Robert Grossberg

New York State Psychiatric Institute, New York City, New York, United States

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Publications (9)16.52 Total impact

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    ABSTRACT: Background: Due to the increasing incidence of anal cancer in HIV, public health advocates have recommended screening for anal cancer with anal cytology (APAP). However, there is limited information regarding the optimal screening device for APAP. A moistened Dacron swab (DS) has historically been used, though its performance is limited. Extrapolating from cervical Pap devices, a cytobrush (CB) may improve the identification of anal intraepithelial neoplasia and cancer. This prospective study evaluates the performance of a moistened DS and a CB in the same patient. Methods: We recruited 57 HIV-infected and 3 organ transplanted subjects with an abnormal APAP who presented for high resolution anoscopy with biopsy (n=56). After a standard-of-care (SOC) APAP using a DS, each subject underwent a second sampling: 30 subjects with a DS and 30 with a CB. Study pathologists then assigned each sample a cellularity score, diagnosis (Bethesda system), and noted the presence or absence of transformation zone components (TZC) as an indicator of specimen adequacy. Anal biopsies were taken as per SOC and categorized as negative, AIN I/warts, or AINII-III. We recorded clinical characteristics, including those affecting cytology yield. Results: DS and CB had fair agreement of the cellularity index (K=0.3) and TZC (K=0.3). A CB detected a significantly higher number of TZC than the DS (67% vs. 45%, McNemar’s test p=.007). The agreement of APAP results between the two devices was moderate, K=0.58. Histology results are in Table 1. Of eight HSIL APAPs, six were AINII-III and two were negative on biopsy. There is little difference in predictive yield of AIN II-III between DS and CB. Table 1 APAP Histology (n=56) DS Normal (%) AINI/warts (%) AINII-III (%) LSIL (31) 3 (5.3) 9 (16.1) 19 (33.9) HSIL (6) 2 (3.6) 0 (0) 4 (7.1) CB LSIL (34) 4 (7.1) 9 (16.1) 19 (33.9) HSIL (2) 0 (0) 0 (0) 2 (3.6) Total 12(21.4) 18(32.1) 26(46.4) Conclusion: Our results show that a CB is comparable to a DS with regards to cytology yield. APAP using CB yields less cellularity, but improved sample quality when compared to a DB. Pap results of both devices poorly predict accurate histology, as previously reported. Performance of HPV DNA and other molecular markers are currently underway and might provide further guidance as to the optimal sampling device for anal cancer screening.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-ToF MS) is a rapid and accurate method of identifying microorganisms. Throughout Europe, it is already in routine use, but has not yet been widely implemented in the United States pending FDA approval. Here, we describe two medically complex patients at a large, tertiary-care, academic medical center with recurring bacteremias caused by distinct but related species. Bacterial identifications were initially obtained using the VITEK-2 system with GPI Card for Enterococcus and API system for Staphylococci. Initial results mislead clinicians as to the source and proper management of these patients. Retrospective investigation with MALDI-ToF MS clarified the diagnosis by identifying a single microorganism as the pathogen in each case. To our knowledge, this is one of the first reports in the United States demonstrating the use of MALDI-ToF MS to facilitate the clinical diagnosis in patients with recurrent bacteremias of unclear source.
    Journal of clinical microbiology 03/2013; · 4.16 Impact Factor
  • Theo G M Sandfort, Kate L Collier, Robert Grossberg
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    ABSTRACT: Evidence suggests that sexual problems are common among people living with HIV and may be related to sexual risk taking and treatment adherence. This study explored the extent to which sexual problems experienced by people with HIV are addressed in primary care as well as how primary care responses to sexual problems are experienced by patients. Structured interviews were conducted with 60 patients at an urban HIV clinic. The average age of the participants (37 male, 23 female) was 45.8 years (SD = 7.9). Sexual problems were common. The most common sexual problem experienced in the past year was a lack of interest in sex (53.3 % reported) and the least common problem was painful intercourse (reported by 20 %). There were no gender differences in reports of sexual problems, except that painful intercourse was more frequently reported by women than men. Relatively few individuals who experienced sexual problems had discussed them with their provider, but these individuals were generally pleased with the counseling they had received and could identify several factors that facilitated a positive patient-provider interaction. Those who offer primary care services to people with HIV should be aware of sexual problems their patients may be experiencing and should feel confident in their ability to successfully address these problems. Providers may need additional training in order to adequately address sexual problems among people with HIV in primary care settings.
    Archives of Sexual Behavior 09/2012; · 3.53 Impact Factor
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    ABSTRACT: There is no consensus on optimal screening for anal cancer (AC) in HIV+ women. Seven hundred fifteen unique asymptomatic women in a high-prevalence HIV+ community were screened for AC with anal cytology and triage to high-resolution anoscopy after routine screening was implemented in a large urban hospital system. Of these, 75 (10.5%) had an abnormal anal cytology and 29 (38.7%) of those with an abnormality had high-grade anal intraepithelial neoplasia (AIN). Women with poorly controlled HIV were significantly more likely to have high-grade AIN (P = 0.03). Given the high rate of AIN in screened HIV-infected women, routine AC screening in all HIV-infected women should be strongly considered.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 03/2012; 60(2):169-72. · 4.65 Impact Factor
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    ABSTRACT: Aging, HIV infection, and antiretroviral therapy have been associated with increasing rates of chronic comorbidities in patients with HIV. Urban minority populations in particular are affected by both the HIV/AIDS and chronic disease epidemics. Our objectives were to estimate the prevalence of and risk factors for hypertension, dyslipidemia, and diabetes among HIV-infected adults in the Bronx and describe comorbidity-related treatment outcomes. This was a cross-sectional study of 854 HIV-positive adults receiving care at 11 clinics which provide HIV primary care services; clinics were affiliated with a large urban academic medical center. Data on blood pressure (BP), cholesterol, and glycemic control were collected through standardized chart review of outpatient medical records. We found prevalence rates of 26%, 48%, and 13% for hypertension, dyslipidemia, and diabetes, respectively. Older age, obesity, family history, and current protease inhibitor use were consistently associated with comorbidity. Diabetes treatment goals were achieved less often than BP and lipid goals, and concurrent diabetes was a significant predictor for BP and lipid control. In conclusion, major cardiovascular-related comorbidities are prevalent among HIV-positive adults in the Bronx, especially older and obese individuals. Differences exist in comorbidity-related treatment outcomes, especially for patients with concurrent diabetes. Because cardiovascular risk is modifiable, effective treatment of related comorbidities may improve morbidity and mortality in HIV-infected patients.
    Journal of Urban Health 02/2011; 88(3):507-16. · 1.89 Impact Factor
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    C Chu, G Umanski, A Blank, R Grossberg, P A Selwyn
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    ABSTRACT: The HIV-infected population in the USA is expanding as patients survive longer and new infections are identified. In many areas, particularly rural/medically underserved regions, there is a growing shortage of providers with sufficient HIV expertise. HIV services incorporated into community-based (CB), primary care settings may therefore improve the distribution and delivery of HIV treatment. Our objective was to describe/compare patients and treatment outcomes in two settings: a community-located, primary care-based HIV program, and a hospital-based (HB) specialty center. CB providers had on-site access to generalist HIV experts. The hospital center was staffed primarily by infectious disease physicians. This was a retrospective cohort study of 854 HIV-positive adults initiating care between 1/2005 and 12/2007 within an academic medical center network in the Bronx, NY. Treatment outcomes were virologic and immunologic response at 16-32 and 48 weeks, respectively, after combination antiretroviral therapy (cART) initiation. We found that HB subjects presented with a higher prevalence of AIDS (59% vs. 46%, p<0.01) and lower initial CD4 (385 vs. 437, p<0.05) than CB subjects. Among 178 community vs. 237 hospital subjects starting cART, 66% vs. 62% achieved virologic suppression (95% confidence interval (CI) difference -0.14-0.06) and 49% vs. 59% achieved immunologic success, defined as a 100 cell/mm³ increase in CD4 (95% CI difference 0.00-0.19). The multivariate-adjusted likelihoods of achieving viral suppression [OR=1.24 (95% CI 0.69-2.33)] and immunologic success [OR=0.76 (95% CI 0.47-1.21)] were not statistically significant for community vs. hospital subjects. Because this was an observational study, propensity scores were used to address potential selection bias when subjects presented to a particular setting. In conclusion, HIV-infected patients initiate care at CB clinics earlier and with less advanced HIV disease. Treatment outcomes are comparable to those at a HB specialty center, suggesting that HIV care can be delivered effectively in community settings.
    AIDS Care 12/2010; 22(12):1522-9. · 1.60 Impact Factor
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    ABSTRACT: BACKGROUND: Follicular dendritic cell (FDC) sarcoma is an uncommon neoplasm occurring not only in lymph nodes but also in extranodal sites. Because of an increasing number of case reports, awareness of this tumor has grown. The nature of the disease and its relation to other diseases, treatment, prognosis and immunochemistry findings are being actively studied. So far, only a limited number of cytology cases describing the fine needle aspiration (FNA) biopsy findings of FDC sarcoma have been reported. CASE: A 47-year-old man had a history of hypertension and human immunodeficiency virus (HIV) infection treated with antiretroviral therapy. He developed a slowly growing, nontender right neck mass over the course of 3 years. FNA revealed sheets and thick syncytial clusters of bland cells with pale cytoplasm and indistinct cell borders, round to oval nuclei with fine or vesicular chromatin, and small nucleoli. The mass was subsequently excised. A diagnosis of FDC sarcoma was made based on the histologic appearance and the marker studies. Conclusion The diagnosis ofFDC sarcoma in FNA can be suspected if a pathologist is aware of its characteristic features. Research studies have demonstrated the presence of HIV-related FDC hyperplasia. It is likely that HIV infection may have played a role in tumor formation in this patient. (Acta
    Acta cytologica 01/2010; 54(5):707-11. · 0.69 Impact Factor
  • Acta Cytologica - ACTA CYTOL. 01/2010; 54:707-711.
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    ABSTRACT: Background: Community-based HIV services may help reduce health disparities by facilitating earlier diagnosis and treatment of HIV/AIDS. We describe patients and HAART outcomes in our network of academically-affiliated, community-based clinics offering HIV services in the Bronx, NY. Methods: Retrospective cohort study of HIV-positive adults in a large primary care network; data were collected from standardized chart review. Chi-square, t-tests, and multivariate regression were used. Results: 423 HIV-infected adults initiated care from 1/05-12/07. Mean age was 43.7 years, 57% were male, 85.1% African-American or Latino, and 63% acquired HIV sexually. Median duration of known infection was 9 years. 46% presented with AIDS (vs. 59% of patients at our hospital-based specialty center, p < 0.01). Median initial CD4 count was 392 cells/mm3. 22% were recently diagnosed; these patients were 1.8x likelier to present with AIDS (vs. patients with chronic infection [95% CI 1.10-2.88], p = 0.02). Of 178 subjects starting HAART, 66% achieved viral suppression in 16-32 weeks (vs. 62% at the specialty center, p = 0.41). Patients with ≥ 95% HAART adherence were 3.1x likelier to achieve viral suppression (vs. patients with unknown/< 95% adherence [95% CI 2.24-3.95], p < 0.01). Conclusions: This predominantly minority population of HIV-infected patients received effective HIV care in community-based, primary care settings. Although individuals present to community-based clinics (vs. hospital settings) with less advanced disease, patients with recent diagnoses are likelier to present with AIDS. This underscores the need for expanded testing, earlier diagnosis, and HIV-focused services to engage individuals in ongoing care.
    137st APHA Annual Meeting and Exposition 2009; 11/2009