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Outcomes among HIV-positive patients hospitalized with COVID-19

Karmen-Tuohy, Savannah; Carlucci, Philip M; Zervou, Fainareti N; Zacharioudakis, Ioannis M; Rebick, Gabriel; Klein, Elizabeth; Reich, Jenna; Jones, Simon; Rahimian, Joseph
BACKGROUND:SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggests that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection. METHODS:Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020 and April 23, 2020, we matched 21 HIV-positive patients to 42 non-HIV patients using a greedy nearest neighbor algorithm. Admission characteristics, laboratory results, and hospital outcomes were recorded and compared between the two groups. RESULTS:While there was a trend toward increased rates of ICU admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak CRP values. Other inflammatory markers did not differ significantly between groups, though HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all three patients expired during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups. CONCLUSION/CONCLUSIONS:This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared to matched non-HIV patients. A larger study is required to determine if the trends we observed apply to all HIV-positive patients.
PMID: 32568770
ISSN: 1944-7884
CID: 4506692

Evidenced-Based Guidelines For Tuberculosis Screening Before Biologic Treatment Initiation [Letter]

Shah, Payal; Rebick, Gabriel; Bajaj, Shirin; Desvignes, Ludovic
PMID: 32222451
ISSN: 1097-6787
CID: 4371212

Developing a performance framework for measuring comprehensive, community-based primary healthcare for people with HIV

Johnston, Sharon; Hogel, Matthew; Burchell, Ann N; Rebick, Gabriel; Antoniou, Tony; McLaren, Meaghan; Loutfy, Mona; Liddy, Clare; Kendall, Claire
OBJECTIVES: People with human immunodeficiency virus (HIV) are living longer lives and like many other patients, need a health system better adapted for the management of complex chronic conditions. A key element of system transformation is measuring and reporting on system performance indicators relevant to the different stakeholders. Our objective was to produce a performance measurement framework for assessing the quality of comprehensive community-based primary healthcare for people with HIV. METHODS: Semi-structured interviews were performed with HIV providers, advocates, and policy-makers to obtain input on a draft performance framework, constructed using existing HIV-specific indicators, as well as the use of performance data in improving care for people with HIV. RESULTS: Stakeholders were overwhelmingly supportive of the framework's comprehensiveness. Many noted the absence of indicators addressing social determinants of health and had mixed opinions on the importance of indicators addressing access to after-hours care and the frequency of routine screening for behavioural risk factors. The draft framework was modified to reflect stakeholder input, triangulated against expert opinion and recently released HIV care guidelines, and finalized at 79 indicators. The resources and infrastructure to collect and use performance data will have to be improved for performance measurement to contribute to improving care for people with HIV. CONCLUSIONS: This framework presents a comprehensive though not exhaustive tool to support performance measurement and improvement in the care for people with HIV. However, advances in data collection and use across the system will be needed to support performance measurement driving quality improvement.
PMID: 26627002
ISSN: 1477-1128
CID: 2472662

Food Insecurity, Dietary Diversity, and Body Mass Index of HIV-Infected Individuals on Antiretroviral Therapy in Rural Haiti

Rebick, Gabriel W; Franke, Molly F; Teng, Jessica E; Gregory Jerome, J; Ivers, Louise C
Food rations are increasingly offered as part of HIV programs in resource-poor settings, often targeted solely to those with under-nutrition by low body mass index (BMI). This practice does not consider food insecurity, another important risk factor for poor outcomes in people living with HIV/AIDS (PLWH). We analyzed factors associated with low BMI and severe food insecurity in 523 PLWH receiving antiretroviral therapy in rural Haiti using logistic regression. Food insecurity was present in 89 % of individuals. Among those with severe food insecurity, 86 % had a BMI >/= 18.5 kg/m(2). Severe food insecurity was associated with illiteracy [adjusted odds ratio (AOR) 1.79, p = 0.005], having no income (AOR 1.58, p = 0.04), and poverty (p < 0.001). Compared with those with little to no food insecurity, individuals with severe food insecurity had a less diverse diet. We found that food insecurity was highly prevalent in PLWH receiving antiretroviral therapy in rural Haiti. Using BMI as a sole criterion for food supplementation in HIV programs can exclude highly vulnerable individuals who may benefit from such support.
PMID: 26350637
ISSN: 1573-3254
CID: 2472672

Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study

Leis, Jerome A; Rebick, Gabriel W; Daneman, Nick; Gold, Wayne L; Poutanen, Susan M; Lo, Pauline; Larocque, Michael; Shojania, Kaveh G; McGeer, Allison
This proof-of-concept study demonstrates that no longer routinely reporting urine culture results from noncatheterized medical and surgical inpatients can greatly reduce unnecessary antimicrobial therapy for asymptomatic bacteriuria without significant additional laboratory workload. Larger studies are needed to confirm the generalizability, safety, and sustainability of this model of care.
PMID: 24577290
ISSN: 1537-6591
CID: 2472682

A 34-year-old man with urethral discharge [Case Report]

Rebick, Gabriel W; Allen, Vanessa G; Gold, Wayne L
PMCID:3602258
PMID: 23422446
ISSN: 1488-2329
CID: 3122652

Post-traumatic vancomycin-resistant enterococcal endophthalmitis

Hillier, Roxane J; Arjmand, Parnian; Rebick, Gabriel; Ostrowski, Mario; Muni, Rajeev H
The emergence of antibiotic-resistant organisms among severe ocular infections is of grave concern. We describe the first reported case of vancomycin-resistant enterococcal endophthalmitis following ocular trauma, uniquely caused by Enterococcus gallinarum. The organism demonstrated intrinsic resistance to ceftazidime and vancomycin but responded favorably to a combination of intravitreal and intravenous ampicillin, plus intravitreal amikacin. When faced with a multidrug-resistant organism, the ophthalmologist must consider alternative antibiotic strategies.
PMCID:3605398
PMID: 23514354
ISSN: 1869-5760
CID: 2472702

Whipple's endocarditis: An enigmatic cause of culture-negative bacterial endocarditis

Weisman, Alanna; Rebick, Gabriel; Morris, Andrew; Butany, Jagdish; Liles, W Conrad
PMCID:3720009
PMID: 24421813
ISSN: 1712-9532
CID: 2472692

Issues in resistance, adherence, and comparative efficacy of the single-tablet regimen combination of tenofovir, emtricitabine, and efavirenz in the management of HIV-1 infection gabriel rebick

Rebick, Gabriel; Walmsley, Sharon L.
Atripla is the first once-daily, single-tablet, triple-combination antiretroviral therapy. It is recommended for the initial treatment of the naïve patient with human immunodeficiency virus-1 (HIV-1) infection in all current guidelines, based on its proven efficacy in numerous head-to-head randomized clinical trials. Not only has it proven efficacy, but the fixed-dose combination, Atripla, has resulted in an improvement in adherence, quality of life, and satisfaction among naïve as well as virally suppressed patients switching from another regimen. Despite the advantages, tolerability issues can arise that are related primarily to the efavirenz component, which is known to cause central nervous side effects such as dizziness, abnormal dreams, and anxiety. Although generally self-limited, these side-effects can lead to treatment discontinuation in the short- or long-term. Based on the observation of neural tube defects in macaque models, and isolated case reports in human fetuses with first trimester exposure, it is rated as Food and Drug Administration pregnancy category D, and considered as contraindicated in the first trimester of pregnancy where alternatives are available. Given the low genetic barrier of each of the individual components, resistance remains an important issue for patients with poor adherence, but is balanced in part by the long half-life of the drugs. Transmitted resistance is described in up to 16% of newly infected patients in population surveys, and is particularly prevalent in men who have sex with men. Minority variants that may impart resistant to efavirenz are not detected with currently used HIV-1 genotype assays, but nonetheless may also be implicated in patients who fail initial treatment. Several single-tablet regimens are recently licensed or in development that will challenge Atripla as the single-tablet first-line option, but none have shown superior efficacy to date. © 2012 Rebick and Walmsley, publisher and licensee Dove Medical Press Ltd.
SCOPUS:84866599999
ISSN: 1179-1624
CID: 4136302

The thinker's sign [Case Report]

Rebick, Gabriel; Morin, Suzanne
PMCID:2527394
PMID: 18779534
ISSN: 1488-2329
CID: 4136292