Anne K Monroe's research while affiliated with George Washington University and other places
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Publications (70)
People with HIV (PWH) have a high burden of medical comorbidities, potentially putting them at increased risk for severe COVID-19. Additionally, during the COVID-19 pandemic, HIV care delivery has been restructured and the impact on HIV outcomes is unknown. The objectives of this study were first, to examine the risk of severe COVID-19 among PWH, u...
Background
Washington, DC, and sub-Saharan Africa are both affected by generalized HIV epidemics. However, care for persons living with HIV (PLWH) and clinical outcomes may differ in these geographically and culturally diverse areas. We compared patient and clinical site characteristics among adult persons living with HIV (PLWH) enrolled in two lon...
This study explored virological outcomes of two-drug (2DRs) and three-drug (3DRs) antiretroviral regimens in adults with HIV in the DC Cohort. We analyzed 310 treatment-experienced adults with sustained HIV RNA ≤50 copies/mL at baseline, 53 of whom switched to 2DRs and 257 continued 3DRs. Adults on 2DRs and 3DRs had similar demographics (median age...
Background:
The Undetectable = Untransmittable (U = U) campaign advances the goal of ending the HIV epidemic by promoting durable viral suppression and therefore reducing sexual transmission. We used geospatial analysis to assess the potential for sexual HIV transmission by ZIP code of residence in the District of Columbia (DC) using data from the...
In Washington, DC, 2% of residents are living with HIV, with 15.3% of them experiencing homelessness. Additionally, over half of DC-area renters are paying over 30% of their income for housing. The primary objective of this study was to describe HIV outcomes at initial intake at Housing Counseling Services (HCS). This retrospective study included a...
In Reply We thank Terlizzi et al for their comments on our cohort study¹ and insightful review of the current literature, which highlights the importance of anal dysplasia screening in high-risk individuals and the subsequent treatment of high-grade lesions to prevent the progression to anal cancer. We agree with their impassioned call to begin scr...
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1...
Integrase inhibitors (INSTIs) are recommended by expert panels as initial therapy for people with HIV. Because there can be disparities in prescribing and uptake of novel and/or recommended therapies, this analysis assessed potential INSTI prescribing disparities using a combined dataset from the Johns Hopkins HIV Clinical Cohort and the DC Cohort....
We conducted a retrospective analysis of 38 children and youth with HIV (aged 0-<20 years) in the United States and report an increased rate of change of BMI-for-age z-score after initiating integrase strand transfer inhibitors (+0.19 z-score units/year, 95% CI 0.01, 0.37, p=0.036) for a median follow-up of 527.5 days.
Substance use disorders (SUDs) are common among people with HIV and can prevent achievement of optimal health outcomes. Using data from a longitudinal HIV cohort study in the District of Columbia (2011–2018), we calculated the prevalence and correlates of SUD (alcohol, stimulant, and/or opioid use disorders) and determined the association of SUD wi...
The process of recruiting racial and ethnic minority persons living with HIV (PLWH) is important for research studies to ensure inclusivity of underrepresented groups. To understand factors associated with recruitment of minority PLWH, this study examined the recruitment process of PLWH for an observational study of their routine medical care at 14...
In this era of effective combination antiretroviral therapy the incidence of AIDS defining cancers (ADCs) is projected to decline while the incidence of certain non-AIDS defining cancers (NADCs) increases. Some of these NADCs are potentially preventable with appropriate cancer screening. We examined cancer incidence, screening eligibility, and rece...
Importance
In the US, incidence of and mortality due to anal carcinoma are rising faster than for most other cancers. Identifying populations who have a higher risk of developing anal cancers is critical to target preventive interventions.
Objective
To assess the risk of developing anal carcinoma in adults living with HIV who have a history of ano...
Introduction: People living with HIV (PLWH) with hypertension (HTN) have a higher risk of cardiovascular events and all-cause mortality compared with PLWH with normal blood pressure (BP) and HIV-uninfected adults with HTN. The prevalence and control of HTN among PLWH have not been widely studied since the release of newer 2017 ACC/AHA guidelines (n...
With more effective antiretroviral therapy (ART), people with HIV (PWH) are living longer and have more chronic diseases, including diabetes mellitus (DM). The prevalence of DM has been estimated in PWH previously, however there is less research regarding DM control. Our objectives were to determine the prevalence of DM and DM control and determine...
Background:
Optimal management of non-communicable diseases, including Diabetes Mellitus (DM), is crucially important as people with HIV (PWH) live longer with antiretroviral therapy (ART). Our objective was to assess patient-and clinic-level factors associated with achieving a hemoglobin A1c (HbA1c) ≤7.0% among PWH and DM.
Setting:
The DC Cohor...
Background:
Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type.
Methods:
We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) vers...
Background:
Direct oral anticoagulants (DOACs) have become first-line treatment for venous thrombotic events. DOAC prescribing trends among people with HIV (PWH) are not well described. Co-administration of DOACs with the antiretroviral (ARV) pharmacokinetic boosters ritonavir (RTV) or cobicistat (COBI) may be complicated by pharmacokinetic intera...
Background:
Data on integrase strand transfer inhibitor (INSTI) use in children, adolescents and young adults with HIV are limited. We evaluated virologic and safety outcomes following INSTI initiation among treatment-experienced children, adolescents and young adults.
Methods:
The DC Cohort is a multicenter observational study of individuals re...
Background: Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus...
Objective
A rise in incidence of STIs has been noted in the USA and in the District of Columbia (DC). We aim to describe changes in incident STIs among persons in care for HIV in Washington, DC as well as trends in HIV viral load among those with incident STIs.
Methods
We conducted a retrospective DC Cohort analysis (n=7810) measuring STI incidenc...
Background:
Using the results of a site assessment survey performed at clinics throughout Washington DC, we studied the impact of clinic-level factors on antiretroviral therapy (ART) initiation and viral suppression (VS) among people living with HIV (PLWH).
Methods:
This was a retrospective analysis from the DC Cohort, an observational clinical...
Background
Among persons living with HIV (PLWH) with type 2 diabetes mellitus (DM) there is limited research on the effect of DM control on CD4 count. Current guidelines recommend that PLWH with DM maintain a hemoglobin A1c (HbA1c) <7%. This analysis examined the impact of HbA1c on trends in CD4 count among PLWH receiving care in Washington, DC.
M...
Background
Agents from the integrase inhibitor (INSTI) therapeutic class only are recommended as initial therapy for most patients with HIV. Clinicians now face a decision when treating ART-experienced patients on non-INSTI regimens: continue current therapy or switch to INSTI. Multiple factors may be considered in this decision: clinician/patient...
Background
In 2019, the US Administration announced the Ending the HIV Epidemic plan to decrease new infections. A key component is the Test and Treat plan to diagnose early, treat rapidly and achieve viral suppression (VS) among persons living with HIV (PLWH). We assessed retention in care (RIC), antiretroviral therapy (ART) initiation and VS amon...
Objective:
To evaluate associations of mood, anxiety, stress-/trauma-related, and psychotic disorders, both treated and untreated, with duration of unsuppressed HIV viral load (VL) among persons living with HIV (PLWH).
Setting:
The DC Cohort, an observational clinical cohort of PLWH followed from 2011-2018 at 14 sites in Washington, DC.
Methods...
Background: Despite near-universal access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus pu...
Background: Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus...
Background: Despite widely available access to HIV care in Washington, DC, inequities in HIV outcomes persist. We hypothesized that laboratory monitoring and virologic outcomes would not differ significantly based on insurance type. Methods: We compared HIV monitoring with outcomes among people with HIV (PWH) with private (commercial payer) versus...
Ancillary service needs likely influence time to diagnosis and presentation for HIV care. The effect of both met and unmet needs on late presentation to HIV care is not well understood. We used baseline data from 348 people with HIV (PWH) with no prior HIV care who enrolled in iENGAGE (a randomized controlled trial (RCT) of an intervention to suppo...
Background:
Inadequate identification and treatment of substance use (SU) and mental health (MH) disorders hinders retention in HIV care. The objective of this study was to elicit stakeholder input on integration of SU/MH screening using computer-assisted patient-reported outcomes (PROs) into clinical practice.
Methods:
We conducted semi-structu...
Background:
Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associatio...
IntroductionGaps in Medicaid enrollment may affect HIV outcomes. We evaluated factors associated with Medicaid enrollment gaps and their effect on viral suppression (VS) within the HIV Research Network (HIVRN).Methods
We used a combined dataset with Medicaid enrollment files from 2006-10 and HIVRN demographic and clinical data. A gap was defined as...
Background:
Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals.
Setting:
We analyzed clinical and demographic data from the HIV Research Network (HIVRN) and prescribing data from Medicaid for non-cancer patients seeking HIV tr...
Background
Many individuals with HIV in the USA are unaware of their diagnosis, and therefore cannot be engaged in treatment services, have worse clinical outcomes and are more likely to transmit HIV to others. Mobile van testing may increase HIV testing and diagnosis. Our objective was to characterise risk factors for HIV seroconversion among indi...
Background
While marijuana use is prevalent among persons with HIV (PWH), few studies have examined the relationship between marijuana use and HIV treatment outcomes independent of alcohol and other drug use.
Methods
We conducted a prospective cohort study to examine the relationships between frequency of marijuana use and antiretroviral therapy (...
As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/o...
Heavy alcohol use has adverse effects in women with HIV. We examined the association between changes in alcohol use (measured with Timeline Followback) and changes in antiretroviral therapy adherence (medication possession ratio) and viral suppression (HIV RNA), measured over 6-month intervals. Among women who were (1) non-adherent or not virologic...
Objectives:
Annual screening for gonorrhea (NG) and chlamydia (CT) is recommended for all sexually-active persons living with HIV (PLWH) but is poorly implemented. Studies demonstrating no increases in NG and/or CT (NG/CT) case detection in clinics that successfully expanded NG/CT screening raise questions about this broad screening approach. We e...
Background:
Some individuals who appear poorly retained by clinic visit-based retention measures are using antiretroviral therapy (ART) and maintaining viral suppression. We examined whether individuals with a gap in HIV primary care (≥180 days between HIV outpatient clinic visits) obtained ART during that gap after 180 days.
Setting:
HIV Resear...
Background
Indigenous populations in Latin America have worse health outcomes than their nonindigenous counterparts. Differences in access to and use of biomedical resources may explain some of the observed disparities. Efforts to address these differences could be aided in part by better understanding the socio-medical contexts in which they occur...
Objectives:
HIV-associated neurocognitive disorders are highly prevalent, and physical activity (PA) is a modifiable behaviour that may affect neurocognitive function. Our objective was to determine the association between PA and neurocognitive function and the effect of HIV on this association.
Methods:
PA was assessed in the Multicenter AIDS C...
Background:
Poor retention in HIV care is associated with worse clinical outcomes and increased HIV transmission. We examined the relationship between self-reported alcohol use, a potentially modifiable behavior, and retention.
Methods:
9,694 people living with HIV (PLWH) from 7 participating U.S. HIV clinical sites (the CFAR Network of Integrat...
Objective:
To study cardiovascular disease risk score utility, we compared the association between Framingham Risk Score (FRS)/pooled cohort equation (PCE) categories and coronary artery plaque presence by HIV serostatus and evaluated whether D : A : D risk category more accurately identifies plaque in HIV-infected men.
Design:
Cross-sectional a...
Background
Persons living with HIV (PLWH) and substance use/misuse experience significant barriers to engagement in HIV care at every step of the HIV care continuum including: (1) HIV testing and diagnosis (2) linkage to clinical care (3) retention in care pre-antiretroviral therapy (ART) (4) ART initiation and adherence (5) viral suppression. We q...
Background:
Costs of care for persons living with HIV (PLWH) have been high historically. Cost estimates based on data from one health care site may underestimate total expenditures; using insurance claims avoids this limitation. We used Medicaid claims data to comprehensively assess payments for care for PLWH between 2006 and 2010.
Methods:
Fiv...
Background:
Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unk...
The association between physical activity (PA), degree of insulin resistance (IR), and HIV infection is unclear. We hypothesized that PA might differentially affect the degree of IR through the direct and indirect influences of HIV, antiretroviral medications, and sociodemographic characteristics. The International Physical Activity Questionnaire (...
Despite increasing numbers in academic medicine, women remain underrepresented in top leadership positions. The objectives of this study were to characterize leadership positions held by department of medicine (DOM) faculty at all ranks at one Academic Health Center and to compare leadership positions held by male and female faculty.
This was a cro...
Abstract Objectives: Treating cardiovascular disease (CVD) risk factors, including dyslipidemia, is important in HIV care. Low density lipoprotein cholesterol (LDL-c) target achievement is a readily available benchmark for dyslipidemia control, although use of this target is not uniformly endorsed by professional societies. We examined whether HIV...
Diabetes mellitus (DM) is a common condition with significant associated morbidity and mortality. DM diagnosis and management
among human immunodeficiency virus (HIV)-infected patients is a particularly relevant topic as the HIV-infected population
ages and more HIV-infected individuals live with chronic medical comorbidities. Although there is mix...
To the Editor—We read with interest the updated human immunodeficiency virus (HIV) primary care guidelines by Aberg et al in Clinical Infectious Diseases on 1 January 2014 [1] and would like to bring an additional comment to readers' attention.
We agree with the authors that the preferred initial assay for hypogonadism diagnosis in HIV-infected me...
ABSTRACT Purpose: To describe a case of Rosai-Dorfman-associated sclerouveitis in an HIV-infected patient. Design: Case report. Methods: A 49-year-old man with HIV had bilateral eye pain, redness, photophobia, and multiple systemic complaints. He underwent serial ocular examinations, abdomen/pelvis CT scan, and lymph node biopsy. Results: Ophthalmo...
Some patients do not tolerate or respond to high-intensity statin monotherapy. Lower-intensity statin combined with nonstatin medication may be an alternative, but the benefits and risks compared with those of higher-intensity statin monotherapy are unclear.
To compare the clinical benefits, adherence, and harms of lower-intensity statin combinatio...
Hypogonadism is common among HIV-infected men, even among men receiving antiretroviral therapy (ART). Our objective in this study was to determine the prevalence of biochemical hypogonadism among HIV-infected men compared with HIV-uninfected controls. We also examined the use of free testosterone (FT) and total testosterone (TT) measurements in the...
People with HIV are living longer with potent antiretroviral therapy (ART), and HIV is increasingly complicated by other chronic medical comorbidities. The objective of this study was to explore HIV-positive patients' perspectives on living with HIV and diabetes mellitus (DM) or hypertension (HTN) and factors affecting medication adherence.
We cond...
To review recent data concerning the relationship between endogenous testosterone and lipids as well as testosterone replacement therapy and lipids. To describe the effects of sex hormones on cardiovascular disease (CVD) that may act via serum lipids.
Low endogenous testosterone is associated with high low-density lipoprotein and low high-density l...
Low testosterone (T) has been associated with insulin resistance and diabetes mellitus (DM) among men in population-based studies. These studies included racially diverse men, but did not target for inclusion individuals with opiate use, Hepatitis C Virus (HCV) infection, or Human Immunodeficiency Virus (HIV) infection, which disproportionately aff...
Low testosterone (T) is associated with cardiovascular disease (CVD) and increased mortality in the general population; however, the impact of T on subclinical CVD in HIV disease is unknown. This study examined the relationships among free testosterone (FT), subclinical CVD, and HIV disease.
This was a cross-sectional analysis in 322 HIV-uninfected...
With improved combination antiretroviral therapy-related survival, diabetes and hypertension increasingly contribute to morbidity and mortality among individuals with HIV. However, there is limited data on diabetes and blood pressure control in this population. We examined whether virologic control is associated with control of diabetes and hyperte...
To examine the relationship of free testosterone (FT) and sex hormone-binding globulin (SHBG) with insulin resistance and diabetes mellitus (DM) in HIV disease.
Cross-sectional analysis from 322 HIV-uninfected and 534 HIV-infected men in the Multicenter AIDS Cohort Study.
: The main outcomes were DM and homeostasis model assessment-insulin resistan...
Citations
... Studies conducted in Europe 20 , China 15,21 , Kenya 22 , and South Africa 23 have reported that female PLWH have a lower risk of mortality than male PLWH. This is possibly because of women's better adherence to ART 15,21 , lower rate of substance use 24 , or more favorable immune response to combined ART (cART) 25 . Therefore, a lower proportion of HIV acquisition through injecting drugs in women may explain potential differences in mortality between transmission categories 26,27 . ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/921923877867521-1596815189321_Q64/Matthew-Levy-6.jpg)
... The odds of developing anal carcinoma were 12.79 (95% CI 6.19-26.45; P < 0.001) times higher in individuals with a history of anogenital warts compared with individuals without a history of anogenital warts [51]. ...
Reference: Asian guidelines for condyloma acuminatum
... 19,23,[26][27][28][29] To complicate this, there are also data to support there being no statistically significant differences that occur between age and glycaemia. 17,18,21,22,[30][31][32] In developed countries, we found that in the 'older has worse glycaemia category' vs. 'older has improved glycaemia category' vs. 'non-significant category', there were two, two and four studies, respectively. In LMIC, there were three studies in each of the categories. ...
... In particular, women living with HIV (human immunodeficiency virus) (WLH) are disproportionately affected by ICC. Compared to women without HIV, WLH have a fourfold excess risk of developing dysplasia largely due to immunosuppression caused by their HIV status [3] and are more likely to have persistent HPV infection with increased progression to high-grade cervical intraepithelial neoplasia and ICC [2,[4][5][6]. ...
... Multi-level analyses using census tracts and states as levels or the inclusion of random effects in the statistical modelling might help mitigate some of this problem. Although, a recent study found that among PWDH in Washington D.C., those privately insured had greater durable viral suppression than those publicly insured, pointing out the need for more research to further examine HIV quality of care in association with Medicaid expansion [32]. Longitudinal analyses examining HIV viral suppression in relation to the timing of Medicaid expansion implementation across states may provide additional evidence for the impact of this policy on achieving the EHE goals. ...
... (v) Several studies assessed the benefits of DOAC administration in PWH. A longitudinal cohort study assessed DOAC safety among PWH who were undergoing ART (165) and concluded that there were similar effects compared to those taking warfarin, i.e., that these patients should be monitored as drug-drug interactions are likely, especially when DOACs are coadministered with protease inhibitors. This can lead to an increased risk of bleeding. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/903084603633667-1592323556598_Q64/Jomy-George-4.jpg)
... 31 Patients with high baseline viral load (≥1000 copies/mL) were reported to be less likely to achieve virological suppression with INSTI-based ART. 32 A recent study in Tanzania showed DTG-based regimens are still effective among treatment-experienced patients who had high viral load when using NNRTI regimens in Tanzania. 33 On 48 weeks follow-up, 5.7% of patients had rebound viremia. ...
... To achieve the new goals of "DC Ends HIV" in the District of Columbia, enhanced and timely prevention, rapid testing, and partner treatment for HIV and STIs are necessary [8]. Previously, we described significant yearly increases in STI incidence rates observed across all adult age groups in the DC Cohort [12,23]. Identifying geographically specific information regarding STIs and potential for HIV transmission allows for expansion of resources on treatment and prevention of HIV, including outreach for U = U, PrEP, and STI prevention campaigns. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/776677705670656-1562185803168_Q64/Hana-Akselrod.jpg)