Newer HIV therapies have led to gains in viral suppression rates over past 2 decades

1. Newer HIV therapies have led to dramatic gains in viral suppression rates over the past 2 decades

Younger persons and blacks saw lower rates of improvement

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2242

Editorial: http://annals.org/aim/article/doi/10.7326/M18-1944

URLs go live when the embargo lifts

Viral suppression rates have nearly tripled in the U.S. over the past 2 decades, but disparities still exist for younger persons and blacks living with HIV. Researchers say that newer, better-tolerated treatment regimens, such as fixed-drug combinations that include integrase strand transfer inhibitors (ISTIs), have likely contributed to these dramatic gains. Findings from an observational cohort study are published in Annals of Internal Medicine.

 <p>Approximately 1.2 million adults in the U.S. are living with HIV, and men who have sex with men and African Americans are disproportionately affected. Achieving and maintaining HIV viral suppression is essential for optimal outcomes and prevention efforts. As such, understanding trends and predictors of viral suppression is imperative to inform public health policy.</p>     <p>Researchers supported by the National Institutes of Health (NIH) analyzed data for nearly 32,000 adults living with HIV who were enrolled in care at eight Centers for AIDS Research Network of Integrated Clinical Systems sites from 1997 to 2015 to evaluate trends in viral suppression. The researchers evaluated associated factors, such as demographic characteristics and ISTI use. They found that overall rates of viral suppression increased significantly during the timeframe, from 32 percent in 1997 to 86 percent in 2015. They also found that the average interval from enrollment to suppression was shortened substantially from 9 months for those initiating antiretroviral therapy, or ART, between 1997 and 2000 to 2 months for those initiating ART between 2010 and 2015. However, the gains in viral suppression were not equally distributed across populations. Younger persons and blacks were more likely to have detectable viral load. According to the researchers, these disparities warrant further research.</p>     <p>Media contact: For an embargoed PDF, please contact Lauren Evans at [email protected] To interview the lead author, Heidi M. Crane, MD, MPH, please contact Susan Gregg at [email protected] To reach the author of the editorial, please contact Hillary Hoffman at [email protected]    <strong><p>2. Pregabalin may increase risk for death when coprescribed with opioids</p></strong>  

Product monograph should be revised to include a warning about the risk for serious adverse events when combined with opioids

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1136

Editorial: http://annals.org/aim/article/doi/10.7326/M18-2175

URLs go live when the embargo lifts

Pregabalin, an anticonvulsant increasingly prescribed as an adjunct for chronic pain, is associated with an increased risk for opioid-related death when coprescribed with opioids. A brief research report is published in Annals of Internal Medicine.

Pregabalin can be sedating and may augment central nervous system (CNS) depression in patients also receiving opioids. Because more than one half of Ontario residents who initiate pregabalin therapy are concurrently prescribed an opioid, determining the risk for opioid-related death among persons coprescribed these medications has important clinical implications.

Researchers from St. Michael's Hospital and the University of Toronto identified a cohort of persons aged 15 to 105 who received publicly funded opioid prescriptions between August 1997 and December 2016. Case patients who died of an opioid-related cause were matched by age, sex, and other characteristics to up to four control participants. After adjusting for multiple variables, the researchers concluded that concomitant exposure with opioids and pregabalin in the preceding 120 days was associated with significantly increased odds of opioid-related death compared with exposure to opioids alone.

According to the researchers, these findings warrant a revision to the pregabalin product monograph, which does not currently warn about the risk for serious adverse events when combined with opioids.

Media contact: For an embargoed PDF, please contact Lauren Evans at [email protected] To interview the lead author, Tara Gomes, MHSc, PhD, please contact Debora Creatura at [email protected]

3. Studies needed to determine the effects of marijuana use in pregnancy

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1141

URLs go live when the embargo lifts

Marijuana use among pregnant women has increased over the past decade and research is needed to determine its effect on fetal and neonatal outcomes. Authors from Kaiser Permanente Northern

California health system describe the limitations of previous studies and outline a strategy for future research in Annals of Internal Medicine.

With the growing acceptance, accessibility, and legalization of marijuana, its use is likely to rise among pregnant women. As such, it is crucial to understand the effects of prenatal exposure. The weakness of previous studies is that they did not fully account for confounding factors. The authors present new data on the high rate of substance co-use of pregnant patients in the Kaiser Permanente Northern California health system who were universally screened for any prenatal substance use between 2009 and 2016. More than a third of women who had a screening result positive for marijuana use also had a positive result for at least one other substance. This result highlights the importance of controlling for co-occurring prenatal substance use to accurately detect marijuana-specific health risks.

According to the authors, well-designed retrospective and prospective cohort studies should include current, large, representative populations, and use validated measures of marijuana exposure while adjusting for other types of substance use. Large health care systems like Kaiser Permanente are well-positioned for this type of research, the results of which can help women make informed decisions about marijuana use during pregnancy.

 <p>Media contact: For an embargoed PDF, please contact Lauren Evans at [email protected] To interview the lead author, Kelly C. Young-Wolff, PhD, please contact Brett Israel at [email protected]    

Also new in this issue:

Clinical-Community Partnerships to Reduce Food Insecurity Among High-Need, High-Cost Medicaid Patients

Katherine Rediger, MSN, CRNP; D.R. Bailey Miles, MD

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1104

Association Between Publication Characteristics and Treatment Effect Estimates

Agnes Dechartres, MD, PhD; Ignacio Atal, MSc; Carolina Riveros, MSc; Joerg Meerpohl, MD; Philippe Ravaud, MD, PhD

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1517

<p>###</p>                           <p><strong>Media Contact</strong></p>    <p>Lauren Evans<br/>[email protected]<br/>215-351-2513<br/> @ACPinternists     

http://www.acponline.org

Comments