Kerianne Burke’s research while affiliated with University of Illinois Chicago and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (9)


1466. Antiretroviral (ART) Virologic Suppression (VS) and Patient Reported Outcomes (PROs) at 6 Months in the Clinical Opportunities and Management to Exploit Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) an Asynchronous Connection Key (COMEBACK) Study
  • Article
  • Full-text available

December 2022

·

47 Reads

·

1 Citation

Open Forum Infectious Diseases

Lindsey Roden

·

Gregory Huhn

·

Camille E DeMarco

·

[...]

·

Kerianne Burke

Background Effectively interrupting the source of transmission is a critical step in ending the HIV epidemic. COMEBACK (NCT04519970) is a 48-week single-center study in Chicago implemented in September 2020, with its main objectives to reengage lost-to-care patients and rapidly reinitiate ART to promote VS and favorable PROs. Methods Adults off ART ≥2 weeks, without history of significant B/F/TAF resistance or renal impairment, were rapidly started on B/F/TAF upon reengagement after same day collection of baseline labs and PROs. A retention screening assessment was used to stratify participants into case management (CM) tiers: Minimal, Moderate, or Advanced. An acuity assessment tool was adapted to determine whether participants needed additional support based on retention and VS. Currently, 80 of the expected 100 subjects are enrolled and 55 have reached the 24-week timepoint. Baseline and 6-month endpoints were analyzed for these participants. Results At baseline (N=55), median age was 34 years (range, 24–62), with 92.6% Black and 72.2% cisgender male. Median CD4+ was 338 cells/mm3, with a median viral load 7,402copies/mL, (range, < 40–333,350, 16.3% VS). Median time off ART was 2.6 months (range, 0.5-243). For CM, participants were stratified into Minimal (71%) and Moderate (29%) tiers; none were identified as Advanced. Table 1 reflects tier shifts through 24 weeks. Shifts in CM intensity differs from the HIV adherence self-efficacy PRO completed within 24 weeks, indicating that at least 50% underestimated their need to integrate and maintain adherence to ART treatment. Forty of 55 participants (72.7%) were retained-in-care at 6 months, with VS in 61.8% (N=34/55) by intention-to-treat and 85% (N=34/40) by observed analysis. No resistance to B/F/TAF was detected through 6 months. Note: The table reflects patients retained on study at their week 24 endpoint. Conclusion VS was high for participants retained-in-care, but lapses in retention and shifts toward more intense CM were likely due to social determinants of health challenges, including incarceration, housing insecurity, and COVID-19-related disruptions in healthcare. Disclosures Gregory Huhn, MD, MPHTM, Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Jannsen: Advisor/Consultant|Jannsen: Grant/Research Support|Merck: Advisor/Consultant|Viiv: Advisor/Consultant|Viiv: Grant/Research Support.

Download

Steatosis Rates by Liver Biopsy and Transient Elastography Controlled Attenuated Parameter (CAP) in Clinical Experience of Hepatitis C (HCV) and HIV/HCV Coinfection in a Large U.S. Hepatitis Clinic

March 2019

·

25 Reads

·

16 Citations

Open Forum Infectious Diseases

Background Steatosis contributes to liver fibrosis in HCV and HIV/HCV coinfection. Liver biopsy (LB) is the gold standard for grading steatosis and staging fibrosis, yet recent advances in noninvasive modalities have largely supplanted LB, which may limit recognition of steatosis. We evaluated steatosis rates by LB and transient elastography (TE) with controlled attenuated parameter (CAP) among HCV and HIV/HCV patients in a U.S. clinic. Methods Patients with chronic HCV during pretreatment evaluation by LB (N=421, December 2001 – May 2014) and TE with CAP (N=1157, May 2016 – May 2017) were included. Fibrosis and steatosis rates by LB and TE with CAP were stratified by HCV versus HIV/HCV coinfection status. Results Steatosis was not reported in 26.4% of LB. Significant steatosis rates (>S2) were more often detected by CAP than by LB (24.0% versus 11.4%). Median CAP scores were higher in HCV monoinfection versus coinfection (230 vs 215.5, p=0.0001). Higher rates of advanced fibrosis (F3-F4) were seen in HCV monoinfection versus coinfection by TE (25.9% v 14.8%, p=0.0002). In LB and TE, advanced fibrosis (F3-F4) in HCV monoinfection was associated with moderate-severe steatosis (S2-S3) compared to coinfection (p=0.0028 and p=0.0083, respectively). Conclusions In patients with chronic hepatitis C undergoing liver fibrosis staging we identified steatosis rates that were more often detected in the modern HCV treatment era when measured by CAP than by LB, with higher median CAP scores in HCV monoinfection in comparison to HIV/HCV coinfection. Steatosis severity may be increasing in the modern HCV treatment era.


Figure 1: (a-c) Ten year CVD risk models across infection group based on model specific definitions of risk cutoff. D:A:D distribution extrapolated from 5-year risk score assuming constant risk over 10 years for ease of comparison.
2252. Predictors of Cardiovascular Outcomes in Older HIV-Infected Patients: CORE50 Cohort 10-Year Follow-up

November 2018

·

24 Reads

Open Forum Infectious Diseases

Background Cardiovascular (CV) disease is increasingly recognized in HIV+ patients. Currently there are limited data on older HIV+ patients in regards to CV outcomes. The CORE50 study was a cross-sectional study of 121 HIV+ patients ≥ 50 years (83% African American) recruited 2005–2006 at the CORE Center. The goal of this study was to identify predictors of CV outcomes and the impact of the Framingham cardiac risk at baseline on CV outcomes and mortality >10 years later. Methods Retrospective chart review was conducted in 2018 to evaluate HAART therapy, CD4, viral suppression, HCV coinfection or treatment history, comorbid conditions, BMI, renal function and current medications. Patients were evaluated for CV events (defined as myocardial infarction, cerebrovascular events, transient ischemic attacks and peripheral artery disease). Results At follow-up, 60 (49%) patients with a mean age of 65 years remained in care at CORE. Mean CD4 count was 529 cells/mm³ and 82% had undetectable HIVRNA. 22 patients had died (18%), 10(8%) had transferred care and 29(24%) lost to follow-up. The mean age at death was 61 years. The causes of death were CV (18.2%), cancer (36.4%), infection (18.5%) and other (27.2%; organ failure/overdose/unknown). On Univariate analysis, Framingham cardiac risk (FCR) of >10% at baseline (2005/2006) was associated with increased CV events (P = 0.05). FCR >20% was associated with increased death (P = 0.01). Smoking at baseline and follow-up were associated with increased CV events (P = 0.05 and P = 0.035, respectively). Evaluation of medication regimen showed history of protease inhibitor use or current use of integrase inhibitor was associated with increased CV events (P = 0.01 and P = 0.011, respectively). History of depression was associated with increased CV events (P = 0.035). Aspirin use at initial assessment was associated with decreased death (P < 0.000). Conclusion This retrospective study shows that FCR, history of depression and smoking are associated with adverse outcomes in HIV patients. It suggests that the FCR is useful for risk stratification of cardiovascular disease in HIV patients. It is extremely important to identify and manage cardiac risk factors in older HIV patients to reduce cardiovascular morbidity and mortality. Disclosures All authors: No reported disclosures.


Table 1 . Proportion of Patients with ≥F3 at Follow-Up Stratified by Baseline Stage
2208. Fibrosis Surveillance by Transient Elastography in Patients with Untreated Hepatitis C Infection

November 2018

·

27 Reads

·

1 Citation

Open Forum Infectious Diseases

Background Despite the widespread availability of curative HCV therapy and recommendations to consider all HCV-infected patients for treatment, many remain untreated. Illinois medicaid continues to restrict HCV therapy to patients with stage F3 or F4 fibrosis. In our Hepatitis Clinic, untreated patients are counseled and scheduled for follow-up scans at 6–12 months. This keeps patients engaged in care and allows us to identify progression of liver disease. Our study aims were to describe fibrosis assessments in HCV patients and identify predictors of fibrosis progression among untreated HCV-infected patients. Methods HCV-infected untreated patients with >1 transient elastography by Fibroscan® between April 2014 and March 2018 and with a baseline scan ≤Stage 2 fibrosis were included in the study. All scans were done by certified operators; 793 (63%) done by one operator. Fibroscan criteria; Stages 0–1 fibrosis; <7.0 kPa and Stage 2 fibrosis; 7.1–9.4 kPa. Results A total of 545 patients had a total of 1,260 scans. Median age of 59 years, 64% male, 70% African American, 23% White and 14% Hispanic. 196 (36%) HIV+. 399 (73%) patients had two scans, 127 (23%) patients had three scans and 14 (4%) patients had ≥4 scans. Median time between scans was 12.8 months (range 9.2–17.3 months) with a median duration of 12.8, 24.5 and 40 months between the baseline and second, third or fourth scans respectively. Median baseline score was 6.4 (range 5.3–7.7); 65.3% F0–F1 and 34.7% F2. At last scan, 62% remained at the same stage, 23% had moved 1 stage and 15% regressed from Stage 2 to Stage 1. In the subset who regressed, scores went from 7.8 to 6.1. Conclusion For the majority of HCV+ patients with mild liver fibrosis at baseline, fibrosis severity remained essentially flat. Progression to moderate/severe fibrosis occurred more often among patients with Stage 2 fibrosis at baseline. Engagement in care remains important to identify patients with fibrosis progression as advocacy to ensure access to curative treatment for all continues. Table 1 Proportion of Patients with ≥F3 at Follow-Up Stratified by Baseline Stage Baseline Fibrosis N (%) ≥F3 at Follow-Up 1 (Median Time to Scan) N (%) ≥F3 at Follow-Up 2 (Median Time to Scan) N (%) ≥F3 at Follow-Up 3 (Median Time to Scan) Stages 0–1 13 (5.1%) 17.0 months 3 (3.4%) 19.0 months 0 (0%) Stage 2 41 (30.1%) 12.7 months 11 (25%) 20.1 months 2 (1.5%)26.1 months Baseline Fibrosis N (%) ≥F3 at Follow-Up 1 (Median Time to Scan) N (%) ≥F3 at Follow-Up 2 (Median Time to Scan) N (%) ≥F3 at Follow-Up 3 (Median Time to Scan) Stages 0–1 13 (5.1%) 17.0 months 3 (3.4%) 19.0 months 0 (0%) Stage 2 41 (30.1%) 12.7 months 11 (25%) 20.1 months 2 (1.5%)26.1 months Table 1 Proportion of Patients with ≥F3 at Follow-Up Stratified by Baseline Stage Baseline Fibrosis N (%) ≥F3 at Follow-Up 1 (Median Time to Scan) N (%) ≥F3 at Follow-Up 2 (Median Time to Scan) N (%) ≥F3 at Follow-Up 3 (Median Time to Scan) Stages 0–1 13 (5.1%) 17.0 months 3 (3.4%) 19.0 months 0 (0%) Stage 2 41 (30.1%) 12.7 months 11 (25%) 20.1 months 2 (1.5%)26.1 months Baseline Fibrosis N (%) ≥F3 at Follow-Up 1 (Median Time to Scan) N (%) ≥F3 at Follow-Up 2 (Median Time to Scan) N (%) ≥F3 at Follow-Up 3 (Median Time to Scan) Stages 0–1 13 (5.1%) 17.0 months 3 (3.4%) 19.0 months 0 (0%) Stage 2 41 (30.1%) 12.7 months 11 (25%) 20.1 months 2 (1.5%)26.1 months Disclosures G. Huhn, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; ViiV Healthcare: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient; Theratechnologies: Scientific Advisor, Consulting fee; Proteus: Grant Investigator, Grant recipient.


Factors Associated with Appropriate Hepatocellular Carcinoma (HCC) Screening Among Chronic Hepatitis C (HCV) Patients with Cirrhosis at an Urban Safety-net Hospital System

October 2017

·

20 Reads

Open Forum Infectious Diseases

Background Despite guidelines recommending liver ultrasound (US) every 6 months for HCC screening in cirrhotic patients with HCV, reported screening rates remain low. Our study evaluated (1) timely screening among patients with HCV cirrhosis identified by transient elastography (FibroScan [FS]) and (2) described factors associated with lack of screening. Methods All HCV patients with score ≥12.5 kPa (cirrhosis) on FS obtained 3/27/2014- 4/30/2016 for evaluation for HCV treatment within 6 months of index FS by a gastroenterology (GI) or infectious disease (ID) provider within the Cook County Health and Hospitals System were identified. Patient and provider factors and screening were determined through retrospective chart review. Relative risks (RR) for screening failure at 6 months and 12 months after index FS were calculated. Results Among 243 patients, 64% were men and 38% were co-infected with HIV. Median age was 57 years (range 31 to 79). Median FS score was 21.1 kPa (12.1 to 75). ID requested the index FS in 47%; GI, 47%; and primary care, 5%. In the first 6 months after index FS, 54% underwent US screening; 40% did not have US scheduled; 4.9% had their US cancelled; and 1.2% were scheduled but did not show. Among 112 patients not screened in the first 6 months, 39% underwent US in the subsequent 6 months, 55% were not scheduled for one and 5.4% were scheduled but did not show. At 12 months 72% of all patients were screened. Screening rates at 6 months were significantly higher for index FS obtained in 2015 (62%) compared with in 2014 (44%; P = 0.018) but not in 2016 compared with 2015. Comparing GI vs. ID, RR for screening failure at 1 year was 0.51 (95% CI 0.33-0.80, P = 0.003). Conclusion In patients with HCV cirrhosis, failure to obtain timely HCC screening was prevalent and driven by failure to order or schedule imaging. ID management was associated with a higher risk of failure of timely screening. Algorithms to improve HCC screening rates will be vital as more ID providers take on a greater role in HCV care. Disclosures All authors: No reported disclosures.


Figure 1. Drexel ID ACGME Fellow Survey Scores 2015–2017. 
Reluctance to Prescribe Pre-Exposure Prophylaxis (PrEP) Among Internal Medicine Residents (IMRs) Training at a U.S. Hospital with a Large HIV-infected Population

October 2017

·

39 Reads

·

4 Citations

Open Forum Infectious Diseases

Background PrEP is effective in HIV prevention, though access to PrEP in the US has been concentrated in HIV/STI healthcare settings. We examined IMRs’ willingness to prescribe PrEP in an urban hospital in Chicago associated with a large HIV outpatient center. Methods IMRs were anonymously surveyed regarding their knowledge and likelihood of prescribing PrEP stratified by patient risk behaviors and their own attitudes and perceptions. Bivariate analysis was performed, and p-values with α <0.05 for significance were calculated for comparisons by IMRs who had rotated on a dedicated HIV inpatient service, by level of training (PGY-1 vs. >PGY-2), and between planning on specializing in primary care (PC), infectious disease (ID) vs. other specialties. Results Most 86/120 (71%) of IMRs completed the survey and 30/86 (35%) had completed an inpatient HIV service rotation. The majority (88.4%) believed it is “very important” to universally screen patients for HIV, and most (72.1%) said they were “comfortable” or “very comfortable” taking a sexual history. Very few (2.3%) had ever prescribed PrEP, though only 3.5% reported requests for PreP in their practice, and 44.2% would be “unlikely” or “somewhat unlikely” to prescribe PrEP to patients if requested. IMRs with HIV service experience correctly identified the number of pills in PrEP compared with IMRs with no experience (47.0% vs 18.9%, P = 0.01). IMRs planning on other specialties were more likely to rank knowledge of PrEP as “not familiar” when compared with IMRs entering PC and ID, (21.0% vs. 0%, P = 0.02). The most common barriers to prescribing PrEP were lack of familiarity, lack of program guidance, cost, and unclear risk to benefit ratios (75.6%, 41.9%, 29.1%, 26.7%, respectively). Conclusion While recognizing that HIV testing is important, IMRs surveyed displayed a lack of knowledge of PrEP, most likely due to limited exposure in their medical education/training. Rotations on an HIV service appeared to increase PrEP knowledge as did planned entry into PC or ID. In order to increase PrEP knowledge and usage, enhanced PrEP education, and importantly exposure to high-risk patients should be incorporated into the curriculum of evidence-based prevention interventions during IMR training. Disclosures All authors: No reported disclosures.




Citations (2)


... The hepatocyte ballooning score was also determined using the following score: 0 points: no ballooning, 1 point: few or many non-classic hepatocyte ballooning, 2 points: few classic hepatocyte ballooning, 3 points: many hepatocyte ballooning, and 4 points: severe ballooning 24 . The number of immune cells was also counted to represent the immune cell infiltration (hepatic inflammation), while hepatocyte steatosis was also scored using the following the modified scale: 0 point: 0-10% of steatosis area, 1 point: 11-30% of steatosis area, 2 points: 31-60% steatosis area, and 3 points: > 60% steatosis area 25 . Additionally, tissue cytokines of the livers were also evaluated following a previous protocol 26 using the thoroughly sonicated tissue samples, and supernatant from the homogenous tissue preparation was collected for cytokine measurement by ELISA assay (Biolegend) as in the serum samples. ...

Reference:

Alcohol-induced gut permeability defect through dysbiosis and enterocytic mitochondrial interference causing pro-inflammatory macrophages in a dose dependent manner
Steatosis Rates by Liver Biopsy and Transient Elastography Controlled Attenuated Parameter (CAP) in Clinical Experience of Hepatitis C (HCV) and HIV/HCV Coinfection in a Large U.S. Hepatitis Clinic

Open Forum Infectious Diseases

... When LGBTQ individuals such as minoritized Black men who have sex with men are stigmatized by health care providers, this leads to distrust of providers, lack of sexual orientation disclosure, delays in seeking needed medical care, and incomplete disclosure of risk-taking behaviors related to HIV [4][5][6][7][8][9][10]. A survey of 120 American internal medicine residents revealed that only 2.3% had ever prescribed PrEP, with the top barrier being lack of familiarity, likely because of a lack of provider education and training [11]. Discomfort with sexual history taking and genital examinations was identified as a barrier to sexually transmitted infection (STI) testing [12,13] and decreased the likelihood of prescribing PrEP [14][15][16]. ...

Reluctance to Prescribe Pre-Exposure Prophylaxis (PrEP) Among Internal Medicine Residents (IMRs) Training at a U.S. Hospital with a Large HIV-infected Population

Open Forum Infectious Diseases