Assessing Timely Presentation to Care Among People Diagnosed with HIV During Hospital Admission: A Population-Based Study in Ontario, Canada

Profile and outcome of multiple myeloma with and without HIV treated at a tertiary hospital in KwaZulu-Natal, South Africa

OBJECTIVES

To profile the outcome of multiple myeloma (MM) patients treated at a South African tertiary hospital in KwaZulu-Natal (KZN) and to compare MM in HIV-negative patients and MM in people living with HIV (PLWH).

METHODS

A retrospective analysis of patients with MM was conducted over 5 years (2015-2020). Patient demographics, presenting complaints, symptom duration, disease stage, molecular profile, treatment, and survival data were captured. Statistical analysis was conducted using R Statistical software of the R Core Team, 2020, version 3.6.3.

RESULTS

135 patients; 79% (n = 106) HIV-negative and 21% (n = 29) PLWH were investigated. 54% (n = 74) females and 57% (n = 76) 51-70-year-olds. The 40-50-year-old patient group had a significantly higher proportion of PLWH (p = 0.032). Pathological fractures were the commonest presenting complaint, 47% (n = 57 and 49% (n = 49) had International Staging System, stage III disease. Fluorescent in-situ hybridization (FISH) MM profiling was completed in 58% (n = 78). Positivity for del 11q22 was found in 23.7% (n = 14) with significantly more HIV-negative patients having the mutation (p = 0.027). Overall, 42.2% (n = 57) achieved 2-year overall survival (OS). There were no significant differences in treatment (p = 0.926) and 2-year survival outcome (p = 0.792) between the two groups.

CONCLUSION

The incidence of HIV in newly diagnosed MM patients in KZN was increasing. KZN patient profile differed from other reports by showing female predominance but was similar in advanced-stage presentation and bone fracture predominance. Statistically significant differences between the HIV-negative patients and PLWH were observed in age distribution and mutational landscape. Further studies are required in this area.

The associations of population mobility in HIV disease severity and mortality rate in China

Background

Human immunodeficiency virus (HIV) infection has become a chronic disease and attracted public attention globally. Population migration was considered hindering the control and management of HIV infection, but limited studies have explored how population mobility could influence the development of HIV-related complications and overall prognosis.

Methods

We enrolled hospitalized HIV patients in this cross-sectional study between January 1, 2006, and December 31, 2016. We extracted demographic, hospitalization, and patient diagnosis data. Patients were divided into three groups according to the population type: (I) resident of Guangzhou City (local resident); (II) migrant outside of Guangzhou City but within Guangdong Province (migrant within the province); and (III) migrant outside of Guangdong Province (migrant outside the province). To represent the prognosis of HIV, in-hospital death was defined as the worst outcome, whereas vision-related events were considered moderate-to-severe complications. Logistic regression models were used to analyze factors influencing the prognosis of HIV.

Results

Eight thousand and six hundred thirty-one inpatients (14,954 cases) were enrolled. The overall mortality was 7.9%, decreasing from 21.5% in 2006 to 3.8% in 2016. The prevalence of vision-related events was 14.4% between 2015 and 2016. Compared to local patients, migrant patients (within and outside the province) were younger, had significantly less access to health insurance, fewer hospitalization admissions, longer hospital stays, and a higher proportion of physical work (P<0.01). Furthermore, they had a higher prevalence of vision-related events (16.2% and 17.4% in migrant patients within the province and outside the province, respectively vs. 9.5%) and infectious diseases, but lower in-hospital mortality (5.9% and 7.0% vs. 12.3%) than local patients. Migrants correlated negatively with in-hospital death [odds ratio (OR) 95% CI, 0.37 (0.29–0.48) and 0.52 (0.40–0.68)] but correlated positively with vision-related events [OR (95% CI), 2.08 (1.54–2.80) and 2.03 (1.47–2.80)].

Conclusions

Migrant patients have significantly poorer access to health insurance, with an increased risk of developing moderate-to-severe HIV infection but a decreased risk of in-hospital death, indicating a trend toward withdrawing treatment in migrant patients when they have advanced diseases. Managements such as optimizing access to health insurance and improving follow-up visits for HIV infection should be considered in the context of the population mobility of HIV patients.

Antiretroviral Prescription Pick-up and Physician Follow-up After Hospital Discharge Among Medically Complex People With HIV

In this study, only 22 of 206 (10.7%) socially marginalized individuals living with HIV and multiple comorbid conditions filled a prescription for antiretroviral therapy within 7 days of discharge from an HIV specialty hospital, despite comprehensive discharge planning. Additional interventions facilitating postdischarge continuity of care are required for this population.