Myron S. Cohen

Bio: Myron S. Cohen is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Population & Acquired immunodeficiency syndrome (AIDS). The author has an hindex of 103, co-authored 549 publications receiving 46021 citations. Previous affiliations of Myron S. Cohen include University of Massachusetts Medical School & Scripps Health.

Cost-Effectiveness of Long-Acting Injectable HIV Preexposure Prophylaxis in the United States

Abstract: BACKGROUND The HIV Prevention Trials Network (HPTN) 083 trial demonstrated the superiority of long-acting injectable cabotegravir (CAB-LA) compared with oral emtricitabine-tenofovir disoproxil fumarate (F/TDF) for HIV preexposure prophylaxis (PrEP). OBJECTIVE To identify the maximum price premium (that is, greatest possible price differential) that society should be willing to accept for the additional benefits of CAB-LA over tenofovir-based PrEP among men who have sex with men and transgender women (MSM/TGW) in the United States. DESIGN Simulation, cost-effectiveness analysis. DATA SOURCES Trial and published data, including estimated HIV incidence (5.32, 1.33, and 0.26 per 100 person-years for off PrEP, generic F/TDF and branded emtricitabine-tenofovir alafenamide (F/TAF), and CAB-LA, respectively); 28% 6-year PrEP retention. Annual base-case drug costs: $360 and $16 800 for generic F/TDF and branded F/TAF. Fewer side effects with branded F/TAF versus generic F/TDF were assumed. TARGET POPULATION 476 700 MSM/TGW at very high risk for HIV (VHR). TIME HORIZON 10 years. PERSPECTIVE Health care system. INTERVENTION CAB-LA versus generic F/TDF or branded F/TAF for HIV PrEP. OUTCOME MEASURES Primary transmissions, quality-adjusted life-years (QALYs), costs (2020 U.S. dollars), incremental cost-effectiveness ratios (ICERs; U.S. dollars per QALY), maximum price premium for CAB-LA versus tenofovir-based PrEP. RESULTS OF BASE-CASE ANALYSIS Compared with generic F/TDF (or branded F/TAF), CAB-LA increased life expectancy by 28 000 QALYs (26 000 QALYs) among those at VHR. Branded F/TAF cost more per QALY gained than generic F/TDF compared with no PrEP. At 10 years, CAB-LA could achieve an ICER of at most $100 000 per QALY compared with generic F/TDF at a maximum price premium of $3700 per year over generic F/TDF (CAB-LA price <$4100 per year). RESULTS OF SENSITIVITY ANALYSIS In a PrEP-eligible population at high risk for HIV, rather than at VHR (n = 1 906 800; off PrEP incidence: 1.54 per 100 person-years), CAB-LA could achieve an ICER of at most $100 000 per QALY versus generic F/TDF at a maximum price premium of $1100 per year over generic F/TDF (CAB-LA price <$1500 per year). LIMITATION Uncertain clinical and economic benefits of averting future transmissions. CONCLUSION Effective oral PrEP limits the additional price society should be willing to pay for CAB-LA. PRIMARY FUNDING SOURCE FHI 360; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Allergy and Infectious Diseases; National Heart, Lung, and Blood Institute; National Institute on Drug Abuse; the Reich HIV Scholar Award; and the Steve and Deborah Gorlin MGH Research Scholars Award.

Treatment to Prevent HIV Transmission in Serodiscordant Couples in Henan, China, 2006 to 2012

Abstract: Since 2012, several human immunodeficiency virus (HIV) treatment guidelines have begun calling for immediate treatment of all HIV-infected persons regardless of CD4 cell count [1–3]. The guideline changes are attributable, in part, to results of a clinical trial showing that antiretroviral treatment (ART) can stop sexual HIV transmission [4], as well as evidence that earlier ART reduces HIV morbidity and mortality [5]. Supporters of rapid rollout of “treatment as prevention” strategies argue that the effect is already visible in areas where broader ART access has coincided with declines in measured sexual transmission of HIV [6, 7]. However exceptions to this pattern [8] and the potential risks of rapid rollout such as widespread emergence of drug resistance [9] or changes in risk behaviors [10], have tempered enthusiasm. In resource-poor settings, limited access to the resources required for durable viral suppression—optimal drug regimens and routine laboratory monitoring, for example—have prompted calls for research to inform treatment as prevention guidelines adapted to these locations [11]. Of about a dozen observational studies reporting on the real world effect of ART on sexual HIV transmission by following serodiscordant couples, in which only 1 partner is infected [12, 13], only 3 have followed those receiving routine care in resource-limited settings (the remainder tracked patients in wealthy countries or who received specialized care as part of scientific research studies). One of these 3 studies reported that ART prevented linked HIV transmission in couples from the southern Chinese province of Yunnan, though the uniqueness of the cohort—the initially infected (or “index”) partners were overwhelming male (78.7%), with about half reporting historic drug use (45.1%)—and high loss of follow-up among untreated couples, limited generalizability of the results [13]. Notably, the remaining 2 reports from Uganda [14] and Henan Province in China [15], both reported a lack of protective immunity attributable to the index partner's ART use. Follow-up of the Henan cohort has been ongoing, and an analysis of a later phase of follow-up showed that ART was instead highly protective against transmission [16], raising further questions about the relationship between ART exposure and HIV transmission in nontrial settings. The Chinese government provides free HIV testing and universal ART through the existing healthcare system, in many cases managed by nonphysician clinicians [17], which provides a realistic version of proposed test and treat strategies [18]. The purpose of the current report is to investigate how well ART can work under such conditions so as to inform future programming for the use of treatment as prevention, particularly in resource poor settings.

HIV treatment as prevention: to be or not to be?

Abstract: Now 30 years after the first case of AIDS was described we have yet to develop reliable methods—either behavioral or biological—to prevent the spread of HIV. The spectacular and life-saving success of antiretroviral therapy has been more than offset by the challenge of treating millions of people world wide for their entire lives, and the sobering observation that for every person we treat several more become newly infected. Given this sad reality, no prevention stone should go unturned. And it seems more than reasonable to believe that antiretroviral drugs can be used for prevention. Indeed, these drugs have demonstrated the ability to nearly eliminate vertical (mother to baby) transmission of HIV, implementation challenges notwithstanding. Antiretroviral agents could be used to prevent the sexual transmission of HIV as preexposure prophylaxis, postexposure prophylaxis or to reduce transmission from infected patients. The latter approach has great promise: because personal health can benefit from antiretroviral therapy (ART) why not exploit the public health benefit as well? Indeed, many drugs concentrate in the genital secretions leading to profound and prolonged (albeit incomplete) suppression of HIV in the genital tract. The widespread availability of ever safer ART has led to clinical observations that support treatment as prevention. Several studies of discordant couples demonstrate dramatically reduced risk to the HIV-negative sexual partner when the infected person takes ART. And some (but not all) population based studies suggest the potential for falling prevalence of HIV in communities where ART is broadly used. Under idealized conditions, where most HIV-infected people are tested and treated and suppressed for life, it is possible to formulate a mathematical model where we literally ‘‘treat our way out of the epidemic.’’ But 3 big concerns have clouded the picture: (1) transmission of resistant viral strains; (2) the contribution of patients with acute and early HIV (subjects who are not likely to be detected routinely but contribute substantially to the spread of HIV; and (3) the practicality of the idea. In this issue of J Acquir Immune Defic Syndr, a Chinese team of investigators have offered us an eye-opening ‘‘real world view.’’ The Chinese HIVepidemic includes a large subgroup of paid plasma donors (now called former plasma donors in deference to the elimination of the practice) who were inadvertently infected with HIV through flawed procedures. In the current report, Wang et al retrospectively evaluated 1927 discordant couples for 2 years, 2006–2008. The index case received HIV care (including ART) free of charge. The results related to HIV transmission in these couples are important, surprising and cautionary. Eighty-four seroconversion events were observed in 4.3% of couples with 2 critical twists. First, the transmission events increased with time of follow-up, regardless of counseling, knowledge, and condom availability. This result demonstrates no protective immunity in partners who were, by definition, exposed and uninfected at the time the study started. Second, and perhaps most important, transmission events occurred with equal frequency in couples regardless of whether the partner was provided free ART. Of course, it is possible that HIV was acquired from another sexual partner (as has been observed in studies in Africa). Or the patients may have used their drugs poorly and/or developed resistance to therapy. But the main point is that the Chinese patients were receiving routine health care. Studies reporting the great success of ART in reducing HIV

Prevention of HIV-1 Infection with Early Antiretroviral Therapy

Abstract: Background Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. Methods In nine countries, we...

Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults

Abstract: Lionel A. Mandell, Richard G. Wunderink, Antonio Anzueto, John G. Bartlett, G. Douglas Campbell, Nathan C. Dean, Scott F. Dowell, Thomas M. File, Jr. Daniel M. Musher, Michael S. Niederman, Antonio Torres, and Cynthia G. Whitney McMaster University Medical School, Hamilton, Ontario, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; University of Texas Health Science Center and South Texas Veterans Health Care System, San Antonio, and Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas; Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; Division of Pulmonary and Critical Care Medicine, LDS Hospital, and University of Utah, Salt Lake City, Utah; Centers for Disease Control and Prevention, Atlanta, Georgia; Northeastern Ohio Universities College of Medicine, Rootstown, and Summa Health System, Akron, Ohio; State University of New York at Stony Brook, Stony Brook, and Department of Medicine, Winthrop University Hospital, Mineola, New York; and Cap de Servei de Pneumologia i Allergia Respiratoria, Institut Clinic del Torax, Hospital Clinic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain.

Role of free radicals and catalytic metal ions in human disease: an overview.

Abstract: Publisher Summary This chapter discusses the role of free radicals and catalytic metal ions in human disease. The importance of transition metal ions in mediating oxidant damage naturally leads to the question as to what forms of such ions might be available to catalyze radical reactions in vivo . The chapter discusses the metabolism of transition metals, such as iron and copper. It also discusses the chelation therapy that is an approach to site-specific antioxidant protection. The detection and measurement of lipid peroxidation is the evidence most frequently cited to support the involvement of free radical reactions in toxicology and in human disease. A wide range of techniques is available to measure the rate of this process, but none is applicable to all circumstances. The two most popular are the measurement of diene conjugation and the thiobarbituric acid (TBA) test, but they are both subject to pitfalls, especially when applied to human samples. The chapter also discusses the essential principles of the peroxidation process. When discussing lipid peroxidation, it is essential to use clear terminology for the sequence of events involved; an imprecise use of terms such as initiation has caused considerable confusion in the literature. In a completely peroxide-free lipid system, first chain initiation of a peroxidation sequence in a membrane or polyunsaturated fatty acid refers to the attack of any species that has sufficient reactivity to abstract a hydrogen atom from a methylene group.

Regression Diagnostics: Identifying Influential Data and Sources of Collinearity

Abstract: 1. Introduction and Overview. 2. Detecting Influential Observations and Outliers. 3. Detecting and Assessing Collinearity. 4. Applications and Remedies. 5. Research Issues and Directions for Extensions. Bibliography. Author Index. Subject Index.

Sexually transmitted diseases treatment guidelines.

Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.