Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa.

Purpose: Hepatocellular carcinoma (HCC) is common and deadly in sub-Saharan Africa, where advanced imaging techniques, such as computerized tomography and magnetic resonance imaging, are scarce. The purpose of this study was to develop a pragmatic HCC diagnostic strategy for such settings.

Methods: We evaluated standardized protocol-collected data on clinical, ultrasonographic, biochemical, and pathological criteria in a multisite study of 649 suspected HCC cases in Uganda.

Multiple approaches to genetic sequencing to identify hepatitis C virus reinfection among people who inject drugs.

The burden of hepatitis C virus (HCV) among persons who inject drugs is determined by dynamics of infection, spontaneous clearance, treatment clearance, treatment failure, and reinfection. Although analysis of HCV sequences is often used to infer the net contribution of these factors, those inferences are complicated by the quasispecies distribution and continued evolution of infection within each host. We used deep sequencing by Nanopore to study sequences of persons with and without self-reported HCV treatment.

Changes in the prevalence of non-AIDS conditions among hospitalized persons with HIV in the United States and Canada, 2008-2018.

Background: Hospitalization causes among persons with HIV (PWH) have shifted to non-AIDS conditions, but the complete disease profile of hospitalized PWH has not been well described. To inform hospitalization and readmission prevention efforts, we examined non-AIDS disease prevalence among PWH hospitalized in four US and one Canadian cohorts.

Methods: Among PWH with ≥1 hospitalization from 2008 to 2018, we used log-binomial regression with generalized estimating equations to estimate trends in the annual prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease stage ≥3 (CKD), and multimorbidity (≥2 and ≥3 conditions), defined using longitudinal diagnosis, medication, and laboratory data.

Cognitive function and mortality among persons aging with HIV and injection drug use.

Objective: Cognitive impairment and frailty are critical, aging-related phenotypes prevalent among people with HIV (PWH). Yet, limited data exist isolating the determinants of cognitive function among persons with a history of injection drug use (PWID) with and at risk for HIV, or on the intersecting relationship of cognitive function and frailty with mortality in this population.

Design/methods: Standard cognitive assessments were performed among PWID with and without HIV in the AIDS Linked to the IntraVenous Experience (ALIVE) cohort.

Drug treatment and support service utilization amidst the COVID-19 pandemic among people who inject drugs in Baltimore, Maryland: An interrupted time-series analysis, 2015-2022.

Background: The COVID-19 pandemic prompted many structural and social changes including adaptations to drug treatment policies and provision (e.g., take-home methadone flexibilities and telehealth services), but their collective impact on drug treatment use among people who inject drugs in the US remains unclear.

Proteomic signature of HIV-associated subclinical left atrial remodeling and incident heart failure.

People living with HIV are at higher risk of heart failure and associated left atrial remodeling compared to people without HIV. Mechanisms are unclear but have been linked to inflammation and premature aging. Here we obtain plasma proteomics concurrently with cardiac magnetic resonance imaging in two independent study populations to identify parallels between HIV-related and aging-related immune dysfunction that could contribute to atrial remodeling and clinical heart failure.

Impact of Pandemic-Induced Service Disruptions and Behavioral Changes on Hepatitis C Virus and HIV Transmission Amongst People Who Inject Drugs: A Modeling Study.

Background: The coronavirus disease 2019 (COVID-19) pandemic may have disproportionally impacted vulnerable groups such as people who inject drugs (PWID) through reduced health care services as well as social changes from pandemic mitigation measures. Understanding how the COVID-19 pandemic and associated mitigation strategies subsequently changed the trajectory of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission is critical to estimating disease burdens, identifying outbreak risk, and developing informed intervention strategies.

Methods: Using behavioral data from the AIDS Linked to the IntraVenous Experience (ALIVE) study, an ongoing community-based cohort of PWID in Baltimore, United States, and an individual-based network model, we explored the impacts of service disruptions combined with changes in social networks and injecting behaviors of PWID on HCV and HIV transmission.

Association of inadequate sleep with mortality among persons who inject drugs.

Background: Inadequate sleep is associated with all-cause mortality in the general population. Substance use has adverse effects on sleep, and insomnia symptoms are common among people with HIV. Therefore, persons who inject drugs may face a heightened risk of adverse outcomes from inadequate sleep.

Individual Heterogeneity and Trends in Hepatitis C Infection Risk Among People Who Inject Drugs: A Longitudinal Analysis.

Hepatitis C virus (HCV) causes substantial morbidity and mortality, particularly among people who inject drugs (PWID). While elimination of HCV as a public health problem may be possible through treatment-as-prevention, reinfection can attenuate the impact of treatment scale-up. There is a need to better understand the distribution and temporal trends in HCV infection risk, including among HCV-seropositive individuals who will be eligible for treatment and at risk for subsequent reinfection.

"Especially being homeless, they just think you're infected with COVID or something": A qualitative exploration of the COVID-19 pandemic's impact on people experiencing homelessness with a history of injection drug use in Baltimore, Maryland.

People experiencing homelessness with a substance use disorder are a highly structurally vulnerable population, facing a unique burden of compounding stigma, discrimination, and adverse health outcomes. Evidence remains mixed on best practices for housing interventions designed to best meet the needs of this population. Ten people with a history of injection drug use experiencing homelessness during the COVID-19 pandemic were interviewed between July, 2021 and February, 2022 in Baltimore, Maryland.

Prediction of differential Gag versus Env responses to a mosaic HIV-1 vaccine regimen by HLA class I alleles.

class I variation has the strongest effect genome-wide on outcome after HIV infection, and as such, an understanding of the impact of polymorphism on response to HIV vaccination may inform vaccine design. We sought associations with HIV-directed immunogenicity in the phase 1/2a APPROACH vaccine trial, which tested vaccine regimens containing mosaic inserts in Ad26 and MVA vectors, with or without a trimeric gp140 protein. While there were no allelic associations with the overall cellular immune response to the vaccine assessed by ELISpot (Gag, Pol, and Env combined), significant associations with differential response to Gag compared to Env antigens were observed.

Association of primary care engagement with initiation and continuation of medication treatment for opioid use disorder among persons with a history of injection drug use.

Background: For patients with opioid use disorder (OUD), primary care can serve as a pathway to medication for OUD (MOUD). No community-based studies have examined whether people with OUD engaged in primary care are more likely to a) initiate or b) continue MOUD.

Methods: Data were collected 2014-2020 from two subsamples of the AIDS Linked to the Intravenous Experience (ALIVE) cohort, a community-recruited cohort of people from Baltimore who have injected drugs: 1) people who reported past-six-month illicit opioid use and no MOUD (360 participants, 789 study visits), and 2) people who reported MOUD and no illicit opioid use in the past six months (561 participants, 2027 visits).

Relationship between patient activation and utilisation of health care and harm reduction services among people who inject drugs in Baltimore, Maryland.

Introduction: Given structural barriers, access to services is key for preventing drug-related harms and managing chronic disease among people who inject drugs (PWID). The Patient Activation Measure (PAM), a validated scale to assess self-efficacy in navigating one's own health care, was operationalised to improve service utilisation and outcomes but has not been assessed among PWID. We characterised PAM and its association with healthcare and harm reduction utilisation among PWID in the AIDS Linked to IntraVenous Experience cohort in Baltimore.

Hepatitis B Virus DNA and RNA Persist in Liver After Serologic Recovery in Persons With Hepatitis C Virus.

After recovery from a hepatitis B virus (HBV) infection, reactivation can occur with immunosuppression; thus, it is assumed that replication competent HBV persists in the liver. We sought to detect persistent HBV from 13 people with spontaneous recovery. We quantified HBV DNA and RNA in core liver biopsy specimens (median, 1.

Structural and social changes due to the COVID-19 pandemic and their impact on engagement in substance use disorder treatment services: a qualitative study among people with a recent history of injection drug use in Baltimore, Maryland.

Background: Substance use disorder treatment and recovery support services are critical for achieving and maintaining recovery. There are limited data on how structural and social changes due to the COVID-19 pandemic impacted individual-level experiences with substance use disorder treatment-related services among community-based samples of people who inject drugs.

Methods: People with a recent history of injection drug use who were enrolled in the community-based AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland participated in a one-time, semi-structured interview between July 2021 and February 2022 about their experiences living through the COVID-19 pandemic (n = 28).

Baltimore oral epidemiology, disease effects, and HIV evaluation study (BEEHIVE) study protocol: a prospective cohort study.

Background: As antiretroviral therapy has become widely available and highly effective, HIV has evolved to a manageable, chronic disease. Despite this health advancement, people living with HIV (PLWH) are at an increased risk for age-related non-communicable diseases (NCDs) compared to HIV-uninfected individuals. Similarly, PLWH are at an increased risk for selected oral diseases.

Hepatocellular carcinoma surveillance among people living with hepatitis B in Senegal (SEN-B): insights from a prospective cohort study.

Background: Chronic hepatitis B virus (HBV) infection is the predominant cause of hepatocellular carcinoma in west Africa, yet data on the incidence of HBV-related hepatocellular carcinoma remain scarce. We aimed to describe the uptake and early outcomes of systematic ultrasound-based hepatocellular carcinoma screening in SEN-B, which is a prospective HBV cohort in Senegal.

Methods: In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the two infectious diseases clinics (the Department of Tropical and Infectious Diseases and Ambulatory Treatment Center) at Fann University Hospital of Dakar, Senegal, between Oct 1, 2019, and Oct 31, 2022.

Characterizing multimorbidity in ALIVE: comparing single and ensemble clustering methods.

Multimorbidity, defined as having 2 or more chronic conditions, is a growing public health concern, but research in this area is complicated by the fact that multimorbidity is a highly heterogenous outcome. Individuals in a sample may have a differing number and varied combinations of conditions. Clustering methods, such as unsupervised machine learning algorithms, may allow us to tease out the unique multimorbidity phenotypes.

Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use.

Background: People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population.

Methods: This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland.

Temporal trends in HCV treatment uptake and success among people who inject drugs in Baltimore, MD since the introduction of direct acting antivirals.

Background: Although hepatitis C virus (HCV) can be cured by direct acting antivirals (DAA), uptake is not well characterized for people who inject drugs (PWID).

Methods: Among 1,130 participants of a community-based cohort of PWID with chronic HCV, we longitudinally characterized HCV treatment uptake and cure early (2014-2016) and later (2017-2020).

Results: Cumulative HCV treatment uptake increased from 4% in 2014 to 68% in 2020 and the percent with HCV viremia declined from nearly 100% to 33%.

Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study.

Background: Delay discounting quantifies an individual's preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions.

Longitudinal patterns of use of stimulants and opioids in the AIDS linked to the IntraVenous experience cohort, 2005-2019.

Background: Overdoses involving opioids and stimulants are on the rise, yet few studies have examined longitudinal trends in use of both substances. We sought to describe use and co-use of opioids and stimulants, 2005-2019, in the AIDS Linked to the Intravenous Experience (ALIVE) cohort - a community-based cohort of people with a history of injection drug use living in or near Baltimore, MD.

Methods: We included 2083 ALIVE participants, who had at least two visits during the study period.

Proteomic Signature of HIV-Associated Subclinical Left Atrial Remodeling and Incident Heart Failure.

Background: People living with HIV (PLWH) are at higher risk of heart failure (HF) and preceding subclinical cardiac abnormalities, including left atrial dilation, compared to people without HIV (PWOH). Hypothesized mechanisms include premature aging linked to chronic immune activation. We leveraged plasma proteomics to identify potential novel contributors to HIV-associated differences in indexed left atrial volume (LAVi) among PLWH and PWOH and externally validated identified proteomic signatures with incident HF among a cohort of older PWOH.