New research was presented at IDWeek 2019, the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medical Association, and the Pediatric Infectious Diseases Society, from October 2-6 in Washington, DC. The features below highlight some of the studies that emerged from the conference.
Grindr Used To Identify MSM At High Risk Of HIV
Evidence suggests that men who have sex with men (MSM) are adapting to use technology, primarily the Grindr application, to find sexual partners. For a study, researchers assessed on-screen activity on Grindr in MSM in correlation with sexual risk behavior and substance use. Participants completed surveys on demographics, substance use, risky behavior, and Grindr use over the previous 3 months, with their smartphones used to objectively track time spent on the app. Surveys revealed that 48% participants had used Grindr in the previous 7 days. Among Grindr users who had iPhones with the ability to track weekly app use (61%), average usage time on the app was 144 minutes. Participants with high Grindr use had significantly higher scores in a measure of risk behavior and a tendency toward a higher proportion of substance users. The researchers suggest this study “introduces Grindr on-screen activity as an objective measure that can help identify MSM at high risk for HIV.”
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Flu Vaccine Decreases Risks in Adults & Children
Prior research indicates that people who refuse flu vaccines commonly claim that they once got the shot and still got the flu. Researchers investigated the likelihood of reduced severity, length of hospital stays, and even death in patients who contracted the flu. Two studies were conducted, an adult study over five seasons (2013/14-2017/18), and a pediatric study spanning two seasons (2016/17-2017/18). The study team found vaccinated adult patients were 19% less likely to be admitted to the ICU, 34% less likely to need mechanical ventilation, 36% less likely to die because of the sickness, and 17% less likely to contract pneumonia. The percentages increased for vaccinated patients older than 65. The pediatric study revealed that vaccinated children were half as likely to be hospitalized with the flu when compared with those who were not vaccinated. Of children hospitalized with the flu, 60% had an underlying medical condition.
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Outcomes With a Rapid Blood Culture Detection System Plus Real-Time Notification
Previous research indicates that length of stay (LOS), time to optimal therapy (TTOT), and antibiotic days of therapy decrease following implementation of the Accelerate Pheno blood culture detection system (AXDX)—which provides identification and antimicrobial susceptibility testing within 8 hours of growth in a blood culture—along with an active antimicrobial stewardship program (ASP). Whether the addition of real-time notification (RTN) of results to AXDX further improves these outcomes remains unclear. For a before-and-after study of adult bacteremic inpatients, researchers compared a 2017 historical cohort with AXDX performed 24/7 with results reviewed by providers or ASP as part of their normal workflow or AXDX performed 24/7 with RTN to ASP 7 days per week from 9:00am to 5:00pm and overnight results called to ASP at 9:00am. Following AXDX implementation, LOS, TTOT, total days of therapy (DOT), and frequency of achieving optimal therapy were significantly improved when compared with the historical cohort. While addition of RTN to AXDX results in an already active ASP did not further improve these outcomes, AXDX with RTN did significantly impact specific subsets of antibiotic use compared with the historical arm (AXDX alone did not).
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Oral Vs Long-Acting Injectable ART: Perceptions & Preferences
Although ART options with reduced dosing frequency and innovative delivery methods may have address challenges with oral dosing of existing regimens, patient and physician satisfaction with these options and preferences for switching to a monthly or bi-monthly long-acting injectable (LAI) ART are not well understood. Patients with HIV who were on ART for at least 6 months and virally suppressed and their physicians participated in a survey that assessed these variables. More than half (55%) of patients reported changing ART at least three times, with 47% reporting they were not totally satisfied with their current ART. The most commonly reported reasons for dissatisfaction were daily reminder of having HIV (31%) and having to take medicine every day (28%). Among participants, 28% reported forgetting to take their ART during the previous month. Remaining on the current treatment was preferred by 47% of patients, with 45% of patients preferring to switch to LAI, and the remaining 8% choosing to switch to another oral ART regimen.
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Inpatient ART Improves Short-Term Mortality
Despite data showing that early initiation of combined ART (cART) is associated with improved engagement in care and outcomes, cART is often deferred in hospitalized patients with HIV. For a study, researchers prospectively identified all patients with HIV hospitalized at their institution and had infectious diseases physicians and pharmacists ensure these patients were on appropriate cART and linked to outpatient care as part of an intervention. Clinical and lab date were collected to assess the impact of the intervention on inpatient and 30-day mortality, 30-day readmission rate, and frequency of outpatient follow-up. Although patients initiated on cART as part of the intervention had similar immunologic and virologic baseline characteristics as those not initiated on cART, their inpatient and 30-day mortality rates were similar to those of patients who were already on cART upon hospital admission. Readmission rates were also decreased in the intervention group, with more than half of those who could be tracked long enough achieving virologic suppression by 90 days post-discharge.
