Alina Burgi

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

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Publications (9)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: Background: Depression is common among HIV-infected patients, often requiring antidepressant therapy (ADT). Data suggest higher antiretroviral (ART) adherence rates occur in patients adherent to ADT. The relationship between ADT adherence and HIV virologic response has not been examined. We sought to determine if ADT and ART adherence correlate with virologic response in HIV-infected patients with a mood disorder. Methods: The charts of 543 HIV-infected patients were reviewed for receipt of ART and mood disorder diagnosis. Patients were stratified into three groups: no treatment, treatment with ADT alone, and ADT plus psychotherapy. ART adherence and HIV viral loads (VLs) were compared between the three groups using rank-sum and Pearson correlation tests. Results:161/543 (30%) patients had a mood disorder or were treated with ADT; 8/161 were excluded due to inadequate follow-up. 51% had major depression, 19% dysthymia, and 30% adjustment disorder; mean age was 39.8 years (range 20-68). 79/153 (52%) patients were also receiving ART; of these, 26 were untreated, 34 received ADT alone, and 19 received ADT plus psychotherapy. Adherence to ART was negatively correlated with HIV viral loads in all groups (r=-0.37, p<0.001); adherence to ART was positively correlated with ADT adherence (r=0.31, p<0.02). Virologic responses were significantly better in patients adherent (>80%) to ADT (mean log VL 2.2) compared to those non-adherent (<80%) to ADT (log VL 2.8) (p=0.006) and a trend toward improvement when compared to those untreated (log VL 2.4) (p=0.09). Conclusion: Higher ADT adherence rates yield better adherence to ART. Patients adherent to ADT have better virologic control than those prescribed but non-adherent to such therapy. ADT adherence in HIV-infected patients with comorbid mood disorder is of paramount importance in maintaining virologic response to ART.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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    ABSTRACT: Background: HSV2 influences both HIV transmission and acquisition, but its affect on HIV progression is unclear. We evaluated the impact of HSV2 on HIV progression in a large HIV cohort. Methods: HIV-infected persons were tested for HSV2 using a type specific serologic assay. Demographics, hepatitis serologies, time to antiretroviral medications (CD4 count <350 or 18%), CD4 counts and HIV viral loads (VLs) for 3 years were collected. HIV seroconverters were defined by a negative HIV test within two years of their first positive test. HSV2 seropositive patients were compared to seronegative patients using Fisher’s exact and rank sum tests. Differences in the rate of CD4 and VL changes over time were analyzed. Results: 200 (55%) of 367 HIV patients were HSV2 seropositive. Those with HSV2 were older (p<0.001) and hepatitis B core antibody positive (p=0.004) compared to HSV2 negatives. The baseline CD4 count was not significantly different between those with and without HSV2. However, HSV2 seropositive compared to seronegative patients had a greater decline in CD4 counts from baseline to 1 year (130 CD4 cell difference, p=0.003) and at 3 years (142 CD4 cell difference, p=0.03). VL’s showed a nonsignificant trend toward higher values (0.1 log increase at 1 year, and 0.6 at 3 years) among those with HSV2. 219 (60%) patients were documented HIV seroconverters; similar CD4 and VL changes were noted in this group. The percentage of HSV2 patients requiring HIV medications at <1 year or at 3 years after HIV diagnosis was not significantly different from those without HSV2. Conclusion: HSV2 co-infection results in a greater decline in the CD4 counts during early HIV infection. The clinical significance of this findings is unclear, since the time to initiating ART was not significantly altered.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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    ABSTRACT: Background: HIV-infected men have an increased rate of hypogonadism. There are no data regarding the rate of bone density abnormalities in this group. We evaluated prevalence and predictors of osteopenia/osteoporosis among hypogonadal men with HIV. Methods: All adult HIV-infected men in our clinic (n=450) were offered study enrollment to evaluate for hypogonadism. Each participant had evaluation for early morning testosterone level. Those with hypogonadism were offered bone density testing with DEXA scans. Osteopenia was defined as a T-score -1 to -2.5 SD, and <-2.5 as osteoporosis. Statistical analysis included Fisher’s exact and rank sum tests. Multivariate logistic models were constructed. Results: 300 patients were enrolled; the mean age of 39 years (range 19-72); 15% were greater than 50 years old. Mean duration of HIV was 9 years and mean CD4 count was 522 cells/mm3. Sixty percent were receiving antiretroviral therapy; 35% were on a protease inhibitor. Mean BMI was 26.7 (range 15.6-42.1). Fifty (17%) men were hypogonadal (<300 ng/dl) and 48 (16%) additional patients had borderline testosterone levels (300-400 ng/dl). Nineteen of the hypogonadal men had a DEXA scan; 48% had osteoporosis (32%) or osteopenia (16%). Those with osteopenia/osteoporosis had a lower estradiol level (36 vs. 60 pg/ml)) than those with normal bone density (p=0.03); there were no differences in demographics, CD4 counts, or ART/PI therapy. Conclusion: Osteoporosis and osteopenia are common among HIV-infected men with hypogonadism with a prevalence rate of 50% in our small sample. Low estrogen levels, along with low testosterone levels, are associated with a low bone density as measured by DEXA in this population. HIV-positive patients diagnosed with hypogonadism should be concurrently screened for osteoporosis.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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    ABSTRACT: Background: As HIV-infected patients live longer and may be exposed to potentially nephrotoxic medications, there may be an increasing likelihood of renal dysfunction. We evaluated the prevalence and predictors of renal dysfunction among HIV patients. Methods: We reviewed creatinine values of 303 HIV patients with >38,200 months of follow-up. Creatinine clearance (CrCl) using the Cockroft-Gault formula and MDRD were calculated. CrCl values were compared using T tests; predictors for declining renal function were analyzed using linear regression models. Results: The 303 patients had a mean age of 40.1 years (range 20-70) and a mean duration of HIV of 10.5 years. HIV patients’ mean current CrCl (107.3 ml/min) was lower than the baseline CrCl at time of HIV diagnosis (112.3) (p=0.001), but consistent with the reduction in CrCl in the general population with aging. Predictors of a greater decline in CrCl included increasing age (p=0.002), race (p=0.044), hypertension (p=0.007), and tenofovir use (p=0.009). Years of HIV infection was not predictive. In the multivariate analysis, race, hypertension and tenofovir remained significant. We evaluated CrCl values before and after 2 years of HAART and there were no significant changes (112.7 vs. 112.9 ml/min). There was a significant decline in the CrCl of -9.3 ml/min (112.3 vs. 103.0, p<0.001) during a mean of 2 years of tenofovir use with 16% of patients developing a CrCl<80ml/min and 72% loosing some renal function with tenofovir treatment. Conclusion: Creatinine clearance decreased in HIV patients at a similar rate compared to the general population suggesting that HIV does not significantly increase the rate of renal dysfunction. Modifiable predictors of a greater decline in renal function among HIV patients include hypertension and tenofovir use.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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    ABSTRACT: Background: Syphilis may increase HIV transmission and acquisition rates, but whether syphilis affects HIV progression is unclear. We evaluated the epidemiology of syphilis in a large HIV clinic and describe the effects of syphilis on HIV viral loads (VLs) and CD4 counts. Methods: We identified all HIV patients with syphilis in our clinic and recorded CD4 counts and VLs every 3 months for 18 months before and after the diagnosis of syphilis. VLs and CD4 counts before, at, and after syphilis diagnosis were compared using Wilcoxin signed-rank test. Results: Among 431 HIV patients, 56 (13%) had a history of syphilis. Of these, 9 (16%) were diagnosed concurrently with HIV infection and 30 (54%) after HIV diagnosis. The stage was primary in 60%, secondary in 28%, and tertiary 13%. There were no associations between syphilis stage and CD4 count. Patients with syphilis had a mean age of 34 years; 38% were black and 34% white; 74% were hepatitis B core positive, and 67% were HSV2 positive. There were three cases of TP (Treponema pallidum ELISA) positive, RPR negative confirmed syphilis. CD4 counts at syphilis diagnosis were significantly lower than before diagnosis (396 vs. 536 cells/mm3, p<0.001). CD4 counts after diagnosis of syphilis increased, but were still lower than before the diagnosis of syphilis (437 vs. 536 cells/mm3, p=0.01). There were no significant changes in the HIV VL. Conclusion: Syphilis infections among HIV-infected patients are common. Patients who develop syphilis experience a decrease in their CD4 counts at the time of syphilis diagnosis that does not completely recover even after 18 months of follow-up.
    Infectious Diseases Society of America 2006 Annual Meeting; 10/2006
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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
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    ABSTRACT: Background: Malignancies such as Kaposi’s sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer are known to occur at higher rates among HIV-infected persons, but whether non-AIDS-defining cancers (NADC) are more common in those with HIV-infection remains an open question. Methods: We conducted a retrospective study among participants enrolled in the U.S. Military HIV Natural History Study (1988-2003). Data collected included demographics, year of HIV infection, use of high-active antiretroviral therapy (HAART), history of opportunistic infections, CD4 counts, HIV viral load, and cancer diagnoses. Descriptive statistics were performed; univariate and multivariate analyses were conducted using logistic regression with evaluation for confounding (SAS 8e software). P-values were two-sided with a value <0.05 as statistically significant. Results: One hundred thirty-five (3.3%) of 4,145 subjects developed NADC. The mean time of cancer was 5 years after the diagnosis of HIV. The most common cancers involved the skin (n=68, 50%) and included basal cell cancer, squamous cell cancer, and melanoma. Rates for anal cancer, Hodgkin’s disease, prostate cancer, and melanoma were significantly higher among HIV patients than the national rates. In the multivariate model, age >40 years (OR 16.3, p<0.001), white/non-Hispanic (OR 2.0, p=0.02), HIV viral load >75,000 (OR 2.8, p=0.01), and years of HIV infection (OR 1.3, p<0.001) were associated with the development of NADC; antiretroviral therapy (OR 0.3, p<0.001) was negatively associated with cancer. Conclusion: Several non-AIDS-defining cancers occur at higher rates among HIV-infected persons. Risk factors for cancer development include age, white race, high HIV viral load, and duration of HIV infection. HAART appears to be protective. Serial screening for NADC, especially skin cancers, should be considered among HIV-infected persons.
    Infectious Diseases Society of America 2004 Annual Meeting; 10/2004