scholarly journals The Effects of Viral Load Burden on Pregnancy Loss among HIV-Infected Women in the United States

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Jordan E. Cates ◽  
Daniel Westreich ◽  
Andrew Edmonds ◽  
Rodney L. Wright ◽  
Howard Minkoff ◽  
...  
Keyword(s):  
United States ◽  
Viral Load ◽  
Pregnancy Loss ◽  
Ethnically Diverse ◽  
The United States ◽  
Hiv Replication ◽  
Hiv Viral Load ◽  
Adjusted Risk ◽  
Hiv Rna ◽  
Risk Ratios

Background. To evaluate the effects of HIV viral load, measured cross-sectionally and cumulatively, on the risk of miscarriage or stillbirth (pregnancy loss) among HIV-infected women enrolled in the Women’s Interagency HIV Study between 1994 and 2013.Methods. We assessed three exposures: most recent viral load measure before the pregnancy ended, log10copy-years viremia from initiation of antiretroviral therapy (ART) to conception, and log10copy-years viremia in the two years before conception.Results. The risk of pregnancy loss for those with log10viral load >4.00 before pregnancy ended was 1.59 (95% confidence interval (CI): 0.99, 2.56) times as high as the risk for women whose log10viral load was ≤1.60. There was not a meaningful impact of log10copy-years viremia since ART or log10copy-years viremia in the two years before conception on pregnancy loss (adjusted risk ratios (aRRs): 0.80 (95% CI: 0.69, 0.92) and 1.00 (95% CI: 0.90, 1.11), resp.).Conclusions. Cumulative viral load burden does not appear to be an informative measure for pregnancy loss risk, but the extent of HIV replication during pregnancy, as represented by plasma HIV RNA viral load, predicted loss versus live birth in this ethnically diverse cohort of HIV-infected US women.

scholarly journals COVID-19 Severity among Women of Reproductive Age with Symptomatic Laboratory-Confirmed SARS-CoV-2 by Pregnancy Status – United States, Jan 1, 2020 – Sep 30, 2021

2021 ◽  
Author(s):  
Penelope Strid ◽  
Lauren B. Zapata ◽  
Van T. Tong ◽  
Laura D. Zambrano ◽  
Kate R. Woodworth ◽  
...  
Keyword(s):  
United States ◽  
Severe Disease ◽  
The United States ◽  
Reproductive Age ◽  
Invasive Ventilation ◽  
Women Of Reproductive Age ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Pregnancy Status ◽  
Risk Ratios

Abstract Importance: Pregnant people are at increased risk for severe COVID-19 compared with nonpregnant people. Limited information is available on the severity of COVID-19 attributable to the Delta variant, the predominant variant in the United States as of late June 2021, among pregnant persons.Objective: To assess risk for severe COVID-19 by pregnancy status and time period relative to Delta variant predominance. Design: Using a cross-sectional design, we describe characteristics of symptomatic women of reproductive age (WRA) with COVID-19 and calculate adjusted risk ratios for severe disease comparing pregnant with nonpregnant WRA during the pre-Delta period (January 1, 2020 – June 26, 2021) and the Delta period (June 27, 2021 – September 30, 2021). Additionally, we calculate adjusted risk ratios for severe disease comparing the Delta period with the pre-Delta period for pregnant and nonpregnant WRA.Setting: Reports of COVID-19 in the United States occurring from January 1, 2020 ─ September 30, 2021, submitted to the CDC.Participants: Pregnant and nonpregnant women aged 15-44 years.Exposure(s): Laboratory-confirmed, symptomatic SARS-CoV-2 infection.Main Outcome(s): Severe disease: (intensive care unit [ICU] admission, receipt of invasive ventilation or extracorporeal membrane oxygenation [ECMO], and death).Results: Among 1,856,428 cases of symptomatic COVID-19 in WRA, the risk for severe disease was increased among pregnant compared with nonpregnant WRA during the pre-Delta and Delta periods. Compared with the pre-Delta period, the risk of ICU admission during the Delta period was 66% higher (adjusted risk ratio [aRR] 1.66, 95% CI: 1.34-2.06) for pregnant WRA and 23% higher (aRR 1.23, 95% CI: 1.12-1.35) for nonpregnant WRA. The risk of invasive ventilation or ECMO was higher for pregnant and nonpregnant WRA in the Delta period. During the Delta period, the risk of death was 3.40 (95% CI: 2.36-4.91) times the risk in the pre-Delta period among pregnant WRA and 1.96 (95% CI: 1.75-2.18) among nonpregnant WRA. Conclusions and Relevance: The overall risk for severe COVID-19 among WRA remains low; however, symptomatic pregnant WRA remain at increased risk for severe outcomes compared with symptomatic nonpregnant WRA during Delta variant predominance. Compared with the pre-Delta period, pregnant and nonpregnant WRA are at increased risk for severe COVID-19 in the Delta period.

scholarly journals Time Spent with HIV Viral Load > 1500 Copies/mL Among Persons Engaged in Continuity HIV Care in an Urban Clinic in the United States, 2010–2015

2018 ◽  
Vol 22 (11) ◽  
pp. 3443-3450 ◽  
Author(s):  
Catherine R. Lesko ◽  
Bryan Lau ◽  
Geetanjali Chander ◽  
Richard D. Moore
Keyword(s):  
United States ◽  
Viral Load ◽  
The United States ◽  
Hiv Care ◽  
Hiv Viral Load ◽  
Urban Clinic

scholarly journals Abuse and Resilience in Relation to HAART Medication Adherence and HIV Viral Load Among Women with HIV in the United States

2014 ◽  
Vol 28 (3) ◽  
pp. 136-143 ◽  
Author(s):  
Sannisha Dale ◽  
Mardge Cohen ◽  
Kathleen Weber ◽  
Ruth Cruise ◽  
Gwendolyn Kelso ◽  
...  
Keyword(s):  
United States ◽  
Viral Load ◽  
Medication Adherence ◽  
The United States ◽  
Hiv Viral Load ◽  
Women With Hiv

Abstract 514: Sex-Related Disparities in Outcomes After Myocardial Infarction Among Patients With Atrial Fibrillation: Evidence From a Nationwide Study

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Akintunde M Akinjero ◽  
Oluwole Adegbala ◽  
Tomi Akinyemiju
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Female Gender ◽  
The United States ◽  
Nationwide Study ◽  
Adjusted Risk ◽  
Targeted Interventions ◽  
Significant Difference

Background: The overall mortality rate after acute myocardial infarction (AMI) is falling in the United States. However, outcomes remain unacceptably worse in females compared to males. It is not known how coexisting atrial fibrillation (AF) modify outcomes among the sexes. We sought to examine the association of sex with clinical characteristics and outcomes after AMI among patients with AF. Methods: We accessed the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to extract all hospitalizations between 2007 and 2011 for patients above 18yrs with principal diagnosis of AMI and coexisting diagnosis of AF using ICD 9-CM codes. The NIS represents the largest all-payer hospitalization database in the United States, sampling approximately 8 million hospitalizations per year. We also extracted outcomes data (length of stay (LOS), stroke and in-hospital mortality) after AMI among Patients with AF. We then compared sex differences. Univariate and Multivariate analysis were conducted to determine the presence of statistically significant difference in outcomes between men and women. Results: A total of 184,584 AF patients with AMI were sampled, consisting of 46.82% (86,420) women and 53.13% (98,164) men. Compared with men, women with AF and AMI had a greater multivariate-adjusted risk for increased stroke rate (aOR=1.51, 95% CI=1.45-1.59), and higher in-hospital mortality (aOR=1.12, 95% CI=1.09-1.15). However, female gender was not significantly associated with longer LOS (aOR=-0.22, 95% CI= -0.29-(-0.14). Conclusion: In this large nationwide study of a population-based cohort, women experienced worse outcomes after AMI among patients with AF. They had higher in-hospital mortality and increased stroke rates. Our findings highlight the need for targeted interventions to improve these disparities in outcomes.

P–776 Singleton pregnancies conceived with infertility treatments and the risk of
neonatal and infant mortality

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
G Farley ◽  
M Sauer ◽  
J Brandt ◽  
C Ananth
Keyword(s):  
United States ◽  
Neonatal Mortality ◽  
Preterm Delivery ◽  
The United States ◽  
Infertility Treatment ◽  
Exposure Misclassification ◽  
Unmeasured Confounding ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Singleton Live Birth

Abstract Study question Is maternal infertility treatment associated with an increased risk of neonatal and infant mortality when compared to natural conception? Summary answer Infertility treatment is associated with a 70% increased adjusted risk of neonatal mortality. This association is strongly mediated by preterm delivery. What is known already The number of assisted reproduction technology (ART) cycles performed in the United States (US) increased by 39% from 142,435 cycles in 2007 to 197,737 in 2016. Within this growing experience, several studies described an increased risk of preterm delivery, low birth weight, congenital malformations, neonatal intensive care unit admission, stillbirth, and perinatal mortality among singletons conceived through ART compared to those conceived naturally. Experts have called for ART patients to be advised of potential increased risk for adverse perinatal outcomes and for obstetricians to manage these pregnancies as high risk. Study design, size, duration This is a cross-sectional study of 11,289,466 pregnancies in the United States (US) from 2015–2017 that resulted in a non-malformed singleton live birth. The exposure group includes births resulting from any infertility treatment method, including ART and fertility-enhancing drugs. The control group includes births resulting from natural conceptions. The primary outcomes measured were neonatal (within 1 month), post-neonatal (1 month to a year), and infant (up to 1 year) mortality. Participants/materials, setting, methods Pregnancies (n = 11,289,466) resulting in a non-malformed singleton live birth in the US from 2015–2017. Associations were estimated from log-linear Poisson regression models with robust variance. Risk ratio (RR) and 95% confidence interval (CI) were derived as the effect measure with adjustments for confounders. The impact of exposure misclassification and unmeasured confounding biases were assessed. A causal mediation analysis of the infertility treatment-mortality association with preterm delivery (<37 weeks) was performed. Main results and the role of chance Any infertility treatment was documented in 1.3% (n = 142,215) of singleton live births during the study period. Any infertility treatment was associated with a 70% increased adjusted risk of neonatal mortality (RR 1.70, 95% CI 1.54–1.88), with an even higher risk for early neonatal (RR 1.82, 95% CI 1.63–2.05) than late neonatal (RR 1.37, 95% CI 1.11–1.69) mortality. These risks were similar among pregnancies conceived through ART and treatment with fertility-enhancing drugs. The mediation analysis showed that 68% (95% CI 59–81) of the total effect of infertility treatment on neonatal mortality was mediated through preterm delivery. In a sensitivity analysis, following corrections for exposure misclassification and unmeasured confounding biases, these risks were higher for early neonatal (bias-corrected RR [RRbc] 2.94 95% CIbc 2.16–4.01), but not for late neonatal (RRbc 1.04, 95% CIbc 0.68–1.59) mortality. Limitations, reasons for caution Limitations of the study include the potential underreporting of infertility treatment on birth certificates and potential confounding from sociodemographic characteristics that were not accounted for in this study. Wider implications of the findings: Pregnancies conceived with infertility treatment are associated with increased neonatal mortality and this association is mediated by the increased risk of preterm delivery. Knowledge of this risk should be shared with prospective couples consulting for fertility care in order to best provide adequate informed consent. Trial registration number Not applicable

The Melting Pot of the Pacific

2013 ◽  
Author(s):  
Ellen D. Wu
Keyword(s):  
United States ◽  
World War Ii ◽  
Indigenous Population ◽  
Ethnically Diverse ◽  
Asian Population ◽  
The United States ◽  
World War ◽  
Melting Pot ◽  
The Pacific ◽  
Racial Harmony

This chapter deals with the concept of Hawaiʻi as a racial paradise. In the 1920s and 1930s, intellectuals began to tout the islands' ethnically diverse composition—including the indigenous population, white settler colonists, and imported labor from Asia and other locales—as a Pacific melting pot free of the mainland's social taboos on intermingling. After World War II, the association of Hawaiʻi with racial harmony and tolerance received unprecedented national attention as Americans heatedly debated the question of whether or not the territory, annexed to the United States in 1898, should become a state. Statehood enthusiasts tagged the islands' majority Asian population, with its demonstrated capability of assimilation, as a forceful rationale for admission.

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