Robert Bettiker | Temple University (original) (raw)

Papers by Robert Bettiker

Aids Patient Care and Stds, Apr 1, 2011

Clinical Infectious Disease

BMJ Open

ObjectivesHIV scholars and practitioners have worked to expand strategies for prevention among ma... more ObjectivesHIV scholars and practitioners have worked to expand strategies for prevention among marginalised populations who are disproportionately impacted by the epidemic, such as racial minority men who have sex with men (MSM). Given this urgency, the objective of this study was to assess interest in biomedical prevention strategies.MethodsThis exploratory and cross-sectional study investigated interest in four biomedical prevention tools—rectal douche, dissolvable implant, removable implant and injection—among a racially diverse sample of MSM from the Northeast Corridor region between Philadelphia and Trenton. Data were collected as part of screening for Connecting Latinos en Pareja, a couples-based HIV prevention intervention for Latino MSM and their partners.ResultsA total of 381 individuals participated in the screener and provided information about their interest in bio tools. Approximately 26% of participants identified as black, 28% as white and 42% as ‘other’ or multiracia...

Objective:�ToreviewtheHIVscreeningpracticesof� internalmedicineresidentsinouroutpatientclinic� an... more Objective:�ToreviewtheHIVscreeningpracticesof� internalmedicineresidentsinouroutpatientclinic� andtosurveyphysiciansandpatientstodetermine� acceptabilityofscreening. •� Methods:�Aretrospectivechartreview�(n�=�205)�was� conductedtoevaluateifHIVscreeningtookplace.�A� separatesampleofclinicpatientswassurveyedregard- ingacceptabilityoftesting.�Physiciansweresurveyed� regardingtheirperceivedsuccessinHIVscreeningand� identificationofbarrierstoscreeningefforts. •� Results:�HIVscreeningwasofferedto�39%�(80)�ofpa- tientsand�35%�(71)�weretested.�Factorsassociated� withHIVriskwerepresentin�45%.�Inthesubsetof� patientsnotofferedtesting,�29%�hadariskfactoras- sociatedwithHIV.�64%�ofphysicianssaidtheywould� screenmorepatientsifrapidtestingwereavailable.� Timeconstraintsandcompetinghealthissueswere� citedasthegreatestbarrierstoscreening.�Only�4�of� 29�patientssaidtheywoulddeclinetesting.� •� Conclusion:� HIVtestingisunderperformedinour� clinic.�MostpatientswerereceptivetoHIVtesting.� Advocates for...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2020

Patient acceptance of long-acting injectable antiretroviral (LAI-ARV) HIV-1 regimens will determi... more Patient acceptance of long-acting injectable antiretroviral (LAI-ARV) HIV-1 regimens will determine uptake. Although previous literature reports high satisfaction, these data stem from clinical trials subject to selection bias. This cross-sectional survey from the HIV practices of an urban academic medical center assessed perceptions and preferences using Likert scales toward overall acceptability, proposed frequencies, injection-site reaction durations, and distribution venue. 59% of surveys were completed resulting 202 respondents. 60% were male, 72% black, and the median age was 49 (IQR 36-58). 93% reported a once daily tablet frequency, 69% reported single tablet regimens, and 59% reported missing zero doses in the prior 30 days. Patients self-categorized as likely (57%) or unlikely (43%) to accept LAI-ARV. Both decreasing frequencies between injections and durations of injection-site reactions resulted higher acceptability scores. 57% of respondents preferred receiving an injec...

Open Forum Infectious Diseases, 2020

Background Two-drug antiretroviral (ARV) regimens to achieve and maintain HIV viral suppression m... more Background Two-drug antiretroviral (ARV) regimens to achieve and maintain HIV viral suppression may lead to decreases in associated drug interactions, adverse events, and pill burden. Dolutegravir-lamivudine (DTG-3TC) has been established as safe and effective in treatment naïve and experienced adults. Further research is warranted to assess insertion into real-world practice. Methods This descriptive retrospective cohort consisted of all patients at an academic medical center HIV practice with a confirmed order of DTG-3TC between April 2019 and March 2020. Patients who were not linked to care by the site’s practices were excluded. The primary endpoint was number of patients initiated on DTG-3TC to determine uptake. Secondary endpoints included demographics and viral outcomes. Descriptive measures of central tendencies and variability were used for analysis. Results DTG-3TC was initiated in 49 patients. Sixty-nine percent were male (34/49), 90% carried publicly funded insurance (44/...

Open Forum Infectious Diseases, 2019

Background Although new injectable antiretrovirals (ARV) for HIV may soon be available, there is ... more Background Although new injectable antiretrovirals (ARV) for HIV may soon be available, there is little research on patient preferences. We examined perceptions of injectable ARV among persons living with HIV (PLWH). Methods This cross-sectional study was conducted among PLWH presenting for an appointment at TempleHealth in Philadelphia, PA between March 11 and April 18, 2019. Respondents completed a self-administered survey comprising 29 questions about socio-demographic data, current ARV, and preferences regarding injectable ARV therapies. Responses were recorded on a 10-point Likert scale, on which responses in the 1–5 range were defined as unlikely and 6–10 range as likely to choose injectable ARV. The primary endpoint was to describe factors associated with likely vs. unlikely uptake of injectable ARV. Responses between groups were compared with Chi-square or Wilcoxon rank-sum tests. Results 171 patients completed a survey with a 56% response rate. Demographics were 60% male, 7...

Neurobiology of Aging, 1994

Current opinion in HIV and AIDS, 2018

Antiretroviral options for patients infected with multiclass resistant HIV-1 warrant the developm... more Antiretroviral options for patients infected with multiclass resistant HIV-1 warrant the development of new agents with unique mechanisms of action and modes of delivery. Here we review one such agent, ibalizumab, a parenteral CD4 postattachment inhibitor that has demonstrated efficacy as part of combination antiretroviral therapy in the treatment of HIV-1. In a phase III clinical trial in HIV-infected participants with multiclass antiretroviral drug resistance, the intravenous administration of ibalizumab led to declines in plasma HIV-1 RNA more than 0.5 log in 83% of participants at 1 week. An optimized background antiretroviral regimen was then added, and plasma HIV-1 RNA became less than 50 copies/ml in 43% of participants at 24 weeks. Adverse effects of ibalizumab were uncommon and generally low grade. Ibalizumab was approved by the US Food and Drug Administration on March 16, 2018, under the trade name Trogarzo. Ibalizumab has demonstrated both safety and efficacy in the treat...

Clinical Microbiology Newsletter, 2012

Patients undergoing thoracic organ transplantation procedures involving the heart or lung are at ... more Patients undergoing thoracic organ transplantation procedures involving the heart or lung are at increased risk for developing a wide variety of infections due to their underlying immunosuppression and/or other factors. Lung transplant recipients are at high risk for developing infections caused by bacteria, viruses, and opportunistic fungi, whereas heart transplant recipients are at risk for developing infections caused by these same microorganisms, as well as parasitic infections, including toxoplasmosis and New World trypanosomiasis. This review will highlight the various infections that thoracic organ transplant recipients may develop following their procedures.

Drug Discovery, Development, and Manufacturing, 2011

Challenging Cases in Rheumatology and Diseases of the Immune System, 2012

Human immunodeficiency virus (HIV) is a lymphotropic retrovirus that infects a subset of cells wi... more Human immunodeficiency virus (HIV) is a lymphotropic retrovirus that infects a subset of cells within the immune system. As HIV infection progresses, the ability of the immune system to detect and suppress a variety of conditions such as cancer and infections is impaired. Here, we present a case of B-cell lymphoma as the initial presentation of HIV infection as well as a case of histoplasmosis secondary to HIV infection presenting as a colonic mass.

Sequelae and Long-Term Consequences of Infectious Diseases

Page 401. Sequelae and Long-Term Consequences of Infectious Diseases Edited by Pina M. Fratamico,... more Page 401. Sequelae and Long-Term Consequences of Infectious Diseases Edited by Pina M. Fratamico, James L. Smith, and Kim A. Brogden © 2009 ASM Press, Washington, DC Chapter 21 Slow Viral Infections Raﬁk Samuel ...

Nature Medicine, 1995

from the authors. 2. Williams, G.H. An 4nai,tlvsis of the Review of I'ltitlf-Oriented Research PR... more from the authors. 2. Williams, G.H. An 4nai,tlvsis of the Review of I'ltitlf-Oriented Research PR) Gn tr pplications 1iv thie D)ivisiol fRcseahll (;Ganti, NIH Clinical Research Study Group. NIH 1994). 3. Kell, \.M., and Randolph, M.A Caieers Clinical Rescalic: Obstadchl aitd Opportilities INational Academy Press. \Val\hington, 1994). 4. Ibc, I.C. et al. Th.l essentiall role of integrative biorincdical sciences i protectillg and contributing to the health and icel l-heing our nation.

Nature Medicine, 1996

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Brain Research, 1993

We used in vivo microdialysis to examine the acute effects of systemically administered nicotine ... more We used in vivo microdialysis to examine the acute effects of systemically administered nicotine (0.8-8.0 mg/kg, s.c.) on extracellular levels of serotonin (5-HT) in the frontal cortex of awake rats and animals anesthetized with chloralose/urethane. In anesthetized animals, 5-HT efflux was elevated during the initial 15 min after nicotine administration (2-8 mg/kg), but then returned to baseline values. All of the effective nicotine doses also lowered and then raised blood pressure in these animals. However, other drugs which raised (methoxamine, 0.07 mg/kg, i.v.) or lowered (mecamylamine, 5 mg/kg, i.p.) blood pressure without directly activating nicotinic receptors failed to alter 5-HT release. Moreover, pretreatment with a centrally active dose of mecamylamine, a known nicotinic antagonist, blocked the effects of nicotine (4 mg/kg) on 5-HT release. For studies on awake rats the peffusion fluid also contained fluoxetine, since basal 5-HT levels were barely detectable without this uptake blocker. In such animals, 1.6 mg/kg of nicotine significantly increased 5-HT release, an effect apparent in the initial 20 min after treatment and persisting for at least 2 h. These observations demonstrate that systemically administered nicotine increases frontocortical 5-HT release, that this effect is independent of the cardiovascular responses to the drug, and that it probably results from the activation of previously described nicotinic receptors on raphe neurons. The present findings are consistent with the hypothesis that the appetitive and mood disturbances associated with nicotine withdrawal may be mediated by diminished serotoninergic transmission.

Archives of Pharmacal Research, 2006

As we approach the completion of the first 25 years of the human immunodeficiency virus (HIV) epi... more As we approach the completion of the first 25 years of the human immunodeficiency virus (HIV) epidemic, there have been dramatic improvements in the care of patients with HIV infection. These have prolonged life and decreased morbidity. There are twenty currently available antiretrovirals approved in the United States for the treatment of this infection. The medications, including their pharmacokinetic properties, side effects, and dosing are reviewed. In addition, the current approach to the use of these medicines is discussed. We have included a section addressing common comorbid conditions including hepatitis B and C along with tuberculosis.

Archives of Pharmacal Research, 2002

It is now more than two decades since the AIDS epidemic began with a cluster of Pneumocystis cari... more It is now more than two decades since the AIDS epidemic began with a cluster of Pneumocystis carinii pneumonia (PCP) in a community of homosexual men. Since then, many other infections have been characterized as opportunistic infections secondary to HIV infection. These include, but are not limited to, infections with Toxoplasma gondii, Cytomegalovirus (CMV), Mycobacterium avium complex (MAC), and Cryptococcus neoformans. Over the last two decades, there have been dramatic improvements in diagnosis, prevention and treatment of all these infections. As a result, in North America and Western Europe the rates of opportunistic infections secondary to AIDS have decreased substantially. We will review these common opportunistic infections below.

American Journal of Infection Control, 2006

Pseudo-outbreaks of mycobacteria are difficult to recognize because of long incubation periods fo... more Pseudo-outbreaks of mycobacteria are difficult to recognize because of long incubation periods for growth and species identification. We report our experience with one clinical microbiology laboratory that isolated a species of nontuberculous mycobacteria from 14 patient specimens. These specimens came from 12 patients at 2 hospitals over a 6-day period and included 6 different fluids or tissues. Because of the delay between mycobacterial specimen submission and growth in culture, the outbreak was not noted until more than a month later. Initial species determination by a reference laboratory indicated that these isolates were Mycobacterium fortuitum. One patient received treatment for presumed M fortuitum brain infection, and it was not effective in changing her clinical course. The isolates were sent to the Centers for Disease Control and Prevention (CDC) for identification and typing by pulsed-field gel electrophoresis. The CDC determined that the isolates were an identical strain of M terrae, thus confirming a pseudo-outbreak. Combining pseudo-outbreak isolates with those correctly identified initially as M terrae during the 6-day period in question, there were 22 samples from 20 patients with M terrae. Since the pseudo-outbreak, the number of cultures of M terrae in the clinical laboratory has returned to baseline levels without any specific intervention.