Publications by authors named "Gregory Fusco"
Background: Two-drug regimens (2DRs) have been introduced in recent years to potentially reduce antiretroviral therapy (ART) toxicities and drug-drug interactions while demonstrating comparable efficacy to three-drug regimens (3DRs) for people with HIV (PWH). The objective of this study was to compare the real-world effectiveness and durability of a single-tablet 2DR of dolutegravir/lamivudine (DTG/3TC) with that of commonly prescribed 3DRs in ART-experienced, virologically suppressed PWH during the first 24 months of DTG/3TC availability in the United States.
Methods: Virologically suppressed (viral load [VL] < 200 copies/mL) adult PWH initiating DTG/3TC 2DR, bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), or a DTG-based 3DR between 01MAY2019 and 31OCT2020 were identified in the OPERA cohort and followed through 30APR2021.
Article Synopsis
- Fostemsavir is a new drug used alongside other treatments for adults with multidrug-resistant HIV-1, focusing on its real-world effects in the OPERA cohort.
- The study analyzed immunological (CD4 T-cell counts) and virological (viral load) responses in participants starting fostemsavir, categorizing results based on their initial viral load and CD4 count.
- Results showed that while most individuals with suppressed viral loads maintained their status, those with low CD4 counts had notable improvements in immune response with fostemsavir, despite limited virological success in those who were viraemic.
Article Synopsis
- The study evaluates the effectiveness of the two-drug regimen (DTG/3TC) for HIV treatment, focusing on individuals transitioning from a three-drug regimen while maintaining a viral load under 50 copies/mL.
- It includes 787 treatment-experienced participants followed for a median of 13.6 months, finding low rates of virologic failure and loss of viral control.
- Results indicate that DTG/3TC is a viable and generally well-tolerated option for HIV treatment across different age, sex, and racial groups.
Article Synopsis
- The study assessed the CHORUS™ app's effectiveness in improving adherence to monthly CAB + RPV long-acting injectable injections.
- Healthcare centers were split into two groups: one with access to the app and one without, to compare adherence rates.
- Although access to the app didn't significantly increase adherence, using the app did raise adherence rates, particularly in smaller healthcare centers lacking established procedures.
HIV-associated wasting (HIVAW) is an underappreciated AIDS-defining illness, despite highly effective antiretroviral therapy (ART). We (a) assessed the association between incident HIVAW/low weight and all-cause mortality and (b) described virologic outcomes after people with HIV (PWH) experienced HIVAW/low weight while on ART. In the Observational Pharmaco-Epidemiology Research & Analysis (OPERA) cohort, PWH without prior HIVAW/low weight who were active in care in 2016-2020 were followed through the first of the following censoring events: death, loss to follow-up, or study end (October 31, 2021).
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- The study reviews the effectiveness and adherence to the new long-acting injectable HIV treatment, cabotegravir + rilpivirine (CAB + RPV LA), which is approved for individuals with stable virus levels and no treatment history issues.
- In a sample of 321 adults receiving this treatment, 90% of injections were administered on schedule, and almost all patients maintained undetectable or suppressed viral loads during follow-ups.
- Overall, the findings suggest that CAB + RPV LA is effective in real-world clinical settings, with minimal impact from minor delays in injection schedules on patient outcomes.
Article Synopsis
- - The study analyzed HIV-associated wasting (HIVAW) and low weight in people with HIV in the U.S. using data from the OPERA cohort, finding a consistent prevalence rate of 12% over two time periods (2012-2015 and 2016-2020).
- - Among a large cohort of adults with HIV who had not previously experienced low weight, 7% developed HIVAW over a median of 64 months post-diagnosis, with demographic factors like age, sex, and race influencing odds of weight issues.
- - The findings highlight that advanced HIV and comorbid conditions are strong predictors of HIVAW, suggesting a need for increased awareness among healthcare providers, particularly for older and fra
Article Synopsis
- The study aimed to compare immune responses and treatment outcomes among advanced HIV patients in the USA who started different antiretroviral therapy (ART) regimens.
- A total of 1349 participants were monitored for around 22 months after starting either bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), boosted darunavir (bDRV), dolutegravir (DTG), or elvitegravir (EVG/c).
- Results indicated that those on B/F/TAF experienced quicker CD4 cell recovery and better virological outcomes, while the CD4:CD8 ratio improvements were similar across all regimens.
Article Synopsis
- - The study compared clinical outcomes between heavily treatment-experienced (HTE) and non-HTE people living with HIV (PLWH), focusing on their ART regimens and resistance to treatments over a median follow-up of 28 months.
- - Results indicated that HTE PLWH had lower chances of achieving undetectable viral loads and maintaining adequate CD4 cell counts compared to non-HTE PLWH, and they were also more likely to need changes in their treatment regimens.
- - Both groups experienced non-AIDS defining morbidities, with a higher prevalence in HTE PLWH (45%) versus non-HTE (35%), though serious morbidities and deaths were relatively rare.
Article Synopsis
- The study assessed whether identifying people with HIV (PWH) at risk of falling out of care, along with automated outreach prompts, improved retention in care across 20 healthcare centers in the U.S.
- Results indicated that 56% of PWH in care were flagged, and both the intervention and control groups had similar visit rates after being flagged, but intervention centers slightly outperformed controls.
- The proportion of at-risk PWH achieving viral load suppression improved more significantly in intervention centers, suggesting potential benefits of integrating automated flags into existing care systems.
Article Synopsis
- A study investigated weight gain in people with HIV who were virologically suppressed and switched to new medication regimens including tenofovir alafenamide/emtricitabine (TAF/FTC) combined with various antiretroviral drugs.
- Out of 5,536 participants, 18% gained at least 5% of their weight within 28 weeks, and 9% gained 10% or more within 54 weeks, but no significant differences in weight gain were found among the different treatment regimens.
- Overall, while some individuals did experience excessive weight gain, the average weight changes remained small and consistent across the different medication groups over the follow-up period.
Article Synopsis
- About 20% of new HIV cases in the U.S. involve advanced HIV infection, and research on effective antiretroviral therapy (ART) for these cases is limited.
- A study compared several ART regimens (B/F/TAF, boosted darunavir, dolutegravir, and elvitegravir/cobicistat) among ART-naïve individuals with advanced HIV and assessed their regimen discontinuation and effectiveness.
- Results showed that those on B/F/TAF were less likely to discontinue treatment and more successful in achieving viral suppression compared to those on boosted darunavir, but no significant differences were found with other integrase inhibitors.
Article Synopsis
- * Researchers found that low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) increased significantly, particularly during the first 9 to 16 months after switching to TAF.
- * The observed lipid increases were consistent even when accounting for other medications, suggesting that the TDF to TAF switch directly contributed to these changes.
Article Synopsis
- Preventing HIV transmission is essential to ending the HIV epidemic, and effective PrEP has been available since 2012, aiming to help those at highest risk.
- A study compared the demographics of nearly 15,000 PrEP users with over 3,500 newly diagnosed HIV cases to evaluate who was receiving PrEP and identify gaps in access to care.
- The findings revealed disparities in PrEP prescriptions, with older, non-Black males more likely to receive it, and emphasized the need for targeted programs to reach underrepresented populations, particularly young people, women, Black individuals, and intravenous drug users.
Article Synopsis
- A study assessed the effects of switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) on cholesterol and triglyceride levels in people living with HIV (PLWH) who had been on TDF for at least 4 weeks.* -
- Results showed a significant increase in total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides, while high-density lipoprotein (HDL) cholesterol decreased after the switch.* -
- Despite a high percentage of patients (31%) having an elevated risk for heart disease after switching, many were not prescribed statins, indicating an underutilization of necessary lipid management treatments.*
Article Synopsis
- A study investigated treatment outcomes for ART-naive people living with HIV (PLWH) who began antiretroviral therapy with high viral loads (≥100,000 copies/mL).
- The research, conducted using data from the OPERA database, focused on the effectiveness of different ART regimens, including dolutegravir (DTG), elvitegravir (EVG), raltegravir (RAL), and darunavir (DRV), over a median follow-up of 18.1 months.
- Results indicated that those starting on DTG had a lower virologic failure rate (9.2%) compared to EVG (13.2%), RAL (18.4
With obesity on the rise among people living with HIV (PLWH), there is growing concern that weight gain may result as an undesired effect of antiretroviral therapy (ART). This analysis sought to assess the association between ART regimens and changes in body mass index (BMI) among ART-experienced, virologically suppressed PLWH. ART-experienced, virologically suppressed PLWH ≥18 years of age in the Observational Pharmacoepidemiology Research and Analysis (OPERA) cohort were included for analysis if prescribed a new regimen containing one of the following core agents: dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), rilpivirine (RPV), or boosted darunavir (bDRV), for the first time between August 1, 2013 and December 31, 2017.
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- The study investigates weight changes in HIV-positive individuals who switched from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF), analyzing the weight gain associated with these medications.
- It includes 6,908 participants from the U.S. OPERA cohort, examining those who maintained their antiretrovirals and those switching to integrase strand transfer inhibitors (InSTIs).
- Results show that while there was modest weight gain on TDF, switching to TAF resulted in significant early weight gain for all participants, regardless of whether they switched to an InSTI or not.
Article Synopsis
- The study aimed to evaluate the risks of adverse health diagnoses and lab issues linked to daily doses of lamivudine (3TC) in people living with HIV who have moderate kidney function (eGFR between 30 and 49 ml/min).
- It involved analyzing health records from 539 participants, comparing those starting on a 150 mg dose versus a 300 mg dose of 3TC.
- Findings indicated that while there were no major differences in severe lab abnormalities or diagnoses between the two doses, those on 150 mg had higher HIV levels and more health issues, suggesting that 300 mg may not require adjustment for this group unless gastrointestinal or moderate lab problems arise.
Article Synopsis
- * The findings showed that usage of dolutegravir (DTG) was common, while elvitegravir (EVG) users tended to be younger and healthier compared to those on DTG or other drugs like raltegravir (RAL) and darunavir (DRV).
- * Importantly, the analysis revealed no significant differences in the incidence of moderate/severe liver chemistry elevations between the different drug groups, despite some variations in patient characteristics.
Article Synopsis
- Researchers found that common HIV treatments can bias creatinine measurements used to assess kidney function, leading to misleading low estimated GFR (eGFR) values.
- They developed correction factors for eGFR calculations based on literature to address this issue.
- Their analysis showed that without correction, certain HIV regimens seemed to worsen kidney function, but with correction, the perceived risk was significantly reduced, indicating the importance of accounting for measurement biases.
Article Synopsis
- The study examines how common prediabetes and type 2 diabetes (T2DM) are among people living with HIV (PLHIV) and investigates the impact of different antiretroviral therapy (ART) regimens on the risk of developing T2DM.
- By analyzing the health records of nearly 30,000 PLHIV, researchers found that the prevalence of prediabetes was around 8-11% and T2DM was 4-10%, with incidence rates varying for ART-naive and ART-experienced individuals.
- The results indicated no significant differences in T2DM risk associated with ART regimens like dolutegravir compared to others (elvite
Introduction: Two-drug regimens (2-DR) have the potential to be a viable solution to the challenges of treatment complexity, cost, adverse effects and contraindications. We sought to describe the real-world use and effectiveness of 2-DR among persons living with HIV (PLHIV) in the United States.
Methods: We analysed data for 10,190 treatment-experienced patients from the OPERA® Observational Database initiating a new 2-DR or three-drug regimen (3-DR) between 1 January 2010 and 30 June 2016.
Article Synopsis
- The study compares the clinical effectiveness of four antiretroviral therapy (ART) agents—Dolutegravir (DTG), Elvitegravir (EVG), Raltegravir (RAL), and Darunavir (DRV)—in preventing virologic failure among HIV-positive individuals.
- The analysis included 4049 ART-naïve patients and found that those starting on DTG had significantly higher rates of viral suppression compared to those on RAL and DRV, with rates of 78.7% for DTG versus only 51.9% and 48.6% for RAL and DRV, respectively.
- This indicates that DTG is more effective in achieving viral suppression and has lower associated
Background: Quality measures are effective tools to improve patient outreach, retention in care, adherence, and outcomes. This study benchmarks National Quality Forum-endorsed HIV quality measures in a US clinical cohort.
Methods: This observational study utilized prospectively captured data from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) database over 2014-2016 to assess quality measure achievement among patients with HIV in terms of (#2079), (#2080), (#2082), and (ART) (#2083).