For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.

A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.

The record influx of positions was driven in part, by the increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs, said Mona Signer, NRMP president and CEO.

“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”

Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.

Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.

Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.

“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”

Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.

“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.

However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.

“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.

Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.

Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.

“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”

Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”

“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”

agallegos@mdedge.com

For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.

A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.

The record influx of positions was driven in part, by the increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs, said Mona Signer, NRMP president and CEO.

“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”

Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.

Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.

Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.

“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”

Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.

“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.

However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.

“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.

Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.

Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.

“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”

Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”

“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”

agallegos@mdedge.com

For the seventh straight year, the Main Residency Match experienced record growth, with more spots for residency programs and a higher number of slots filled than ever before.

A total of 38,376 applicants in 2019 submitted program choices for 35,185 positions, a 6% slot increase from 2018, while the number of available first-year (PGY-1) positions rose to 32,194, an increase of 6.5% (1,962) from 2018, according to data from the National Resident Matching Program (NRMP). Of the total PGY-1 positions offered, 95% were filled.

The record influx of positions was driven in part, by the increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs, said Mona Signer, NRMP president and CEO.

“Many of the programs previously accredited by the American Osteopathic Association came into our match this year because they’re now accredited by the [The Accreditation Council for Graduate Medical Education],” Ms. Signer said in an interview. “That contributed to a significant increase in physicians and a significant increase in the number of applicants.”

Family medicine residency programs offered 4,107 positions this year, up by 478 from 2018. Of the family medicine offerings, 93% positions were filled, and 39% were filled with U.S. allopathic seniors. The number of U.S. allopathic seniors matching to family medicine decreased in 2019; however, a record 986 osteopathic students matched to family medicine, accounting for 26% of all applicants who matched to the specialty.

Internal medicine programs offered 8,116 positions in 2019, 574 more than in 2018. Of internal medicine programs, 97% of the positions were filled and 42% were filled with U.S. allopathic seniors. The NRMP notes the percentage of internal medicine positions filled by U.S. allopathic seniors has declined every year since 2015.

Clifton Knight, MD, vice president for education at the American Academy of Family Physicians, said he was pleased to see that the overall number of family medicine residency matches increased this year. However, he expressed concern that the number of U.S. allopathic seniors who applied to family medicine residencies continued to go down.

“That should be a big red flag for everyone at a time [when] it’s important to grow the family medicine workforce because of the increasing needs for family physicians,” Dr. Knight said in an interview. “We need more folks to choose family medicine. We applaud those schools that are producing higher levels of family physicians, but we are concerned there are a lot of schools that the academic environment is not supportive of family medicine. We would like to see a greater emphasis on improving that academic environment to support family medicine at all medical schools.”

Davoren Chick, MD, senior vice president for medical education at the American College of Physicians, said she found the 7.5% increase in internal medicine residency program slots reassuring, and she noted that internal medicine remains the largest field in the match.

“Internal medicine clearly continues to grow because institutions and applicants believe in the value of internal medicine in terms of how it contributes to the overall health care workforce,” Dr. Chick said in an interview.

However, the ACP would like to see a greater number of internists who remain within general internal medicine at the end of their residency, Dr. Chick said. ACP data shows only 11% of third-year residents in internal medicine training programs plan a career in general internal medicine, she added, a percentage that has continued to fall over the last 20 years.

“While we are very happy to see growth and interest in very essential areas of subspecialty internal medicine [and] growing interest in hospital-based careers in internal medicine, we do feel we need to continue advocating for the practice environment needs of generalists across the primary care spectrum,” Dr. Chick said.

Twitter was abuzz with celebratory tweets and photos under the hashtag #MatchDay in the days leading up to March 15 and after official assignments were revealed.

Kyle Yasuda, MD, president for the American Academy of Pediatrics tweeted his congratulations to students matching to pediatric residency programs.

“Being a pediatrician is rewarding beyond words because we #PutKids1st,” he tweeted. “Welcome.”

Supportive tweets also were sent to those who did not match, including an uplifting tweet by Jenny Wang, a fourth-year medical student in New York who matched this year to a dermatology residency at the University of California, Davis. In her tweet, Ms. Wang wrote that in 2018, she applied but did not match, which she described as the “worst feeling in the world.”

“Take some time to heal and ignore the world,” Ms. Wang tweeted, sharing a blog she wrote about not matching. “Just know that when you’re ready, there is a path ahead, and you don’t have to walk it alone.”

agallegos@mdedge.com

The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.

Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.

Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.

Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.

Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

The pediatrics specialty filled 97.6% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 60.2% were filled by U.S. seniors, which was down from last year’s 63.1%.

Pediatrics brought 2,847 first-year positions to the 2019 Main Resident Match day, up from 2,768 in 2018. However, a slightly higher proportion (97.9%) of Match Day offerings were filled in 2018 than in 2019. Internal medicine/pediatrics offered 390 positions, more than 2018’s 382 positions. Although a slightly smaller proportion were filled in 2019 (98.2% vs. 98.7% ), a slightly larger proportion of positions in 2019 were filled by U.S. graduates (80.8% in 2019 vs. 80.1% in 2018). For all specialties, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP in its 2019 Main Resident Match report.

Overall, the 2019 Match set a new high for total positions offered at 35,135, for which there were a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.

The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”

The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.

The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.

The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.

The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”

mlesney@mdedge.com

SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.

“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.

The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”

The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.

The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.

The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.

The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”

mlesney@mdedge.com

SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.

“Alternative treatment options should generally be used for most patients,” rather than paclitaxel-coated balloons and stents for peripheral arterial disease (PAD), pending an ongoing safety review, according to the Food and Drug Administration.

The FDA conducted a preliminary analysis of long-term follow-up data (up to 5 years in some studies) of the pivotal premarket randomized trials for paclitaxel-coated products indicated for peripheral arterial disease (PAD). In a Letter to Healthcare providers issued March 15, the FDA reported that their preliminary review of these data found “a potentially concerning signal of increased long-term mortality in study subjects treated with paclitaxel-coated products, compared to patients treated with uncoated devices.”

The three trials (totaling 975 patients) that had 5-year follow-up data demonstrated an approximately 50% increased risk of mortality in subjects treated with paclitaxel-coated devices vs. those treated with control devices (20.1% vs. 13.4% crude risk of death at 5 years), according to the agency.

The FDA indicated that these data “should be interpreted with caution for several reasons.” They cited a large variability in the risk estimate of mortality because of the limited amount of long-term data and pointed out that the studies were not designed to be pooled. In addition, the specific cause and mechanism of the increased mortality was unknown.

The FDA also announced that they are planning on convening an Advisory Committee meeting of the Circulatory System Devices Panel to address this issue, including plausible mechanisms for this mortality effect, a re-examination of the benefit-risk profile, modifications of current and future clinical trials regarding these devices, and guidance to any regulatory action, as needed. The timing of this meeting is to be announced within the upcoming weeks.

The FDA letter further stated that the agency intends to conduct additional analyses “to determine whether the benefits continue to outweigh the risks for approved paclitaxel-coated balloons and paclitaxel-eluting stents when used in accordance with their indications for use.”

mlesney@mdedge.com

SOURCE: Food and Drug Administration Letter to Healthcare Providers. 2019 Mar 15.

Family medicine residency slots rose by 13% for Match Day 2019, but the number of positions filled by U.S. allopathic seniors dropped for the first time since 2009, according to the National Resident Matching Program (NRMP).

First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.

Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.
 

rfranki@mdedge.com

Family medicine residency slots rose by 13% for Match Day 2019, but the number of positions filled by U.S. allopathic seniors dropped for the first time since 2009, according to the National Resident Matching Program (NRMP).

First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.

Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.
 

rfranki@mdedge.com

Family medicine residency slots rose by 13% for Match Day 2019, but the number of positions filled by U.S. allopathic seniors dropped for the first time since 2009, according to the National Resident Matching Program (NRMP).

First-year FP slots rose from 3,629 to 4,107 as family medicine doubled the 6.5% increase in all first-year positions over 2018. The numbers of applicants (38,376) and total positions offered (35,185) were both record highs for the Match,although they were affected, in part, by “increased numbers of osteopathic programs that joined the Main Residency Match as a result of the ongoing transition to a single accreditation system for graduate medical education programs,” the NRMP noted.

Family medicine programs filled 39.0% of first-year positions with U.S. allopathic seniors, which was down from 44.9% in 2018 and 45.1% in 2017. In terms of the numbers of U.S. seniors involved, the drop was fairly small: from 1,628 in 2018 to 1,601 in 2019; however, the 986 osteopathic students and graduates who matched set a new record and accounted for almost 26% of all successful FP applicants, the NRMP reported.“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said in a written statement.
 

rfranki@mdedge.com

Dermatology had its second-largest gain in residency slots and matches since 2015 on what is now the largest Match Day on record, according to the National Resident Matching Program (NRMP).

Available dermatology PGY-2 slots rose by 4.9% from 426 in 2018 to 447 in 2019, while slots filled grew by 5.5% from 420 to 443, for an overall fill rate of 99.3%. In addition, the fill rate for U.S. graduates grew for the first time since 2015, rising from 81.7% to 82.8%.

An overall total of 2,756 PGY-2 slots were offered, 97.2% of which were filled; 67.5% were filled by U.S. graduates, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” NRMP officials said in a statement.

lfranki@mdedge.com

Dermatology had its second-largest gain in residency slots and matches since 2015 on what is now the largest Match Day on record, according to the National Resident Matching Program (NRMP).

Available dermatology PGY-2 slots rose by 4.9% from 426 in 2018 to 447 in 2019, while slots filled grew by 5.5% from 420 to 443, for an overall fill rate of 99.3%. In addition, the fill rate for U.S. graduates grew for the first time since 2015, rising from 81.7% to 82.8%.

An overall total of 2,756 PGY-2 slots were offered, 97.2% of which were filled; 67.5% were filled by U.S. graduates, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” NRMP officials said in a statement.

lfranki@mdedge.com

Dermatology had its second-largest gain in residency slots and matches since 2015 on what is now the largest Match Day on record, according to the National Resident Matching Program (NRMP).

Available dermatology PGY-2 slots rose by 4.9% from 426 in 2018 to 447 in 2019, while slots filled grew by 5.5% from 420 to 443, for an overall fill rate of 99.3%. In addition, the fill rate for U.S. graduates grew for the first time since 2015, rising from 81.7% to 82.8%.

An overall total of 2,756 PGY-2 slots were offered, 97.2% of which were filled; 67.5% were filled by U.S. graduates, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” NRMP officials said in a statement.

lfranki@mdedge.com

Ob.gyn. filled 99.8% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 75.2% were filled by U.S. seniors, which was down from last year’s 78.7%.

Ob.gyn. brought 1,395 first-year positions to the 2019 Main Resident Match, up from 1,336 in 2018. Also up from last year is the fill rate, with 2018’s Match Day filling 99.6% of available positions.

For all specialties in the main Match, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP report.

The 2019 Match also set a new high for total positions offered at 35,135, for which there was a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

Ob.gyn. filled 99.8% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 75.2% were filled by U.S. seniors, which was down from last year’s 78.7%.

Ob.gyn. brought 1,395 first-year positions to the 2019 Main Resident Match, up from 1,336 in 2018. Also up from last year is the fill rate, with 2018’s Match Day filling 99.6% of available positions.

For all specialties in the main Match, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP report.

The 2019 Match also set a new high for total positions offered at 35,135, for which there was a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

Ob.gyn. filled 99.8% of its offered positions, according to the National Resident Matching Program (NRMP). Of these, 75.2% were filled by U.S. seniors, which was down from last year’s 78.7%.

Ob.gyn. brought 1,395 first-year positions to the 2019 Main Resident Match, up from 1,336 in 2018. Also up from last year is the fill rate, with 2018’s Match Day filling 99.6% of available positions.

For all specialties in the main Match, U.S. first-year applicants filled 55.2%, and the overall fill rate was 94.9% of the 32,194 available positions, an increase of 6.5% over the number of positions available in 2018, according to the NRMP report.

The 2019 Match also set a new high for total positions offered at 35,135, for which there was a record-high 38,376 applicants. The increases are likely related, in part, to the greater number of osteopathic programs joining the Match Day offerings because of an ongoing move toward a single accreditation system.

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

cpalmer@mdedge.com

Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.