Cohort Definition Name : Earliest event of Human Immunodeficiency Virus I (HIV), with treatment, lab or 2nd diagnosis
Contributor name : Rupa Makadia, Jamie Calusardo
Contributor OrcId :
Logic Description : Earliest event of Type 2 Diabetes Mellitus (DM), indexed on diagnosis or Blood glucose lowering drugs excluding insulin or high Hemoglobin A1c (limited to treatments or measurement that are followed with Type 2 DM diagnosis within 365 days) excluding persons with Type 1 DM or secondary diabetes mellitus in the all time prior including index date
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Diagnosis: The only method to determine HIV status is through screening tests. HIV tests are available at many medical clinics, substance abuse programs, community health centers, and hospitals. Home testing kits are also available at many pharmacies or online. Several types of HIV tests exist, including nucleic acid tests (NAT), antigen/antibody tests, and antibody tests.Prognosis and Treatment: Without treatment, the average survival of individuals with AIDS is approximately 3 years; however, the occurrence of opportunistic infection decreases life expectancy without treatment to 1 year. That being said, taking HIV medicine (i.e., antiretroviral therapy) may enable individuals with HIV to live long and healthy lives, and prevent the transmission of HIV to their sexual partners. In addition, certain measures can decrease the risk getting HIV through sex or injection drug equipment, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).Assessment: There are three types of HIV diagnostic tests: Nucleic acid tests (NAT), antigen/antibody tests, and antibody tests. NATs look for the actual virus in the blood. This test is very expensive and is not routinely used for HIV screening unless the person recently had a high-risk exposure or a possible exposure with early symptoms of HIV infection. A NAT can usually detect HIV infection 10 to 33 days after an exposure. Antigen/antibody tests look for both HIV antibodies and antigens. If you have HIV, an antigen called p24 is produced even before antibodies develop. Antigen/antibody tests are recommended for testing done in labs and are now common in the US. An antigen/antibody test performed by a lab on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. There is also a rapid test available that is done with a finger prick which can take longer to detect HIV (18-90 days after an exposure). Antibody tests look for antibodies in your blood or oral fluid. These tests can take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and only FDA-approved HIV self-tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger or prick or with oral fluid. An initial HIV test usually with either be an antigen/antibody test or an antibody test. If the initial HIV test is a rapid test or a self-test and it is positive, the individual should go to a health care provider to get follow-up testing. If the initial HIV test is a lab test and it is positive, the lab will usually conduct follow-up testing on the same blood sample as the initial test. Although HIV test are generally very accurate, follow-up testing allows the health care provider to be sure the diagnosis is correct. Plan: The primary goal of treatment in HIV patients is to achieve an undetectable viral load in order to reduce morbidity and mortality as well as prevent transmission. There are seven HIV drug classes: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Nucleoside reverse transcriptase inhibitors (NRTIs), Protease inhibitors (PIs), Fusion inhibitors, CCR5 antagonists, Integrase strand transfer inhibitors (INSTIs), and Post-attachment inhibitors. Treatment for patients with HIV tends to be complex. Treatment should start with a baseline evaluation where lab tests such as CD4 t lymphocyte cell counts, Plasma HIV RNA, complete blood count, fasting blood glucose, genotypic resistance, etc. should be performed. Antiretroviral (ARV) drug resistance testing is important prior to creating a treatment plan. Once antiretroviral therapy (ART) is started, laboratory test should be given at recommended time frames (e.g. every 3, 6 or 12 months) to assess the virologic and immunologic efficacy of the treatment in addition to monitor for laboratory abnormalities that may be associated with ARV drugs. Patients should also be tested for HBV and HCV co-infection prior to ART initiation and periodically after, as treatment of these coinfections may affect the choice of ART and likelihood of drug-induced hepatoxicity. In addition to laboratory testing, at each visit for HIV care, adherence to ART should be addressed and patients should be counseled in regards to the importance of ART to their own health as well as its role in prevent sexual HIV transmission. Prognosis: Without treatment, the average survival of individuals with AIDS is approximately 3 years; however, the occurrence of opportunistic infection decreases life expectancy without treatment to 1 year. That being said, taking HIV medicine (i.e., antiretroviral therapy) may enable individuals with HIV to live long and healthy lives, and prevent the transmission of HIV to their sexual partners.
Evaluation conclusion : We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR). HIV diagnostic and treatment pathway is complex, so we considered a variety of variables to address the complexity of including laboratory measurements where databases support the use of labs and treatment options. It is important to note that the vast majority of laboratory values were found to be either missing or invalid within the databases included within our analyses. When comparing the cohorts that includedHigh specificity and NPV (e.g., >95%) was achieved across all phenotypes. The phenotypes including only a single diagnosis code for HIV had the highest sensitivity but had lower PPV. On the other hand, phenotypes requiring 2 diagnosis codes for HIV and a drug exposure to HIV medications had the highest PPV but lower sensitivity.
Imported to the OHDSI Phenotype Library. It may be expected to be found with id = 1033 in the next release. Thank you