Reducing Stigma-Driven Health Disparities in People Living with HIV (PLWH): A Literature Review

Introduction: Research has found that HIV-related stigma has numerous negative impacts on the lives of people living with HIV (PLWH). Although there are more resources than ever dedicated to HIV/AIDS efforts, stigma continues to be a major factor challenging the prevention and treatment of HIV today. Understanding the impacts of stigma on health outcomes and quality of life in PLWH is essential to address the global HIV epidemic and reduce health disparities. Search Strategy: We conducted a secondary meta-analysis of existing research that discussed and evaluated the impacts of HIV-related stigma and discrimination on PLWH. We searched the following databases for peerreviewed articles: EBSCO Host, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed. We also obtained reports from Centers for Disease Control (CDC), Food and Drug Administration (FDA), Office of the High Commissioner for Human Rights (OHCHR), World Health Organization (WHO), and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Results: Our review of the literature revealed that HIV-related stigma is a socially constructed global phenomenon that reflects social and cultural tradition. Most current stigma-reduction interventions are designed to address individual-level stigma (symbolic stigma). While this has contributed to improvements in individual attitudes towards PLWH, interventions at the individual level alone do not address the macro-level attitudes and societal norms that influence individual ideals and behaviors. Conclusion: Findings in the literature review suggest that because of the pervasiveness of HIV-related stigma globally, addressing stigma is imperative to the HIV response. It also suggests that interventions that address stigma at the structural level and target multiple domains might have a more profound impact on HIV-related health outcomes

Worldwide Innovative Network (WIN) Consortium in Personalized Cancer Medicine: Bringing next-generation precision oncology to patients.

The human genome project ushered in a genomic medicine era that was largely unimaginable three decades ago. Discoveries of druggable cancer drivers enabled biomarker-driven gene- and immune-targeted therapy and transformed cancer treatment. Minimizing treatment not expected to benefit, and toxicity-including financial and time-are important goals of modern oncology. The Worldwide Innovative Network (WIN) Consortium in Personalized Cancer Medicine founded by Drs. John Mendelsohn and Thomas Tursz provided a vision for innovation, collaboration and global impact in precision oncology. Through pursuit of transcriptomic signatures, artificial intelligence (AI) algorithms, global precision cancer medicine clinical trials and input from an international Molecular Tumor Board (MTB), WIN has led the way in demonstrating patient benefit from precision-therapeutics through N-of-1 molecularly-driven studies. WIN Next-Generation Precision Oncology (WINGPO) trials are being developed in the neoadjuvant, adjuvant or metastatic settings, incorporate real-world data, digital pathology, and advanced algorithms to guide MTB prioritization of therapy combinations for a diverse global population. WIN has pursued combinations that target multiple drivers/hallmarks of cancer in individual patients. WIN continues to be impactful through collaboration with industry, government, sponsors, funders, academic and community centers, patient advocates, and other stakeholders to tackle challenges including drug access, costs, regulatory barriers, and patient support. WIN\u27s collaborative next generation of precision oncology trials will guide treatment selection for patients with advanced cancers through MTB and AI algorithms based on serial liquid and tissue biopsies and exploratory omics including transcriptomics, proteomics, metabolomics and functional precision medicine. Our vision is to accelerate the future of precision oncology care

Abstract 12093: Tafamidis Use and New Onset Atrial Fibrillation in Patients With Cardiac Amyloidosis

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia seen in patients with cardiac amyloidosis (CA). Tafamidis, a transthyretin stabilizer, has been associated with reductions in all-cause mortality and other promising outcomes in patients with CA. However, its effect on incidence of AF still remains unknown. Hypothesis: Tafamidis therapy in patients with CA is associated with lower incidence of AF. Methods: A group of 200 patients with transthyretin CA following at our institution between 2003 and 2019 were retrospectively reviewed. Baseline characteristics, onset of AF (determined by ECG, device interrogation, or ambulatory monitoring) and tafamidis use data were collected. Patients with diagnosis of AF at baseline were excluded. Patients were matched based on age, sex, BMI, DM, HTN, ischemic heart disease, and stage of amyloid disease. Time to event analysis was performed to assess the incidence of new-onset AF in patients who had received tafamidis versus those who had not. Results: In total, 36 patients met inclusion criteria. Of these 36 patients diagnosed with incident AF, 10 received tafamidis therapy prior to AF diagnosis and 26 did not. Median time to Tafamidis initiation after diagnosis of cardiac amyloidosis was 243 [64, 776] days [IQR]. Average follow-up time was 21.8 ± 24.4 months. There were no significant differences between baseline characteristics, however there were more African Americans (27% vs. 0%) and Val122Ile mutations (23% vs. 10%) in the control group. Overall, tafamidis initiation was associated with lower incidence of new-onset AF compared to those who had not received the therapy (p=0.026). Persistent AF was the most common type of AF, no matter being on tafamidis or not. Conclusions: Tafamidis therapy in patients with CA might be associated with lower incidence of AF. The mechanism however is not clear and further studies are needed to re-examine this finding and elucidate the potential mechanism. </jats:p

The Type I interferon antiviral gene program is impaired by lockdown and preserved by caregiving

Previous research has linked perceived social isolation (loneliness) to reduced antiviral immunity, but the immunologic effects of the objective social isolation imposed by pandemic “shelter in place” (SIP) policies is unknown. We assessed the immunologic impact of SIP by relocating 21 adult male rhesus macaques from 2,000-m2 field cage communities of 70 to 132 other macaques to 2 wk of individual housing in indoor shelters. SIP was associated with 30% to 50% reductions in all circulating immune cell populations (lymphocytes, monocytes, and granulocytes), down-regulation of Type I interferon (IFN) antiviral gene expression, and a relative up-regulation of CD16− classical monocytes. These effects emerged within the first 48 h of SIP, persisted for at least 2 wk, and abated within 4 wk of return to social housing. A subsequent round of SIP in the presence of a novel juvenile macaque showed comparable reductions in circulating immune cell populations but reversal of Type I IFN reductions and classical monocyte increases observed during individual SIP. Analyses of lymph node tissues showed parallel up-regulation of Type I IFN genes and enhanced control of viral gene expression during juvenile-partnered SIP compared to isolated SIP. These results identify a significant adverse effect of SIP social isolation on antiviral immune regulation in both circulating immune cells and lymphoid tissues, and they suggest a potential behavioral strategy for ameliorating gene regulatory impacts (but not immune cell declines) by promoting prosocial engagement during SIP. © 2021 National Academy of Sciences. All rights reserved

The Type I interferon antiviral gene program is impaired by lockdown and preserved by caregiving.

Previous research has linked perceived social isolation (loneliness) to reduced antiviral immunity, but the immunologic effects of the objective social isolation imposed by pandemic "shelter in place" (SIP) policies is unknown. We assessed the immunologic impact of SIP by relocating 21 adult male rhesus macaques from 2,000-m2 field cage communities of 70 to 132 other macaques to 2 wk of individual housing in indoor shelters. SIP was associated with 30% to 50% reductions in all circulating immune cell populations (lymphocytes, monocytes, and granulocytes), down-regulation of Type I interferon (IFN) antiviral gene expression, and a relative up-regulation of CD16- classical monocytes. These effects emerged within the first 48 h of SIP, persisted for at least 2 wk, and abated within 4 wk of return to social housing. A subsequent round of SIP in the presence of a novel juvenile macaque showed comparable reductions in circulating immune cell populations but reversal of Type I IFN reductions and classical monocyte increases observed during individual SIP. Analyses of lymph node tissues showed parallel up-regulation of Type I IFN genes and enhanced control of viral gene expression during juvenile-partnered SIP compared to isolated SIP. These results identify a significant adverse effect of SIP social isolation on antiviral immune regulation in both circulating immune cells and lymphoid tissues, and they suggest a potential behavioral strategy for ameliorating gene regulatory impacts (but not immune cell declines) by promoting prosocial engagement during SIP

The Type I interferon antiviral gene program is impaired by lockdown and preserved by caregiving

Significance “Shelter in place” (SIP) orders have been deployed to slow the spread of SARS-CoV-2, but they induce social isolation that may paradoxically weaken antiviral immunity. We examined the impact of 2-wk SIP on immune cell population dynamics and gene regulation in 21 adult rhesus macaques, finding 30 to 50% declines in circulating immune cells, decreases in antiviral gene expression, and increased inflammatory cells in blood and inflammatory gene expression in lymph nodes. Declines in antiviral gene expression (but not circulating immune cells) were blocked by the presence of a novel juvenile partner during SIP, suggesting a potential strategy for maintaining antiviral immunity during SIP by enhancing prosocial engagement.</jats:p

Abstract 15185: Outcomes of Radiofrequency Catheter Ablation of Atrial Arrhythmias in Lung Transplant Recipients

Introduction: Atrial arrhythmias (AA) are common after lung transplant (LT) and may impact overall mortality. The majority of arrhythmias tend to be organized flutter, amenable to ablation; however the data is limited. Hypothesis: The purpose of this study was to investigate the outcomes of radiofrequency catheter ablation of AA in LT recipients. Methods: All LT recipients undergoing electrophysiology study at our institution between 2011-2018 were retrospectively reviewed. A total of 20 atrial ablations were identified in 16 patients. Mean follow-up was 4 ± 2.9 years. Results: Overall, mean age was 55 ± 13 years, 63% were male, 63% were status post bilateral (vs. single) LT, and mean LVEF was 57%. Transplant indications included interstitial lung disease (44%), COPD (19%), and cystic fibrosis (19%). Antiarrhythmics and beta blockers were used in 44% and 75%, respectively. Mean time from transplant to first ablation was 2.7 years. Of 20 ablations, macro-reentrant flutter (75%) and focal atrial tachycardia (15%) were common, particularly in double LT recipients (Figure). The most common ablation sites were pulmonary vein anastomosis/left atrial ridge (60%), mitral annulus (35%) and left atrial roof (30%). Restoration of sinus rhythm occurred in 19 of 20 procedures and only one complication occurred (e.g. small pericardial effusion without tamponade). Arrhythmia recurred in 10 (63%) patients, however, most were managed conservatively. Repeat ablation was needed in 4 patients, of which AAs originated from different locations. Beta blocker use was associated with a lower risk of SVT recurrence (p=0.04). Reduced LVEF and longer time to procedure post-transplant were associated with repeat ablation (p&lt;0.05). Conclusions: The majority of AAs in LT recipients are atrial flutter originating near the pulmonary vein anastomosis sites. Despite a high immediate procedural success rate, recurrence is high and 25% of patients require multiple ablation attempts. </jats:p

Design, fabrication, and performance evaluation of open raceway ponds for the cultivation of Chlorella vulgaris beijerinck in the Philippines

Two pilot-scale open raceway pond systems were designed and fabricated in the University of the Philippines Los Baños (UPLB) for the cultivation of Chlorella vulgaris Beijerinck to observe the biomass productivity of the alga in an open condition in the Philippines. One design was an oval track with a middle island, while the other was a multi-stage raceway pond (MSRP) consisted of several sections separated by baffles. The pond designs aimed to accommodate 1,000 L of culture. The nutrient media used was composed of urea, NPK (16-20-0), FeCl3, and Na2EDTA – a locally formulated medium that sustains the growth of the species. Paddlewheel was installed to provide mixing, which was turned on during the daytime, while aeration was continuously supplied through perforated air-distributor PVC pipes installed on the pond floor. Only natural light was utilized, and no lighting was provided during the night. The growth rate was generated by monitoring the biomass concentration in the pond through spectrophotometry at 425 nm, where optical density and biomass concentration relationship was initially established. Using the equation for first-order kinetics and taking the points from the exponential phase, the specific growth rate of Chlorella obtained from the oval raceway pond was computed to be 0.007308 h–1 with doubling time of 94.84 h. The biomass productivity rate was computed to be 308.49 g/m3-d or equivalent to 63.24 g/m2-d. On the other hand, the MSRP obtained a specific growth rate of 0.003389 h–1 with a doubling time of 204.55 h and equivalent biomass productivity of 302.19 g/m3-d or 60.44 g/m2-d. The biomass productivity obtained is comparable, even superior to other commercial open pond cultivation using C. vulgaris