Publications by authors named "Jack Fuhrer"

8 Publications

  • Page 1 of 1

Hepatitis C Virus Testing Among Men With Human Immunodeficiency Virus Who Have Sex With Men: Temporal Trends and Racial/Ethnic Disparities.

Open Forum Infect Dis 2021 Apr 17;8(4):ofaa645. Epub 2021 Apr 17.

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: National guidelines recommend that sexually active people with human immunodeficiency virus (PWH) who are men who have sex with men (MSM) be tested for hepatitis C virus (HCV) infection at least annually. Hepatitis C virus testing rates vary by race/ethnicity in the general population, but limited data are available for PWH.

Methods: We analyzed medical records data from MSM in the HIV Outpatient Study at 9 human immunodeficiency virus (HIV) clinics from January 1, 2011 through December 31, 2019. We excluded observation time after documented past or current HCV infection. We evaluated HCV antibody testing in each calendar year among HCV-seronegative MSM, and we assessed testing correlates by generalized estimating equation analyses.

Results: Of 1829 eligible MSM who were PWH, 1174 (64.2%) were non-Hispanic/Latino white (NHW), 402 (22.0%) non-Hispanic black (NHB), 187 (10.2%) Hispanic/Latino, and 66 (3.6%) of other race/ethnicity. Most were ≥40 years old (68.9%), privately insured (64.5%), with CD4 cell count/mm (CD4) ≥350 (77.0%), and with HIV viral load <200 copies/mL (76.9%). During 2011-2019, 1205 (65.9%) had ≥1 HCV antibody test and average annual HCV percentage tested was 30.3% (from 33.8% for NHB to 28.5% for NHW; < .001). Multivariable factors positively associated ( < .05) with HCV testing included more recent HIV diagnosis, public insurance, lower CD4, prior chlamydia, gonorrhea, syphilis, or hepatitis B virus diagnoses, and elevated liver enzyme levels, but not race/ethnicity.

Conclusions: Although we found no disparities by race/ethnicity in HCV testing, low overall HCV testing rates indicate suboptimal uptake of recommended HCV testing among MSM in HIV care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ofid/ofaa645DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052496PMC
April 2021

The HIV Outpatient Study-25 Years of HIV Patient Care and Epidemiologic Research.

Open Forum Infect Dis 2020 May 11;7(5):ofaa123. Epub 2020 Apr 11.

Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum.

Methods: We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993-2017) and mortality (1994-2017) for 10 566 HOPS participants.

Results: The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm to 640 cells/mm from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 ( < .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92.2% in 2017.

Conclusions: Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ofid/ofaa123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235508PMC
May 2020

Alpha Omega Alpha Honor Medical Society: A Commitment to Inclusion, Diversity, Equity, and Service in the Profession of Medicine.

Acad Med 2020 05;95(5):670-673

R.L. Byyny is executive director, Alpha Omega Alpha Honor Medical Society, Aurora, Colorado, chancellor emeritus, University of Colorado Boulder, Boulder, Colorado, and a retired internal medicine physician. D. Martinez is chief of staff, Alpha Omega Alpha Honor Medical Society, Aurora, Colorado. L. Cleary is associate dean for curriculum, senior associate dean for education, vice president for academic affairs, and AΩA chapter councilor, State University of New York, Upstate, Syracuse, New York. B. Ballard is associate dean for continuing medical education, chairman and professor of pathology, and AΩA chapter councilor, Meharry Medical College, Nashville, Tennessee; ORCID: https://orcid.org/0000-0001-7202-2506. B.E. Barth is associate professor, emergency medicine, and assistant dean for student affairs, University of Kansas Medical Center, Kansas City, Kansas; ORCID: https://orcid.org/0000-0003-3996-1346. S. Christensen is a psychiatry resident and drug abuse and research training fellow, Medical University of South Carolina, Charleston, South Carolina; ORCID: https://orcid.org/0000-0002-0702-1862. W. Eidson-Ton is professor of family medicine and obstetrics and AΩA chapter councilor, University of California, Davis, Sacramento, California. D. Estevez-Ordonez is a neurosurgery resident, University of Alabama at Birmingham, Birmingham, Alabama, and a student director, AΩA Board of Directors. J. Fuhrer is associate dean for admissions, director, HIV Treatment Center, associate professor of medicine, and AΩA chapter councilor, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York. J.M. Kinzie is associate professor of psychiatry and AΩA chapter councilor, Oregon Health & Science University, Portland, Oregon. A.L. Lee is assistant professor, Department of Family Medicine, and AΩA chapter councilor, Tufts University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7956-4746. C. Lynch is associate vice president, College of Medicine obstetrics and gynecology, associate vice president, women's health and faculty development, associate dean, faculty development, professor, obstetrics and gynecology, and AΩA chapter councilor, University of South Florida, Tampa, Florida; ORCID: https://orcid.org/0000-0002-6478-2561. S. Pfeil is medical director, Clinical Skills Education and Assessment Center, professor, Division of Gastroenterology, Hepatology and Nutrition, and AΩA chapter councilor, The Ohio State University College of Medicine and Wexner Medical Center, Columbus, Ohio. E. Schoenbaum is professor, Department of Epidemiology & Population Health, professor, Department of Medicine, Infectious Diseases, director, Medical Student Research, Office of Medical Education, and AΩA chapter councilor, Albert Einstein College of Medicine, New York City, New York; ORCID: http://orcid.org/0000-0002-0878-284X.

With a motto of "Be Worthy to Serve the Suffering," Alpha Omega Alpha Honor Medical Society (AΩA) supports the importance, inclusion, and development of a culturally and ethnically diverse medical profession with equitable access for all. The underrepresentation of minorities in medical schools and medicine continues to be a challenge for the medical profession, medical education, and AΩA. AΩA has worked, and continues to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms.Inclusion of talented individuals from different backgrounds benefits patient care, population health, education, and scientific discovery. AΩA values an inclusive, diverse, fair, and equitable work and learning environment for all and supports the medical profession in its work to achieve a welcoming, inclusive environment in teaching, learning, caring for patients, and collaboration.The diversity of medical schools is changing and will continue to change. AΩA is committed to continuing to work with its members, medical school deans, and AΩA chapters to assure that AΩA elections are unbiased and based on the values of AΩA and the profession of medicine in service to patients and the profession.Progress toward diversity, inclusion, and equity is more than simply checking off a box or responding to criticism-it is about being and developing diverse excellent physicians. AΩA and all those in the medical profession must continue to guide medicine to be unbiased, open, accepting, inclusive, and culturally aware in order to "Be Worthy to Serve the Suffering."
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ACM.0000000000003088DOI Listing
May 2020

Team Triage Intervention, Including Licensed Practical Nurse, to Increase HIV Testing Rates in the Emergency Department: A Quality Improvement Project.

J Emerg Nurs 2019 Nov 4;45(6):685-689. Epub 2019 Oct 4.

Introduction: Emergency departments have an important role in screening for human immunodeficiency virus infection and reducing the morbidity, mortality, and transmission of the human immunodeficiency virus. There are debates about human immunodeficiency virus screening, including opt-in, opt-out, and active choice models. Previous studies have shown that multiple factors affect the patient rate of acceptance, including where, when, and by whom the screening is offered. The purpose of this quality improvement project was to test a team-based triage intervention to improve the amount of HIV testing done in our emergency department.

Methods: The design was a single site quality improvement intervention with post-intervention monthly rates compared to historic monthly rate controls. The intervention focused on the introduction of a Licensed Practical Nurse in addition to the current triage process and personnel. The percentage of patients receiving human immunodeficiency virus testing and the number of tests sent per month before and after the implementation of the intervention were measured.

Results: Our results show that 0.6% (SD < 0.01) and 2.5% (SD 2.2) of patients received human immunodeficiency virus testing before and after implementation of the intervention, respectively (χ = 501.76, P < 0.05). A mean of 37.4 (SD = 12.91) and 151.3 (SD = 33.34) human immunodeficiency virus tests were sent per month before and after implementation of the intervention, respectively (t = 8.53, P < 0.001).

Discussion: This process intervention, in which licensed practical nurses offered human immunodeficiency virus screening tests during team triage, resulted in a 3-fold increase in the percentage of patients being tested for human immunodeficiency virus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jen.2019.07.016DOI Listing
November 2019

Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru.

Am J Trop Med Hyg 2018 08 31;99(2):331-337. Epub 2018 May 31.

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ test, -test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4269/ajtmh.17-0909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090363PMC
August 2018

Successful treatment of invasive Aspergillus sinusitis with caspofungin and voriconazole.

Ear Nose Throat J 2008 Jan;87(1):30-3

Division of Infectious Diseases, Stony Brook University Medical Center, Stony Brook, NY 11794-8153, USA.

Chronic invasive Aspergillus sinusitis is a rare and potentially devastating infection. Management typically requires extensive surgical debridement followed by long-term antifungal therapy, primarily with intravenous amphotericin B. We describe the case of an elderly woman who had been diagnosed with extensive Aspergillus sinusitis that had invaded critical structures. The extensiveness of the infection and the patients frailty and unwillingness to undergo a disfiguring procedure precluded surgery, and her medical condition was too fragile to withstandamphotericin B therapy Therefore, we decided to treat her with a combination ofcaspofungin and voriconazole, two relatively nontoxic antifungal agents that have different mechanisms of action. After administration of this novel regimen, the infection resolved rapidly.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2008

Hepatitis A and B vaccination practices for ambulatory patients infected with HIV.

Clin Infect Dis 2004 May 28;38(10):1478-84. Epub 2004 Apr 28.

General Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.

Few studies exist of adherence to guidelines for vaccination of persons infected with human immunodeficiency virus (HIV), especially in the era of highly active antiretroviral therapy (HAART). In a retrospective, cross-sectional analysis in the HIV Outpatient Study sites, 198 (32.4%) of 612 patients eligible for hepatitis B vaccine received at least 1 dose. In multivariate analysis, hepatitis B vaccination was associated with HIV risk category, education level, and number of visits to the HIV clinic per year. Among 716 patients eligible for hepatitis A vaccine, 167 (23.3%) received > or =1 dose. Response to hepatitis B vaccination was associated with higher nadir CD4+ cell counts (P=.008) and HIV RNA levels less than the level of detection (P=.04), although some response was documented at all CD4+ levels. Although there were low rates of complete hepatitis vaccination in this cohort of ambulatory patients, prompt efforts to vaccinate patients entering care, receipt of antiretroviral therapy, and practice reminder systems may enhance vaccination practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1086/420740DOI Listing
May 2004

Improved insulin sensitivity and body fat distribution in HIV-infected patients treated with rosiglitazone: a pilot study.

J Acquir Immune Defic Syndr 2002 Oct;31(2):163-70

Department of Medicine, State University of New York at Stony Brook, 11794-8154, USA.

The insulin-sensitizing drugs thiazolidinediones (TZDs), such as rosiglitazone, improve insulin sensitivity and also promote adipocyte differentiation in vitro. The authors hypothesized that TZDs might be beneficial to patients with HIV disease to improve insulin sensitivity and the distribution of body fat by increasing peripheral fat. The ability of rosiglitazone (8 mg/d) to improve insulin sensitivity (from hyperinsulinemic-euglycemic clamp) and to improve body fat distribution (determined from computed tomography measurements of visceral adipose tissue [VAT] and subcutaneous adipose tissue [SAT]) was determined in 8 HIV-positive patients. Before treatment, the insulin sensitivity of the patients was reduced to approximately 34% of that in control subjects. The rate of glucose disposal during a hyperinsulinemic-euglycemic clamp (Rd) was 3.8 +/-.4 (SEM) mg glucose/kg lean body mass/min compared with 11.08 +/- 1.1 (p<.001) in healthy age- and body mass index (BMI)-matched control subjects. After rosiglitazone treatment of 6 to 12 weeks, Rd increased to 5.99 +/-.9 (p=.02), an improvement of 59 +/- 22%. SAT increased by 23 +/- 10% (p=.05), and, surprisingly, VAT was decreased by 21 +/- 8% (p=.04) with a trend for increased SAT/VAT that failed to reach statistical significance. There were no significant changes in blood counts, viral loads, or CD4 counts with rosiglitazone treatment. The study demonstrates that rosiglitazone therapy improves insulin resistance and body fat distribution in some patients with HIV disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00126334-200210010-00006DOI Listing
October 2002