potent ART. In the majority of such cases, the clinical outcome of immune reconstitution PML has been beneficial to the host, although several case reports have described worsening or fatal outcomes in PML patients as a result of potent ART. The following 2 cases of immune reconstitution PML described in this report illustrate the varied radiological manifestations and clinical outcomes that can develop in AIDS patients with PML receiving potent ART. Moreover, these cases highlight the inflammatory changes observed on neuroimaging in AIDS patients with immune reconstitution PML receiving potent ART and to our knowledge are the first reports of immune reconstitution isolated to the cerebellum in such patients.