Alina Burgi

Naval Medical Center San Diego, San Diego, California, United States

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Publications (3)6.2 Total impact

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    ABSTRACT: Community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) rates have rapidly increased in the general population; however, little data on recent incidence rates and risk factors of CA-MRSA infections among HIV patients appear in the literature. A retrospective study was conducted from 1993 through 2005 among patients at a large HIV clinic. Trends in CA-MRSA infection incidence rates, clinical characteristics and risk factors for CA-MRSA were evaluated. Seven percent of our cohort developed a CA-MRSA infection during the study period. The rate of CA-MRSA infections among HIV-infected population significantly increased since 2003, with an incidence of 40.3 cases/1000 person-years in 2005, which was 18-fold higher than the general population served at our facility. In all, 90% of infections were skin/soft tissue infections with a predilection for buttock or scrotal abscess formation; 21% of patients experienced a recurrent infection. Risk factors included a low CD4 count at the time of infection (odds ratio [OR] per 100 CD4 cells 0.84, P = 0.03), high maximum log(10) HIV viral load (OR 4.54, P<0.001), recent use of beta-lactam antibiotics (OR 6.0 for receipt of two prescriptions, P<0.001) and a history of syphilis (OR 4.55, P = 0.01). No patient receiving trimethoprim-sulfamethoxazole prophylaxis developed a CA-MRSA infection. Over the study period, CA-MRSA accounted for an increasing percentage of positive wound cultures and Staphylococcus aureus isolates, 37% and 65%, respectively, during 2005. In conclusion, CA-MRSA infections have rapidly increased among HIV-infected patients, a group which has a higher rate of these infections than the general population. Risk factors for CA-MRSA among HIV-infected patients include low current CD4 cell count, recent beta-lactam antibiotic use and potentially high-risk sexual activity as demonstrated by a history of syphilis infection.
    International Journal of STD & AIDS 08/2007; 18(8):521-6. · 1.00 Impact Factor
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    ABSTRACT: Before the advent of highly active antiretroviral therapy (HAART), persons infected with HIV typically died of opportunistic infections; malignancies accounted for less than 10% of all deaths. In the pre-HAART era, 3 cancers were classified as AIDS-defining conditions, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer. Since the introduction of HAART, the incidence of Kaposi sarcoma and non-Hodgkin lymphoma has decreased, but certain non-AIDS-defining cancers are occurring at increased rates and accounting for greater numbers of deaths. We review the trends in the incidence and the proportion of deaths due to malignancies among adult HIV-infected persons.
    Infectious Disease in Clinical Practice 08/2006; 14(5):258-265.
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    ABSTRACT: The objective of this study was to determine the rates and predictors of non-AIDS-defining cancers (NADCs) among a cohort of human immunodeficiency virus (HIV)-infected individuals. The authors conducted a retrospective study of 4144 HIV-infected individuals who had 26,916 person-years of follow-up and who had open access to medical care at 1 of the United States military HIV clinics during the years 1988-2003. Cancer incidence rates were race specific and were adjusted for age; these were compared with national rates using logistic regression to assess predictors of NADC development. One hundred thirty-three NADCs were diagnosed with a rate of 980 diagnoses per 100,000 person-years. The most frequent NADCs were skin carcinomas (basal cell and squamous cell), Hodgkin disease, and anal carcinoma. The results showed that there were higher rates of melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease among the HIV-infected cohort compared with age-adjusted rates for the general United States population. Predictors of NADCs included age older than 40 years (odds ratio [OR], 12.2; P < 0.001), Caucasian/non-Hispanic race (OR, 2.1; P < 0.001), longer duration of HIV infection (OR, 1.2; P < 0.001), and a history of opportunistic infection (OR, 2.5; P < 0.001). The use of highly active antiretroviral therapy (HAART) was associated with lower rates of NADCs (OR, 0.21; P < 0.001). A low CD4 nadir or CD4 count at diagnosis (< 200 cells/mL) was not predictive of NADCs. The most frequent NADCs were primary skin malignancies. Melanoma, basal and squamous cell skin carcinomas, anal carcinoma, prostate carcinoma, and Hodgkin disease occurred at higher rates among HIV-infected individuals. The implementation of screening programs for these malignancies should be considered. Most risk factors for the development of NADCs are nonmodifiable; however, the use of HAART appeared to be beneficial in protecting against the development of malignant disease.
    Cancer 11/2005; 104(7):1505-11. · 5.20 Impact Factor