Study Overview

Objective. To evaluate the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons in Washington, DC.

Design. Descriptive, retrospective cohort study.

Setting and participants. HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. The DC Cohort is a clinic-based, city-wide, longitudinal observational cohort launched in 2011 to better understand HIV epidemiology in DC, describe clinical outcomes among those in care, and improve the quality of care for people living with HIV in the DC metropolitan area. Eligible participants included those enrolled from 1 January 2011 to 31 March 2015. Participant follow-up time included time from enrollment to 30 June 2015 or until one of these occurred: death, withdrawal from the DC Cohort, or loss to follow-up.

Main outcomes measures. Confirmed cases of chlamydia, gonorrhea, and syphilis, as well as HIV viral loads at the time of sexually transmitted infection (STI) diagnosis as a proxy for HIV transmission risk.

Main results. Around the time of the study, there were approximately 11,235 persons with HIV infection receiving care at the 13 DC Cohort sites, of which 8732 (77.7%) were approached for enrollment. Of those approached, 7004 (80.2%) agreed to participate and provided consent, 948 (10.9%) declined to enroll, 14 (0.2%) withdrew consent, and 766 (8.8%) remained undecided. There were significant differences between those consenting and declining, including female gender (27.8% of those consenting vs 36.1% of those declining, P < 0.001), white race/ethnicity (13.1% of those consenting vs 6.6% of those declining, P < 0.001), and private insurance status (27.6% of those consenting vs 33.2% of those declining, P < 0.001).

Median age of patients was 47 years (interquartile range, 36.5–54.5 years); 71% were male, 76% were non-Hispanic black, 39% were men who have sex with men (MSM), and 29% were heterosexual. 63.8% had public insurance. 6.7% (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STI was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and MSM, 7.7 (95% CI, 7.1–8.4). Multivariate regression analysis showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable viral load within 1 month of STI diagnosis, and 14.6% had a viral load ≥ 1500 copies/mL.

Conclusion. STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

Commentary

Although the number of new HIV cases in Washington, DC, has been decreasing over recent years [1], it still has one of the highest rates of HIV infection in the United States [2]. In this large-scale, single-city analysis, Lucar et al reported on the incidence and factors associated with the development of chlamydia, gonorrhea, and syphilis in a cohort of people living with HIV in care in DC. Consistent with incidence rates among the DC general population [2], chlamydia had the highest incidence, followed by gonorrhea and then syphilis, each with particularly high rates among 18- to 34-year-olds, MSM, transgender women, and Hispanics.

Studies have shown that many people with HIV do not consistently practice safer sex, placing themselves and others at risk for HIV or STI infection/co-infection [3]. While most HIV prevention programs target HIV-negative individuals, targeting sexual risk behaviors in HIV-positive people can prevent the transmission of HIV and other STIs to uninfected individuals and can also prevent co-infections with other STIs [3]. However, effective interventions to maintain long-term behavior change and prevent HIV transmission are needed. In a recent systematic review and meta-analysis by Globerman et al [3] assessing the effectiveness of HIV/STI prevention interventions for people living with HIV, group-level health education interventions were found to be effective in reducing HIV/STI incidence when compared to attention controls. Another intervention type, comprehensive risk counseling and services, was found to be effective in reducing sexual risk behaviors when compared to both active and attention controls. All other intervention types showed no statistically significant effect or had low or very low quality of evidence. Improving strategies to reduce the impact of HIV and STDs may require an understanding of how different populations are experiencing those conditions [1].

This study has several limitations. First, the observational nature of the DC Cohort precluded standardized STI screening for all participants. STIs are frequently asymptomatic, and differences in screening practices can impact the observed STI frequency [4,5]. Subsequently, reported STI incidence rates are likely underestimating the true STI incidence in people with HIV in care in DC. Furthermore, STI screening may provide diagnosis dates distant from the actual time of STI acquisition. Similarly, the study design also limited the availability of HIV viral loads during the same encounter of STI diagnosis. In addition, the population enrolled in the DC Cohort may not be fully representative of the larger HIV-infected population in DC, as enrollment requires some degree of engagement in care, and the demographics of those declining to participate differed somewhat from those who provided consent.

Strengths of the study include its city-wide reach, prospective enrollment of participants, its longitudinal study design, and the large sample size. Also, since the study linked data from clinical sites with data reported to the local health department, this improved the accuracy of STI diagnosis frequency and provided insight into care received for STIs outside of the primary HIV care site.

Applications for Clinical Practice

Risk reduction interventions are needed for people living with HIV to help control the spread of STIs and reduce HIV transmission. More high-quality research on HIV/STI prevention interventions is needed. While there have been only a few studies, the existing data indicate that integration of STI services into HIV care and treatment service can be feasible and can have positive outcomes [6].

Study Overview

Objective. To evaluate the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons in Washington, DC.

Design. Descriptive, retrospective cohort study.

Setting and participants. HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. The DC Cohort is a clinic-based, city-wide, longitudinal observational cohort launched in 2011 to better understand HIV epidemiology in DC, describe clinical outcomes among those in care, and improve the quality of care for people living with HIV in the DC metropolitan area. Eligible participants included those enrolled from 1 January 2011 to 31 March 2015. Participant follow-up time included time from enrollment to 30 June 2015 or until one of these occurred: death, withdrawal from the DC Cohort, or loss to follow-up.

Main outcomes measures. Confirmed cases of chlamydia, gonorrhea, and syphilis, as well as HIV viral loads at the time of sexually transmitted infection (STI) diagnosis as a proxy for HIV transmission risk.

Main results. Around the time of the study, there were approximately 11,235 persons with HIV infection receiving care at the 13 DC Cohort sites, of which 8732 (77.7%) were approached for enrollment. Of those approached, 7004 (80.2%) agreed to participate and provided consent, 948 (10.9%) declined to enroll, 14 (0.2%) withdrew consent, and 766 (8.8%) remained undecided. There were significant differences between those consenting and declining, including female gender (27.8% of those consenting vs 36.1% of those declining, P < 0.001), white race/ethnicity (13.1% of those consenting vs 6.6% of those declining, P < 0.001), and private insurance status (27.6% of those consenting vs 33.2% of those declining, P < 0.001).

Median age of patients was 47 years (interquartile range, 36.5–54.5 years); 71% were male, 76% were non-Hispanic black, 39% were men who have sex with men (MSM), and 29% were heterosexual. 63.8% had public insurance. 6.7% (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STI was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and MSM, 7.7 (95% CI, 7.1–8.4). Multivariate regression analysis showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable viral load within 1 month of STI diagnosis, and 14.6% had a viral load ≥ 1500 copies/mL.

Conclusion. STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

Commentary

Although the number of new HIV cases in Washington, DC, has been decreasing over recent years [1], it still has one of the highest rates of HIV infection in the United States [2]. In this large-scale, single-city analysis, Lucar et al reported on the incidence and factors associated with the development of chlamydia, gonorrhea, and syphilis in a cohort of people living with HIV in care in DC. Consistent with incidence rates among the DC general population [2], chlamydia had the highest incidence, followed by gonorrhea and then syphilis, each with particularly high rates among 18- to 34-year-olds, MSM, transgender women, and Hispanics.

Studies have shown that many people with HIV do not consistently practice safer sex, placing themselves and others at risk for HIV or STI infection/co-infection [3]. While most HIV prevention programs target HIV-negative individuals, targeting sexual risk behaviors in HIV-positive people can prevent the transmission of HIV and other STIs to uninfected individuals and can also prevent co-infections with other STIs [3]. However, effective interventions to maintain long-term behavior change and prevent HIV transmission are needed. In a recent systematic review and meta-analysis by Globerman et al [3] assessing the effectiveness of HIV/STI prevention interventions for people living with HIV, group-level health education interventions were found to be effective in reducing HIV/STI incidence when compared to attention controls. Another intervention type, comprehensive risk counseling and services, was found to be effective in reducing sexual risk behaviors when compared to both active and attention controls. All other intervention types showed no statistically significant effect or had low or very low quality of evidence. Improving strategies to reduce the impact of HIV and STDs may require an understanding of how different populations are experiencing those conditions [1].

This study has several limitations. First, the observational nature of the DC Cohort precluded standardized STI screening for all participants. STIs are frequently asymptomatic, and differences in screening practices can impact the observed STI frequency [4,5]. Subsequently, reported STI incidence rates are likely underestimating the true STI incidence in people with HIV in care in DC. Furthermore, STI screening may provide diagnosis dates distant from the actual time of STI acquisition. Similarly, the study design also limited the availability of HIV viral loads during the same encounter of STI diagnosis. In addition, the population enrolled in the DC Cohort may not be fully representative of the larger HIV-infected population in DC, as enrollment requires some degree of engagement in care, and the demographics of those declining to participate differed somewhat from those who provided consent.

Strengths of the study include its city-wide reach, prospective enrollment of participants, its longitudinal study design, and the large sample size. Also, since the study linked data from clinical sites with data reported to the local health department, this improved the accuracy of STI diagnosis frequency and provided insight into care received for STIs outside of the primary HIV care site.

Applications for Clinical Practice

Risk reduction interventions are needed for people living with HIV to help control the spread of STIs and reduce HIV transmission. More high-quality research on HIV/STI prevention interventions is needed. While there have been only a few studies, the existing data indicate that integration of STI services into HIV care and treatment service can be feasible and can have positive outcomes [6].

Study Overview

Objective. To evaluate the incidence and demographic factors associated with chlamydia, gonorrhea, and syphilis among HIV-infected persons in Washington, DC.

Design. Descriptive, retrospective cohort study.

Setting and participants. HIV-infected persons enrolled at 13 DC Cohort sites from 2011 to 2015. The DC Cohort is a clinic-based, city-wide, longitudinal observational cohort launched in 2011 to better understand HIV epidemiology in DC, describe clinical outcomes among those in care, and improve the quality of care for people living with HIV in the DC metropolitan area. Eligible participants included those enrolled from 1 January 2011 to 31 March 2015. Participant follow-up time included time from enrollment to 30 June 2015 or until one of these occurred: death, withdrawal from the DC Cohort, or loss to follow-up.

Main outcomes measures. Confirmed cases of chlamydia, gonorrhea, and syphilis, as well as HIV viral loads at the time of sexually transmitted infection (STI) diagnosis as a proxy for HIV transmission risk.

Main results. Around the time of the study, there were approximately 11,235 persons with HIV infection receiving care at the 13 DC Cohort sites, of which 8732 (77.7%) were approached for enrollment. Of those approached, 7004 (80.2%) agreed to participate and provided consent, 948 (10.9%) declined to enroll, 14 (0.2%) withdrew consent, and 766 (8.8%) remained undecided. There were significant differences between those consenting and declining, including female gender (27.8% of those consenting vs 36.1% of those declining, P < 0.001), white race/ethnicity (13.1% of those consenting vs 6.6% of those declining, P < 0.001), and private insurance status (27.6% of those consenting vs 33.2% of those declining, P < 0.001).

Median age of patients was 47 years (interquartile range, 36.5–54.5 years); 71% were male, 76% were non-Hispanic black, 39% were men who have sex with men (MSM), and 29% were heterosexual. 63.8% had public insurance. 6.7% (451/6672) developed an incident STI during a median follow-up of 32.5 months (4% chlamydia, 3% gonorrhea, 2% syphilis); 30% of participants had 2 or more STI episodes. The incidence rate of any STI was 3.8 cases per 100 person-years (95% confidence interval [CI], 3.5–4.1); age 18–34 years, 10.8 (95% CI, 9.7–12.0); transgender women, 9.9 (95% CI, 6.9–14.0); Hispanics, 9.2 (95% CI, 7.2–11.8); and MSM, 7.7 (95% CI, 7.1–8.4). Multivariate regression analysis showed younger age, Hispanic ethnicity, MSM risk, and higher nadir CD4 counts to be strongly associated with STIs. Among those with an STI, 41.8% had a detectable viral load within 1 month of STI diagnosis, and 14.6% had a viral load ≥ 1500 copies/mL.

Conclusion. STIs are highly prevalent among HIV-infected persons receiving care in DC. HIV transmission risk is considerable at the time of STI diagnosis. Interventions toward risk reduction, antiretroviral therapy adherence, and HIV virologic suppression are critical at the time of STI evaluation.

Commentary

Although the number of new HIV cases in Washington, DC, has been decreasing over recent years [1], it still has one of the highest rates of HIV infection in the United States [2]. In this large-scale, single-city analysis, Lucar et al reported on the incidence and factors associated with the development of chlamydia, gonorrhea, and syphilis in a cohort of people living with HIV in care in DC. Consistent with incidence rates among the DC general population [2], chlamydia had the highest incidence, followed by gonorrhea and then syphilis, each with particularly high rates among 18- to 34-year-olds, MSM, transgender women, and Hispanics.

Studies have shown that many people with HIV do not consistently practice safer sex, placing themselves and others at risk for HIV or STI infection/co-infection [3]. While most HIV prevention programs target HIV-negative individuals, targeting sexual risk behaviors in HIV-positive people can prevent the transmission of HIV and other STIs to uninfected individuals and can also prevent co-infections with other STIs [3]. However, effective interventions to maintain long-term behavior change and prevent HIV transmission are needed. In a recent systematic review and meta-analysis by Globerman et al [3] assessing the effectiveness of HIV/STI prevention interventions for people living with HIV, group-level health education interventions were found to be effective in reducing HIV/STI incidence when compared to attention controls. Another intervention type, comprehensive risk counseling and services, was found to be effective in reducing sexual risk behaviors when compared to both active and attention controls. All other intervention types showed no statistically significant effect or had low or very low quality of evidence. Improving strategies to reduce the impact of HIV and STDs may require an understanding of how different populations are experiencing those conditions [1].

This study has several limitations. First, the observational nature of the DC Cohort precluded standardized STI screening for all participants. STIs are frequently asymptomatic, and differences in screening practices can impact the observed STI frequency [4,5]. Subsequently, reported STI incidence rates are likely underestimating the true STI incidence in people with HIV in care in DC. Furthermore, STI screening may provide diagnosis dates distant from the actual time of STI acquisition. Similarly, the study design also limited the availability of HIV viral loads during the same encounter of STI diagnosis. In addition, the population enrolled in the DC Cohort may not be fully representative of the larger HIV-infected population in DC, as enrollment requires some degree of engagement in care, and the demographics of those declining to participate differed somewhat from those who provided consent.

Strengths of the study include its city-wide reach, prospective enrollment of participants, its longitudinal study design, and the large sample size. Also, since the study linked data from clinical sites with data reported to the local health department, this improved the accuracy of STI diagnosis frequency and provided insight into care received for STIs outside of the primary HIV care site.

Applications for Clinical Practice

Risk reduction interventions are needed for people living with HIV to help control the spread of STIs and reduce HIV transmission. More high-quality research on HIV/STI prevention interventions is needed. While there have been only a few studies, the existing data indicate that integration of STI services into HIV care and treatment service can be feasible and can have positive outcomes [6].

CHICAGO – Adjuvant pembrolizumab for resected high-risk melanoma slowed the rate of recurrence or death by 43% compared with placebo in a phase 3 trial of 1,519 patients.

After 15 months of follow-up, 12-month rates of recurrence-free survival (RFS) were 75% for pembrolizumab and 61% for placebo (hazard ratio, 0.57; P less than .001), Alexander M.M. Eggermont, MD, PhD, reported at the annual meeting of the American Association for Cancer Research.

By 18 months, the RFS difference between the arms had widened even more (71% versus 53%), Dr. Eggermont and his associates said at the meeting. The report was published simultaneously in the New England Journal of Medicine.

Adjuvant pembrolizumab was effective irrespective of PD-L1 tumor expression status. In a subgroup of more than 800 patients with PD-L1-positive tumors, 12-month RFS rates were 77% for pembrolizumab and 63% for placebo (HR, 0.54; 95% CI, 0.42 to 0.69; P less than .001). Among 116 patients who were PD-L1-negative, these rates were 72% and 52%, respectively (HR, 0.47; P = .01).

Treatment produced no new safety signals, said Dr. Eggermont of Gustave Roussy Cancer Campus Grand Paris and University Paris-Saclay, Villejuif, France. Grade 3 or higher toxicities affected 15% of pembrolizumab patients. Myositis caused one pembrolizumab-related death.

The findings bolster data suggesting that adjuvant therapy can stop or delay recurrence in resected high-risk melanoma. Previously, adjuvant ipilimumab was approved after significantly extending RFS and overall survival in the placebo-controlled European Organization for Research and Treatment of Cancer 18071 trial. More recently, adjuvant dabrafenib plus trametinib reduced the risk of recurrence compared with placebo in completely resected stage III melanoma with BRAF mutations (COMBI-AD), and adjuvant nivolumab significantly improved RFS and was less toxic than was ipilimumab in patients with advanced resected BRAF-mutated and BRAF-wild-type melanomas (CheckMate 238).

SOURCE: Eggermont AMM et al. AACR Annual Meeting Abstract CT001.

CHICAGO – Adjuvant pembrolizumab for resected high-risk melanoma slowed the rate of recurrence or death by 43% compared with placebo in a phase 3 trial of 1,519 patients.

After 15 months of follow-up, 12-month rates of recurrence-free survival (RFS) were 75% for pembrolizumab and 61% for placebo (hazard ratio, 0.57; P less than .001), Alexander M.M. Eggermont, MD, PhD, reported at the annual meeting of the American Association for Cancer Research.

By 18 months, the RFS difference between the arms had widened even more (71% versus 53%), Dr. Eggermont and his associates said at the meeting. The report was published simultaneously in the New England Journal of Medicine.

Adjuvant pembrolizumab was effective irrespective of PD-L1 tumor expression status. In a subgroup of more than 800 patients with PD-L1-positive tumors, 12-month RFS rates were 77% for pembrolizumab and 63% for placebo (HR, 0.54; 95% CI, 0.42 to 0.69; P less than .001). Among 116 patients who were PD-L1-negative, these rates were 72% and 52%, respectively (HR, 0.47; P = .01).

Treatment produced no new safety signals, said Dr. Eggermont of Gustave Roussy Cancer Campus Grand Paris and University Paris-Saclay, Villejuif, France. Grade 3 or higher toxicities affected 15% of pembrolizumab patients. Myositis caused one pembrolizumab-related death.

The findings bolster data suggesting that adjuvant therapy can stop or delay recurrence in resected high-risk melanoma. Previously, adjuvant ipilimumab was approved after significantly extending RFS and overall survival in the placebo-controlled European Organization for Research and Treatment of Cancer 18071 trial. More recently, adjuvant dabrafenib plus trametinib reduced the risk of recurrence compared with placebo in completely resected stage III melanoma with BRAF mutations (COMBI-AD), and adjuvant nivolumab significantly improved RFS and was less toxic than was ipilimumab in patients with advanced resected BRAF-mutated and BRAF-wild-type melanomas (CheckMate 238).

SOURCE: Eggermont AMM et al. AACR Annual Meeting Abstract CT001.

CHICAGO – Adjuvant pembrolizumab for resected high-risk melanoma slowed the rate of recurrence or death by 43% compared with placebo in a phase 3 trial of 1,519 patients.

After 15 months of follow-up, 12-month rates of recurrence-free survival (RFS) were 75% for pembrolizumab and 61% for placebo (hazard ratio, 0.57; P less than .001), Alexander M.M. Eggermont, MD, PhD, reported at the annual meeting of the American Association for Cancer Research.

By 18 months, the RFS difference between the arms had widened even more (71% versus 53%), Dr. Eggermont and his associates said at the meeting. The report was published simultaneously in the New England Journal of Medicine.

Adjuvant pembrolizumab was effective irrespective of PD-L1 tumor expression status. In a subgroup of more than 800 patients with PD-L1-positive tumors, 12-month RFS rates were 77% for pembrolizumab and 63% for placebo (HR, 0.54; 95% CI, 0.42 to 0.69; P less than .001). Among 116 patients who were PD-L1-negative, these rates were 72% and 52%, respectively (HR, 0.47; P = .01).

Treatment produced no new safety signals, said Dr. Eggermont of Gustave Roussy Cancer Campus Grand Paris and University Paris-Saclay, Villejuif, France. Grade 3 or higher toxicities affected 15% of pembrolizumab patients. Myositis caused one pembrolizumab-related death.

The findings bolster data suggesting that adjuvant therapy can stop or delay recurrence in resected high-risk melanoma. Previously, adjuvant ipilimumab was approved after significantly extending RFS and overall survival in the placebo-controlled European Organization for Research and Treatment of Cancer 18071 trial. More recently, adjuvant dabrafenib plus trametinib reduced the risk of recurrence compared with placebo in completely resected stage III melanoma with BRAF mutations (COMBI-AD), and adjuvant nivolumab significantly improved RFS and was less toxic than was ipilimumab in patients with advanced resected BRAF-mutated and BRAF-wild-type melanomas (CheckMate 238).

SOURCE: Eggermont AMM et al. AACR Annual Meeting Abstract CT001.

Apply to become a member of the Academy of Master Surgeon Educators, a unique program of the American College of Surgeons. Membership will be open to master surgeon educators from across the surgical specialties. Learn more here. The deadline for nominating a colleague is April 20. The deadline for self-nomination is May 14.

Apply to become a member of the Academy of Master Surgeon Educators, a unique program of the American College of Surgeons. Membership will be open to master surgeon educators from across the surgical specialties. Learn more here. The deadline for nominating a colleague is April 20. The deadline for self-nomination is May 14.

Apply to become a member of the Academy of Master Surgeon Educators, a unique program of the American College of Surgeons. Membership will be open to master surgeon educators from across the surgical specialties. Learn more here. The deadline for nominating a colleague is April 20. The deadline for self-nomination is May 14.

Neoadjuvant nivolumab did not delay surgery and produced at least 90% tumor regression in nearly half of early-stage, resectable non–small cell lung cancers (NSCLC), according to the results of a 21-patient pilot trial.

Eighty percent of patients were alive and recurrence-free a year after surgery, said Patrick M. Forde, MBBCh, and his colleagues from Johns Hopkins University, Baltimore. The only grade 3 or higher adverse event was treatment-related pneumonia, which did not prevent surgery. The findings were reported at the annual meeting of the American Association for Cancer Research and simultaneously in the New England Journal of Medicine.

©Sebastian Kaulitzki/Thinkstock

SOURCE: Forde PM. AACR Annual Meeting 2018. Forde PM et al. N Engl J Med. 2018 Apr 16. doi: 10.1056/NEJMoa1716078.

Neoadjuvant nivolumab did not delay surgery and produced at least 90% tumor regression in nearly half of early-stage, resectable non–small cell lung cancers (NSCLC), according to the results of a 21-patient pilot trial.

Eighty percent of patients were alive and recurrence-free a year after surgery, said Patrick M. Forde, MBBCh, and his colleagues from Johns Hopkins University, Baltimore. The only grade 3 or higher adverse event was treatment-related pneumonia, which did not prevent surgery. The findings were reported at the annual meeting of the American Association for Cancer Research and simultaneously in the New England Journal of Medicine.

©Sebastian Kaulitzki/Thinkstock

SOURCE: Forde PM. AACR Annual Meeting 2018. Forde PM et al. N Engl J Med. 2018 Apr 16. doi: 10.1056/NEJMoa1716078.

Neoadjuvant nivolumab did not delay surgery and produced at least 90% tumor regression in nearly half of early-stage, resectable non–small cell lung cancers (NSCLC), according to the results of a 21-patient pilot trial.

Eighty percent of patients were alive and recurrence-free a year after surgery, said Patrick M. Forde, MBBCh, and his colleagues from Johns Hopkins University, Baltimore. The only grade 3 or higher adverse event was treatment-related pneumonia, which did not prevent surgery. The findings were reported at the annual meeting of the American Association for Cancer Research and simultaneously in the New England Journal of Medicine.

©Sebastian Kaulitzki/Thinkstock

SOURCE: Forde PM. AACR Annual Meeting 2018. Forde PM et al. N Engl J Med. 2018 Apr 16. doi: 10.1056/NEJMoa1716078.

The theme of this year’s Vascular Annual Meeting is “Home of the Vascular Team – Partners in Patient Care.” To celebrate the work of all of the members of the vascular team, we want you to send in your team pictures. Round up the staff and take a picture with your cell phone or tablet. Then send it by May 15 to communications@vascularsociety.org. We’ll use these team photos for social media and, during the meeting itself, in various slide shows. VAM will be June 20 to 23 in Boston. Exhibits are June 21-22 and scientific sessions are June 21-23.

The theme of this year’s Vascular Annual Meeting is “Home of the Vascular Team – Partners in Patient Care.” To celebrate the work of all of the members of the vascular team, we want you to send in your team pictures. Round up the staff and take a picture with your cell phone or tablet. Then send it by May 15 to communications@vascularsociety.org. We’ll use these team photos for social media and, during the meeting itself, in various slide shows. VAM will be June 20 to 23 in Boston. Exhibits are June 21-22 and scientific sessions are June 21-23.

The theme of this year’s Vascular Annual Meeting is “Home of the Vascular Team – Partners in Patient Care.” To celebrate the work of all of the members of the vascular team, we want you to send in your team pictures. Round up the staff and take a picture with your cell phone or tablet. Then send it by May 15 to communications@vascularsociety.org. We’ll use these team photos for social media and, during the meeting itself, in various slide shows. VAM will be June 20 to 23 in Boston. Exhibits are June 21-22 and scientific sessions are June 21-23.

SVS and the SVS Community Practice Committee will hold an informative webinar for SVS members on April 30 on “Negotiating Physician Employment Agreements.” The 75-minute webinar will begin at 8 p.m. Eastern, 7 p.m. Central, 6 p.m. Mountain and 5 p.m. Pacific times. Topics will include current trends, regulatory overview and key contractual provisions. Register here.

SVS and the SVS Community Practice Committee will hold an informative webinar for SVS members on April 30 on “Negotiating Physician Employment Agreements.” The 75-minute webinar will begin at 8 p.m. Eastern, 7 p.m. Central, 6 p.m. Mountain and 5 p.m. Pacific times. Topics will include current trends, regulatory overview and key contractual provisions. Register here.

SVS and the SVS Community Practice Committee will hold an informative webinar for SVS members on April 30 on “Negotiating Physician Employment Agreements.” The 75-minute webinar will begin at 8 p.m. Eastern, 7 p.m. Central, 6 p.m. Mountain and 5 p.m. Pacific times. Topics will include current trends, regulatory overview and key contractual provisions. Register here.

When: June 20-23
Where: Hynes Convention Center, Boston
Scientific Sessions: June 21-23
Exhibit Hall: June 21-22
Register: vsweb.org/VAM18
#VAM18

What’s happening this year at the Society for Vascular Surgery’s Vascular Annual Meeting?

• Enhanced online program planner that syncs with meeting app and makes it simple to plan your schedule. Follow this link to start now
• New opportunities for audience participation and discussion
• Programming aimed at physicians and the vascular team in all practice settings
• Cooperative scheduling with the Society for Vascular Nursing and physician assistants
• Great minds, stimulating discussions and events that include the entire vascular team

The 2018 VAM, sponsored by the SVS, will be at the Hynes Convention Center in Boston, Mass., June 20-23. The scientific sessions and exhibit hall open June 21. Registration numbers are already exceeding last year’s benchmarks, organizers said.

Abstracts for all the scientific sessions will be available in the June Journal of Vascular Surgery supplement.

Some of the highlights:

Inclusive. – This year’s meeting has a theme: The Vascular Team: Partners in Patient Care.  Every member of the vascular team – surgeons, nurses, nurse practitioners, PAs – will find a reason to attend.

The meeting provides programming across all practice settings with an even stronger focus on practical, take-home information for all.

View Dr. Darling’s “wicked awesome” Welcome to VAM18 video

The Society for Vascular Nursing’s annual meeting will be in the same location June 20-21. Registration for the SVN meeting includes access to VAM.

This year, the newly established membership section for vascular PAs will present PA-focused education. Within just the past few months, more than 130 PAs joined SVS and many are expected to be at VAM.

An Intuitive Planner - VAM18 meeting will see a new online program planner that allows attendees to filter by session type, areas of interest, faculty, and more. Attendees can favorite a session to build their own meeting schedule. The online planner will sync with the new meeting mobile app, so that attendees can carry their schedule with them. The mobile app will be available through the SVS store in June.

Interactive sessions - Meeting organizers have added more opportunities for small group and audience interaction during and after sessions. 

Industry’s best – This year’s Exhibit Hall will run for two days with longer hours each day than in previous years. It will feature the crowd-pleasing Vascular Live sessions each day, as well as exhibits showing off innovative devices and offering a chance to chat one-on-one with company representatives. To add to the festivities, a scavenger hunt will foster interaction.

Familiar favorites will be back – workshops, postgraduate courses, international sessions, posters, collaborative events with other societies and many, many chances to network and catch up with old friends. The essential VAM on Demand post-meeting slides, audio and video will help members revisit VAM anytime.

Learn more about the 2018 VAM here: All about VAM18

When: June 20-23
Where: Hynes Convention Center, Boston
Scientific Sessions: June 21-23
Exhibit Hall: June 21-22
Register: vsweb.org/VAM18
#VAM18

What’s happening this year at the Society for Vascular Surgery’s Vascular Annual Meeting?

• Enhanced online program planner that syncs with meeting app and makes it simple to plan your schedule. Follow this link to start now
• New opportunities for audience participation and discussion
• Programming aimed at physicians and the vascular team in all practice settings
• Cooperative scheduling with the Society for Vascular Nursing and physician assistants
• Great minds, stimulating discussions and events that include the entire vascular team

The 2018 VAM, sponsored by the SVS, will be at the Hynes Convention Center in Boston, Mass., June 20-23. The scientific sessions and exhibit hall open June 21. Registration numbers are already exceeding last year’s benchmarks, organizers said.

Abstracts for all the scientific sessions will be available in the June Journal of Vascular Surgery supplement.

Some of the highlights:

Inclusive. – This year’s meeting has a theme: The Vascular Team: Partners in Patient Care.  Every member of the vascular team – surgeons, nurses, nurse practitioners, PAs – will find a reason to attend.

The meeting provides programming across all practice settings with an even stronger focus on practical, take-home information for all.

View Dr. Darling’s “wicked awesome” Welcome to VAM18 video

The Society for Vascular Nursing’s annual meeting will be in the same location June 20-21. Registration for the SVN meeting includes access to VAM.

This year, the newly established membership section for vascular PAs will present PA-focused education. Within just the past few months, more than 130 PAs joined SVS and many are expected to be at VAM.

An Intuitive Planner - VAM18 meeting will see a new online program planner that allows attendees to filter by session type, areas of interest, faculty, and more. Attendees can favorite a session to build their own meeting schedule. The online planner will sync with the new meeting mobile app, so that attendees can carry their schedule with them. The mobile app will be available through the SVS store in June.

Interactive sessions - Meeting organizers have added more opportunities for small group and audience interaction during and after sessions. 

Industry’s best – This year’s Exhibit Hall will run for two days with longer hours each day than in previous years. It will feature the crowd-pleasing Vascular Live sessions each day, as well as exhibits showing off innovative devices and offering a chance to chat one-on-one with company representatives. To add to the festivities, a scavenger hunt will foster interaction.

Familiar favorites will be back – workshops, postgraduate courses, international sessions, posters, collaborative events with other societies and many, many chances to network and catch up with old friends. The essential VAM on Demand post-meeting slides, audio and video will help members revisit VAM anytime.

Learn more about the 2018 VAM here: All about VAM18

When: June 20-23
Where: Hynes Convention Center, Boston
Scientific Sessions: June 21-23
Exhibit Hall: June 21-22
Register: vsweb.org/VAM18
#VAM18

What’s happening this year at the Society for Vascular Surgery’s Vascular Annual Meeting?

• Enhanced online program planner that syncs with meeting app and makes it simple to plan your schedule. Follow this link to start now
• New opportunities for audience participation and discussion
• Programming aimed at physicians and the vascular team in all practice settings
• Cooperative scheduling with the Society for Vascular Nursing and physician assistants
• Great minds, stimulating discussions and events that include the entire vascular team

The 2018 VAM, sponsored by the SVS, will be at the Hynes Convention Center in Boston, Mass., June 20-23. The scientific sessions and exhibit hall open June 21. Registration numbers are already exceeding last year’s benchmarks, organizers said.

Abstracts for all the scientific sessions will be available in the June Journal of Vascular Surgery supplement.

Some of the highlights:

Inclusive. – This year’s meeting has a theme: The Vascular Team: Partners in Patient Care.  Every member of the vascular team – surgeons, nurses, nurse practitioners, PAs – will find a reason to attend.

The meeting provides programming across all practice settings with an even stronger focus on practical, take-home information for all.

View Dr. Darling’s “wicked awesome” Welcome to VAM18 video

The Society for Vascular Nursing’s annual meeting will be in the same location June 20-21. Registration for the SVN meeting includes access to VAM.

This year, the newly established membership section for vascular PAs will present PA-focused education. Within just the past few months, more than 130 PAs joined SVS and many are expected to be at VAM.

An Intuitive Planner - VAM18 meeting will see a new online program planner that allows attendees to filter by session type, areas of interest, faculty, and more. Attendees can favorite a session to build their own meeting schedule. The online planner will sync with the new meeting mobile app, so that attendees can carry their schedule with them. The mobile app will be available through the SVS store in June.

Interactive sessions - Meeting organizers have added more opportunities for small group and audience interaction during and after sessions. 

Industry’s best – This year’s Exhibit Hall will run for two days with longer hours each day than in previous years. It will feature the crowd-pleasing Vascular Live sessions each day, as well as exhibits showing off innovative devices and offering a chance to chat one-on-one with company representatives. To add to the festivities, a scavenger hunt will foster interaction.

Familiar favorites will be back – workshops, postgraduate courses, international sessions, posters, collaborative events with other societies and many, many chances to network and catch up with old friends. The essential VAM on Demand post-meeting slides, audio and video will help members revisit VAM anytime.

Learn more about the 2018 VAM here: All about VAM18

Herpes zoster boosts short-term stroke and TIA risk. Americans don’t know about cancer drug shortages – but they want to. Complication rates rise after uterine fibroid morcellation’s boxed warning. And marijuana use may spur change in safety-sensitive industries.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Herpes zoster boosts short-term stroke and TIA risk. Americans don’t know about cancer drug shortages – but they want to. Complication rates rise after uterine fibroid morcellation’s boxed warning. And marijuana use may spur change in safety-sensitive industries.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Herpes zoster boosts short-term stroke and TIA risk. Americans don’t know about cancer drug shortages – but they want to. Complication rates rise after uterine fibroid morcellation’s boxed warning. And marijuana use may spur change in safety-sensitive industries.

Listen to the MDedge Daily News podcast for all the details on today’s top news.


 

Cigarette smoking is an important risk factor for heart failure in blacks, according to results of an investigation of patients in the Jackson Heart Study.

Current smoking among blacks was associated with higher mean left ventricular (LV) mass and lower mean LV systolic function, even after adjustment for confounding factors, authors of the analysis reported in the journal Circulation.

beichh4046/gettyimages

SOURCE: Kamimura D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.117.031912.

Cigarette smoking is an important risk factor for heart failure in blacks, according to results of an investigation of patients in the Jackson Heart Study.

Current smoking among blacks was associated with higher mean left ventricular (LV) mass and lower mean LV systolic function, even after adjustment for confounding factors, authors of the analysis reported in the journal Circulation.

beichh4046/gettyimages

SOURCE: Kamimura D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.117.031912.

Cigarette smoking is an important risk factor for heart failure in blacks, according to results of an investigation of patients in the Jackson Heart Study.

Current smoking among blacks was associated with higher mean left ventricular (LV) mass and lower mean LV systolic function, even after adjustment for confounding factors, authors of the analysis reported in the journal Circulation.

beichh4046/gettyimages

SOURCE: Kamimura D et al. Circulation. 2018. doi: 10.1161/CIRCULATIONAHA.117.031912.

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.

In 2016, a Virginia dentist who had been recently diagnosed with idiopathic pulmonary fibrosis (IPF) was being treated at a specialty clinic. The CDC was contacted to report concerns that IPF had been diagnosed in multiple dentists, also from Virginia, who had also sought treatment at the same specialty clinic.

CDC researchers reviewed medical records of 894 patients treated for IPF at the tertiary care center between 1996-2017. They found 8 patients were dentists and 1 was a dental technician. Seven of the patients had died.

Idiopathic pulmonary fibrosis is a chronic, progressive, fibrosing interstitial pneumonia. This is the first known described cluster of IPF among dental personnel, the CDC says. Although no clear etiology could be found, it is possible that occupational exposure contributed to the development of IPF. Viral infections, cigarette smoking, and exposure to dust, wood dust, and metal dust have been implicated. One of the surviving patients reported polishing dental appliances and preparing amalgams and impressions without respiratory protection, which could have exposed him to silica, alginate, and other compounds with known or potential respiratory toxicity.

The CDC researchers note that dental personnel are exposed to infectious agents, chemicals, airborne particulates, ionizing radiation, and other potentially hazardous materials. They cite the case of a dentist who died of respiratory failure. Postmortem analysis identified pneumoconiosis; examination of lung tissue revealed particles consistent with alginate impression powders.

Idiopathic pulmonary fibrosis has not previously been described among dental personnel, the researchers say. But when they queried the National Occupational Respiratory Mortality System for “other interstitial pulmonary diseases with fibrosis” listed as the underlying or contributing cause of death, they found 35 decedents categorized as having worked in dentists’ offices or as dentists. During 2016, dentists accounted for an estimated 0.038% of US residents, yet represented 0.893% of patients being treated for IPF at a tertiary care center—nearly a 23-fold difference. Those findings suggest, the researchers say, that a higher rate of IPF might occur among dental personnel than among the general population.