Publications by authors named "Althoff K"

Background: We developed a United States-based real-world data resource to better understand the continued impact of the coronavirus disease 2019 (COVID-19) pandemic on immunocompromised patients, who are typically underrepresented in prospective studies and clinical trials.

Methods: The COVID-19 Real World Data infrastructure (CRWDi) was created by linking and harmonizing de-identified HealthVerity medical and pharmacy claims data from 1 December 2018 to 31 December 2023, with severe acute respiratory syndrome coronavirus 2 virologic and serologic laboratory data from major commercial laboratories and Northwell Health; COVID-19 vaccination data; and, for patients with cancer, 2010 to 2021 National Cancer Institute Surveillance, Epidemiology, and End Results registry data.

Results: The CRWDi contains 4 cohorts: patients with cancer; patients with rheumatic diseases receiving pharmacotherapy; noncancer solid organ and hematopoietic stem cell transplant recipients; and people from the general population including adults and pediatric patients.

View Article and Find Full Text PDF

Background: The effect of initial antiretroviral therapy (ART) class on cancer risk in people with HIV (PWH) remains unclear.

Setting: Cohort study of 36,322 PWH enrolled (1996-2014) in the North American AIDS Cohort Collaboration on Research and Design.

Methods: We followed individuals from ART initiation (protease inhibitor [PI]-, non-nucleoside reverse transcriptase inhibitor [NNRTI]-, or integrase strand transfer inhibitor [INSTI]-based) until incident cancer, death, loss-to-follow-up, 12/31/2014, 85 months (intention-to-treat analyses [ITT]), or 30 months (per-protocol [PP] analyses).

View Article and Find Full Text PDF

HIV incidence among transgender women remains high and disproportionately impacts young, Black, and Latina transgender women. Data on preferred PrEP modalities among this population are limited. Participants in The LITE Cohort completed a survey module on PrEP modality preferences during 24-month study visits.

View Article and Find Full Text PDF

Background: While people with HIV (PWH) start antiretroviral treatment (ART) regardless of CD4 count, CD4 measurement remains crucial for detecting advanced HIV disease and evaluating ART programmes. We explored CD4 measurement (proportion of PWH with a CD4 result available) and prevalence of CD4 <200 cells/µL at ART initiation within the International epidemiology Databases to Evaluate AIDS (IeDEA) global collaboration.

Methods: We included PWH at participating ART programmes who first initiated ART at age 15-80 years during 2005-2019.

View Article and Find Full Text PDF

HIV care continuum outcome disparities by health insurance status have been noted among people with HIV (PWH). We therefore examined associations between state Medicaid expansion and HIV outcomes in the United States. Adults (≥18 years) with ≥1 visit in NA-ACCORD clinical cohorts from 2012-2017 contributed person-time annually between first and final visit or death; in each calendar year, clinical retention was ≥2 completed visits > 90 days apart, antiretroviral therapy (ART) receipt was receipt of ≥3 antiretroviral agents, and viral suppression was last measured HIV-1 RNA < 200 copies/mL.

View Article and Find Full Text PDF
Article Synopsis
  • Socioeconomic status (SES) affects the well-being of people living with HIV (PWH), and using area-level SES indicators can help when individual data isn't available.
  • ZIP code-level SES indicators were found to relate to viral suppression rates, and racial disparities in viral suppression narrowed by 3%-4% when accounting for SES factors.
  • This study suggests that including ZIP code-based SES can enhance understanding of how social determinants and racial disparities impact health outcomes for PWH.
View Article and Find Full Text PDF

Background: Increasing the equitable distribution of take home naloxone (THN) may result in reduced deaths from opioid overdose (OD).

Objectives: The primary study objective is to describe the demographic and clinical characteristics of emergency department (ED) patients who decline THN. The findings of this descriptive study may generate new hypotheses for successful THN distribution.

View Article and Find Full Text PDF
Article Synopsis
  • Transgender women (TW) face significant challenges with HIV, and there's a growing interest in using digital methods for HIV research, though bias between digital and site-based data collection is under-explored.
  • A study involving 1,312 TW in the eastern and southern USA compared characteristics of those participating in site-based versus digital modes, focusing on demographics, healthcare access, and mental health factors.
  • Results indicated that site-based participants were generally younger, more likely to identify as people of color, and had different experiences and risks related to HIV compared to those who participated online, suggesting that a hybrid approach may provide a more representative sample for research.
View Article and Find Full Text PDF
Article Synopsis
  • The HEALthy Brain and Child Development (HBCD) Study is a long-term research project focusing on the development of children's brains and related factors, starting from pregnancy through early childhood.
  • It aims to include a diverse range of pregnant individuals in the U.S., with a specific emphasis on those who use substances during pregnancy, in order to study the effects of prenatal substance use on child development.
  • The study employs innovative recruitment strategies, continuous monitoring of participant groups, and careful planning of data collection methods to ensure valid and reliable results over time.
View Article and Find Full Text PDF

Background: In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes.

Objective: Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women.

View Article and Find Full Text PDF

Purpose This study estimated risk of incident mental disorders in adulthood associated with both transient and persistent adolescent psychotic experiences (PEs). Methods A nested case-control design was used within the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth cohort study which recruited expectant mothers from 1991-1992. Participants consisted of 8822 offspring of ALSPAC mothers who completed the Psychosis-like Symptoms Interview Questionnaire (PLIKSi-Q).

View Article and Find Full Text PDF

Background: Anemia is an independent predictor of mortality, which may be utilized as a signal of deteriorating health. We estimated the association between anemia severity categories and mortality following the initiation of antiretroviral therapy (ART) among people with HIV (PWH) in North America.

Methods: Within the NA-ACCORD, annual median hemoglobin measurements between January 01, 2007, and December 31, 2016, were categorized using World Health Organization criteria into mild (11.

View Article and Find Full Text PDF
Article Synopsis
  • Anemia is prevalent among people living with HIV (PWH), and categorizing it by mean corpuscular volume (MCV) can help identify its underlying causes while receiving antiretroviral therapy (ART).
  • In a study of nearly 15,000 anemic PWH, 74% had normocytic anemia, while smaller percentages had microcytic or macrocytic types, with distinctions based on sex.
  • The study found that older age and comorbidities increased the likelihood of developing macrocytic anemia; however, the overall rates of macrocytic anemia decreased over time as microcytic anemia rates increased among females.
View Article and Find Full Text PDF
Article Synopsis
  • Researchers looked at why some patients with HIV go back to the hospital within 30 days after leaving, compared to those without HIV.
  • They studied a lot of hospital records from 2019 and found that patients with HIV had a higher chance (20.9%) of being readmitted than those without HIV (12.2%).
  • Young women with HIV had the highest readmission rates, and overall, patients with HIV need more support to stay healthy after being hospitalized.
View Article and Find Full Text PDF

Background: Anal cancer risk is elevated among people with HIV. Recent anal cancer incidence patterns among people with HIV in the United States and Canada remain unclear. It is unknown how the incidence patterns may evolve.

View Article and Find Full Text PDF

Objective: The aim of this study is to describe the incidence of diabetes mellitus type 2 (T2DM), hypercholesterolemia, hypertriglyceridemia, hypertension, and chronic kidney disease (CKD) from 2000 to 2019 among North American adults with perinatally acquired HIV (PHIV) aged 18-30 years.

Design: Description of outcomes based on electronic health records for a cohort of 375 young adults with PHIV enrolled in routine HIV care at clinics contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

Methods: We estimated overall, sex, and race-stratified cumulative incidences using Turnbull estimation, and incidence rates using quasi-Poisson regression.

View Article and Find Full Text PDF

Background: While national adoption of universal HIV treatment guidelines has led to improved, timely uptake of antiretroviral therapy (ART), longer-term care outcomes are understudied. There is little data from real-world service delivery settings on patient attrition, viral load (VL) monitoring, and viral suppression (VS) at 24 and 36 months after HIV treatment initiation.

Methods And Findings: For this retrospective cohort analysis, we used observational data from 25 countries in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium's Asia-Pacific, Central Africa, East Africa, Central/South America, and North America regions for patients who were ART naïve and aged ≥15 years at care enrollment between 24 months before and 12 months after national adoption of universal treatment guidelines, occurring 2012 to 2018.

View Article and Find Full Text PDF

The prevalence and correlates of food insecurity-the unavailability of food and limited access to it-have not been adequately considered among transgender women (TW), particularly alongside other health-related conditions burdening this population, such as HIV infection. This study examined the prevalence and correlates of food insecurity among TW. Between 2018 and 2020, 1590 TW in the Eastern and Southern U.

View Article and Find Full Text PDF

Objective: Almost 400 000 people with HIV (PWH) in the United States are over age 55 years and at risk for age-associated dementias (AAD), including Alzheimer's disease and vascular contributions to cognitive impairment and dementia (VCID). We projected the cumulative incidence and mortality associated with AAD among PWH at least 60 years in the United States compared with the general population.

Design/methods: Integrating the CEPAC and AgeD-Pol models, we simulated two cohorts of 60-year-old male and female individuals: PWH, and the general US population.

View Article and Find Full Text PDF

Objectives: To measure associations between residential moves because of unaffordable housing costs and disruptions in access to the Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; and Medicaid in a health care-based sample of families with young children.

Methods: We used cross-sectional survey data on social safety net-eligible caregivers and children recruited into the Children's HealthWatch study from emergency departments and primary care clinics in Baltimore and Philadelphia (2011-2019). Children's HealthWatch measured residential moves (cost-driven and noncost-driven) in the past year and disruptions in safety net access.

View Article and Find Full Text PDF

Background: Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States.

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to predict the prevalence of comorbidities and multimorbidity among people living with HIV in the US by 2030, utilizing the PEARL agent-based simulation model.
  • It forecasted that the population of individuals on antiretroviral therapy (ART) will grow from 670,000 in 2020 to 908,000 by 2030, reflecting increases among various demographic groups, including Hispanic and Black/African American individuals.
  • Key findings indicated a rise in mental health issues like depression and anxiety, projecting an increase from 60% to 64% prevalence, while hypertension was expected to decrease.
View Article and Find Full Text PDF

Background: While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status and the availability of PrEP services across HIV care sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium.

Methods: We used country-level PrEP drug registration status from the AIDS Vaccine Advocacy Coalition and data from IeDEA surveys conducted in 2014, 2017 and 2020 among participating HIV clinics in seven global regions.

View Article and Find Full Text PDF

Introduction: Transgender women in the United States experience high HIV incidence and suboptimal Pre-exposure prophylaxis (PrEP) engagement. We sought to estimate PrEP initiation and discontinuation rates and characterize PrEP discontinuation experiences among a prospective cohort of transgender women.

Methods: Using a sequential, explanatory, mixed-methods design, 1312 transgender women at risk for HIV acquisition were enrolled from March 2018 to August 2020 and followed through July 2022 (median follow-up 24 months; interquartile range 15-36).

View Article and Find Full Text PDF
Article Synopsis
  • The study explores the impact of different mortality rate models on forecasts of HIV population size and deaths, emphasizing the importance of considering subgroup-specific characteristics in the analysis.* -
  • Using an agent-based simulation, the researchers assessed various scenarios, including all PWH and specific subgroups by sex, race/ethnicity, and HIV acquisition risk, to understand how these factors affect mortality predictions.* -
  • Findings indicate that models ignoring subgroup-specific mortality rates and allowing unlimited reductions in mortality may lead to significant underestimations of future deaths among people with HIV.*
View Article and Find Full Text PDF