Women who inject drugs have been shown to have higher incidence of HIV and risk behaviors than men, but there are conflicting reports about hepatitis C virus (HCV) incidence. We systematically reviewed the literature to examine the female to male (F:M) HCV incidence in female and male persons who inject drugs (PWID), and also to explore the heterogeneity (i.e., methodological diversity) in these differences. We searched PubMed and EMBASE for studies published between 1989 to March 2015 for research that reported incidence of HCV infection by sex or HCV incidence F:M rate ratio. A total of 28 studies, which enrolled 9,325 PWID were included. The overall pooled HCV incidence rate (per 100 person-years observation) was 20.36 (95%CI: 13.86, 29.90) and 15.20 (95%CI: 10.52, 21.97) in females and males, respectively. F:M ratio was 1.36:1 (95%CI: 1.13,1.64) with substantial heterogeneity (I-squared = 71.6%). The F:M ratio varied by geographic location: from 4.0 (95%CI: 1.80, 8.89) in China to 1.17 (95%CI: 0.95,1.43) in the U.S. In studies which recruited participants from community settings, the F:M ratio was 1.24 (95%CI: 1.03,1.48), which was lower than that reported in the clinical settings (1.72, 95%CI: 0.86,3.45). The number of studies included provided sufficient statistical power to detect sex differences in this analysis. Our findings raise questions and concerns regarding sex differences with respect to the risk of HCV. Both behavioral and biological studies are needed to investigate causes and potential mechanisms as well as sex-specific prevention approaches to HCV infection.

The risk of sepsis is low. The best probiotic to optimize outcomes has not yet been identified. Potential benefit for CD4 count, recurrence or management of bacterial vaginosis and diarrhea. Uncertain effect on translocation, BV treatment.

BackgroundApproximately 28.5 million people living with HIV are eligible for treatment (CD4<500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality.ObjectivesWe synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease.MethodsWe searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs.Principal FindingsFrom 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞).ConclusionsMNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV.

Our findings indicate that women who inject drugs may be at greater risk of HCV acquisition than men, independent of demographic characteristics and risk behaviors. Multiple factors, including biological (hormonal), social network, and differential access to prevention services, may contribute to increased HCV susceptibility in women who inject drugs.

Objective The Veterans Health Administration (VHA) conducted a randomized quality improvement evaluation to determine whether augmenting patient‐centered medical homes with Primary care Intensive Management (PIM) decreased utilization of acute care and health care costs among patients at high risk for hospitalization. PIM was cost‐neutral in the first year; we analyzed changes in utilization and costs in the second year. Data sources VHA administrative data for five demonstration sites from August 2013 to March 2019. Data sources Administrative data extracted from VHA's Corporate Data Warehouse. Study design Veterans with a risk of 90‐day hospitalization in the top 10th percentile and recent hospitalization or emergency department (ED) visit were randomly assigned to usual primary care vs primary care augmented by PIM. PIM included interdisciplinary teams, comprehensive patient assessment, intensive case management, and care coordination services. We compared the change in mean VHA inpatient and outpatient utilization and costs (including PIM expenses) per patient for the 12‐month period before randomization and 13‐24 months after randomization for PIM vs usual care using difference‐in‐differences. Principal findings Both PIM patients (n = 1902) and usual care patients (n = 1882) had a mean of 5.6 chronic conditions. PIM patients had a greater number of primary care visits compared to those in usual care (mean 4.6 visits/patient/year vs 3.7 visits/patient/year, p < 0.05), but ED visits (p = 0.45) and hospitalizations (p = 0.95) were not significantly different. We found a small relative increase in outpatient costs among PIM patients compared to those in usual care (mean difference + $928/patient/year, p = 0.053), but no significant differences in mean inpatient costs (+$245/patient/year, p = 0.97). Total mean health care costs were similar between the two groups during the second year (mean difference + $1479/patient/year, p = 0.73). Conclusions Approaches that target patients solely based on the high risk of hospitalization are unlikely to reduce acute care use or total costs in VHA, which already offers patient‐centered medical homes.