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Biomedical subjects

Heidi M Crane

Publications and source records attributed to Heidi M Crane.

5 recordsLinked to original sources
PubMed2006

Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy.

OBJECTIVE: To examine the effect of antiretroviral agents and clinical factors on the development of elevated blood pressure (BP). METHODS: Observational cohort study of patients initiating their first HAART regimen. We evaluated mean BP prior to HAART and while receiving HAART in relation to antiretroviral classes and individual agents, and demographic and clinical characteristics including change in body mass index (BMI) while on HAART. We used logistic regression analysis to examine factors associated with elevated BP [> or = 10 mmHg increase in systolic BP (SBP), diastolic BP (DBP) or new diagnosis of hypertension]. RESULTS: Among 444 patients who had 4592 BP readings, 95 patients developed elevated SBP (n = 83), elevated DBP (n = 33), or a new diagnosis of hypertension (n = 11) after initiating HAART. In multivariate analysis, patients on lopinavir/ritonavir had the highest risk of developing elevated BP [odds ratio (OR), 2.5; P = 0.03] compared with efavirenz-based regimens. When change in BMI was added to the model, increased BMI was significantly associated with elevated BP (OR, 1.3; P = 0.02), and the association between lopinavir/ritonavir and elevated BP was no longer present. Compared with lopinavir/ritonavir-based regimens, patients receiving atazanavir (OR, 0.2; P = 0.03), efavirenz (OR, 0.4; P = 0.02), nelfinavir (OR, 0.3; P = 0.02), or indinavir (OR, 0.3; P = 0.01) had significantly lower odds of developing elevated BP. CONCLUSIONS: Treatment with lopinavir/ritonavir is significantly associated with elevated BP, an effect that appears to be mediated through an increase in BMI. Patients receiving atazanavir were least likely to develop elevated BP. The impact of antiretroviral medications on cardiovascular disease risk factors will increasingly influence treatment decisions.

Adult↗
PubMed2006

A single-item measure of health-related quality-of-life for HIV-infected patients in routine clinical care.

Measurement of health-related quality-of-life (HRQL) captures dimensions of health not otherwise assessed. However, HRQL measurement is time-consuming and difficult to incorporate into a routine clinical care setting. The purpose of this study was to assess the construct validity, discriminative ability, and feasibility of administering a single-item health status measure (EVGGFP) of HRQL rating health as excellent, very good, good, fair, or poor among HIV-infected patients in routine clinical care. Patients attending an urban HIV specialty clinic completed a survey assessing their current symptom burden, HRQL as measured by EVGGFP and by a 7-domain, 21-item HRQL instrument (HRQL-21), and sociodemographic factors (n = 269). Patients were predominantly men (91%), 27% reported a history of intravenous drug use, and over half had some college education. We used multiple regression analysis to examine the association between HRQL assessed by EVGGFP and the HRQL-21. We compared the discriminative ability of EVGGFP and the HRQL-21 to detect differences in CD4 cell count, plasma HIV-1 RNA level, and symptom burden. We found that HRQL scores determined by EVGGFP were significantly associated with domain scores from the HRQL-21 (adjusted R2 0.42-0.69). The discriminative ability of EVGGFP was equivalent to that of the HRQL-21. EVGGFP had high sensitivity and low to moderate specificity in identifying patients with poor overall HRQL who might benefit from more comprehensive evaluation of multiple HRQL domains. EVGGFP can be used to assess health status among HIV-infected patients in routine clinical care and may be useful in settings in which comprehensive HRQL assessment is not practical.

Adult↗
PubMed2006

Diabetes case identification methods applied to electronic medical record systems: their use in HIV-infected patients.

OBJECTIVE: New onset diabetes mellitus type 2 is increasing among HIV-infected patients in the era of potent antiretroviral therapy. Accurately identifying HIV-infected patients with a diagnosis of diabetes in electronic medical record systems will facilitate the study of patients with this disease. STUDY DESIGN AND SETTING: We examined electronic medical record data for all patients who initiated care at an HIV clinic between 1/1/1997 and 12/31/2001 to identify potential cases of diabetes. Case identification methods included clinician-coded diagnoses, medications, and HbA1c and glucose levels. Diabetes diagnoses were verified by clinician documentation in an electronic medical record progress note. Test characteristics of each case identification method were calculated. RESULTS: 53 cases of diabetes were identified among the cohort of 1,441 patients. Use of clinician-coded diagnoses alone or combined with other methods was the most sensitive method for identifying diabetes cases. Clinician-coded diagnoses were also the best method as assessed by standard receiver operator characteristic plots. A significant attenuation of odds ratios for associations with diabetes were found for case identification methods with imperfect specificity such as serum glucose levels. CONCLUSIONS: This study demonstrates that electronic medical record data can be used to accurately identify HIV-infected patients with diabetes. The optimal method applied will depend on the goals of a particular study.

Academic Medical Centers↗
PubMed2005

Fatal Kaposi's sarcoma-associated immune reconstitution following HAART initiation.

This unique report describes a fatal case of immune reconstitution syndrome associated with Kaposi's sarcoma (KS). This case also illustrates the possibility of cryptic visceral KS with minimal cutaneous disease, as well as the potential for differential responses of cutaneous and visceral KS to treatment.

Antiretroviral Therapy, Highly Active↗