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Vyas N, Dornseifer M, Nair M. Mucinous Adenocarcinoma of the Appendix: The Challenges of Managing a Complex Surgical Case. Cureus 2021; 13:e20157. [PMID: 34900502 PMCID: PMC8648134 DOI: 10.7759/cureus.20157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2021] [Indexed: 11/29/2022] Open
Abstract
Mucinous adenocarcinomas of the appendix are rare and often present as a suspected appendicitis. Diagnostic work-up encompasses colonoscopy, tissue biopsy, CT scan, and a multidisciplinary team input. Management involves surgery, hyperthermic intraperitoneal chemotherapy, and adjuvant chemotherapy. Our patient was known to be human immunodeficiency virus (HIV) positive; therefore, careful consideration had to be taken in starting adjuvant chemotherapy as there were concerns of drug interactions and further immunosuppression. Despite all these challenges the patient has had an excellent outcome with no evidence of recurrence or distant disease.
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Affiliation(s)
- Nirav Vyas
- General Surgery, North Middlesex University Hospital, London, GBR
| | - Mamun Dornseifer
- General Surgery, North Middlesex University Hospital, London, GBR
| | - Manoj Nair
- General Surgery, North Middlesex University Hospital, London, GBR
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Carrieri MP, Protopopescu C, Raffi F, March L, Reboud P, Spire B, Leport C. Low alcohol consumption as a predictor of higher CD4+ cell count in HIV-treated patients: a french paradox or a proxy of healthy behaviors? The ANRS APROCO-COPILOTE CO-08 cohort. J Acquir Immune Defic Syndr 2014; 65:e148-50. [PMID: 24346641 DOI: 10.1097/qai.0000000000000087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Maria Patrizia Carrieri
- *INSERM, UMR912 (SESSTIM), Marseille, France †Aix Marseille Université, UMR_S912, IRD, Marseille, France ‡ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France §CHU Hôtel-Dieu, Nantes, France ‖INSERM, U897, Université Bordeaux Segalen, ISPED, Bordeaux, France ¶Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France #INSERM, UMR 738, Paris, France
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Des Jarlais DC, McCarty D, Vega WA, Bramson H. HIV infection among people who inject drugs: the challenge of racial/ethnic disparities. AMERICAN PSYCHOLOGIST 2013; 68:274-85. [PMID: 23688094 PMCID: PMC3710402 DOI: 10.1037/a0032745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Racial/ethnic disparities in HIV infection, with minority groups typically having higher rates of infection, are a formidable public health challenge. In the United States, among both men and women who inject drugs, HIV infection rates are elevated among Hispanics and non-Hispanic Blacks. A meta-analysis of international research concluded that among persons who inject drugs, racial and ethnic minorities were twice as likely to acquire an HIV infection, though there was great variation across the individual studies. To examine strategies to reduce racial/ethnic disparities among persons who inject drugs, we reviewed studies on injection drug use and its role in HIV transmission. We identified four sets of evidence-based interventions that may reduce racial/ethnic disparities among persons who inject drugs: HIV counseling and testing, risk reduction services, access to antiretroviral therapy, and drug abuse treatment. Implementation of these services, however, is insufficient in many countries, including the United States. Persons who inject drugs appear to be changing drug use norms and rituals to reduce their risks. The challenges are to (a) develop a validated model of how racial/ethnic disparities in HIV infection arise, persist, and are reduced or eliminated over time and (b) implement evidence-based services on a sufficient scale to eliminate HIV transmission among all persons who inject drugs.
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Affiliation(s)
- Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10038, USA.
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Social and structural factors associated with HIV disease progression among illicit drug users: a systematic review. AIDS 2012; 26:1049-63. [PMID: 22333747 DOI: 10.1097/qad.0b013e32835221cc] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically review factors associated with HIV disease progression among illicit drug users, focusing on exposures exogenous to individuals that likely shape access and adherence to HIV treatment. DESIGN A systematic review of peer-reviewed English-language studies among HIV-seropositive illicit drug users with at least one of these endpoint of interest: a diagnosis of AIDS; death; changes/differences in CD4 cell counts; or changes/differences in plasma HIV-1 RNA levels. METHODS Articles were included if they reported factors associated with an outcome of interest among a group of illicit drug users. Studies were identified, screened and selected using systematic methods. RESULTS Of 2668 studies matching the search criteria, 58 (2%) met the inclusion criteria, all but one from North America or western Europe. Overall, 41 (71%) studies contained significant individual-level clinical characteristics or behaviors (e.g. illicit drug use) associated with disease progression. Fifteen studies (26%) identified significant social, physical, economic or policy-level exposures, including incarceration, housing status or lack of legal income. CONCLUSION Although past studies demonstrate important environmental exposures that appear to shape access to care and subsequent disease progression, the limited literature to examine these factors demonstrates the need for future research to consider risk environment characteristics and the role they may play in shaping health outcomes from HIV infection among drug users through determining access and adherence to evidence-based care.
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Carrieri MP, Protopopescu C, Le Moing V, Reboud P, Raffi F, Mahy S, Roux P, Cuzin L, Spire B, Leport C. Impact of immunodepression and moderate alcohol consumption on coronary and other arterial disease events in an 11-year cohort of HIV-infected patients on antiretroviral therapy. BMJ Open 2012; 2:e001155. [PMID: 23180454 PMCID: PMC3533116 DOI: 10.1136/bmjopen-2012-001155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To investigate the relationship between response to antiretroviral therapy (ART), alcohol use and occurrence of a major coronary or other arterial disease event (CADE) in HIV-infected individuals. DESIGN A cohort study. A Cox model was used to identify the correlates of a first occurrence of a major CADE. SETTING The French ANRS CO8 APROCO-COPILOTE cohort was set up in 1997 to study clinical progression and patient-reported outcomes (PRO) after initiating a protease inhibitor-containing ART. Clinical data were retrieved from medical records. Self-administered questionnaires collected data on PRO and behaviours, including alcohol use. PARTICIPANTS Metabolic data were only available for a subgroup (n=675) of the study group (n=1154). MAIN OUTCOME MEASURES Major coronary or other arterial disease first event. RESULTS Over the 11-year follow-up, 49 major CADE were observed, with an incidence rate (95% CI)=0.75(0.57 to 0.99) per 100 person-years. Immunodepression (CD4 cell count <200 cells/mm(3)) was associated with an increased risk of CADE (adjusted HR (95% CI)=2.52(1.15 to 5.48)) after adjustment for female gender (0.25(0.08 to 0.83)), age (1.07(1.04 to 1.10)) and smoking>20 cigarettes/day (4.19(2.17 to 8.11)). Moreover, individuals with moderate alcohol consumption (≤4(3) alcohol units (AU)/day for men(women)) had a lower risk of CADE (0.38(0.20 to 0.71)) than alcohol abstainers, although the risk for those drinking>4(3) AU/day for men(women) was not significantly different from this latter group. These associations remained valid after adjustment for metabolic disorders. No significant association with exposure to any specific antiretroviral was detected. CONCLUSIONS In the long term, absence of immunodepression and moderate alcohol consumption remain associated with a lower risk of a major CADE. Combined interventions to reduce CADE-risk-related behaviours including adherence counselling for assuring long-term immunological response to ART in HIV-infected individuals are now a clinical and public health priority.
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Affiliation(s)
- Maria Patrizia Carrieri
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur 13006, Marseille, France
| | - Camelia Protopopescu
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur 13006, Marseille, France
| | - Vincent Le Moing
- Service de Maladies Infectieuses et Tropicales, CHU de Montpellier, UMI 233 TransVIHMI, IRD, Université 34295, Montpellier 1, Montpellier, France
| | - Philippe Reboud
- INSERM, U897, Université Bordeaux Segalen, ISPED, 33076, Bordeaux, France
| | - François Raffi
- Service de Maladies Infectieuses et Tropicales, CHU Hôtel-Dieu, 44093, Nantes, France
| | - Sophie Mahy
- CHU de Dijon, Université de Bourgogne, 21000, Dijon, France
| | - Perrine Roux
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Substance Use Research Center, NYSPI, Columbia University, 10032, New York, USA
| | - Lise Cuzin
- Service de Maladies Infectieuses et Tropicales, CHU Purpan, 31059, Toulouse, France
| | - Bruno Spire
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur 13006, Marseille, France
| | - Catherine Leport
- Université Paris Diderot, Sorbonne Paris Cité, UMR 738, Paris, France
- INSERM, UMR 738, 75018, Paris, 75018, France
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Michel L, Carrieri MP, Fugon L, Roux P, Aubin HJ, Lert F, Obadia Y, Spire B. Harmful alcohol consumption and patterns of substance use in HIV-infected patients receiving antiretrovirals (ANRS-EN12-VESPA Study): relevance for clinical management and intervention. AIDS Care 2011; 22:1136-45. [PMID: 20824566 DOI: 10.1080/09540121003605039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Alcohol abuse affects secondary prevention and disease progression in HIV-infected patients, and adherence and response to treatment in those chronically treated. The objective of this study was to estimate the prevalence of harmful alcohol consumption (HAC) using various indicators and identify which groups of patients may require specific targeted interventions for HAC risk reduction. A cross-sectional survey, based on a random sample representative of people living with HIV/AIDS (PLWHA) was carried out in 102 French hospital departments delivering HIV care. As alcohol abuse is particularly detrimental to patients receiving highly active antiretroviral therapy (HAART), we focused only on those individuals receiving HAART with complete alcohol assessment (CAGE, AUDIT-C, regular binge drinking, N=2340). Collected information included medical and socio-demographic data, HIV risk behaviors, adherence to treatment and substance and alcohol use, together with depression, anxiety, and experience of attempted suicide or sex work. HAC prevalence was evaluated as follows: 12% (CAGE score > or =2), 27% (AUDIT-C), and 9% (regular binge drinking). Three groups were at higher risk of HAC: men who have sex with men using stimulants, polydrug users, and to a lesser degree, ex-drug users. Innovative intervention strategies to reduce HAC and improve HIV prevention and HAART adherence in various PLWHA populations need urgent testing and implementation. Such interventions for alcohol risk reduction remain central to promoting improved HIV prevention and assuring HAART effectiveness in these populations.
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Affiliation(s)
- Laurent Michel
- Health and Medical Research National Institute, Paris, France.
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CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations. Am J Surg 2011; 200:694-9; discussion 699-700. [PMID: 21146004 DOI: 10.1016/j.amjsurg.2010.07.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 07/26/2010] [Accepted: 07/26/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND The impact of immune status and surgical outcome in patients with HIV and acquired immunodeficiency syndrome (AIDS) remains unknown. METHODS Clinical variables of HIV/AIDS patients undergoing abdominal surgery were examined for their impact on outcome. RESULTS Major abdominal procedures were performed in 77 patients with a diagnosis of HIV/AIDS (55 males, mean age 41.1 years, mean CD4 count 210 mg/dL). A majority of operations (53%) were performed on an urgent basis. Patients undergoing urgent procedures had lower CD4 counts (129 ± 121 vs 303 ± 324, P = .002). The mean CD4 count was lower for patients with complications (146 ± 156 vs 288 ± 319, P = .013) and for those who died (112 ± 113 vs 251 ± 283, P = .026). On multivariate analysis, CD4 count was independently associated with an increased risk for complication, and urgent operation was associated with an increased risk for mortality. CONCLUSION Patients with HIV/AIDS who had lower CD4 counts were more likely to require an urgent operation and experience a complication with increased mortality.
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Cook JA. Associations between use of crack cocaine and HIV-1 disease progression: research findings and implications for mother-to-infant transmission. Life Sci 2011; 88:931-9. [PMID: 21219914 DOI: 10.1016/j.lfs.2011.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 10/08/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
Abstract
Recent in vitro and in vivo research has suggested that cocaine has a direct effect on the pathogenesis of AIDS. These findings are confirmed by epidemiological studies linking the use of injected, inhaled, and smoked (crack) cocaine and indicators of HIV disease progression, even among adherent users of highly active antiretroviral therapy. Recent studies of vertical HIV transmission suggest that cocaine use may play a role in mother-to-child infection via alteration of maternal immune responses, enhanced viral replication in maternal immune cells, or alterations in the immune systems of neonates or infants. The purpose of this article is to review research conducted over the past several decades on associations between use of cocaine and HIV disease progression, especially among HIV+ women, and to explore its potential relevance for understanding mother-to-infant transmission of HIV.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, United States.
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Abalo A, Patassi A, James YE, Walla A, Sangare A, Dossim A. Risk factors for surgical wound infection in HIV-positive patients undergoing surgery for orthopaedic trauma. J Orthop Surg (Hong Kong) 2010; 18:224-7. [PMID: 20808017 DOI: 10.1177/230949901001800218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To identify risk factors associated with surgical wound infection in patients infected with human immunodeficiency virus (HIV) undergoing surgery for orthopaedic trauma. METHODS Records of 29 male and 7 female HIV-positive patients aged 18 to 47 years who underwent surgery for orthopaedic trauma were reviewed. Data on HIV-specific variables (HIV clinical classification, CD4+ lymphocyte count) and highly active antiretroviral therapy were retrieved, as were data on wound class, fracture type, surgery type, surgical wound infections, and outcomes. Possible risk factors associated with surgical wound infection were analysed. RESULTS The median follow-up period was 27 (range, 19-41) months. Of the 36 patients, 14 (39%) developed surgical wound infections (4 were deep and 10 superficial). 89% and 67% of them were in HIV clinical category B and in CD4+ T-lymphocyte category 3, respectively. 12 of these infections resolved after debridement and prolonged antibiotic treatment, and 2 developed chronic osteomyelitis. Four of the patients had non-union. Surgical wound infections were associated with HIV clinical category B (p<0.001), CD4+ T-lymphocyte category of more than or equal to 2 (p=0.041), and contaminated wounds (p=0.003). CONCLUSION Identification of risk factors may help minimise morbidity in HIV-positive patients.
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Affiliation(s)
- Anani Abalo
- Department of Orthopaedics, Tokoin Teaching Hospital, Lome, Togo.
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Balestra MR, Baratti D, Crippa F, Laterza B, Kusamura S, Langer M, Deraco M. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a Patient with Peritoneal Mesothelioma and HIV Infection. TUMORI JOURNAL 2010; 96:340-4. [DOI: 10.1177/030089161009600226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High rates of septic complications have been associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, which has been suggested as the treatment of choice for isolated peritoneal malignancies. Patients infected by the human immunodeficiency virus (HIV) are still considered at a high operative risk. Method A 58-year-old man with HIV infection and diffuse peritoneal mesothelioma underwent optimal cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Results The patient experienced a complete clinical response to therapy with no adverse effect on disease course or markers for HIV (CD4 count, beta2-microglobulin, neopterin, p24 antigen, and viral load). Conclusion This report suggests that this innovative approach can be successfully performed also in this clinical setting. In selected patients who respond to all criteria, surgery is possible and is a safe and effective therapeutic option.
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Affiliation(s)
- Maria Rosaria Balestra
- Department of Surgery, National Cancer Institute, Milan
- Department of Surgery, University G. d'Annunzio, Chieti
| | - Dario Baratti
- Department of Surgery, National Cancer Institute, Milan
| | - Fulvio Crippa
- Clinic of Infectious Diseases, San Raffaele Hospital, Milan
| | | | | | - Martin Langer
- Department of Anesthesiology, National Cancer Institute, Milan, Italy
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Borchardt SM, Haufle V, Whitaker EE, Dworkin MS. Predictors of mortality among women with AIDS in Illinois, USA. Int J STD AIDS 2009; 20:623-7. [PMID: 19710335 DOI: 10.1258/ijsa.2009.008499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Population-based surveillance data can help guide research priorities and plan programmes to prevent death among women with AIDS. We describe the predictors of mortality among women diagnosed with AIDS in Illinois, USA. Using the HIV/AIDS Reporting System), we identified 1944 adult women who were diagnosed with AIDS during January 1999-December 2004. The proportion of women who died within one year of diagnosis of AIDS declined from 97% in 1999 to 12% in 2005. Multivariate analysis indicated that age >or=45 years, intravenous drug use, diagnosis of clinical AIDS and hospitalization at the time of AIDS diagnosis were significant predictors of death among women with AIDS. The number of women who died soon after diagnosis with AIDS declined substantially. Nevertheless, prevention programmes designed to improve survival among women with AIDS should emphasize early diagnosis and referral for care in an effort to prevent first diagnosis with clinical AIDS during hospitalization.
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Affiliation(s)
- S M Borchardt
- Division of Infectious Diseases, Illinois Department of Public Health, Chicago, USA.
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Abstract
BACKGROUND Injection drug users (IDUs) have estimated mortality rates over 10 times higher than the general population; much of this excess mortality is HIV-associated. Few mortality estimates among IDUs from developing countries, including India, exist. METHODS IDUs (1158) were recruited in Chennai from April 2005 to May 2006; 293 were HIV positive. Information on deaths and causes was obtained through outreach workers and family/network members. Mortality rates and standardized mortality ratios were calculated; multivariate Poisson regression was used to identify predictors of mortality. RESULTS We observed 85 deaths over 1998 person-years (p-y) of follow-up [mortality rate (MR) 4.25 per 100 p-y; 95% confidence interval (CI) = 3.41-5.23]. The overall standardized mortality ratio was 11.1; for HIV-positive IDUs, the standardized mortality ratio was 23.9. Mortality risk among HIV-positive IDUs (MR: 8.88 per 100 p-y) was nearly three times that of negative IDUs (MR: 3.03 per 100 p-y) and increased with declining immune status (CD4 cells > 350: 5.44 per 100 p-y vs. CD4 cells < or = 200: 34.5 per 100 p-y). This association persisted after adjustment for confounders. The leading causes of mortality in both HIV negative and positive IDUs were overdose (n = 22), AIDS (n = 14), tuberculosis (n = 8) and accident/trauma (n = 9). CONCLUSION Substantial mortality was observed in this cohort with the highest rates among HIV-positive IDUs with CD4 counts of less than 350 cells/microl. Although, in these 2 years, non-AIDS deaths outnumbered 0002030-related deaths, the relative contribution of 0002030-associated mortality is likely to increase with advancing HIV disease progression. These data reinforce the need for interventions to reduce the harms associated with drug use and increase HAART access among IDUs in Chennai.
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Chen KT, Chang HL, Chen CT, Chen YA. The changing face of the HIV epidemic in Taiwan: a new challenge for public health policy strategies. AIDS Patient Care STDS 2009; 23:195-201. [PMID: 19866537 DOI: 10.1089/apc.2008.0047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The goals of this study were to examine trends, risk factors, and survival rates of people diagnosed with HIV/AIDS. We used national surveillance data reported to the Taiwan Center for Disease Control (Taiwan CDC). The subjects of this study were all confirmed HIV and AIDS cases in Taiwan. From 1990 through 2005, the number of people that have been reported to have HIV/AIDS is 9961. Among individuals with HIV/AIDS, the male-to-female ratio was 11:1, the median age was 32 years. The number of HIV and AIDS diagnoses increased significantly for both men and women during the study period. The number of HIV cases among men who have sex with men (MSM) increased from 24 in 1990 to 527 in 2005, while diagnoses among injection drug users (IDUs) rose rapidly from 3 in 1990 to 2450 in 2005. The incidence-to-prevalence ratio (IPR) has risen sharply in recent years and has exceeded the epidemic threshold (IPR(t) = 0.1) for IDUs, indicating a growing epidemic. The corresponding hazard ratios for the highly active antiretroviral therapy (HAART) era versus pre-HAART era in the earlier and late HIV diagnosis groups were 0.45 (95% confidence interval [CI] 0.36-0.54) and 0.39 (95% CI 0.31-0.49), respectively. There was no significant difference in the survival rate of HIV testers. The increasing number of HIV infection places Taiwan among the worst IDU-concentrated epidemic areas in Asia. HIV intervention and prevention strategies, especially targeting IDUs, are urgently needed to reduce the ongoing spread of HIV infections in Taiwan.
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Affiliation(s)
- Kow-Tong Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Ling Chang
- Division of Surveillance, Center longstafor Disease Control, Department of Health, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, National Defense University, Taipei, Taiwan
| | - Chu-Tzu Chen
- Division of HIV/AIDS Prevention and Control, Center longstafor Disease Control, Department of Health, Taipei, Taiwan
| | - Ying-An Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Abstract
BACKGROUND Longitudinal associations between patterns of crack cocaine use and progression of HIV-1 disease are poorly understood, especially among women. This study explores relationships between crack use and HIV-1 disease outcomes in a multicenter cohort of infected women. METHODS Subjects were 1686 HIV-seropositive women enrolled at six US research centers in the Women's Interagency HIV Study. Approximately 80% were non-white and 29% used crack during the study period. Cox survival and random regression analysis examined biannual observations made April 1996 through September 2004. Outcome measures included death due to AIDS-related causes, CD4 cell count, HIV-1 RNA level, and newly acquired AIDS-defining illnesses. RESULTS Persistent crack users were over three times as likely as non-users to die from AIDS-related causes, controlling for use of HAART self-reported at 95% or higher adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunologic indicators. Persistent crack users and intermittent users in active and abstinent phases showed greater CD4 cell loss and higher HIV-1 RNA levels controlling for the same covariates. Persistent and intermittent crack users were more likely than non-users to develop new AIDS-defining illnesses controlling for identical confounds. These results persisted when controlling for heroin use, tobacco smoking, depressive symptoms, hepatitis C virus coinfection, and injection drug use. CONCLUSION Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women.
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Fielden SJ, Rusch ML, Levy AR, Yip B, Wood E, Harrigan RP, Goldstone I, Guillemi S, Montaner JS, Hogg RS. Predicting hospitalization among HIV-infected antiretroviral naïve patients starting HAART: Determining clinical markers and exploring social pathways. AIDS Care 2008; 20:297-303. [DOI: 10.1080/09540120701561296] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah J. Fielden
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- b Department of Interdisciplinary Studies , University of British Columbia , US
| | - Melanie L.A. Rusch
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- c Department of Health Care and Epidemiology , University of British Columbia , US
- d Division of International Health & Cross-Cultural Medicine , University of California , San Diego , CA , US
| | - Adrian R. Levy
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- c Department of Health Care and Epidemiology , University of British Columbia , US
| | - Benita Yip
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
| | - Evan Wood
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- e Department of Medicine , University of British Columbia , US
| | - Richard P. Harrigan
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- e Department of Medicine , University of British Columbia , US
| | - Irene Goldstone
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- f School of Nursing , University of British Columbia , US
| | - Silvia Guillemi
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
| | - Julio S. Montaner
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- e Department of Medicine , University of British Columbia , US
| | - Robert S. Hogg
- a B.C. Centre for Excellence in HIV/AIDS , Vancouver , BC , US
- g Faculty of Health Science , Simon Fraser University , Burnaby , BC , US
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Lert F, Kazatchkine MD. Antiretroviral HIV treatment and care for injecting drug users: an evidence-based overview. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:255-61. [PMID: 17689373 PMCID: PMC2020510 DOI: 10.1016/j.drugpo.2007.05.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 01/15/2007] [Accepted: 05/14/2007] [Indexed: 11/30/2022]
Abstract
AIDS-related mortality and the rate of progression to AIDS have dramatically decreased since the advent of highly active antiretroviral treatment (HAART). The overall benefit from antiretroviral HIV treatment has, however, been lesser in HIV-infected injecting drug users (IDUs) than in other patient groups (e.g. men who have sex with men). Poorer outcomes in HIV-infected IDUs are related to a variety of factors, including increased rates of non-HIV-related deaths, hepatitis C, delayed access to effective treatment, lower adherence to care and treatment regimens, continuation of illicit drug use, depression and negative life events. The available evidence strongly suggests the need for the large-scale implementation of comprehensive treatment and care strategies for IDUs that include both treatment of drug dependence and HAART.
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Affiliation(s)
- France Lert
- Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé
INSERM : U687 IFR69Université Paris Sud - Paris XI Université de Versailles-Saint Quentin en YvelinesHopital National de Saint-Maurice
14, Rue du Val D'Osne
94415 ST MAURICE CEDEX,FR
- * Correspondence should be adressed to: France Lert
| | - Michel D. Kazatchkine
- Immunopathologie et immunointervention thérapeutique
INSERM : U681 IFR58Université Pierre et Marie Curie - Paris VIInstitut Des Cordeliers
15, Rue de L'Ecole de Medecine
75006 Paris Cedex 06,FR
- Ministère des Affaires Etrangères
Paris,FR
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