Changing Conditions and Treatments in a Dynamic Cohort of Ambulatory HIV Patients

Moorman, Anne C.; Holmberg, Scott D.; Marlowe, Steven I.; Bargen, Jennifer C. Von; Yangco, Bienvenido G.; Palella, Frank J.; Ward, Douglas J.; Loveless, Mark O.; Fuhrer, Jack; Joseph, Patrick; Alexander, William N.; Aschman, Diane

doi:10.1016/s1047-2797(99)00005-8

Cited by 69 publications

(33 citation statements)

References 21 publications

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“…In addition, most published data on the effectiveness and "real-world" outcomes of HIV treatment (i.e., not from clinical trials) are from hospital-based or academically affiliated HIV centers and large infectious disease practices. [59][60][61][62] Therefore, clinicians, researchers, and health systems must work together to critically examine alternative structures of HIV healthcare delivery and develop mechanisms that support all effective models.…”

Section: Models For Hiv Carementioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care-and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.

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Section: Models For Hiv Carementioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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“…Several large cohort databases provide valuable and upto-date clinical and epidemiological information regarding HIV-infected patients [5][6][7][8]. Most of them collect information relating to 6-to 12-month periods.…”

Section: Introductionmentioning

confidence: 99%

A large French prospective cohort of HIV‐infected patients: the Nadis Cohort

et al. 2009

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The aim of this article is to describe the development of a dynamic French cohort of HIV-infected patients, the methodological issues and decisions made, and the characteristics of the patients currently enrolled. MethodsData are collected during medical encounters. Data quality is ensured by automated checks during data capture, by regular controls, by annual assessments, and by ad hoc processes before any scientific analysis is performed. ResultsIn September 2007, 10 458 patients representing 59 383 patient-years of follow-up were followed in our centres, including 446 with a first HIV diagnosis in the past year. Among these recently diagnosed patients, 25.6% presented with late diagnosis. Our cohort included 3017 women (28.8%). The women were less likely to be receiving highly active antiretroviral therapy (HAART) than men, and when treated were less likely to be receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Our network includes medical centres in overseas territories (1105 patients living overseas). In this particular population, women represented 38.5% of the patients, and the probable route of infection was heterosexual in 75.7% of the patients. Despite epidemiological and social disparities, more patients had nondetectable viral loads when receiving HAART in overseas departments than in metropolitan France. ConclusionThe Nadis Cohort represents a collaboration of major French HIV treatment centres. In September 2007, the cohort database contained up-to-date information on more than 10 000 patients, of whom a significant proportion were women. As a consequence of the choices made when building the cohort and the efforts made to ensure the quality of the database, scientific studies are regularly performed using this cohort.

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“…More than half of HIV-infected individuals receiving medical care in the United States are current cigarette smokers (Burns et al, 1996; The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group, 2003;Galai et al, 1997;Hessol et al, 2000;Moorman et al, 1999;Turner et al, 2001), and several studies aimed at describing the smoking behaviors of this population have been published (Burkhalter, Springer, Chhabra, Ostroff, & Rapkin, 2005;Mamary, Bahrs, & Martinez, 2002). One study demonstrated inferior self-reported adherence to HAART among HIV-infected female smokers as compared with nonsmokers (Feldman et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy

Shuter

Bernstein

2008

Nicotine & Tobacco Res.

124

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Current treatment guidelines for the management of HIV-infected individuals emphasize the importance of excellent adherence to antiretroviral medications. We conducted a prospective 24-week study of adherence to lopinavir/ritonavir in a group of 64 subjects using the Medication Event Monitoring System (MEMS). A range of demographic and clinical information, including cigarette smoking status, was collected from each participant. The overall mean adherence rate of the study cohort was 72.8% (SD = 22.2%). Current smokers took 63.5% (SD = 22.1) of prescribed doses, compared with 84.8% (SD = 15.8%) in nonsmokers (p<.001). We found no difference in adherence rates between ex-smokers and subjects who had never smoked. In a multiple linear regression model, factors independently associated with lower adherence rates included current smoking (p = .001), lower CD4+ lymphocyte count at enrollment (p = .04), and lower educational attainment (p = .04). Depression and history of illicit substance use were not associated with nonadherence. In our study cohort, current cigarette smoking was an important and significant marker of inferior adherence to antiretroviral medication.

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Changing Conditions and Treatments in a Dynamic Cohort of Ambulatory HIV Patients

Cited by 69 publications

References 21 publications

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

A large French prospective cohort of HIV‐infected patients: the Nadis Cohort

Cigarette smoking is an independent predictor of nonadherence in HIV-infected individuals receiving highly active antiretroviral therapy

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