Background: Smoking contributes to significant morbidity and mortality in people with HIV. People with HIV have relatively high nicotine metabolism rates, as measured by the nicotine metabolite ratio (NMR, 3-hydroxycotinine/cotinine). A higher NMR is associated with difficulty quitting smoking. We hypothesized that HIV infection might upregulate nicotine metabolism.

Increasing needle fear in the past two decades impacts acceptability and adherence to injectable biologic medications, immunomodulatory, and allergen immunotherapy. We hypothesized that the 6-fold increase in scheduled vaccines (since the 1970s) correlates with needle fear by birth year. METHODS: We conducted a systematic literature search [1958 to 2016] using the search terms Blood Injection Injury phobia, needle phobia, vasovagal, and needle fear. Additional studies were identified using bibliographies and via pediatric pain Listserv peer request. Studies were included if data provided included average birth year/age and percent endorsing needle fear (either present/absent or with Visual Analogue Scale (VAS)). Number of recommended injected vaccines from 0-6 years by birth year was determined by using CDC website http://www.cdc.gov/ vaccines/schedules/past.html, sources of historical schedules (1921+) and state schedules. The correlation between average fear and scheduled vaccines was calculated using the Kendall rank correlation coefficient for non-linear non-parametric associations. RESULTS: Eighteen studies were identified, with 15 meeting inclusion criteria. Of 8459 subjects, 36% were under the age of 18; average birth year ranged from 1931 to 2003. The curve of increasing needle fear correlated strongly with increasing vaccine number (Kendall's tau b 5 0.747, 95%CI 0.513 to 0.982, p50.0003). CONCLUSIONS: The increase in reported needle fear related to the increased number of childhood vaccines. As 2/3 of our sample were adults, these results imply fear acquired in childhood persists. As more immunologic therapies rely on percutaneous delivery, atraumatic methods to give vaccines and research on resilience and fear reduction are needed to enhance immunotherapy adherence.

Background For patients with melanoma, gastrointestinal immune-related adverse events are common after receipt of anti-CTLA4 therapy. These present difficult decision points regarding whether to discontinue therapy. Detailing the situations in which colitis might predict for improved survival and how this is affected by discontinuation or resumption of therapy can help guide clinical decision-making. Materials and Methods Patients with stage IV melanoma receiving anti-CTLA4 therapy from 2008 to 2019 were analyzed. Immune-related colitis treated with ≥50 mg prednisone or equivalent daily or secondary immunosuppression was included. Moderate colitis was defined as receipt of oral glucocorticoids only; severe colitis was defined as requiring intravenous glucocorticoids or secondary immunosuppression. The primary outcome was overall survival (OS). Results In total, 171 patients received monotherapy, and 91 received dual checkpoint therapy. In the monotherapy group, 25 patients developed colitis and a nonsignificant trend toward improved OS was observed in this group. Notably, when colitis was categorized as none, moderate or severe, OS was significantly improved for moderate colitis only. This survival difference was not present after dual checkpoint therapy. There were no differences in known prognostic variables between groups, and on multivariable analysis neither completion of all ipilimumab cycles nor resumption of immunotherapy correlated with OS, while the development of moderate colitis did significantly affect OS. Conclusion This single-institution retrospective series suggests moderate colitis correlates with improved OS for patients with stage IV melanoma treated with single-agent anti-CTLA4, but not dual agent, and that this is true regardless of whether the immune-checkpoint blockade is permanently discontinued.