Adverse Events in a Cohort of HIV Infected Pregnant and Non-Pregnant Women Treated with Nevirapine versus Non-Nevirapine Antiretroviral Medication

BACKGROUND: Predictors of adverse events (AE) associated with nevirapine use are needed to better understand reports of severe rash or liver enzyme elevation (LEE) in HIV+ women. METHODOLOGY: AE rates following ART initiation were retrospectively assessed in a multi-site cohort of 612 women. Predictors of onset of rash or LEE were determined using univariate and multivariate analyses. PRINCIPAL FINDINGS: Of 612 subjects, 152 (24.8%) initiated NVP-based regimens with 86 (56.6%) pregnant; 460 (75.2%) initiated non-NVP regimens with 67 (14.6%) pregnant. LEE: No significant difference was found between regimens in the development of new grade ≥2 LEE (p  =  0.885). Multivariate logistic regression demonstrated an increased likelihood of LEE with HCV co-infection (OR 2.502, 95% CI: 1.04 to 6, p =  0.040); pregnancy, NVP-based regimen, and baseline CD4 >250 cells/mm(3) were not associated with this toxicity. RASH: NVP initiation was associated with rash after controlling for CD4 and pregnancy (OR 2.78; 95%CI: 1.14-6.76), as was baseline CD4 >250 cells/mm(3) when controlling for pregnancy and type of regimen (OR 2.68; 95% CI: 1.19-6.02 p  =  0.017). CONCLUSIONS: CD4 at initiation of therapy was a predictor of rash but not LEE with NVP use in HIV+ women. Pregnancy was not an independent risk factor for the development of AEs assessed. The findings from this study have significant implications for women of child-bearing age initiating NVP-based ART particularly in resource limited settings. This study sheds more confidence on the lack of LEE risk and the need to monitor rash with the use of this medication

Perceptions of U.S. Medical Residents Regarding Amount and Usefulness of Sexual Health Instruction in Preparation for Clinical Practice

Despite patient demand for sexual health discussions with their physicians, sexuality instruction in residency is often lacking. This exploratory quantitative study assessed the amount and usefulness of sexuality instruction received by a sample of medical residents, as well as the residents\u27 self-perceived readiness regarding addressing sexuality issues. Data were obtained through a self-administered survey with 130 resident respondents. The majority reported receiving little/no formal sexuality instruction. Many indicated that additional sexuality instruction would be useful in their practice. Although the majority reported comfort discussing sexuality, they reported rarely/never initiating these discussions. Recommendations for changes in graduate medical education programming are provided

Subjects included in rash analysis.

<p>Subjects included in rash analysis.</p

Subjects included in hepatic adverse events analysis.

<p>Subjects included in hepatic adverse events analysis.</p

Study Sample Demographic and Clinical Characteristics stratified by Pregnancy Status (N = 612).

<p><i>Percentages may not equal 100 due to rounding.</i></p

Demographic and Clinical Characteristics at Enrollment for 612 HIV+ Women stratified by Antiretroviral Regimen.

<p><i>Percentages may not equal 100 due to rounding.</i></p

Clinical Characteristics of HIV+ women developing new onset grade ≥2 LEE (n = 27).

<p>*<i>All p values are continuity-corrected chi-square, 2-tailed.</i></p><p>**<i>HCV denominators are lower because this information was not available for all subjects.</i></p><p><i>(a) p = 0.054 two-tailed for the comparison of NVP related relative risks in high and low baseline CD4 count groups.</i></p><p><i>NA: Risk estimates are not reported since adverse events were not observed for both treatment categories.</i></p