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1.
BMC Public Health ; 19(1): 1440, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675932

RESUMO

BACKGROUND: San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS: Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS: A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS: Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.


Assuntos
Causas de Morte/tendências , Infecções por HIV/diagnóstico , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/mortalidade , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , São Francisco/epidemiologia , Adulto Jovem
2.
AIDS Behav ; 23(9): 2326-2336, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31324996

RESUMO

While poverty is an established barrier to achieving success at each step of the HIV care continuum, less is known about specific aspects of poverty and how they overlap with behavior in exceptionally low-income individuals who live in well-resourced areas. We considered unsuppressed viral load over 3 years among women living with HIV in San Francisco who used homeless shelters, low-income hotels and free meal programs. One-hundred twenty study participants were followed; 60% had > 1 unsuppressed viral load and 19% were unsuppressed at every visit. Across six-month intervals, the odds of unsuppressed viral load were 11% higher for every 10 nights spent sleeping on the street [Adjusted Odds Ratio (AOR) 1.11, 95% CI 1.02-1.20]; 16% higher for every 10 nights spent sleeping in a shelter (AOR/10 nights 1.16, 95% CI 1.06-1.27); 4% higher for every 10 nights spent sleeping in a single-room occupancy hotel (AOR/10 nights 1.04, 95% CI 1.02-1.07); and over threefold higher among women who experienced any recent incarceration (AOR 3.56, 95% CI 1.84-6.86). Violence and recent use of outpatient health care did not significantly predict viral suppression in adjusted analysis. While strategies to promote retention in care are important for vulnerable persons living with HIV, they are insufficient to ensure sustained viral suppression in low-income women experiencing homelessness and incarceration. Results presented here in combination with prior research linking incarceration to homelessness among women indicate that tailored interventions, which not only consider but prioritize affordable housing, are critical to achieving sustained viral suppression in low-income women living with HIV.


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Pessoas em Situação de Rua/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Feminino , Infecções por HIV/epidemiologia , Pessoas em Situação de Rua/psicologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Razão de Chances , Pobreza , São Francisco/epidemiologia , Testes Sorológicos , Adulto Jovem
3.
J Neurooncol ; 143(3): 547-552, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31089924

RESUMO

INTRODUCTION: Hemangioblastomas are uncommon tumors of the central nervous system that can be seen in Von Hippel-Lindau (VHL) disease. Despite their benign histology, hemangioblastomas can cause substantial morbidity due to involvement of critical structures. In order to better understand the clinical behavior of spinal cord hemangioblastomas, we have analyzed the clinical, pathologic, radiologic characteristics and management of sporadic and VHL-associated cases at our institution. METHODS: We performed a database search to identify all spinal hemangioblastomas at our institution between 1997 and 2016. Tumor characteristics were analyzed for sporadic and VHL-associated tumors separately in order to understand the differences in groups. RESULTS: We included 20 patients with VHL-associated spinal hemangioblastomas, and 22 patients with sporadic spinal hemangioblastomas. VHL-associated patients were significantly younger at time of presentation compared to sporadic patients (p < 0.0025). Thirty-two patients (76.2%) presented with focal weakness, 34 (81.0%) with sensory loss, and 22 (52.4%) with pain. VHL patients were more likely to present with multiple symptoms (p < 0.001). Median follow-up time was 20.9 months, during which 17 tumors recurred. The median recurrence free interval was 44 months. There were no differences in gross total resection rates between sporadic and VHL-associated cases (p = 0.197). VHL-associated cases had a higher rate of repeat surgery for recurrence (14 patients-73.6%) compared to sporadic cases (3 patients-13.6%; p < 0.001). CONCLUSION: VHL-associated spinal hemangioblastomas differ from sporadic tumors in terms of age, presenting symptoms, multifocality, and rate of recurrence. Recurrences seem to be unrelated to the extent of resection, indicating the need for life-long follow up for VHL patients.


Assuntos
Hemangioblastoma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Reoperação/estatística & dados numéricos , Neoplasias da Medula Espinal/cirurgia , Doença de von Hippel-Lindau/complicações , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Seguimentos , Hemangioblastoma/etiologia , Hemangioblastoma/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Estudos Retrospectivos , São Francisco/epidemiologia , Neoplasias da Medula Espinal/etiologia , Neoplasias da Medula Espinal/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
5.
AIDS Patient Care STDS ; 33(4): 167-174, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30932698

RESUMO

Increasing rates of sexually transmitted infections (STIs) in the United States among men who have sex with men (MSM) have raised concerns that pre-exposure prophylaxis (PrEP) has been associated with higher engagement in condomless anal intercourse (CAI). While partnership characteristics have previously been found to influence condom use, the extent to which PrEP use may modify their effect on CAI remains unknown. A secondary analysis of 535 sexual partnerships from a cross-sectional study in San Francisco was conducted to evaluate interactions between PrEP use and partnership characteristics on CAI. Bivariate and multivariate generalized estimating equation (GEE) logistic regression models were used to estimate relative measures of association, adjusted for confounding by seroconcordance and partnership type, as well as account for repeated partnerships per respondent. Partnerships where both partners used biomedical prevention had significantly greater odds of CAI [odds ratio (OR) = 5.19, 95% confidence interval (CI): 2.27-11.9] compared to those where only one partner used biomedical prevention, while those where neither partner used biomedical prevention had significantly lower odds of CAI (OR = 0.61, 95% CI: 0.40-0.93). There was no significant association between meeting place (online vs. offline) and sexual risk taking (OR = 1.03, p = 0.894). Having one partner disclose their HIV status (compared to neither partner having disclosed) was associated with significantly higher odds of CAI among partnerships of PrEP-using MSM [adjusted OR (aOR) = 5.28, 95% CI: 1.91-14.61], while the association was not significant among the partnerships of non-PrEP-using MSM (aOR = 1.29, 95% CI: 0.75-2.21). Differences in condom use among MSM using PrEP may not be well explained by differences in the effect of partnership characteristics. MSM using PrEP appear to commonly practice biomedical matching and high engagement in CAI with other biomedical prevention users, which could indicate relatively concentrated sexual networks and partly explain their disproportionate risk for STIs. Future studies should further investigate biomedical matching to develop interventions that further promote the sexual health of those using PrEP.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/métodos , Adulto , Estudos Transversais , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Sexo Seguro , São Francisco/epidemiologia , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Estados Unidos , Adulto Jovem
6.
PLoS One ; 14(3): e0213809, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30908519

RESUMO

Estrogens play a significant role in breast cancer development and are not only produced endogenously, but are also mimicked by estrogen-like compounds from environmental exposures. We evaluated associations between estrogenic (E) activity, demographic factors and breast cancer risk factors in Non-Latina Black (NLB), Non-Latina White (NLW), and Latina women. We examined the association between E activity and Indigenous American (IA) ancestry in Latina women. Total E activity was measured with a bioassay in plasma samples of 503 women who served as controls in the San Francisco Bay Area Breast Cancer Study. In the univariate model that included all women with race/ethnicity as the independent predictor, Latinas had 13% lower E activity (p = 0.239) and NLBs had 35% higher activity (p = 0.04) compared to NLWs. In the multivariable model that adjusted for demographic factors, Latinas continued to show lower E activity levels (26%, p = 0.026), but the difference between NLBs and NLWs was no longer statistically significant (p = 0.431). An inverse association was observed between E activity and IA ancestry among Latina women (50% lower in 0% vs. 100% European ancestry, p = 0.027) consistent with our previously reported association between IA ancestry and breast cancer risk. These findings suggest that endogenous estrogens and exogenous estrogen-like compounds that act on the estrogen receptor and modulate E activity may partially explain racial/ethnic differences in breast cancer risk.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/metabolismo , Estrogênios/metabolismo , Grupos Étnicos/estatística & dados numéricos , Grupos Populacionais/estatística & dados numéricos , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença , Humanos , Pessoa de Meia-Idade , São Francisco/epidemiologia , Adulto Jovem
7.
Am J Emerg Med ; 37(4): 645-650, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30914133

RESUMO

BACKGROUND: Substance abuse is associated with traumatic injuries. Prior studies of drug use and injury have relied on urine drug of abuse screens, which have false positives, false negatives and inability to detect novel drugs. Our study characterizes the relationship between injury mechanism and drugs of abuse detected in serum via confirmatory testing. METHODS: This prospective observational study was conducted from Jan-Sept 2012 at a level 1 trauma center on trauma patients > 13 years who had blood drawn for routine tests. Demographic, injury and standard laboratory data were abstracted from patient charts. Comprehensive serum drug testing was done using liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS, LC1200-TOF/MS 6230, Agilent, Santa Clara, CA). RESULTS: Of 272 patients, 71.0% were male, 30.5% had violent injury type and 32.4% had a penetrating injury mechanism. Violent injury type and penetrating injury mechanisms were more frequent in patients who were male, younger age, Black, or Hispanic (p < 0.05 for all). LC-TOF/MS showed that 46.0% were positive for at least one drug. Stimulant drugs were associated with violent injury type (OR 2.9; 95% CI 1.64-5.15) and penetrating injury mechanism (OR 3.3; 95% CI 1.86-5.82). Tobacco use was associated with violent injury type (OR 3.9; 95% CI 2.25-6.77) and penetrating injury mechanism (OR 4.14; 95%CI 2.4-7.14). CONCLUSIONS: Many drugs are present in trauma patients that are not routinely detected on urine drug of abuse tests. Both stimulant drugs and cigarette smoking are indicators of multidimensional hazardous behaviors, which were associated with more violent and penetrating trauma.


Assuntos
Estimulantes do Sistema Nervoso Central/sangue , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Violência , Ferimentos Penetrantes/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cromatografia Líquida , Fumar Cigarros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , São Francisco/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/sangue , Espectrometria de Massas em Tandem , Adulto Jovem
8.
Am J Addict ; 28(2): 101-110, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30724428

RESUMO

BACKGROUND AND OBJECTIVES: The majority of anabolic androgenic steroid (AAS) studies have focused on the general male population. Approximately 15% of gay or bisexual men are seropositive for HIV and many AASs are administered via injection. Thus, AAS use among gay and bisexual men likely poses a greater risk of spreading infectious disease. Gay and bisexual men who use AAS were compared with non-users regarding self-reported seropositivity for HIV and hepatitis B and C, sexual behaviors and injection practices, illicit drug and alcohol use, and psychiatric disorders. METHODS: The CASTRO (Castro Anabolic Steroid Research Observation) study was a 108-item cross-sectional survey of 153 gay and bisexual men who exercise. Data collection occurred outside four gyms in the San Francisco Castro District. RESULTS: The lifetime prevalence of AAS use among gay and bisexual men in the study was 21.6%. AAS users and non-users did not differ in self-reported seropositivity for HIV or hepatitis B and C, but AAS users reported higher rates of male-male condomless anal sex in the past year (84.8 vs 60.8%, p < .01) than non-users. More AAS users used ecstasy and methamphetamines (39.4 vs 16.7%, p < .01 and 18.2 vs 5.0%, p = .01, respectively) than non-users. DISCUSSION AND CONCLUSIONS: Gay and bisexual men who used AAS were more likely to engage in unsafe sexual behaviors and use illicit drugs relative to non-users. Multiple factors place AAS users at higher risks for spreading infectious diseases. SCIENTIFIC SIGNIFICANT: Our study suggests increased infectious disease risk among gay and bisexual men who use AAS. (Am J Addict 2019;XX:1-10).


Assuntos
Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Congêneres da Testosterona/farmacologia , Sexo sem Proteção , Adulto , Anabolizantes/farmacologia , Estudos Transversais , Soropositividade para HIV/diagnóstico , Hepatite Viral Humana/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , São Francisco/epidemiologia , Autorrelato , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Sexo sem Proteção/prevenção & controle , Sexo sem Proteção/psicologia , Sexo sem Proteção/estatística & dados numéricos
9.
AIDS Behav ; 23(10): 2687-2693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30758787

RESUMO

Efforts in San Francisco are maximizing the use of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) where high levels of use are needed to maximize reducing new HIV infections. National HIV Behavioral Surveillance surveys MSM in San Francisco. Demographics, health care and risk behaviors are assessed. PrEP use is measured for 12 month, 6 month and 30 day periods. Of 399 HIV uninfected men sampled in 2017, 43.4% used PrEP in the past 12 months. Proportions of men using PrEP by race/ethnicity were not significant at any time point. Decreases between 6 month and 30 day use were highest among African American and Latino men. These men had the highest proportion of intermittent use in the past 30 days but not significantly. While our data suggest the disparity in PrEP use by race/ethnicity has narrowed in San Francisco, novel delivery of PrEP may narrow disparity further.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Sexo Seguro/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Estudos Transversais , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , São Francisco/epidemiologia , Minorias Sexuais e de Gênero , Adulto Jovem
11.
Epidemiology ; 30(2): 166-176, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30721163

RESUMO

BACKGROUND: Many approaches are available to researchers who wish to measure individuals' exposure to environmental conditions. Different approaches may yield different estimates of associations with health outcomes. Taking adolescents' exposure to alcohol outlets as an example, we aimed to (1) compare exposure measures and (2) assess whether exposure measures were differentially associated with alcohol consumption. METHODS: We tracked 231 adolescents 14-16 years of age from the San Francisco Bay Area for 4 weeks in 2015/2016 using global positioning systems (GPS). Participants were texted ecologic momentary assessment surveys six times per week, including assessment of alcohol consumption. We used GPS data to calculate exposure to alcohol outlets using three approach types: residence-based (e.g., within the home census tract), activity location-based (e.g., within buffer distances of frequently attended places), and activity path-based (e.g., average outlets per hour within buffer distances of GPS route lines). Spearman correlations compared exposure measures, and separate Tobit models assessed associations with the proportion of ecologic momentary assessment responses positive for alcohol consumption. RESULTS: Measures were mostly strongly correlated within approach types (ρ ≥ 0.7), but weakly (ρ < 0.3) to moderately (0.3 ≤ ρ < 0.7) correlated between approach types. Associations with alcohol consumption were mostly inconsistent within and between approach types. Some of the residence-based measures (e.g., census tract: ß = 8.3, 95% CI = 2.8, 13.8), none of the activity location-based approaches, and most of the activity path-based approaches (e.g., outlet-hours per hour, 100 m buffer: ß = 8.3, 95% CI = 3.3, 13.3) were associated with alcohol consumption. CONCLUSIONS: Methodologic decisions regarding measurement of exposure to environmental conditions may affect study results.


Assuntos
Bebidas Alcoólicas , Anomia (Social) , Carência Cultural , Consumo de Álcool por Menores/estatística & dados numéricos , Adolescente , Coleta de Dados , Avaliação Momentânea Ecológica , Feminino , Sistemas de Informação Geográfica , Humanos , Masculino , Relações Pais-Filho , Pobreza/estatística & dados numéricos , São Francisco/epidemiologia , Evasão Escolar/estatística & dados numéricos , Inquéritos e Questionários , Desemprego/estatística & dados numéricos
12.
Cancer Chemother Pharmacol ; 83(2): 329-340, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30467591

RESUMO

PURPOSE: The aim of the study was to characterize the population pharmacokinetics (PK) of the intravenous formulation of trastuzumab, assess the impact of patient and pathological covariates on trastuzumab PK, and perform simulations to support dosing recommendations in special situations. METHODS: Serum trastuzumab concentrations were obtained from 1582 patients with metastatic breast cancer (MBC), early breast cancer (EBC), advanced gastric cancer (AGC), or other tumor types/healthy volunteers in 18 phase I, II, and III trials and analyzed by nonlinear mixed-effects modeling. RESULTS: A two-compartment model with parallel linear and nonlinear elimination best described the data. During treatment, linear clearance (CL) dominated, resulting in a total CL of 0.173-0.337 L/day, which is similar to other IgG1 monoclonal antibodies. Covariates influencing CL were baseline body weight, aspartate aminotransferase, albumin, gastric cancer, and the presence of liver metastases. MBC and EBC had similar PK parameters, while CL was higher in AGC. Simulations indicated that at least 95% of patients with BC reach concentrations < 1 µg/mL (~ 97% washout) by 7 months. A dose delay in BC or AGC patients of > 1 week would take approximately 6 weeks to get back within steady-state exposure range. CONCLUSIONS: Trastuzumab PK for the intravenous formulation was well-described across cancer types, disease status, and regimens. No dose adjustment is required for any of the identified patient covariates. A 7-month serum washout period for trastuzumab is recommended. A reloading dose is required if a maintenance dose is missed by > 1 week.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/farmacocinética , Modelos Estatísticos , Neoplasias/tratamento farmacológico , Receptor ErbB-2/antagonistas & inibidores , Trastuzumab/administração & dosagem , Trastuzumab/farmacocinética , Administração Intravenosa , Estudos de Casos e Controles , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Prognóstico , Receptor ErbB-2/imunologia , São Francisco/epidemiologia , Distribuição Tecidual
13.
J Immigr Minor Health ; 21(1): 89-97, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29397484

RESUMO

Childhood obesity is increasing especially in Latinos and early intervention is essential to prevent later obesity complications. Latino children (n = 201) recruited at two San Francisco hospitals were assessed at birth including infant anthropometrics and feeding practices and followed to age 9 with annual anthropometric assessments. We evaluated the relationship between perinatal risk factors and obesity at age 9 and chronic obesity (obesity at both 5 and 9 years). Higher birthweight [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.06-5.81] and maternal pre-pregnancy body mass index (BMI) (OR 1.09, 95% CI 1.00-1.18) were associated with increased risk for obesity at 9 years. Higher maternal pre-pregnancy BMI (OR 1.10, 95% CI 1.01-1.20) was associated with chronic obesity. Additionally, prenatal depression symptoms were protective (OR 0.33, 95% CI 0.11-0.94) against chronic obesity. We found no association between maternal age and education, exclusive breastfeeding at 4-6 weeks, rapid infant weight gain, and obesity or chronic obesity. Perinatal risk factors for obesity including higher birthweight and maternal pre-pregnancy BMI persisted until age 9, whereas, other variables significant at age 5 in our cohort and other populations including exclusive breastfeeding and rapid infant weight gain were no longer associated with increased risk.


Assuntos
Peso ao Nascer , Hispano-Americanos/estatística & dados numéricos , Mães/estatística & dados numéricos , Obesidade Pediátrica/etnologia , Índice de Massa Corporal , Pesos e Medidas Corporais , Aleitamento Materno/etnologia , Criança , Pré-Escolar , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Fatores de Risco , São Francisco/epidemiologia , Fatores Socioeconômicos
14.
AIDS Behav ; 23(6): 1586-1589, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30259347

RESUMO

We examined three waves of National HIV Behavioral Surveillance surveys of persons who inject drugs (PWID) in San Francisco to assess meeting UNAIDS 90-90-90 targets. Diagnosis of PWID living with HIV increased from 64.4% in 2009 to 80.5% in 2015. Antiretroviral treatment among those diagnosed did not improve (63.8% in 2009, 62.9% in 2015). Programs in San Francisco have not achieved the first two UNAIDS targets for PWID by 2015. In a context of a rising opioid epidemic, there is urgent need for increased case finding of PWID living with HIV who are undiagnosed with rapid linkage to treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Infecções por HIV/diagnóstico , Inquéritos Epidemiológicos , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , São Francisco/epidemiologia , Adulto Jovem
15.
AIDS Behav ; 23(7): 1841-1845, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30306436

RESUMO

Using data from the National HIV Behavioral Surveillance of men who have sex with men (MSM), we estimated the prevalence of sexual behaviors among HIV-negative San Francisco MSM between 2004 and 2017. We estimate a recent increase in the 1-year prevalence of pre-exposure prophylaxis (PrEP) use, from 9.8% in 2014 to 44.9% in 2017. Over that same period, we estimate a decrease in the prevalence of consistent condom use, from 18.5 to 9.4%, and an increase in the percent of individuals with multiple condomless anal intercourse partners. We conclude that while risks for HIV infection may be decreasing among San Francisco MSM due, in part, to increases in PrEP use, the population faces increased risks for other sexually transmitted infections (STIs). Because PrEP alone does not protect against other STIs, we strongly recommend that PrEP users use condoms when possible, routinely screen for STIs, and disclose infections with sexual partners.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Humanos , Masculino , Prevalência , Sexo Seguro , São Francisco/epidemiologia , Parceiros Sexuais/psicologia
16.
AIDS Behav ; 23(6): 1576-1579, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30382454

RESUMO

Current population size estimates of communities at risk for HIV are needed to adequately plan interventions and care. We update the estimated number of men who have sex with men (MSM) living in San Francisco. Multiple data sources and approaches, including population growth, registered HIV cases, wisdom of the crowd, and a published estimate on the proportion of adults who are MSM were used for estimation. The several estimates were synthesized into a final figure with acceptable bounds using a Bayesian method. We project 69,974 (acceptable bounds 65,523-74,323) MSM are living in San Francisco as of the beginning of 2017. The population of MSM in San Francisco has increased by 19.4% since 2014.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Adulto , Teorema de Bayes , Inquéritos Epidemiológicos , Humanos , Masculino , Densidade Demográfica , Prevalência , São Francisco/epidemiologia
17.
Am J Respir Crit Care Med ; 199(3): 333-341, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30211618

RESUMO

RATIONALE: Pulmonary dead space fraction (Vd/Vt) is an independent predictor of mortality in acute respiratory distress syndrome (ARDS). Yet, it is seldom used in practice. The ventilatory ratio is a simple bedside index that can be calculated using routinely measured respiratory variables and is a measure of impaired ventilation. Ventilatory ratio is defined as [minute ventilation (ml/min) × PaCO2 (mm Hg)]/(predicted body weight × 100 × 37.5). OBJECTIVES: To determine the relation of ventilatory ratio with Vd/Vt in ARDS. METHODS: First, in a single-center, prospective observational study of ARDS, we tested the association of Vd/Vt with ventilatory ratio. With in-hospital mortality as the primary outcome and ventilator-free days as the secondary outcome, we tested the role of ventilatory ratio as an outcome predictor. The findings from this study were further verified in secondary analyses of two NHLBI ARDS Network randomized controlled trials. MEASUREMENTS AND MAIN RESULTS: Ventilatory ratio positively correlated with Vd/Vt. Ordinal groups of ventilatory ratio had significantly higher Vd/Vt. Ventilatory ratio was independently associated with increased risk of mortality after adjusting for PaO2/FiO2, and positive end-expiratory pressure (odds ratio, 1.51; P = 0.024) and after adjusting for Acute Physiologic Assessment and Chronic Health Evaluation II score (odds ratio, 1.59; P = 0.04). These findings were further replicated in secondary analyses of two separate NHLBI randomized controlled trials. CONCLUSIONS: Ventilatory ratio correlates well with Vd/Vt in ARDS, and higher values at baseline are associated with increased risk of adverse outcomes. These results are promising for the use of ventilatory ratio as a simple bedside index of impaired ventilation in ARDS.


Assuntos
Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia , Taxa Respiratória/fisiologia , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , São Francisco/epidemiologia
18.
Headache ; 58 Suppl 3: 276-290, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30403405

RESUMO

OBJECTIVE: To briefly update and correct the available data on anti-calcitonin gene-related peptide (CGRP) therapies for headache since the American Headache Society 60th Scientific Meeting, San Francisco, June 2018. BACKGROUND: CGRP is a target for primary headache therapies. METHODS: The author briefly reviews the new data and publications on gepants and anti-CGRP and anti-CGRP receptor monoclonal antibodies since the writing of his previous review in May 2018, with an emphasis on data provided at the American Headache Society 60th Scientific Meeting, San Francisco, June 2018. RESULTS: The US Food and Drug Administration (FDA) approved erenumab-aooe, an anti-CGRP receptor monoclonal antibody, for the prevention of migraine on May 17, 2018. On September 14, 2018, the FDA approved fremanezumab-vfrm and on September 26, 2018, the FDA approved galcanezumab-gnlm, both anti-CGRP ligand monoclonal antibodies for the prevention of migraine. Galcanezumab showed effectiveness in preventing episodic cluster headache as well, although has not yet been submitted to the FDA for this indication. Both galcanezumab and fremanezumab failed to prevent chronic cluster headache. Eptinezumab will likely be submitted to the FDA for prevention of migraine later in 2018. Two gepants, ubrogepant and rimegepant, have completed positive pivotal trials for the acute treatment of migraine, but have not yet been submitted to the FDA for this indication. A press release with data on the effectiveness of daily atogepant in migraine prevention provides some details. An announcement at the meeting suggests daily rimegepant will be tested for prevention as well. CONCLUSIONS: The development of anti-CGRP therapies opens a new era in the acute and preventive treatment of primary headache disorders.


Assuntos
Antagonistas do Receptor do Peptídeo Relacionado ao Gene de Calcitonina/administração & dosagem , Peptídeo Relacionado com Gene de Calcitonina/antagonistas & inibidores , Congressos como Assunto , Cefaleia/tratamento farmacológico , Cefaleia/epidemiologia , Sociedades Médicas , Anticorpos Monoclonais/administração & dosagem , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Ensaios Clínicos como Assunto/métodos , Congressos como Assunto/tendências , Cefaleia/metabolismo , Humanos , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/metabolismo , São Francisco/epidemiologia , Sociedades Médicas/tendências , Estados Unidos/epidemiologia
19.
Int J Drug Policy ; 61: 44-51, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30388569

RESUMO

BACKGROUND: Peer-to-peer injection (either providing or receiving an injection to/from a person who injects drugs [PWID]) is common (19%-50%) among PWID. Most studies of peer-to-peer injection have focused on receiving injection assistance, with fewer examining providing injection assistance and none considering characteristics of PWID who do both. We examined characteristics of PWID by peer-to-peer injection categories (receiving, providing, both, and neither) and determined if these behaviors were associated with receptive and distributive syringe sharing. METHODS: Los Angeles and San Francisco PWID (N = 777) were recruited using targeted sampling methods and interviewed during 2011-2013. Multinomial logistic regression was used to determine characteristics associated with peer-to-peer injection categories and logistic regression was used to examine if peer-to-peer categories were independently associated with distributive and receptive syringe sharing. RESULTS: Recent peer-to-peer injection was reported by 42% of PWID (18% provider; 14% recipient; 10% both). In multinomial regression analysis, PWID reporting any peer-to-peer injection were more likely to inject with others than those who did neither. Injection providers and those who did both were associated with more frequent injection, illegal income source, and methamphetamine injection while injection recipients were associated with fewer years of injection. Injection providers were younger, had more years of injecting, and were more likely to inject heroin than PWID who did neither. In multivariate analyses, we found that providers and PWID who did both were significantly more likely to report receptive and distributive syringe sharing than PWID who did neither. CONCLUSION: Peer-to-peer injection is associated with HIV/HCV risk. Current prevention strategies may not sufficiently address these behaviors. Modification of existing interventions and development of new interventions to better respond to peer-to-peer injection is urgently needed.


Assuntos
Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , São Francisco/epidemiologia , Abuso de Substâncias por Via Intravenosa/etnologia , Adulto Jovem
20.
Lancet HIV ; 5(11): e647-e655, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30245004

RESUMO

BACKGROUND: Cancer survivors are at increased risk for subsequent primary cancers. People living with HIV are at increased risk for AIDS-defining and non-AIDS-defining cancers, but little is known about their risk of first versus second primary cancers. We identified first and second primary cancers that occurred in above population expected numbers among people diagnosed with HIV in San Francisco, and compared first and second cancer incidence across five time periods that corresponded to important advances in antiretroviral therapy. METHODS: In this population-based study, we used the San Francisco HIV/AIDS case registry to identify people aged 16 years and older who were diagnosed with HIV/AIDS in San Francisco (CA, USA) between Jan 1, 1990, and Dec 31, 2010. We computer-matched records from the registry with the California Cancer Registry to identify primary cancers diagnosed between Jan 1, 1985, and Dec 31, 2013. We calculated year, age, sex, and race adjusted standardised incidence ratios with exact 95% CIs and trends in incidence of first and second AIDS-defining and non-AIDS-defining cancers from 1985 to 2013. FINDINGS: Of the 22 623 people diagnosed with HIV between Jan 1, 1990, and Dec 31, 2010, we identified 5655 incident primary cancers. We excluded 48 cancers with invalid cancer sequence numbers and 1062 in-situ anal cancers, leaving 4545 incident primary cancers, comprising 4144 first primary cancers, 372 second primary cancers, 26 third primary cancers, and three fourth or later primary cancers. First primary cancer standardised incidence ratios were elevated for Kaposi sarcoma (127, 95% CI 121-132), non-Hodgkin lymphoma (17·2, 16·1-18·4), invasive cervical cancer (8·0, 4·1-11·9), anal cancer (46·7, 39·7-53·6), vulvar cancer (13·3, 6·1-20·6), Hodgkin's lymphoma (10·4, 8·4-12·5), eye and orbit cancer (4·2, 1·4-6·9), lip cancer (3·8, 1·3-6·2), penile cancer (3·8, 1·4-6·1), liver cancer (3·0, 2·3-3·7), miscellaneous cancer (2·3, 1·7-3·0), testicular cancer (2·0, 1·4-2·6), tongue cancer (1·9, 1·1-2·7), and lung cancer (1·3, 95% CI 1·1-1·6). Second primary cancer risks were increased for Kaposi sarcoma (28·0, 95% CI 20·2-35·9), anal cancer (17·0, 10·2-23·8), non-Hodgkin lymphoma (11·1, 9·3-12·8), Hodgkin's lymphoma (5·4, 1·1-9·7), and liver cancer (3·6, 1·4-5·8). We observed lower first primary cancer standardised incidence ratios for prostate cancer (0·6, 95% CI 0·5-0·7), colon cancer (0·6, 0·4-0·8), and pancreatic cancer (0·6, 0·3-1·0), and lower second primary cancer standardised incidence ratios for testicular cancer (0·3, 0·0-0·9), kidney cancer (0·4, 0·0-0·9), and prostate cancer (0·6, 0·2-0·9). First and second primary AIDS-defining cancer incidence declined, and second primary non-AIDS-defining cancer incidence increased over time. INTERPRETATION: Because of an increased risk for both first and second primary cancers, enhanced cancer prevention, screening, and treatment efforts are needed for people living with HIV both before and after initial cancer diagnosis. FUNDING: University of California San Francisco and US Centers for Disease Control and Prevention.


Assuntos
Infecções por HIV/complicações , Neoplasias/etiologia , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Fatores de Risco , São Francisco/epidemiologia , Adulto Jovem
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