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Sexually Transmitted Infections Among HIV-Infected Individuals in the District of Columbia and Estimated HIV Transmission Risk: Data From the DC Cohort

Lucar, Jose; Hart, Rachel; Rayeed, Nabil; Terzian, Arpi; Weintrob, Amy; Siegel, Marc; Parenti, David M; Squires, Leah E; Williams, Rush; Castel, Amanda D; Benator, Debra A
Background/UNASSIGNED:Washington, DC, has one of the highest rates of HIV infection in the United States. Sexual intercourse is the leading mode of HIV transmission, and sexually transmitted infections (STIs) are a risk factor for HIV acquisition and transmission. Methods/UNASSIGNED:We evaluated the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. Using Poisson regression, we assessed covariates of risk for incident STIs. We also examined HIV viral loads (VLs) at the time of STI diagnosis as a proxy for HIV transmission risk. Results/UNASSIGNED:Six point seven percent (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STIs was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5-4.1); age 18-34 years, 10.8 (95% CI, 9.7-12.0); transgender women, 9.9 (95% CI, 6.9-14.0); Hispanics, 9.2 (95% CI, 7.2-11.8); and men who have sex with men (MSM), 7.7 (95% CI, 7.1-8.4). Multivariate Poisson regression showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable VL within 1 month of STI diagnosis, and 14.6% had a VL ≥1500 copies/mL. Conclusions/UNASSIGNED:STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.
PMID: 29479550
ISSN: 2328-8957
CID: 2965422

Safety and Tolerability of Maraviroc-Containing Regimens to Prevent HIV Infection in Women: A Phase 2 Randomized Trial

Gulick, Roy M; Wilkin, Timothy J; Chen, Ying Q; Landovitz, Raphael J; Amico, K Rivet; Young, Alicia M; Richardson, Paul; Marzinke, Mark A; Hendrix, Craig W; Eshleman, Susan H; McGowan, Ian; Cottle, Leslie M; Andrade, Adriana; Marcus, Cheryl; Klingman, Karin L; Chege, Wairimu; Rinehart, Alex R; Rooney, James F; Andrew, Philip; Salata, Robert A; Siegel, Marc; Manabe, Yukari C; Frank, Ian; Ho, Ken; Santana, Jorge; Stekler, Joanne D; Swaminathan, Shobha; McCauley, Marybeth; Hodder, Sally; Mayer, Kenneth H
Background/UNASSIGNED:Maraviroc (MVC) is a candidate drug for HIV preexposure prophylaxis (PrEP). Objective/UNASSIGNED:To assess the safety and tolerability of MVC-containing PrEP over 48 weeks in U.S. women at risk for HIV infection. Design/UNASSIGNED:Phase 2 randomized, controlled, double-blinded study of 4 antiretroviral regimens used as PrEP. ( NCT01505114). Setting/UNASSIGNED:12 clinical research sites of the HIV Prevention Trials Network and AIDS Clinical Trials Group. Participants/UNASSIGNED:HIV-uninfected women reporting condomless vaginal or anal intercourse with at least 1 man with HIV infection or unknown serostatus within 90 days. Intervention/UNASSIGNED:MVC only, MVC-emtricitabine (FTC), MVC-tenofovir disoproxil fumarate (TDF), and TDF-FTC (control). Measurements/UNASSIGNED:At each visit, clinical and laboratory (including HIV) assessments were done. Primary outcomes were grade 3 and 4 adverse events and time to permanent discontinuation of the study regimen. All randomly assigned participants were analyzed according to their original assignment. Results/UNASSIGNED:Among 188 participants, 85% completed follow-up, 11% withdrew early, and 4% were lost to follow-up; 19% discontinued their regimen prematurely. The number discontinuing and the time to discontinuation did not differ among regimens. Grade 3 or 4 adverse events occurred in 5 (MVC), 13 (MVC-FTC), 9 (MVC-TDF), and 8 (TDF-FTC) participants; rates did not differ among regimens. One death (by suicide) occurred in the MVC-TDF group but was judged not to be related to study drugs. Of available plasma samples at week 48 (n = 126), 60% showed detectable drug concentrations. No new HIV infections occurred. Limitations/UNASSIGNED:Participants were not necessarily at high risk for HIV infection. The regimen comprised 3 pills taken daily. The study was not powered for efficacy. Conclusion/UNASSIGNED:Maraviroc-containing PrEP regimens were safe and well-tolerated compared with TDF-FTC in U.S. women. No new HIV infections occurred, although whether this was due to study drugs or low risk in the population is uncertain. Maraviroc-containing PrEP for women may warrant further study. Primary Funding Source/UNASSIGNED:National Institutes of Health.
PMID: 28828489
ISSN: 1539-3704
CID: 3070022

The Death of the Bedside Manner: ObamaCare is Speeding the Decline in the Quality of Medical Practice

Siegel, Marc K
PMID: 30323515
ISSN: 0026-6620
CID: 3369772

The Death of the Bedside Manner [Newspaper Article]

Siegel, Marc
[...]the veil was lifted from my eyes, and I awoke to the harsh realities of our medical future
ISSN: 0099-9660
CID: 814912

Marc Siegel: The Death of the Bedside Manner; ObamaCare is speeding the decline in the quality of medical practice. [Newspaper Article]

Siegel, Marc
[...]the veil was lifted from my eyes, and I awoke to the harsh realities of our medical future
ISSN: 0099-9660
CID: 814922

PASSAGES: Taylor Mead 1924-2013 [General Interest Article]

Siegel, Marc
If 1 begin these reflections on Taylor Mead, who died at the age of eighty-eight on May 8, 2013, with brief mention of two underexplored periods in the artist's life-his years in the late Beat scene in Venice and his European period of self-imposed exile from New York in the mid-'60s-it is to suggest that we have yet to account for the breadth, diversity, and wide-ranging importance of more than five decades of work by the disarmingly affable man considered the first superstar of underground film and the "doyen of underground performance. Rice's movie, shot on outdated 16-mm film stock that lent the black-and-white images a wistful look, was both a document of the last remnants of San Francisco's North Beach Beat scene and a lyrical portrayal of Mead's joyful embodiment of flexibility and spontaneity
ISSN: 1086-7058
CID: 814932

Best medical care comes one patient at a time [Newspaper Article]

Siegel, Marc
[...]a third of all people who experience heart attacks have no chest symptoms
ISSN: 0734-7456
CID: 814942

Required Flu Vaccines for Healthcare Workers Won't Protect Patients [Newspaper Article]

Siegel, Marc
From smallpox to polio to measles to hepatitis, modern history has shown us again and again that vaccines are one of the best medical tools we have to eradicate disease and to protect the most vulnerable populations. But recommending a vaccine strongly and mandating its use are two different things. There is simply no convincing evidence that forcing healthcare workers to be vaccinated under threat of losing their jobs cuts down on the risks of patients getting severely ill from, or dying from, the flu
ISSN: 0041-5537
CID: 814952

Surging flu no reason for vaccine mandate [Newspaper Article]

Siegel, Marc
This isn't to say that mandatory vaccines don't have their place, just that mandates should be reserved for situations where a vaccine can play a major role in fighting back a clear public health risk. In the case of seasonal flu, neither the risk of the disease nor the benefit of the vaccine is big enough to warrant forcing health care workers to receive it. Measles, another highly contagious and deadly virus, is another point of reference: Vaccination of health care workers is recommended by the CDC but not mandatory. The chances of a health care worker carrying measles isn't high enough to warrant mandatory vaccine. Instead, mandates are targeted on the most vulnerable population: children. According to the World Health Organization, increased measles vaccination resulted in a three-fourths drop in measles deaths between 2000 and 2010, when 85 percent of the world's children received one dose of the vaccine by age one, up from 72 percent in 2000
ISSN: 0739-0319
CID: 814962

Guest opinion: Health workers fired for skipping flu shot [Newspaper Article]

Siegel, Marc
According to the World Health Organization, increased measles vaccination resulted in a three-fourths drop in measles deaths between 2000 and 2010, when 85 percent of the world's children received one dose of the vaccine by age 1, up from 72 percent in 2000
ISSN: n/a
CID: 814972