Background Integrase strand-transfer inhibitor (INSTI)-based antiretroviral therapy (ART) is recommended for human immunodeficiency virus (HIV) management. Although studies have suggested associations between INSTIs and weight gain, women living with HIV (WLHIV) have been underrepresented in research. We evaluated the effect of switching or adding INSTIs among WLHIV. Methods Women enrolled in the Women’s Interagency HIV Study (WIHS) from 2006–2017 who switched to or added an INSTI to ART (SWAD group) were compared to women on non-INSTI ART (STAY group). Body weight, body mass index (BMI), percentage body fat (PBF), and waist, hip, arm, and thigh circumferences were measured 6–12 months before and 6–18 months after the INSTI switch/add in SWAD participants, with comparable measurement time points in STAY participants. Linear regression models compared changes over time by SWAD/STAY group, adjusted for age, race, WIHS site, education, income, smoking status, and baseline ART regimen. Results We followed 1118 women (234 SWAD and 884 STAY) for a mean of 2.0 years (+/− 0.1 standard deviation [SD]; mean age 48.8 years, SD +/− 8.8); 61% were Black. On average, compared to the STAY group, the SWAD group experienced mean greater increases of 2.1 kg in body weight, 0.8 kg/m2 in BMI, 1.4% in PBF, and 2.0, 1.9, 0.6, and 1.0 cm in waist, hip, arm, and thigh circumference, respectively (all P values < .05). No differences in magnitudes of these changes were observed by INSTI type. Conclusions In WLHIV, a switch to INSTI was associated with significant increases in body weight, body circumferences, and fat percentages, compared to non-INSTI ART. The metabolic and other health effects of these changes deserve further investigation.

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Background Little is known about fertility choices and pregnancy outcome rates among HIV-infected women in the current combination ART era. Objective To describe trends and factors associated with live-birth and abortion rates among HIV-positive and high-risk HIV-negative women enrolled in the Women’s Interagency HIV Study (WIHS) in the United States. Study Design We analyzed longitudinal data collected from October 1st 1994 to September 30th 2012 through WIHS. Age-adjusted rates per 100 person-years (PY) live-births, and induced abortions were calculated by HIV serostatus over four time periods. Poisson mixed effects models containing variables associated with live-births and abortions in bivariable analyses (p<0.05) generated adjusted incidence rate ratios (aIRRs) and 95% confidence intervals. Results There were 1,356 pregnancies among 2,414 women. Among HIV-positive women, age-adjusted rates of live-birth increased from 1994-1997 to 2006-2012 (2.85/100PY to 7.27/100PY, p-trend<0.0001). Age-adjusted rates of abortion in HIV-positive women remained stable over these time periods (4.03/100PY to 4.29/100PY, p-trend=0.09). Significantly lower live-birth rates occurred among HIV-positive compared to HIV-negative women in 1994-1997 and 1997-2001, however rates were similar during 2002-2005 and 2006-2012. Higher CD4+ T cells/mm3 (≥350 aIRR=1.39 [1.03-1.89] versus <350) was significantly associated with increased live-birth rates, while combination antiretroviral treatment (cART) use (aIRR=1.35 [0.99-1.83]) was marginally associated with increased live-birth rates. Younger age, having a prior abortion, condom use and increased parity were associated with increased abortion rates among both HIV-positive and HIV-negative women. CD4+ T-cell count, cART use, and viral load were not associated with abortion rates. Conclusions Unlike earlier periods (pre-2001) when live-birth rates were lower among HIV-positive women, rates are now similar to HIV-negative women, potentially due to improved health status and cART. Abortion rates remain unchanged illuminating a need to improve contraceptive services.

Neutrophils are increasingly associated with tuberculosis (TB) disease. Neutrophil extracellular traps (NETs), which are released by neutrophils as a host antimicrobial defense mechanism, are also associated with tissue damage. However, a link between NET levels and TB disease has not been studied. Here we investigate plasma NETs levels in patients with active pulmonary tuberculosis using an ELISA assay that is suitable for high-throughput processing. We show that plasma NETs levels at baseline correlated with disease severity and decreased with antibiotic therapy. Our study demonstrates the biologic plausibility of measuring NETs in plasma samples from patients with TB.

Objective: To develop a Vaccine Confidence Index (VCI) that is capable of detecting variations in parental confidence towards childhood immunizations centered on trust and concern issues that impact vaccine confidence. Methods: We used a web-based national poll of 893 parents of children <7 years in 2016 to assess the measures created for the Emory VCI (EVCI). EVCI measures were developed using constructs related to vaccine confidence identified by the U.S. National Vaccine Advisory Committee (i.e., “Information Environment”, “Trust”, “Healthcare Provider”, “Attitudes and Beliefs”, and “Social Norms”). Reliability for EVCI was assessed using Cronbach’s alpha. Using the variables related to each of the constructs, we calculated an overall EVCI score that was then assessed against self-reported childhood vaccine receipt using chi-square and the Cochrane-Armitage trend tests. Results: Respondents’ EVCI scores could range from 0 to 24, and the full range of values was observed in this sample (Mean = 17.5 (SD 4.8)). EVCI scores were significantly different (p ≤ 0.006 for all comparisons) between parents who indicated their child(ren) received routinely recommended vaccines compared with parents who indicated they had delayed or declined recommended immunizations. There was also a significant, consistent association between higher EVCI scores and greater reported vaccine receipt. Conclusions: We developed EVCI to reliably measure parental vaccine confidence, with individuals’ scores linked to parental vaccine-related attitudes, intentions, and behaviors. As such, EVCI may be a useful tool for future monitoring of both population and individual confidence in childhood immunization.

Background: Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain among women living with HIV. We aimed to investigate the association between INSTIs and change in cardiometabolic risk indicators. Setting: Retrospective cohort. Methods: Data from 2006 to 2017 were analyzed from women living with HIV enrolled in the longitudinal Women's Interagency HIV Study who were virally controlled on antiretroviral therapy (ART) for ≥5 consecutive semiannual visits. Women who switched/added an INSTI to ART (INSTI group) were compared with women who remained on non-INSTI ART (non-INSTI group). Outcomes included changes in fasting lipids and glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and incident diabetes, hypertension, and insulin resistance. Outcomes were measured 6–12 months before and 6–18 months after INSTI switch/add in the INSTI group with comparable visits in the non-INSTI group. Longitudinal linear regression models compared change over time in each outcome by the study group. Results: One thousand one hundred eighteen participants (234 INSTI, 884 non-INSTI) were followed for a median 2.0 (Q1 1.9, Q3 2.0) years. Participants were median age 49 years, 61% Black, and 73% overweight or obese (body mass index ≥25 kg/m2). Compared with non-INSTI, the INSTI group experienced greater increases in HbA1c (+0.05 vs. −0.06 mg/dL, P = 0.0318), systolic BP (+3.84 vs. +0.84 mm Hg, P = 0.0191), and diastolic BP (+1.62 vs. −0.14 mm Hg, P = 0.0121), with greatest change in HbA1c among women on INSTIs with ≥5% weight gain. Conclusions: INSTI use was associated with unfavorable changes in HbA1c and systolic and diastolic BP during short-term follow-up. Further research is needed to understand long-term cardiometabolic effects of INSTI use.

Longitudinal patterns of health care resource use after screening revealed new evidence on the economic burden of treatment and testing patterns not previously reported. Maintenance of a healthy population has the potential to markedly reduce the economic burden of CVD among asymptomatic individuals.

These data suggest that OS can be safely performed if appropriate precautions and patient selection are followed. Data such as these will help determine health care policy to maximize patient safety.