Bio

Clinical Focus


  • Infectious Disease
  • HIV

Administrative Appointments


  • Senior Fellow, Stanford Center for Inovation in Global Health (CIGH) (2015 - Present)

Professional Education


  • HIV Specialist, AAHIVS, American Academy of HIV Medicine, HIV (2016)
  • Board Certification: Infectious Disease, American Board of Internal Medicine (2014)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2011)
  • Fellowship:Stanford University (2015) CA
  • Residency:New York - Presbyterial Hospital / Weill Cornell Medical College (2011) NY
  • Medical Education:Weill Cornell Medical College (2008) NY
  • Masters of Science, Stanford University, Epidemiology and clinical research (2015)

Community and International Work


  • Simplifying Hepatitis C Antiviral therapy in Rwanda for Elsewhere in the Developing world (SHARED), Rwanda

    Topic

    Hepatitis C clinical research

    Partnering Organization(s)

    Partners in Health, Rwanda Biomedical Center, Rwanda Military Hospital

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Switch From Nevirapine-based Regimen to Once a Day Rilpivirine/Emtricitabine/Tenofovir, Kigali, Rwanda

    Topic

    HIV Clinical Research

    Partnering Organization(s)

    Rwanda Biomedical Center, Rwanda Military Hospital

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Clinical Trials


  • Switch From Nevirapine-based Regimen to Once a Day Rilpivirine/Emtricitabine/Tenofovir Not Recruiting

    The study will be an open-label, pilot study in virologically suppressed patients comparing the efficacy, safety and tolerability of two Antiretroviral regimen strategies: Arm A: "Immediate switch" Rilpivirine/Emtricitabine/Tenofovir (single tablet formulation (STF))at randomization Arm B: "Delayed switch" Continue Nevirapine/Lamivudine/other Nucleoside reverse transcriptase inhibitor (NRTI)through 24 weeks then switch to STF of Rilpivirine/emtrictabine/tenofovir and followed through 48 weeks.

    Stanford is currently not accepting patients for this trial.

    View full details

Publications

All Publications


  • Switching to coformulated rilpivirine (RPV), emtricitabine (FTC) and tenofovir alafenamide from either RPV, FTC and tenofovir disoproxil fumarate (TDF) or efavirenz, FTC and TDF: 96-week results from two randomized clinical trials HIV MEDICINE Hagins, D., Orkin, C., Daar, E. S., Mills, A., Brinson, C., DeJesus, E., Post, F. A., Morales-Ramirez, J., Thompson, M., Osiyemi, O., Rashbaum, B., Stellbrink, H., Martorell, C., Liu, H., Liu, Y., Porter, D., Collins, S. E., SenGupta, D., Das, M. 2018; 19 (10): 724?33

    Abstract

    The single-tablet regimen rilpivirine, emtricitabine and tenofovir alafenamide (RPV/FTC/TAF) for treatment of HIV-1-infected adults was approved based on bioequivalence. We assessed the clinical efficacy, safety and tolerability of switching to RPV/FTC/TAF from either RPV/FTC/tenofovir disoproxil fumarate (TDF) or efavirenz (EFV)/FTC/TDF.We conducted two distinct randomized, double-blind, active-controlled, noninferiority trials in participants taking RPV/FTC/TDF (Study 1216) and EFV/FTC/TDF (Study 1160). Each study randomized virologically suppressed (HIV-1 RNA < 50 copies/mL) adults (1:1) to switch to RPV/FTC/TAF or continue their current regimen for 96 weeks. We evaluated efficacy as the proportion with HIV-1 RNA < 50 copies/mL using the Food and Drug Administration snapshot algorithm and prespecified bone and renal endpoints at week 96.We randomized and treated 630 participants in Study 1216 (RPV/FTC/TAF, n = 316; RPV/FTC/TDF, n = 314) and 875 in Study 1160 (RPV/FTC/TAF, n = 438; EFV/FTC/TDF, n = 437). In both studies, the efficacy of switching to RPV/FTC/TAF was noninferior to that of continuing baseline therapy at week 96, with respective percentages of patients with HIV RNA < 50 copies/mL being 89.2% versus 88.5% in Study 1216 [difference 0.7%; 95% confidence interval (CI) -4.3 to +5.8%] and 85.2% versus 85.1% in Study 1160 (difference 0%; 95% CI -4.8 to +4.8%). No participant on RPV/FTC/TAF developed treatment-emergent resistance versus two on EFV/FTC/TDF and one on RPV/FTC/TDF. Compared with continuing baseline therapy, significant improvements in bone mineral density and renal tubular markers were observed in the RPV/FTC/TAF groups (P < 0.001).Switching to RPV/FTC/TAF from RPV/FTC/TDF or EFV/FTC/TDF was safe and effective and improved bone mineral density and renal biomarkers up to 96 weeks with no cases of treatment-emergent resistance.

    View details for PubMedID 30101539

  • Coformulated bictegravir, emtricitabine, tenofovir alafenamide after initial treatment with bictegravir or dolutegravir and emtricitabine/tenofovir alafenamide AIDS Sax, P. E., DeJesus, E., Crofoot, G., Ward, D., Benson, P., Dretler, R., Mills, A., Brinson, C., Wei, X., Collins, S. E., Cheng, A. 2018; 32 (12): 1723?25

    Abstract

    : A phase 2, randomized, active-controlled study of initial antiretroviral therapy with bictegravir or dolutegravir in combination with emtricitabine and tenofovir alafenamide showed excellent efficacy. After 60 weeks of blinded treatment, participants switched to a single-tablet regimen of bictegravir, emtricitabine, and tenofovir alafenamide. Switching maintained viral suppression in all participants who remained on the study through 12 weeks in the open-label phase, and was safe and well tolerated.

    View details for PubMedID 29794828

  • Mass Spectrometric Identification of Urinary Biomarkers of Pulmonary Tuberculosis EBIOMEDICINE Isa, F., Collins, S., Lee, M., Decome, D., Dorvil, N., Joseph, P., Smith, L., Salerno, S., Wells, M. T., Fischer, S., Bean, J. M., Pape, J. W., Johnson, W. D., Fitzgerald, D. W., Rhee, K. Y. 2018; 31: 157?65

    Abstract

    Tuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics.We conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded "validation" cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry.We discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60?days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease.Urinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB.This study was funded by Weill Cornell Medicine, the National Institute of Allergy and Infectious Diseases, the Clinical and Translational Science Center at Weill Cornell, the NIH Fogarty International Center grants, and the NIH Tuberculosis Research Unit (Tri-I TBRU).

    View details for DOI 10.1016/j.ebiom.2018.04.014

    View details for Web of Science ID 000433078300022

    View details for PubMedID 29752217

  • A Randomized Switch From Nevirapine-Based Antiretroviral Therapy to Single Tablet Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate in Virologically Suppressed Human Immunodeficiency Virus-1-Infected Rwandans. Open forum infectious diseases Collins, S. E., Grant, P. M., Uwinkindi, F., Talbot, A., Seruyange, E., Slamowitz, D., Mugeni, A., Remera, E., Niyonsenga, S. P., Nyirimigabo, J., Uwizihiwe, J. P., Dongier, P., Muhayimpundu, R., Mazarati, J., Zolopa, A., Nsanzimana, S. 2016; 3 (3): ofw141-?

    Abstract

    Background. ?Many human immunodeficiency virus (HIV)-infected patients remain on nevirapine-based antiretroviral therapy (ART) despite safety and efficacy concerns. Switching to a rilpivirine-based regimen is an alternative, but there is little experience with rilpivirine in sub-Saharan Africa where induction of rilpivirine metabolism by nevirapine, HIV subtype, and dietary differences could potentially impact efficacy. Methods. ?We conducted an open-label noninferiority study of virologically suppressed (HIV-1 ribonucleic acid [RNA] < 50 copies/mL) HIV-1-infected Rwandan adults taking nevirapine plus 2 nucleos(t)ide reverse-transcriptase inhibitors. One hundred fifty participants were randomized 2:1 to switch to coformulated rilpivirine-emtricitabine-tenofovir disoproxil fumarate (referenced as the Switch Arm) or continue current therapy. The primary efficacy endpoint was HIV-1 RNA < 200 copies/mL at week 24 assessed by the US Food and Drug Administration Snapshot algorithm with a noninferiority margin of 12%. Results. ?Between April and September 2014, 184 patients were screened, and 150 patients were enrolled; 99 patients switched to rilpivirine-emtricitabine-tenofovir, and 51 patients continued their nevirapine-based ART. The mean age was 42 years and 43% of participants were women. At week 24, virologic suppression (HIV-1 RNA level <200 copies/mL) was maintained in 93% and 92% in the Switch Arm versus the continuation arm, respectively. The Switch Arm was noninferior to continued nevirapine-based ART (efficacy difference 0.8%; 95% confidence interval, -7.5% to +12.0%). Both regimens were generally safe and well tolerated, although 2 deaths, neither attributed to study medications, occurred in participants in the Switch Arm. Conclusions. ?A switch from nevirapine-based ART to rilpivirine-emtricitabine-tenofovir disoproxil fumarate had similar virologic efficacy to continued nevirapine-based ART after 24 weeks with few adverse events.

    View details for PubMedID 27704000

  • Modifying Antiretroviral Therapy in Virologically Suppressed HIV-1-Infected Patients DRUGS Collins, S. E., Grant, P. M., Shafer, R. W. 2016; 76 (1): 75-98

    Abstract

    HIV-1-infected patients with suppressed plasma viral loads often require changes to their antiretroviral (ARV) therapy to manage drug toxicity and intolerance, to improve adherence, and to avoid drug interactions. In patients who have never experienced virologic failure while receiving ARV therapy and who have no evidence of drug resistance, switching to any of the acceptable US Department of Health and Human Services first-line therapies is expected to maintain virologic suppression. However, in virologically suppressed patients with a history of virologic failure or drug resistance, it can be more challenging to change therapy while still maintaining virologic suppression. In these patients, it may be difficult to know whether the discontinuation of one of the ARVs in a suppressive regimen constitutes the removal of a key regimen component that will not be adequately supplanted by one or more substituted ARVs. In this article, we review many of the clinical scenarios requiring ARV therapy modification in patients with stable virologic suppression and outline the strategies for modifying therapy while maintaining long-term virologic suppression.

    View details for DOI 10.1007/s40265-015-0515-6

    View details for Web of Science ID 000367608600005

    View details for PubMedCentralID PMC4700066

  • Modifying Antiretroviral Therapy in Virologically Suppressed HIV-1-Infected Patients. Drugs Collins, S. E., Grant, P. M., Shafer, R. W. 2016; 76 (1): 75?98

    Abstract

    HIV-1-infected patients with suppressed plasma viral loads often require changes to their antiretroviral (ARV) therapy to manage drug toxicity and intolerance, to improve adherence, and to avoid drug interactions. In patients who have never experienced virologic failure while receiving ARV therapy and who have no evidence of drug resistance, switching to any of the acceptable US Department of Health and Human Services first-line therapies is expected to maintain virologic suppression. However, in virologically suppressed patients with a history of virologic failure or drug resistance, it can be more challenging to change therapy while still maintaining virologic suppression. In these patients, it may be difficult to know whether the discontinuation of one of the ARVs in a suppressive regimen constitutes the removal of a key regimen component that will not be adequately supplanted by one or more substituted ARVs. In this article, we review many of the clinical scenarios requiring ARV therapy modification in patients with stable virologic suppression and outline the strategies for modifying therapy while maintaining long-term virologic suppression.

    View details for PubMedID 26677129

  • Tuberculosis in the aftermath of the 2010 earthquake in Haiti BULLETIN OF THE WORLD HEALTH ORGANIZATION Koenig, S. P., Rouzier, V., Vilbrun, S. C., Morose, W., Collins, S. E., Joseph, P., Decome, D., Ocheretina, O., Galbaud, S., Hashiguchi, L., Pierrot, J., Pape, J. W. 2015; 93 (7): 498-502

    Abstract

    In 2010, Haiti sustained a devastating earthquake that crippled the health-care infrastructure in the capital city, Port-au-Prince, and left 1.5 million people homeless. Subsequently, there was an increase in reported tuberculosis in the affected population.We conducted active tuberculosis case finding in a camp for internally displaced persons and a nearby slum. Community health workers screened for tuberculosis at the household level. People with persistent cough were referred to a physician. The National Tuberculosis Program continued its national tuberculosis reporting system.Even before the earthquake, Haiti had the highest tuberculosis incidence in the Americas. About half of the tuberculosis cases occur in the Port-au-Prince region.The number of reported tuberculosis cases in Haiti has increased after the earthquake, but data are too limited to determine if this is due to an increase in tuberculosis burden or to improved case detection. Compared to previous national estimates (230 per 100,000 population), undiagnosed tuberculosis was threefold higher in a camp for internally displaced persons (693 per 100,000) and fivefold higher in an urban slum (1165 per 100,000). With funding from the World Health Organization (WHO), active case finding is now being done systematically in slums and camps.Household-level screening for prolonged cough was effective in identifying patients with active tuberculosis in this study. Without accurate data, early detection of rising tuberculosis rates is challenging; data collection should be incorporated into pragmatic disease response programmes.

    View details for DOI 10.2471/BLT.14.145649

    View details for Web of Science ID 000358888100017

    View details for PubMedID 26170508

    View details for PubMedCentralID PMC4490810

  • CD4 deficit and tuberculosis risk persist with delayed antiretroviral therapy: 5-year data from CIPRA HT-001. international journal of tuberculosis and lung disease Collins, S. E., Jean Juste, M. A., Koenig, S. P., Secours, R., Ocheretina, O., Bernard, D., Riviere, C., Calnan, M., Dunning, A., Hurtado Rúa, S. M., Johnson, W. D., Pape, J. W., Fitzgerald, D. W., Severe, P. 2015; 19 (1): 50-57

    Abstract

    Port-au-Prince, Haiti.To determine long-term effects of early vs. delayed initiation of antiretroviral therapy (ART) on immune recovery and tuberculosis (TB) risk in human immunodeficiency virus (HIV) infected individuals.Open-label randomized controlled trial of immediate ART in HIV-infected adults with CD4 counts between 200 and 350 cells/mm(3) vs. deferring ART until the CD4 count was <200 cells/mm(3). The primary comparisons were CD4 counts over time and risk for incident TB, with 5 years of follow-up.A total of 816 participants were enrolled, with 408 in each treatment arm. The early treatment group started ART within 2 weeks, while the deferred treatment group started ART a median of 1.3 years after enrollment. After 5 years, the mean CD4 count in the early treatment group was significantly higher than in the deferred treatment group (496 cells/mm(3), 95% confidence interval [CI] 477-515 vs. 373 cells/mm(3), 95%CI 357-389; P < 0.0001). TB risk was higher in the deferred treatment group (unadjusted HR 2.41, 95%CI 1.56-3.74; P < 0.0001) and strongly correlated with lower CD4 counts in time-dependent multivariate analysis.Delays in ART initiation for HIV-infected adults with CD4 counts of 200-350 cells/mm(3) can result in long-term immune dysfunction and persistent increased risk for TB.

    View details for DOI 10.5588/ijtld.14.0217

    View details for PubMedID 25519790

  • Whole Genome Sequencing Investigation of a Tuberculosis Outbreak in Port-au-Prince, Haiti Caused by a Strain with a "Low-Level" rpoB Mutation L511P - Insights into a Mechanism of Resistance Escalation. PloS one Ocheretina, O., Shen, L., Escuyer, V. E., Mabou, M., Royal-Mardi, G., Collins, S. E., Pape, J. W., Fitzgerald, D. W. 2015; 10 (6)

    Abstract

    The World Health Organization recommends diagnosing Multidrug-Resistant Tuberculosis (MDR-TB) in high burden countries by detection of mutations in Rifampin (RIF) Resistance Determining Region of Mycobacterium tuberculosis rpoB gene with rapid molecular tests GeneXpert MTB/RIF and Hain MTBDRplus. Such mutations are found in >95% of Mycobacterium tuberculosis strains resistant to RIF by conventional culture-based drug susceptibility testing (DST). However routine diagnostic screening with molecular tests uncovered specific "low level" rpoB mutations conferring resistance to RIF below the critical concentration of 1 ?g/ml in some phenotypically susceptible strains. Cases with discrepant phenotypic (susceptible) and genotypic (resistant) results for resistance to RIF account for at least 10% of resistant diagnoses by molecular tests and urgently require new guidelines to inform therapeutic decision making. Eight strains with a "low level" rpoB mutation L511P were isolated by GHESKIO laboratory between 2008 and 2012 from 6 HIV-negative and 2 HIV-positive patients during routine molecular testing. Five isolates with a single L511P mutation and two isolates with double mutation L511P&M515T had MICs for RIF between 0.125 and 0.5 ?g/ml and tested susceptible in culture-based DST. The eighth isolate carried a double mutation L511P&D516C and was phenotypically resistant to RIF. All eight strains shared the same spoligotype SIT 53 commonly found in Haiti but classic epidemiological investigation failed to uncover direct contacts between the patients. Whole Genome Sequencing (WGS) revealed that L511P cluster isolates resulted from a clonal expansion of an ancestral strain resistant to Isoniazid and to a very low level of RIF. Under the selective pressure of RIF-based therapy the strain acquired mutation in the M306 codon of embB followed by secondary mutations in rpoB and escalation of resistance level. This scenario highlights the importance of subcritical resistance to RIF for both clinical management of patients and public health and provides support for introducing rpoB mutations as proxy for MICs into laboratory diagnosis of RIF resistance. This study illustrates that WGS is a promising multi-purpose genotyping tool for high-burden settings as it provides both "gold standard" sequencing results for prediction of drug susceptibility and a high-resolution data for epidemiological investigation in a single assay.

    View details for DOI 10.1371/journal.pone.0129207

    View details for PubMedID 26039194

  • Gender inequality and HIV transmission: a global analysis JOURNAL OF THE INTERNATIONAL AIDS SOCIETY Richardson, E. T., Collins, S. E., Kung, T., Jones, J. H., Tram, K. H., Boggiano, V. L., Bekker, L., Zolopa, A. R. 2014; 17
  • Correlation between Genotypic and Phenotypic Testing for Resistance to Rifampin in Mycobacterium tuberculosis Clinical Isolates in Haiti: Investigation of Cases with Discrepant Susceptibility Results PLOS ONE Ocheretina, O., Escuyer, V. E., Mabou, M., Royal-Mardi, G., Collins, S., Vilbrun, S. C., Pape, J. W., Fitzgerald, D. W. 2014; 9 (3)

    Abstract

    The World Health Organization has recommended use of molecular-based tests MTBDRplus and GeneXpert MTB/RIF to diagnose multidrug-resistant tuberculosis in developing and high-burden countries. Both tests are based on detection of mutations in the Rifampin (RIF) Resistance-Determining Region of DNA-dependent RNA Polymerase gene (rpoB). Such mutations are found in 95-98% of Mycobacterium tuberculosis strains determined to be RIF-resistant by the "gold standard" culture-based drug susceptibility testing (DST). We report the phenotypic and genotypic characterization of 153 consecutive clinical Mycobacterium tuberculosis strains diagnosed as RIF-resistant by molecular tests in our laboratory in Port-au-Prince, Haiti. 133 isolates (86.9%) were resistant to both RIF and Isoniazid and 4 isolates (2.6%) were RIF mono-resistant in MGIT SIRE liquid culture-based DST. However the remaining 16 isolates (10.5%) tested RIF-sensitive by the assay. Five strains with discordant genotypic and phenotypic susceptibility results had RIF minimal inhibitory concentration (MIC) close to the cut-off value of 1 µg/ml used in phenotypic susceptibility assays and were confirmed as resistant by DST on solid media. Nine strains had sub-critical RIF MICs ranging from 0.063 to 0.5 µg/ml. Finally two strains were pan-susceptible and harbored a silent rpoB mutation. Our data indicate that not only detection of the presence but also identification of the nature of rpoB mutation is needed to accurately diagnose resistance to RIF in Mycobacterium tuberculosis. Observed clinical significance of low-level resistance to RIF supports the re-evaluation of the present critical concentration of the drug used in culture-based DST assays.

    View details for DOI 10.1371/journal.pone.0090569

    View details for Web of Science ID 000332479400094

    View details for PubMedID 24599230

  • Integrating integrase inhibitors into an antiretroviral regimen CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES Collins, S. E., Grant, P. M., Richardson, E. T., Zolopa, A. R. 2014; 6 (2)
  • Outcomes of HIV-infected patients treated for recurrent tuberculosis with the standard retreatment regimen INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE McGreevy, J., Juste, M. A., Severe, P., Collins, S., Koenig, S., Pape, J. W., Fitzgerald, D. W. 2012; 16 (6): 841-845

    Abstract

    The Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (the GHESKIO AIDS and TB Center) in Port-au-Prince, Haiti.To measure the effectiveness of the standard TB retreatment regimen (2HRZES/1HRZE/5HRE) in human immunodeficiency virus (HIV) infected adults.Cohort study.Of 1318 HIV-infected patients with access to antiretroviral therapy following World Health Organization guidelines, 56 were diagnosed with recurrent pulmonary TB and retreated with the standard retreatment regimen: 10 patients (18%) died during retreatment, 3 (5%) defaulted, and 2 (4%) failed treatment. Forty-one patients (73%) achieved retreatment 'success' (cure, treatment completed). Of these, 8 (20%) died during follow-up, 5 (12%) were lost, and 5 (12%) had a second recurrence of TB. Only 26 (46%) of the 56 patients remained alive, in care, and TB-free after a median of 36 months of follow-up.HIV-infected patients treated for recurrent TB with the standard retreatment regimen have high mortality and poor long-term outcomes.

    View details for DOI 10.5588/ijtld.11.0210

    View details for Web of Science ID 000304580400024

    View details for PubMedID 22507948

  • High Mortality among Patients with AIDS Who Received a Diagnosis of Tuberculosis in the First 3 Months of Antiretroviral Therapy CLINICAL INFECTIOUS DISEASES Koenig, S. P., Riviere, C., Leger, P., Joseph, P., Severe, P., Parker, K., Collins, S., Lee, E., Pape, J. W., Fitzgerald, D. W. 2009; 48 (6): 829-831

    Abstract

    We analyzed mortality among 201 patients with AIDS and tuberculosis in Haiti. Patients who received a diagnosis of tuberculosis during the first 3 months after the initiation of antiretroviral therapy were 3.25 times more likely to die than were other patients with AIDS and tuberculosis. Failure to recognize active tuberculosis at initiation of antiretroviral therapy leads to increased mortality.

    View details for DOI 10.1086/597098

    View details for Web of Science ID 000263949000022

    View details for PubMedID 19207078

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