Disparities in Integrase Inhibitor Usage in the Modern HIV Treatment Era: A Population-Based Study in a US City.

Integrase inhibitor-based (INSTI) antiretroviral therapy (ART) regimens are preferred for most people with HIV (PWH). We examined factors associated with INSTI use among PWH in San Francisco who started ART in 2009-2016. PWH who experienced homelessness were less likely, and older PWH were more likely, to use an INSTI.

Sensitivity and Specificity of the National Death Index for Multiple Causes of Death in People With HIV.

Objectives: Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review.

Methods: Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017.

Gender differences in causes of death among persons with HIV/AIDS in San Francisco, California, 1996-2013.

The objective was to examine gender differences in causes of death using the San Francisco HIV/AIDS and death registries. Data from San Francisco residents diagnosed with HIV/AIDS who died from 1996 to 2013 were analyzed. Age, race/ethnicity, year, and gender-adjusted standardized mortality ratios and Poisson 95% confidence intervals were calculated for underlying causes of death.

Disparities and Trends in Viral Suppression During a Transition to a "Test and Treat" Approach to the HIV Epidemic, San Francisco, 2008-2012.

Background: In 2010, 2 years before national recommendations to provide antiretroviral therapy for HIV-infected persons regardless of CD4 count, the San Francisco Department of Public Health (SFDPH) implemented a "test and treat" strategy that expanded HIV testing and offered antiretroviral therapy to persons at all publicly funded HIV clinics. We used the SFDPH registry of HIV-infected persons to measure trends in the time to viral suppression of persons suppressed.

Methods: The Kaplan-Meier product limit method was used to assess trends in time from HIV diagnosis to viral suppression (HIV RNA <200 copies/mL) among persons diagnosed from 2008 to 2012.

Difference in Survival between Housed and Homeless individuals with HIV, San Francisco, 2002-2011.

San Francisco (SF), a city with large HIV-infected and homeless populations, expanded supportive housing for HIV-infected people in 2007. We used the SF HIV/AIDS registry to compare survival between people who were homeless and who were housed at time of HIV diagnosis from 2002 through 2011. Housing status was obtained from medical records and deaths from local, state, and national vital registration.

Changes in causes of death among persons with AIDS: San Francisco, California, 1996-2011.

The increased life expectancy among HIV-infected persons treated with combination antiretroviral therapy (ART), risk behaviors, and co-morbidities associated with ART place HIV-infected persons at risk for non-HIV-related causes of death. We used the San Francisco HIV/AIDS registry to identify deaths that occurred from January 1996 through December 2011. Temporal trends in AIDS- and non-AIDS-related mortality rates, the proportion of underlying and contributory causes of death, and the ratio of observed deaths in the study population to expected number of deaths among California men aged 20-79 (standardized mortality ratio [SMR]) of underlying causes of death were examined.

Trends in early initiation of antiretroviral therapy and characteristics of persons with HIV initiating therapy in San Francisco, 2007-2011.

In 2010, the San Francisco Department of Public Health offered antiretroviral therapy (ART) to all its patients with human immunodeficiency virus (HIV) regardless of CD4 count. We assessed trends in time from diagnosis to ART initiation and factors associated with ART initiation among San Francisco residents living with HIV between 2007 and 2011. Time to ART initiation decreased among those diagnosed with higher CD4 count.

Identifying barriers to HIV testing: personal and contextual factors associated with late HIV testing.

Late diagnosis of HIV is associated with increased morbidity, mortality, and health care costs. Despite the availability of HIV testing, persons continue to test late in the course of HIV infection. We used the HIV/AIDS case registry of San Francisco Department of Public Health to identify and recruit 41 persons who developed AIDS within 12 months of their HIV diagnosis to participate in a qualitative and quantitative interview regarding late diagnosis of HIV.

Estimation of unmet need for HIV primary medical care: a framework and three case studies.

Reauthorization of the Ryan White Comprehensive AIDS Resources Emergency Act requires that each jurisdiction estimate the number of people living with HIV/AIDS who have unmet need for care. Past assessments of unmet need have used various definitions of care, relied on qualitative evaluations, or examined nonrepresentative subpopulations. This article outlines a single, flexible framework designed to quantitatively estimate unmet need in varied settings.

Determinants of survival among HIV-infected chronic dialysis patients.

Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period.

Trends in causes of death among persons with acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy, San Francisco, 1994-1998.

To understand recent temporal trends in acquired immunodeficiency syndrome (AIDS) mortality in the era of highly active antiretroviral therapy (HAART), trends in causes of death among persons with AIDS in San Francisco who died between 1994 and 1998 were analyzed. Among 5234 deaths, the mortality rate for human immunodeficiency virus (HIV)-related or AIDS-related deaths declined after 1995 (P<.01), whereas the mortality rate for non-HIV- or non-AIDS-related deaths remained stable.