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

Ovarian function and cigarette smoking in the BioCycle Study

Cigarette smoking has been implicated in reproductive outcomes including delayed conception, but mechanisms underlying these associations remain unclear. One potential mechanism is the effect of cigarette smoking on reproductive hormones; however, studies evaluating associations between smoking and hormone levels are complicated by variability of hormones and timing of specimen collection. We evaluated smoking among women participating in the BioCycle Study, a longitudinal study of menstrual cycle function in healthy, premenopausal, regularly menstruating women (n = 259). Fertility monitors were used to help guide timing of specimen collection. Serum levels of oestradiol, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH) and total sex-hormone binding globulin (SHBG) across phases of the menstrual cycle were compared between smokers and non-smokers. We observed statistically significant phase-specific differences in hormone levels between smokers and non-smokers. Compared with non-smokers, smokers had higher levels of FSH in the early follicular phase and higher LH at menses after adjusting for potential confounding factors of age, race, body mass index, parity, vigorous exercise, and alcohol and caffeine intake through inverse probability of treatment weights. No statistically significant differences were observed for oestradiol, progesterone or SHBG. These phase-specific differences in levels of LH and FSH in healthy, regularly menstruating women who are current smokers compared with non-smokers reflect one mechanism by which smoking may influence fertility and reproductive health

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