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Annals of Internal Medicine Tip Sheet
November 15, 2016


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. Testing for HPV types 16 and 18 in women with high risk HPV may better inform referral to colposcopy

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2735

Testing for HPV types 16 and 18 in women with minor cervical lesions may be useful as a second triage after high-risk HPV testing to determine which patients should go on to colposcopy. The results of a systematic review and meta-analysis are published in Annals of Internal Medicine.

Women with minor cervical abnormalities, including atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL), have a modestly increased risk for cervical cancer. Testing for high-risk HPV can be used to triage these women, but most will test positive and referring them all to colposcopy carries a considerable burden and cost. Because HPV types 16 and 18 cause about 70 percent of cervical cancer cases, genotyping for these types of HPV could allow for more precise patient management.

Researchers reviewed 24 moderate- to good-quality published studies involving almost 14,000 women with minor cervical lesions to evaluate the accuracy of genotyping for HPV types 16 and 18 and to determine its utility as a second triage step after high-risk HPV testing. The data suggests that genotyping for HPV 16 and 18 was more efficient compared with high-risk HPV testing, but at the expense of a loss in sensitivity. Since women testing positive for HPV 16 and 18 are at high risk for cervical cancer, they should be referred to colposcopy. The authors suggest that women carrying other high-risk HPV types are at borderline risk and may be referred to colposcopy or retesting, depending on local decision thresholds.

2. Arthritis drug shown to reverse hair loss from alopecia universalis

Abstract: http://annals.org/aim/article/doi/10.7326/L16-0125

Tofacitinib, a drug approved to treat moderate to severe rheumatoid arthritis, reversed hair loss for a man and a woman both suffering from alopecia universalis for 10 years. The case report is published in Annals of Internal Medicine.

Alopecia universalies involves complete hair loss in all parts of the body. The cause of alopecia universalis is uncertain, but many investigators believe it to be an autoimmune disease with the patient’s immune system directed against the hair follicles. No treatment is effective, although several have been proposed.

A 38-year-old man and a 20-year-old woman for whom initial treatment failed were treated with tofacitinib, 5 mg orally twice daily. Hair partially grew on the scalp, eyebrows, and axillae after 2 months of therapy. No adverse events were observed after 9 months, although long-term therapy with tofacitinib can cause serious adverse events. The researchers believe that these cases should prompt a clinical trial to determine whether tofacitinib is a reasonable treatment for alopecia universalis despite its risk for adverse effects because successful treatment can improve patients’ lives dramatically.

3. Care in a patient-centered medical home leads to better medication adherence

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2659
Editorial: http://annals.org/aim/article/doi/10.7326/M16-2397

Patients initiating treatment for common chronic diseases have better medication adherence when they receive their care in a patient-centered medical home. This is important because medication adherence is a vital measure of health care quality for chronic diseases. The findings are published in Annals of Internal Medicine.

A patient-centered medical home is a care delivery model where patient treatment is coordinated through their primary care physician so that patients get the care they need, when they need it, and in a manner they can understand. While adoption of this care model has been widespread, it has only been evaluated on a few health care quality measures. Researchers sought to determine whether use of a patient-centered medical homes influenced patients’ adherence to medications initiated for the treatment of hypertension, diabetes, and high cholesterol in a large nationwide sample of providers and practices. The researchers estimated that patients using medical homes that met National Committee for Quality Assurance (NCQA) criteria had levels of adherence that were about 2 to 3 percent higher than among patients receiving care at other practices. The authors point out that meeting these criteria requires substantial time and effort for a practice. They suggest that these findings have significant implications for providers, health plans, and policymakers who are considering the best potential practices for patients because adherence is an important quality measure.

4. Patients with HIV now live about as long as their uninfected peers

Abstract: http://annals.org/aim/article/doi/10.7326/L16-0091

Patients receiving optimal care for HIV infection can expect to live about as long as those who are uninfected, according to an updated analysis being published in Annals of Internal Medicine.

In 2007, survival estimates for persons receiving HIV care in the Danish HIV Cohort Study were encouraging, but fell short of the general population. At the time, a 25-year-old person with HIV infection not co-infected with hepatitis C virus would be expected to live about 63.9 years, which was still about 12.2 years short of that observed in a sex- and age-matched sample of persons from the general population. Using the same methods used in the previous study, the researchers estimated median survival for persons aged 25 years in 5 time periods from 1995 to 2015. They found that persons with HIV not co-infected with hepatitis C virus could expect to live about to about 73.9 years, compared with about 80.0 years for persons from the general population. The authors attribute survival to receipt of optimal care. However, some persons with HIV infection globally lack access to care and treatment and many others are not reaping the possible benefits even when they do have access. The authors say that these issues should be addressed.

Also new in this issue:

Treatment With Ledipasvir–Sofosbuvir for 12 or 24 Weeks in Kidney Transplant Recipients With Chronic Hepatitis C Virus Genotype 1 or 4 Infection: A Randomized Trial

Massimo Colombo, MD; Alessio Aghemo, MD; Hong Liu, PhD; Jie Zhang, PhD; Hadas Dvory-Sobol, PhD; Robert Hyland, DPhil; Chohee Yun, MD; Benedetta Massetto, MD; Diana M. Brainard, MD; John G. McHutchison, MD; Marc Bourlie` re, MD; Markus Peck-Radosavljevic, MD; Michael Manns, MD; and Stanislas Pol, MD
Original Research
Abstract: http://annals.org/aim/article/doi/10.7326/M16-1205

In the hot seat: what is this rash after low molecular weight heparin?

Annals Consult Guys
Video: http://annals.org/aim/article/doi/10.7326/W16-0011

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