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ABSTRACT: The increased risk of anal cancer among individuals living with HIV suggests that anal health (e.g., anal symptoms, anal practices, examination of the anus) should be an issue of priority for HIV care providers to discuss with their HIV-infected patients. We investigated the prevalence of HIV-infected individuals discussing anal health with their HIV primary care provider and factors associated with this discussion. We surveyed 518 adult patients from 5 HIV primary care clinics in Miami, Florida, from May 2004 to May 2005. Overall, only 22% of women, 32% of heterosexual men, and 54% of men who have sex with men (MSM) reported discussing anal health with their HIV providers in the prior 12 months. In a multivariable logistic regression, when adjusting for other factors, heterosexual men and MSM were 2.31 and 5.56 times, respectively, more likely to discuss anal health with their HIV providers compared to their women counterparts. Other factors associated with anal health discussion were the patients' better perception of engagement with HIV providers and having had a sexually transmitted disease exam in the past 12 months. Reporting of unprotected sex with HIV-negative or unknown HIV status was inversely related to discussion of anal health with primary care providers (odds ratio [OR] = 0.53). Efforts are greatly needed to increase the focus on anal health in the HIV primary care setting for both men and women.
AIDS patient care and STDs 09/2010; 24(9):533-8. · 2.68 Impact Factor
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ABSTRACT: Establishing a diagnosis of primary HIV infection (PHI) is important for both the affected individual and public health, because the newly infected individual might readily transmit HIV to others. Unfortunately, diagnosing PHI is hindered by its non-specific presentation, among other factors. We report the case of a patient with extensive multiple organ involvement (fever, rhabdomyolysis, myocarditis, pancreatitis, bilateral renal infarcts, acute renal failure and anemia) in the setting of documented HIV seroconversion as an unusual form of PHI.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2008; 13(4):e177-80. · 2.17 Impact Factor
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Scandinavian Journal of Infectious Diseases 02/2007; 39(6-7):634-6. · 1.72 Impact Factor
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ABSTRACT: We investigated physicians' delivery of HIV prevention counseling to newly diagnosed and established HIV-positive patients.
A questionnaire was developed and mailed to 417 HIV physicians in 4 US cities.
Overall, rates of counseling on the part of physicians were low. Physicians reported counseling newly diagnosed patients more than established patients. Factors associated with increased counseling included having sufficient time with patients and familiarity with treatment guidelines. Physicians who perceived their patients to have mental health and substance abuse problems, who served more male patients, and who were infectious disease specialists were less likely to counsel patients.
Intervention strategies with physicians should be developed to overcome barriers to providing counseling to HIV-positive patients.
American Journal of Public Health 08/2004; 94(7):1186-92. · 3.93 Impact Factor
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ABSTRACT: Pulmonary nocardiosis is an uncommon but serious infection that is increasingly found in immunosuppressed persons, especially transplant recipients and persons with AIDS. The Nocardia species are denizens of soil and decaying plants that gain entry to humans through inhalation or inoculation. Pulmonary nocardiosis typically presents as an acute to subacute necrotizing pneumonia, with a variable clinical picture. Metastatic infections of the brain and subcutaneous tissues are common complications. Most clinical laboratories can isolate these microorganisms, but final speciation may be a challenge and antimicrobial susceptibility testing is especially difficult because of the slow rate of growth of Nocardia species. Full identification of species and susceptibility testing is important because of the epidemiologic implications and the difficulties of successfully treating these infections in immunosuppressed patients. Sulfonamides, including trimethoprim-sulfamethoxazole, remain the most reliable antimicrobials. Many alternative agents are active against Nocardia in vitro, but clinical data are limited.
Current Infectious Disease Reports 07/2001; 3(3):286-292.
