Rajeev B. Shah

Background: Recent United States data on incidence, healthcare resource utilization (HRU), and costs for herpes zoster (HZ) in adults with human immunodeficiency virus (HIV) are lacking. Methods: This retrospective cohort study included insured adults during 2015–2022. HZ incidence rates were estimated among HZ-unvaccinated adults with HIV, HIV without other immunocompromising conditions (ICC) (HIV only), and 1,000,000 randomly selected adults with no ICC. Poisson regression was used to estimate adjusted incidence rate ratios (aIRRs) and 95% confidence intervals (CIs). All-cause HRU and costs were compared between propensity score-matched cohorts with HIV and HZ versus HIV without HZ during the first 1, 3, and 12 months after an episode of HZ. Results: The incidence rates of HZ in the HIV (n = 53,700), HIV only (n = 41,544), and no ICC cohorts were 12.0, 10.3, and 5.6 per 1,000 person-years, respectively (HIV vs. no ICC: aIRR 2.05, 95% CI 1.92–2.19; HIV only vs. no ICC: aIRR 1.93, 95% CI 1.79–2.09). Mean all-cause per-patient costs were higher among adults with HIV and HZ during the first month (n = 1,078 and 4,312; cost difference $3,075, 95% CI $1,239–4,911) and the first 3 months (n = 994 and 3,976; $2,980, 95% CI $649–5,310) compared with adults with HIV without HZ. Conclusions: People with HIV are at increased risk of HZ compared to adults without ICC, and the costs associated with HZ among people with HIV are considerable. These findings support the importance of HZ prevention for adults with HIV.

Several vaccines are recommended for 16-23-year-olds in the United States, but coverage varies widely across these vaccines. Previous studies have indicated that routine healthcare visits are associated with vaccination uptake. This study aimed to describe healthcare visit patterns among 16-23-year-olds to identify challenges and inform opportunities to reach adolescents and young adults for vaccination. A descriptive, retrospective database analysis was conducted of commercially insured and Medicaid-insured 16-23-year-olds from 2019-2022 using IQVIA's PharMetrics® Plus claims database and open-source Longitudinal Prescription/Medical claims databases. The proportion of 16-23-year-olds with healthcare provider (HCP) visits, visit types, provider types involved, visits including vaccination, and specific vaccines delivered were analyzed. In 2022, 68.2% of commercially insured 16-23-year-olds had ≥1 HCP visit. Most commercially insured and Medicaid-insured individuals with ≥1 HCP visit had sick visits (72.9-80.6%). The proportion of individuals with preventative visits was lower as age increased (commercially insured: 73.2% at 16, 67.4% at 18, 56.3% at 19, and 45.3% at 23 years). Lower proportions of individuals with preventative visits with increasing age were also seen among Medicaid-insured individuals, ranging from 53.7% at 16 years to 28.0% at 23 years. Among 16-18-year-olds with ≥1 HCP or pharmacy visit in 2022, 52.6% in the commercial cohort and 33.0% in the Medicaid cohort had visits that involved vaccination; for 19-23-year-olds, these proportions were 34.5% and 25.6%, respectively. Vaccination rates by vaccine type were largely aligned with the ages specified by recommendations, but nonetheless were low. Approximately one-third of commercially insured 16-23-year-olds did not have an annual HCP visit, and among commercially insured and Medicaid-insured individuals who did have visits, a substantial proportion did not have preventative visits; this proportion was higher with increasing age. The proportions of visits with vaccination were particularly low for 19-23-year-olds. Targeted interventions to promote routine visits, including framing these as opportunities for immunization, may help to increase vaccination uptake; based on the findings of this analysis, these efforts should consider age-specific shifts in health-seeking behaviors.

In the United States (US), meningococcal serogroup B (MenB) vaccination is currently recommended under shared clinical decision-making for 16-23-year-olds to prevent invasive meningococcal disease; the MenB vaccine may be co-administered with other vaccines recommended for this age group. A retrospective analysis of two US health insurance claims databases was conducted to estimate the proportion of commercially insured and Medicaid-insured 16-23-year-olds with potential missed opportunities for MenB vaccine series initiation via co-administration. Potential missed opportunities were defined as visits with healthcare providers during which other recommended vaccines (MenACWY, Tdap, HPV, influenza, and/or COVID-19) were administered, but not the initial MenB vaccine dose. In 2022, 74.5% of commercially insured and 67.1% of Medicaid-insured 16-23-year-olds had potential missed opportunities for MenB vaccination initiation via co-administration. The proportion of missed opportunities was higher among 19-23-year-olds (versus 16-18-year-olds) and lower for visits with pediatricians (versus internists or general practitioners/family physicians). The most frequently co-administered vaccine was the MenACWY vaccine. Many 16-23-year-olds had potential missed opportunities for MenB series initiation via co-administration. Increasing awareness of the opportunity to initiate the MenB series via co-administration may improve meningococcal vaccination coverage in the United States.

Enteral tubes are necessary for certain patients; however, medication absorption can be affected by this route of administration potentially resulting in decreased efficacy. All first‐line treatments for Hepatitis C Virus (HCV) infection are only available as tablets and may have decreased absorption if administered via an enteral tube. This report describes the first case of a pegylated interferon and ribavirin treatment‐experienced patient who successfully achieved HCV cure after 12 weeks of elbasvir/grazoprevir administered via percutaneous gastrostomy tube. We further review the available pharmacokinetic and clinical literature regarding administration via enteral feeding tubes for all first‐line direct‐acting antivirals (DAAs). The literature suggests that crushed administration can be considered for DAAs in patients with gastric access. However, caution should be exercised in patients with extragastric enteral tubes and in those with altered gastrointestinal tract anatomy.