News Release

HIV status is not associated with mpox treatment outcomes in persons using tecovirimat

Embargoed News from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians


Embargoed for release until 5:00 p.m. ET on Monday 01 May 2023
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. HIV status is not associated with mpox treatment outcomes in persons using tecovirimat
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3132
URL goes live when the embargo lifts
A cohort study of persons with confirmed mpox infections who were treated with the novel antirviral tecovirimat has found that the HIV status of the patients did not impact treatment outcomes. The findings are published in Annals of Internal Medicine.

In May 2022, an outbreak of the zoonotic DNA orthopoxvirus mpox began in Europe. The most recent outbreak occurred mostly among men who have sex with men (MSM) and has been associated with significant rates of coincident sexually transmitted infections. Almost half of mpox infections during this outbreak occurred in people with HIV, but it is unknown to what degree HIV acts as an independent risk factor for mpox acquisition.

Researchers from Columbia University Medical Center and New York Presbyterian Hospital conducted a retrospective cohort study of 196 people treated with tecovirimat from 20 June to 29 August 2022. Of the 196 participants, 154 were diagnosed with mpox and 72 were persons with HIV. The authors report that indications for tecovirimat treatment were similar between persons with and without HIV. They also report that only 22 percent of participants had nonsevere adverse effects, and only 4 participants had serious adverse events. Three of the four participants who experienced serious adverse were persons with HIV.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Jacob McLean, DO, please email jm5146@cumc.columbia.edu.
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2. Most improvements in acute stroke care attributable to a few quality measures
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3186
URL goes live when the embargo lifts
A cost-effectiveness analysis of acute stroke care found that out of 15 process measures to improve the quality of care, five of them contributed the most to improvements in care. Early carotid imaging and intravenous tissue plasminogen activator contributed the largest fraction of the total potential value of quality improvement, accounting for 72 percent of the total value. The analysis is published in Annals of Internal Medicine.

The American Heart Association (AHA) and American Stroke Association (ASA) endorsed 15 process measures for acute ischemic stroke (AIS) to improve the quality of care. Setting quality targets can help providers prioritize their clinical care efforts, and payers can leverage these measures in designing payment schemes to incentivize high-quality care. However, which measures have the highest value and should be prioritized in stroke quality improvement initiatives remains unclear.

Researchers from Vanderbilt University School of Medicine, Harvard School of Public Health, and Weill Cornell Medicine used a computer simulation model to analyze the cost-effectiveness and health impact of 10 of 15 AHA/ASA-endorsed quality measures. Of the 10 measures with available data on clinical effectiveness, all were estimated to be cost-saving or highly cost-effective, with substantial variation in potential value for improvement across quality measures. The other 5 measures lacked evidence of quantifiable health effects. For example, although rehabilitation programs are effective in reducing recurrent ischemic events, the effect of implementing the quality measure “assessed for rehabilitation” on the engagement in rehabilitation was unclear, highlighting a need for future studies on the clinical evidence to support the use of these 5 quality measures. According to the authors, their findings can assist AIS care providers and payers in setting priorities for quality improvement and value-based payment.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Jinyi Zhu, PhD, please email Jake Lowary at jacob.lowary@vumc.org.
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Also new in this issue:
Challenges in Estimating the Effectiveness of COVID-19 Vaccination Using Observational Data
William J. Hulme, PhD; Elizabeth Williamson, PhD; Elsie M.F. Horne, PhD; Amelia Green, PhD; Helen I. McDonald, PhD; Alex J. Walker, PhD; Helen J. Curtis, DPhil; Caroline E. Morton, MRCGP; Brian MacKenna, MPharm; Richard Croker, MSc; Amir Mehrkar, MRCGP; Seb Bacon, BA; David Evans, MPhil; Peter Inglesby, MPhil; Simon Davy, PhD; Krishnan Bhaskaran, PhD; Anna Schultze, PhD; Christopher T. Rentsch, PhD; Laurie Tomlinson, PhD; Ian J. Douglas, PhD; Stephen J.W. Evans, MSc; Liam Smeeth, PhD; Tom Palmer, PhD; Ben Goldacre, MRCPsych; Miguel A. Hernán, MD, DrPH; and Jonathan A.C. Sterne, PhD
Research and Reporting Methods
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4269

 


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