Long periods of viral suppression shown to prevent cancer in aging HIV population

1. Long periods of viral suppression shown to prevent cancer in aging HIV population
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2094
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Early, sustained antiretroviral therapy (ART), which results in long-term viral suppression, helps to prevent AIDS-defining cancers and also non-AIDS-defining cancers, to a lesser degree. However, patients with long-term viral suppression still had excess cancer risk compared to uninfected patients. The study, published in Annals of Internal Medicine, is the first to examine the effects of prolonged periods of viral suppression and potential cancer prevention benefits for the aging population of persons living with HIV.

Persons with HIV are at increased risk for AIDS-defining cancers (Kaposi sarcoma, non-Hodgkin lymphoma, invasive cervical cancer) and non-AIDS-defining cancers (lung, larynx, melanoma, leukemia, etc.). Some of these cancers are known to be caused by viruses (certain anal, liver, Hodgkin lymphoma, etc.) that are common among persons with HIV. Viral suppression is a key component of HIV treatment, and studies have shown an association between prolonged viral suppression and decreased risk for some types of cancer. However, no studies have specifically focused on the effect of sustained viral suppression on overall cancer risk.

Researchers from the Stanford Center for Population Health Sciences compared cancer rates for 42,441 HIV-positive veterans with those of 104,712 demographically-matched uninfected veterans from 1999-2015 to determine whether long-term viral suppression was associated with decreased cancer risk. They found that cancer risk was highest in the unsuppressed state, lower in early suppression, lower still in long-term suppression, and lowest in uninfected patients for all cancer, AIDS-defining cancer, virus non-AIDS-defining-cancer, and several cancer types.

According to the authors, these findings are helpful to both infectious disease and internal medicine clinicians who care for the population of aging HIV-positive patients. Understanding how HIV interacts with viral coinfections and results in higher risks of cancer may offer critical insight in how to better prevent and treat these cancers for everyone.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Lesley Park, PhD, MPH, please contact Bruce Goldman at goldmanb@stanford.edu. To reach co-lead author, Robert Dubrow, MD, PhD, please contact Michael Greenwood at michael.greenwood@yale.edu.

2. ABIM research suggests that doctors who maintain Board Certification provide better patient care
Abstract: http://annals.org/aim/article/doi/10.7326/M16-2643
Editorial: http://annals.org/aim/article/doi/10.7326/M18-1459
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Physicians who regularly update their medical knowledge through the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program performed better on Healthcare Effectiveness Data and Information Set (HEDIS) measures than physicians who did not. According to ABIM researchers, these findings build on existing evidence that MOC is associated with better patient care. Their analysis is published in Annals of Internal Medicine.

The value of the ABIM MOC program has been questioned by physicians who are already time-strapped and overwhelmed. To assess the effect of MOC participation on selected performance measures associated with good patient care, researchers for the ABIM analyzed 1,260 physicians, 786 of whom maintained their certification and 474 did not, and then identified 85,931 Medicare patients to whom these physicians provided primary care. They used Medicare claims data to calculate physician performance scores based on the percentage of these patients that met a set of HEDIS performance standards for diabetes care, mammography screening and heart disease care. The researchers found that physicians who participated in MOC were more likely to order the recommended tests and provide the appropriate level of care concordant with current clinical practice guidelines.

These findings suggest that MOC status is associated with performance of some preventive health services. However, an accompanying editorial by Dr. Lee Goldman, Dean of the Faculties of Health Sciences and Medicine at Vagelos College of Physicians and Surgeons, Columbia University, notes that the rates of meeting HEDIS standards were low with only minimally better performance by those who maintained certification. Dr. Goldman writes, "... if maintenance of certification simply takes my doctor from a low F to a slightly higher F, or even from D+ to C-, on metrics that may or may not be worth grading, then I don't find it helpful at all."

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Bradley Gray, PhD, please contact John Held at JHeld@ABIM.ORG or Pamela Browner White at PBrownerWhite@abim.org.

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