Novel Use of Surveillance Data to Detect HIV-Infected Persons with Sustained High Viral Load and Durable Virologic Suppression in New York City

Background: Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL). Methods/Principal Findings: Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and $12 years old by the end of 2005 and who had$2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs $100,000 copies/mL and PLWHA with all VLs #400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7 % had SHVL and 38 % had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average. Conclusions/Significance: Nearly 60 % of PLWHA in 2005 had multiple VLs, of whom almost 40 % had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based o

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Preoperative Imaging Assessment of Patients With Suspected Nonfunctioning Pituitary Adenomas.

BACKGROUND: The authors reviewed published articles pertaining to the preoperative imaging evaluation of nonfunctioning pituitary adenomas (NFPAs) and formulated recommendations. OBJECTIVE: To provide an exhaustive review of published articles pertaining to the preoperative imaging evaluation of nonfunctioning pituitary adenomas. METHODS: The MEDLINE database was queried for studies investigating imaging for the preoperative evaluation of pituitary adenomas. RESULTS: From an initial search of 5598 articles, 122 articles were evaluated in detail and included in this article. Based on analysis of these articles, the recommendations are as follows: (1) High-resolution magnetic resonance imaging (level II) is recommended as the standard for preoperative assessment of nonfunctioning pituitary adenomas, but may be supplemented with CT (level III) and fluoroscopy (level III). (2) Although there are promising results suggesting the utility of magnetic resonance spectroscopy, magnetic resonance perfusion, positron emission tomography, and single-photon emission computed tomography, there is insufficient evidence to make formal recommendations pertaining to their clinical applications. CONCLUSION: The authors identified 122 articles that form the basis of recommendations for preoperative imaging evaluation of nonfunctioning pituitary adenomas. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_2. ABBREVIATIONS: CT, computed tomographyDWI, diffusion-weighted imagingMRI, magnetic resonance imagingNFPA, nonfunctioning pituitary adenoma

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Surgical Techniques and Technologies for the Management of Patients With Nonfunctioning Pituitary Adenomas.

BACKGROUND: Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques. OBJECTIVE: To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies. METHODS: An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included. The clinical assessment evidence-based classification was used to ascertain the class of evidence. RESULTS: Fifty-six studies met the inclusion criteria, and evidence-based guidelines were formulated on the use of endoscopy, neuronavigation, intraoperative MRI, CSF diversion, and dural closure techniques. CONCLUSION: Both endoscopic and microscopic transsphenoidal approaches are recommended for symptom relief in patients with NFPAs, with the extent of tumor resection improved by adequate bony exposure and endoscopic visualization. In select cases, combined transcranial and transsphenoidal approaches are recommended. Although intraoperative MRI can improve gross total resection, its use is associated with an increased false-positive rate and is thus not recommended. There is insufficient evidence to recommend the use of neuronavigation, CSF diversion, intrathecal injection, or specific dural closure techniques. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6. ABBREVIATIONS: CSF, cerebrospinal fluidNFPA, nonfunctioning pituitary adenoma

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Surgical Techniques and Technologies for the Management of Patients With Nonfunctioning Pituitary Adenomas.

BACKGROUND: Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques. OBJECTIVE: To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies. METHODS: An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included. The clinical assessment evidence-based classification was used to ascertain the class of evidence. RESULTS: Fifty-six studies met the inclusion criteria, and evidence-based guidelines were formulated on the use of endoscopy, neuronavigation, intraoperative MRI, CSF diversion, and dural closure techniques. CONCLUSION: Both endoscopic and microscopic transsphenoidal approaches are recommended for symptom relief in patients with NFPAs, with the extent of tumor resection improved by adequate bony exposure and endoscopic visualization. In select cases, combined transcranial and transsphenoidal approaches are recommended. Although intraoperative MRI can improve gross total resection, its use is associated with an increased false-positive rate and is thus not recommended. There is insufficient evidence to recommend the use of neuronavigation, CSF diversion, intrathecal injection, or specific dural closure techniques. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6. ABBREVIATIONS: CSF, cerebrospinal fluidNFPA, nonfunctioning pituitary adenoma

Characteristics of HIV-infected New Yorkers with sustained high viral load (SHVL) and durable virologic suppression and all persons diagnosed and presumed living, New York City¹.

<p>VL, viral load. NYC, New York City. PLWHA, persons living with HIV/AIDS. MSM, men who have sex with men. IDU, intravenous drug use. IQR, interquartile range. NA, not available.</p>1<p>Data as reported to the NYC DOHMH by December 31, 2009.</p>2<p>Includes persons who had heterosexual sex with an HIV-infected person, an injection drug user, or a person who has received blood products. For females only, heterosexual sex also includes sex with a male and at least one of the following: history of commercial sex work, multiple male sex partners, sexually transmitted disease, crack/cocaine use, sex with a bisexual male, probable heterosexual transmission as noted in a medical chart, or negative history of injection drug use.</p>3<p>NYC DOHMH collects race and ethnicity data that meet federal standards of classification and maintains ethnicity data separately from race information. Persons of Hispanic or Latino ethnicity have a separate race classification. Due to small numbers, persons reporting more than one race, Native Americans or Alaska Natives, Hawaiian Natives, Asian, and Pacific Islanders were classified as ‘Other’.</p>4<p>Borough of residence refers to the residence at HIV diagnosis for persons living with HIV (non-AIDS) or residence at AIDS diagnosis for PLWHA.</p

HIV-infected New Yorkers grouped by VL trend, 2006–2007.

<p>HIV-infected New Yorkers grouped by VL trend, 2006–2007.</p

Eligibility flow chart on HIV-infected New Yorkers, 2006 and 2007.

<p>Eligibility flow chart on HIV-infected New Yorkers, 2006 and 2007.</p

Characteristics of HIV-infected New Yorkers with ≥2 viral load tests and all persons diagnosed and presumed living, New York City¹.

<p>VL, viral load. NYC, New York City. PLWHA, persons living with HIV/AIDS. MSM, men who have sex with men. IDU, intravenous drug users.</p>1<p>Data as reported to the NYC DOHMH by December 31, 2009.</p>2<p>Includes persons who had heterosexual sex with an HIV-infected person, an injection drug user, or a person who has received blood products. For females only, heterosexual sex also includes sex with a male and at least one of the following: history of commercial sex work, multiple male sex partners, sexually transmitted disease, crack/cocaine use, sex with a bisexual male, probable heterosexual transmission as noted in a medical chart, or negative history of injection drug use.</p>3<p>NYC DOHMH collects race and ethnicity data that meet federal standards of classification and maintains ethnicity data separately from race information. Persons of Hispanic or Latino ethnicity have a separate race classification. Due to small numbers, persons reporting more than one race, Native Americans or Alaska Natives, Hawaiian Natives, Asian, and Pacific Islanders were classified as ‘Other’.</p>4<p>Borough of residence refers to the residence at HIV diagnosis for persons living with HIV (non-AIDS) or residence at AIDS diagnosis for PLWHA.</p