Philip J Peters

Centers for Disease Control and Prevention, Atlanta, MI, United States

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Publications (34)96.79 Total impact

  • Journal of Clinical Virology 10/2014; · 3.29 Impact Factor
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    ABSTRACT: Background: In the new HIV testing algorithm, specimens reactive on an HIV antigen/antibody combination immunoassay (IA) but negative on a supplemental confirmatory test are tested for HIV-1 RNA to distinguish acute HIV infection (AHI) from false positive IA results. We evaluated the diagnostic performance of quantitative HIV-1 RNA viral load (VL) and IA signal-to-cutoff ratios (S/COs) to diagnose AHI in this setting. Methods: The STOP study is a prospective study evaluating methods to detect AHI. Participants (age > 12 years) from 12 HIV testing sites in sexually transmitted infection clinics and community-based programs were screened for HIV with an IA (Architect, Abbott). Repeatedly reactive IA results (S/CO ≥1.00) were confirmed with an HIV-1/HIV-2 antibody differentiation assay (Multispot, Bio-Rad). Discordant IA (reactive) and Multispot (negative) results were tested with a FDA-approved qualitative HIV-1 RNA assay (Aptima; qual-RNA) and/or VL (Abbott m2000 or Roche Amplicor v1.5). Results: Among 86,929 participants who received HIV testing from September 2011 to October 2013, 191 (0.22%) had discordant IA (reactive) and Multispot (negative) results of whom 101 (52.9%) were diagnosed with AHI and 90 (47.1%) were determined to be HIV negative. Among 70 participants who had both qual-RNA and VL performed, 69 (98.6%, 95% Confidence Interval [CI] 90.6 99.8%) had concordant results (49 both reactive, 20 both negative). The one discordant result (non-reactive qual-RNA but detectable VL) was determined to be consistent with AHI on repeat testing. Among participants with AHI who had a VL test (n=100), the estimated geometric mean VL was 1,408,316 (95% CI 915,166 2,167,704) copies/ml and only two of the VLs were less than 10,000 copies/ml (Figure). Among participants determined to be HIV negative who had a VL test (n=50), all VL results were undetectable. IA S/COs among participants with AHI (median 23.68, Interquartile Range [IQR] 7.44 60.43) were also significantly higher than S/COs among those determined to be HIV negative (median 1.91, IQR 1.37 2.93) (p <0.0001). Conclusion: VL, which is more widely available and clinically useful than qual-RNA, consistently distinguished AHI from false positive IA results in the context of the new HIV testing algorithm.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: The incidence of human immunodeficiency virus (HIV) infection has significantly increased among black men who have sex with men (MSM) in the United States, and young black MSM have been disproportionately affected. HIVinfected black MSM are also less likely to engage in HIV care and achieve viral suppression than MSM of other races/ethnicities. Engaging in care and achieving viral suppression is a multistep process that starts with diagnosis. Diagnosing persons unaware of their HIV status traditionally has been a critical component of HIV partner services, but partner services also provide an important opportunity to reengage HIVinfected partners in medical care. One approach for partner services involves contacting partners of persons with newly diagnosed HIV infection and using sexual and social network and molecular phylogenetic data to improve the continuum of HIV care among black MSM. To evaluate the effectiveness of that approach, results from a prospective partner services study conducted in North Carolina were examined, and one of the partner networks identified through this study was evaluated in depth. Overall, partner services were provided to 30 black, HIV-infected MSM who named 95 sex partners and social contacts, of whom 39 (41%) previously had been diagnosed with HIV infection. The partner network evaluation demonstrated that HIV-infected and HIV-negative partners were frequently in the same network, and that the majority of HIV-infected partners were already aware of their diagnosis but had not achieved viral suppression. Using partner services to ensure that HIV-infected partners are linked to care and treatment might reduce HIV transmission and might improve outcomes along the continuum of care.
    MMWR. Morbidity and mortality weekly report 02/2014; 63(5):90-4.
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    ABSTRACT: In 2012, the World Health Organization (WHO) amended their 2010 guidelines for women receiving limited duration, triple-antiretroviral drug regimens during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV (tARV-PMTCT) (Option B) to include the option to continue lifelong combination antiretroviral therapy (cART) (Option B+). We evaluated clinical and CD4 outcomes in women who had received antiretrovirals for prevention of mother-to-child transmission and then discontinued antiretrovirals 6-months postpartum. The Kisumu Breastfeeding Study, 2003-2009, was a prospective, non-randomized, open-label clinical trial of tARV-PMTCT in ARV-naïve, Kenyan women. Women received tARV-PMTCT from 34 weeks' gestation until 6-months postpartum when women were instructed to discontinue breastfeeding. Women with CD4 count (CD4) <250cells/mm3 or WHO stage III/IV prior to 6-months postpartum continued cART indefinitely. We estimated the change in CD4 after discontinuing tARV-PMTCT and the adjusted relative risk [aRR] for factors associated with declines in maternal CD4. We compared maternal and infant outcomes following weaning-when tARV-PMTCT discontinued-by maternal ARV status through 24-months postpartum. Compared with women who continued cART, discontinuing antiretrovirals was associated with infant HIV transmission and death (10.1% vs. 2.4%; P = 0.03). Among women who discontinued antiretrovirals, CD4<500 cells/mm3 at either initiation (21.8% vs. 1.5%; P = 0.002; aRR: 9.8; 95%-confidence interval [CI]: 2.4-40.6) or discontinuation (36.9% vs. 8.3%; P<0.0001; aRR: 4.4; 95%-CI: 1.9-5.0) were each associated with increased risk of women requiring cART for their own health within 6 months after discontinuing. Considering the serious health risks to the woman's infant and the brief reprieve from cART gained by stopping, every country should evaluate the need for and feasibility to implement WHO Option B+ for PMTCT. Evaluating CD4 at antiretroviral initiation or 6-months postpartum can identify pregnant women who would most benefit from continuing cART in settings unable to implement WHO Option B+.
    PLoS ONE 01/2014; 9(4):e93556. · 3.53 Impact Factor
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    ABSTRACT: A new HIV diagnostic algorithm has been proposed which replaces the use of the HIV-1 Western blot and HIV-1 immunofluorescence assays (IFA) as the supplemental test with an HIV-1/HIV-2 antibody differentiation assay. To compare an FDA-approved HIV-1/HIV-2 antibody differentiation test (Multispot) as a confirmatory test with the HIV-1 Western blot and IFA. Participants were screened with an HIV-1/HIV-2 combination Antigen/Antibody (Ag/Ab) screening assay. Specimens with repeatedly reactive results were tested with Multispot and either Western blot or IFA. Specimens with discordant screening and confirmatory results were resolved with HIV-1 RNA testing. Individuals (37,876) were screened for HIV infection and 654 (1.7%) had a repeatedly reactive Ag/Ab assay result. On Multispot, 554 (84.7%) were HIV-1 reactive, 0 (0%) were HIV-2 reactive, 1 (0.2%) was reactive for both HIV-1 and HIV-2 (undifferentiated), 9 (1.4%) were HIV-1 indeterminate, and 90 (13.8%) were non-reactive. HIV-1 RNA was detected in 47/90 Multispot non-reactive (52.2%) specimens. Among specimens confirmed to have HIV infection (true positives), Multispot and Western blot detected HIV-1 antibody in a similar proportion of cases (93.7% vs. 94.4% respectively) while Multispot and IFA also detected HIV-1 antibody in a similar proportion of cases (84.5% vs. 83.4% respectively). In this study, Multispot confirmed HIV infections at a similar proportion to Western blot and IFA. Multispot, Western blot, and IFA, however, did not confirm all of the reactive Ag/Ab assay results and underscores the importance of HIV NAT testing to resolve discordant screening and confirmatory results.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 12/2013; 58 Suppl 1:e92-6. · 3.12 Impact Factor
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    ABSTRACT: Background: FDA-approved 4th-generation combination HIV antigen/antibody immunoassays are highly sensitive for recent infection, but they may not diagnose very early HIV infection when only viral RNA is detectable. The Architect (Abbott) 4th-generation assay generates signal-to-cutoff ratios (S/CO) for each specimen tested; S/CO values < 1 are considered non-reactive. We examined pooled HIV RNA nucleic acid amplification testing (pNAAT) results for specimens with 4th-generation S/CO values < 1. Methods: STOP is an on-going, prospective, within-individual study comparing the 4th-generation assay with pNAAT for detection of early HIV infection in participants with negative rapid HIV antibody tests. Sites include sexually transmitted disease clinics and community-based programs in New York City, San Francisco, and North Carolina. All participants have blood drawn for laboratory-based testing by both methods. We examined the proportion of HIV infections detected by pNAAT in 4th-generation non-reactive specimens (S/CO < 1) and calculated the number needed to test with supplemental RNA screening to detect one additional HIV infection for S/CO thresholds ranging from 0 to 0.999. Results: Between September 2011 and January 2013, 52,118 participants had non-reactive (S/CO <1) Architect results. Of these, 19 (0.04%) had HIV infection detected by pNAAT. Overall, 134 (0.26%) specimens from participants had a S/CO values between 0.7 – 0.999 and HIV infection was diagnosed in 6 (4.48%)[Figure]. At S/CO stratifications below 0.7, the percentage of individuals with HIV infection identified by RNA testing ranged from 0% to 0.14%. To detect one additional HIV infection, supplemental RNA testing would be required for 22.3 (95% CI: 10.4, 49.4) 4th-generation non-reactive specimens with a S/CO range of 0.7 - 0.999 and 83.5 (95% CI: 37.9, 185.5) specimens with a S/CO range of 0.5 - 0.999. Conclusion: Detecting very early HIV infections is an essential step to prevent further HIV transmission and 4th-generation S/CO data can guide the use of RNA screening to detect these infections. This strategy would increase the sensitivity of 4th-generation-based HIV testing algorithms for very early HIV infection. Nicholas J. Moss, MD, MPH, Alameda County Public Health Department, Oakland, CA, Charles Rose, PhD, Centers for Disease Control, Atlanta, GA, Cynthia L. Gay, MD, MPH, Medicine, University of North Carolina, Chapel Hill, NC, Laura Hall, MPH, ICF International, Atlanta, GA, Lisa B. Hightow-Weidman, MD, MPH, University of North Carolina, Chapel Hill, Chapel Hill, NC, Benjamin Tsoi, MD, MPH, Bureau of HIV/AIDS Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, Emily Westheimer, MSc, Bureau of STD Prevention and Control, New York City Department of Health and Mental Hygiene, Queens, NY, Philip J. Peters, MD, Centers for Disease Control and Prevention, Atlanta, GA and Mark Pandori, PhD, San Francisco Department of Public Health, San Francisco, CA Disclosures: N. J. Moss, None C. Rose, None C. L. Gay, None L. Hall, None L. B. Hightow-Weidman, None B. Tsoi, None E. Westheimer, None P. J. Peters, None M. Pandori, None
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Background: FDA-approved 4th-generation HIV antigen/antibody immunoassays can detect HIV infection earlier than traditional confirmatory tests (i.e., Western blot). Screening and confirmatory test results (4th-generation reactive / Western blot negative) that are discordant may be misclassified as HIV-negative by clinicians. Use of an algorithm with HIV-1 Nucleic Acid Amplification Testing (NAAT) for confirmation enables proper classification of reactive 4th-generation test results. We report a prospective evaluation of a testing algorithm using HIV-1 NAAT to confirm reactive 4th-generation results. Methods: The STOP study is an ongoing, multi-site study comparing methods to detect acute HIV infection. In New York City, participants at three STD clinics and two community-based testing programs were screened for HIV with a 4th-generation antigen/antibody immunoassay (Architect, Abbott). Specimens with a reactive 4th-generation result were tested with a qualitative HIV-1 NAAT (APTIMA, Gen-Probe), Western blot (WB, Bio-Rad), and a HIV-1/HIV-2 antibody differentiation assay (Multispot, Bio-Rad). Results: From October 3, 2011 to March 11, 2013, we tested 13,931 specimens with the 4th-generation assay, of which 501 (3.6%) were reactive. HIV-1 RNA was detected in 459 (92%) of these specimens by HIV-1 NAAT (Figure 1). Among the 42 specimens with HIV-1 RNA not detected by NAAT, 7 (1.4%) were reactive by both WB and Multispot, consistent with HIV-1 infection. Three of these 7 individuals were determined to have newly diagnosed HIV infection and denied any HIV antiretroviral use, 4 were already aware of their HIV status. Overall, among 466 HIV infections that were diagnosed in this study, HIV-1 infection was confirmed by NAAT in 98.5% of cases (n=459) compared with 93.6% confirmed by Multispot (n=437; p<0.0001) and 95.1% by WB (n=443; p<0.0001), respectively. Conclusion: In an HIV testing algorithm that uses a 4th-generation assay as the screening test, NAAT confirmed a higher proportion of HIV infections than Multispot or WB. Discordant 4th-generation/NAAT results (4th-generation reactive/NAAT not detected), however, must be resolved by Multispot or WB to properly diagnose infections in persons with undetectable levels of HIV RNA.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Cryptococcal meningitis (CM) remains a significant HIV-associated opportunistic infection in Southeast Asia and Africa, with a high burden of disease and a high mortality rate despite the availability of antiretroviral therapy (ART). We retrospectively examined the utility of cryptococcal antigen screening to identify risk for CM among 211 Thai women initiating ART. Antigenemia prevalence was 11% (n = 9) among 84 women with a CD4 count <100 cells/mm(3). Screening identified all women who later developed CM. Cryptococcal antigen titers decreased over time with ART. Our study confirmed findings from previous studies in Thailand and South Africa and provided novel observational data regarding the course of cryptococcal antigenemia in patients initiating ART and the poor efficacy of low-dose fluconazole prophylaxis in preventing CM among patients with antigenemia.
    Journal of the International Association of Providers of AIDS Care. 09/2013;
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    ABSTRACT: Coinfection with HIV and hepatitis B virus (HBV) is common in resource-limited settings but is frequently not diagnosed. The authors retrospectively tested specimens for HBV in HIV-infected Thai women who had participated in an antiretroviral therapy (ART) clinical study. A substantial proportion (27 of 211; 13%) of HIV-infected women were HBV coinfected. Among HIV/HBV-coinfected women, the authors observed similar rates of antiretroviral-associated liver toxicity (despite nevirapine [NVP] use) and CD4 count reconstitution as observed in HIV-monoinfected women. Hepatitis B surface antigen (HBsAg) screening detected the majority (81%) of HBV coinfections, including all 5 HBV-coinfected women who did not suppress HBV despite 48 weeks of lamivudine (3TC)-containing ART and could be used to tailor ART for patients diagnosed with HBV coinfection in accordance with World Health Organization guidelines. Although HBsAg screening did not diagnose 5 occult HBV coinfections, these women achieved HBV suppression on 3TC-containing ART, suggesting that not detecting occult HBV coinfection would have limited clinical impact.
    Journal of the International Association of Providers of AIDS Care. 06/2013;
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    ABSTRACT: Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007-2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%-15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population.
    Emerging Infectious Diseases 04/2013; 19(4):623-9. · 6.79 Impact Factor
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    ABSTRACT: We compared adverse events among breast-feeding neonates born to Kenyan mothers receiving triple-antiretroviral therapy, including either nevirapine or nelfinavir. Nevirapine-exposed infants had an absolute increase in the risk of rash but no significant risk differences for hepatotoxicity or high-risk hyperbilirubinemia compared with nelfinavir-exposed infants. From an infant-safety perspective, nevirapine-based regimens given during pregnancy and breast-feeding are viable options where alternatives to breast milk are not safe, affordable or feasible.
    The Pediatric Infectious Disease Journal 07/2012; 31(11):1155-7. · 3.57 Impact Factor
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    ABSTRACT: A high prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections have been reported among persons with severe mental illness. In October, 2009, the Cook County Department of Public Health (CCDPH) initiated an investigation following notification of a cluster of HBV infections among mentally ill residents at a long term care facility (LTCF). LTCF staff were interviewed and resident medical records were reviewed. Residents were offered testing for HBV, HCV, and HIV. Serum specimens from residents diagnosed with HBV or HIV infection were sent to the Centers for Disease Control and Prevention (CDC) for analysis. Eleven newly diagnosed HBV infections were identified among mentally ill residents at the LTCF. Of these 11 infections, 4 serum specimens were available for complete HBV genome sequencing; all 4 genomes were found to be closely related. Four newly diagnosed HIV infections were identified within this same population. Upon molecular analysis, 2 of 4 HIV sequences from these new infections were found to be nearly identical and formed a tight phylogenetic cluster. HBV and HIV transmission was identified among mentally ill residents of this LTCF. Continued efforts are needed to prevent bloodborne pathogen transmission among mentally ill residents in LTCFs.
    PLoS ONE 01/2012; 7(8):e43252. · 3.53 Impact Factor
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    ABSTRACT: We performed a nested case-control study of Thai women prescribed nevirapine-based antiretroviral therapy (ART) to determine if development of rash or hepatotoxicity during the first 24 weeks of treatment is associated with plasma nevirapine concentrations. From May 2005-January 2007, we enrolled 217 women initiating nevirapine-based ART in Thailand. Cases (n = 54) were women who during the first 24 weeks of treatment with nevirapine developed rash (any grade, n = 42) or hepatotoxicity (≥grade 2, n = 22, [10 had both]). Controls were the next enrolled woman who was confirmed not to meet the case definition during the first 24 weeks. Nevirapine concentrations after the two week lead-in dose of 200 mg once daily were compared between cases and controls by Wilcoxon rank-sum tests. We found no difference in Week 2 pre-dose nevirapine concentrations: cases median = 3,528 ng/mL (n = 24), controls median = 3,150ng/mL (n = 30), p = 0.5. Cases had higher post-dose nevirapine concentrations (median = 6,150 ng/mL, n = 21) than controls (median = 4,746 ng/mL, n = 20, p = 0.02). When limited to cases who developed a rash at Week 2, we found no differences in the pre-dose (median = 3,270 ng/mL, n = 12, p = 0.9) or post-dose nevirapine concentration (median = 5,443 ng/mL, n = 9, p = 0.4) compared with controls. We cannot conclude definitively that nevirapine concentrations at two weeks of therapy are associated with rash or hepatotoxicity. It is unlikely that therapeutic drug monitoring at that time will improve identification of patients at risk for rash or hepatotoxicity.
    The Open AIDS Journal 01/2012; 6:266-73.
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    ABSTRACT: We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swab specimens of 600 HIV-infected outpatients by selective and nonselective direct plating and broth enrichment. Swabs were collected at baseline, 6-month, and 12-month visits and cultured by direct plating to mannitol salt agar (MSA) and CHROMagar MRSA (CM) and overnight broth enrichment with subculture to MSA (broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the Panton-Valentine leukocidin. At each visit, 13 to 15% of patients were colonized with MRSA and 30 to 33% were colonized with methicillin-susceptible S. aureus (MSSA). Broth, CM, and MSA detected 95%, 82%, and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from broth than CM (P ≤ 0.001) or MSA (P ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly when using broth than when using MSA (P ≤ 0.001). Among specimens collected from the groin, broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (P ≤ 0.001) and MSA (P ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal swab specimen culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (P = 0.05).
    Journal of clinical microbiology 12/2011; 49(12):4126-30. · 4.16 Impact Factor
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    ABSTRACT: Background: Influenza occurs frequently among HIV-infected adults but risk factors for severe illness among these patients are not well defined. Methods: We performed a cross-sectional analysis of influenza hospitalizations during three influenza seasons [2007/08; 2008/09; and 2009/10] using SDI's National Medical Claims Database. We evaluated adults (aged 18-64 years) hospitalized with an ICD-9 code for influenza, for whom we abstracted data including demographics, medical conditions, clinical outcomes, select laboratory results, and treatment. We defined HIV infection by the presence of corresponding ICD-9 codes and illness as severe if it required mechanical ventilation, intensive care unit admission, or resulted in death. Results: Among 11,262 adults hospitalized with influenza during three influenza seasons, 410 (3.5%) were HIV-infected. HIV-infected patients comprised a smaller fraction of hospitalized patients during the pandemic 2009/10 season (306/9462; 3.2%) than the prior two non-pandemic seasons (104/2202; 4.7%; p<0.001). HIV-infected and HIV-uninfected patients had similar frequencies of severe illness (19% vs. 21%; p=0.27) and in multivariable models including all patients, HIV infection was not associated with severe illness (adjusted odds ratio [aOR] = 0.9; 95% confidence interval [CI] = 0.7 1.1). In separate multivariable models for HIV-infected and for HIV-uninfected patients, severe illness was associated with chronic medical conditions (aORs = 4.3 [95% CI = 2.2 8.5] and 2.0 [95% CI = 1.8 2.2] respectively) and hospitalization in the South compared with elsewhere (aORs = 2.7 [95% CI = 1.5 4.9] and 1.2 [95% CI = 1.1 1.3] respectively). Overall, 244 (60%) HIV-infected patients received influenza antiviral therapy; that percentage was higher during the pandemic compared with non-pandemic seasons (64% vs. 46%; p=0.002). Forty-two (74%) of 57 patients with available CD4 cell counts had a value >200 cells/mL. Conclusion: HIV infection alone was not associated with a greater risk of severe influenza illness. Having a chronic medical condition and having been hospitalized in the South, however, conferred substantially greater odds of severe illness for HIV-infected compared with HIV-uninfected patients.
    Infectious Diseases Society of America 2011 Annual Meeting; 10/2011
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    ABSTRACT: Background: Few studies have evaluated the risk of nevirapine (NVP)-associated hepatotoxicity among HIV-infected pregnant women with a CD4 count ≥250 cells/mm(3). We enrolled HIV-infected pregnant Kenyan women who initiated triple antiretroviral therapy (ART) at 34 weeks gestation. We compared the rates of severe hepatotoxicity (grades 3-4 hepatotoxicity) and rash-associated hepatotoxicity (rash with ≥grade 2 hepatotoxicity) with NVP and nelfinavir (NFV), respectively. We initiated triple ART in 522 pregnant women; severe hepatotoxicity and rash-associated hepatotoxicity occurred in 14 (3%) and 9 (2%) women, respectively. Women who initiated NVP had higher rates of severe hepatotoxicity (5% vs 1%; P = .03) and rash-associated hepatotoxicity (4% vs 0%; P = .003) when compared with NFV. Among women who initiated NVP (n = 254), a baseline CD4 count ≥250 cells/mm(3) was not associated with severe hepatotoxicity (5% vs 3%; P = .52) or rash-associated hepatotoxicity (4% vs 3%; P = .69). Nevirapine use but not CD4 count ≥250 cells/mm(3) was associated with hepatotoxicity.
    Journal of the International Association of Physicians in AIDS Care (JIAPAC) 10/2011; 11(2):142-9.
  • Anandi N Sheth, Pragna Patel, Philip J Peters
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    ABSTRACT: Influenza is a common respiratory disease in adults, including those infected with HIV. In the spring of 2009, a pandemic influenza A (H1N1) virus (pH1N1) emerged. In this article, we review the existing literature regarding pH1N1 virus infection in HIV-infected adults, which suggests that susceptibility to pH1N1 virus infection and severity of influenza illness are likely not increased in HIV-infected adults without advanced immunosuppression or comorbid conditions. The risk of influenza-related complications, however, may be increased in those with advanced immunosuppression or high-risk comorbid conditions. Prevention and treatment of high-risk comorbid conditions and annual influenza vaccination should continue to be part of HIV clinical care to help prevent influenza illness and complications. Additional information about pH1N1 vaccine immunogenicity and efficacy in HIV-infected patients would be useful to guide strategies to prevent influenza virus infection in this population.
    Current HIV/AIDS Reports 06/2011; 8(3):181-91.
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    ABSTRACT: Early mortality rates after initiating antiretroviral therapy (ART) are high in sub-Saharan Africa. We examined whether serum chemistries at ART initiation predicted mortality among HIV-infected women. From May 2005 to January 2007, we enrolled women initiating ART in a prospective cohort study in Zambia and Kenya. We used Cox proportional hazards models to identify risk factors associated with mortality. Among 661 HIV-infected women, 53 (8%) died during the first year of ART, and tuberculosis was the most common cause of death (32%). Women were more likely to die if they were both hyponatremic (sodium <135 mmol/liter) and hypochloremic (chloride <95 mmol/liter) (37% vs. 6%) or hypoalbuminemic (albumin <34 g/liter, 13% vs. 4%) when initiating ART. A body mass index <18 kg/m(2) [adjusted hazard ratio (aHR) 5.3, 95% confidence interval (CI) 2.6-10.6] and hyponatremia with hypochloremia (aHR 4.5, 95% CI 2.2-9.4) were associated with 1-year mortality after adjusting for country, CD4 cell count, WHO clinical stage, hemoglobin, and albumin. Among women with a CD4 cell count >50 cells/μl, hypoalbuminemia was also a significant predictor of mortality (aHR=3.7, 95% CI 1.4-9.8). Baseline hyponatremia with hypochloremia and hypoalbuminemia predicted mortality in the first year of initiating ART, and these abnormalities might reflect opportunistic infections (e.g., tuberculosis) or advanced HIV disease. Assessment of serum sodium, chloride, and albumin can identify HIV-infected patients at highest risk for mortality who may benefit from more intensive medical management during the first year of ART.
    AIDS research and human retroviruses 03/2011; 27(11):1149-55. · 2.18 Impact Factor
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    ABSTRACT: We describe the clinical findings of HIV-infected patients hospitalized with 2009 pandemic influenza A (pH1N1). Data were derived from 3 separate case series in the United States. Among 911 adults hospitalized with pH1N1 influenza, 31 (3.4%) were HIV infected compared with an HIV prevalence of 0.45% in the general US adult population. HIV-infected influenza patients experienced similar rates of intensive care unit admission (29% vs 34%) and death (13% vs 13%) compared with non-HIV-infected patients. Among HIV-infected patients with available data, 14 (50%) of 28 patients had a CD4 cell count <200 cells/μL, which was not associated with an increased risk of an intensive care unit admission or death. Overall, 25 (81%) HIV-infected patients received influenza antiviral therapy, but treatment was initiated within 48 h of illness onset in only 33% of cases. Clinicians should consider early empiric influenza antiviral treatment in HIV-infected patients presenting with suspected influenza.
    Clinical Infectious Diseases 01/2011; 52 Suppl 1:S183-8. · 9.37 Impact Factor

Publication Stats

281 Citations
96.79 Total Impact Points

Institutions

  • 2007–2013
    • Centers for Disease Control and Prevention
      • • Division of Viral Hepatitis
      • • Division of HIV/AIDS Prevention, Intervention and Support
      Atlanta, MI, United States
  • 2012
    • Mahidol University
      • Department of Preventive and Social Medicine
      Bangkok, Bangkok, Thailand
  • 2006–2011
    • Emory University
      • Division of Infectious Diseases
      Atlanta, GA, United States