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Li J, Hao Y, Liu Y, Wu L, Liang H, Ni L, Wang F, Wang S, Duan Y, Xu Q, Xiao J, Yang D, Gao G, Ding Y, Gao C, Xiao J, Zhao H. Supervised machine learning algorithms to predict the duration and risk of long-term hospitalization in HIV-infected individuals: a retrospective study. Front Public Health 2024; 11:1282324. [PMID: 38249414 PMCID: PMC10796994 DOI: 10.3389/fpubh.2023.1282324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Objective The study aimed to use supervised machine learning models to predict the length and risk of prolonged hospitalization in PLWHs to help physicians timely clinical intervention and avoid waste of health resources. Methods Regression models were established based on RF, KNN, SVM, and XGB to predict the length of hospital stay using RMSE, MAE, MAPE, and R2, while classification models were established based on RF, KNN, SVM, NN, and XGB to predict risk of prolonged hospital stay using accuracy, PPV, NPV, specificity, sensitivity, and kappa, and visualization evaluation based on AUROC, AUPRC, calibration curves and decision curves of all models were used for internally validation. Results In regression models, XGB model performed best in the internal validation (RMSE = 16.81, MAE = 10.39, MAPE = 0.98, R2 = 0.47) to predict the length of hospital stay, while in classification models, NN model presented good fitting and stable features and performed best in testing sets, with excellent accuracy (0.7623), PPV (0.7853), NPV (0.7092), sensitivity (0.8754), specificity (0.5882), and kappa (0.4672), and further visualization evaluation indicated that the largest AUROC (0.9779), AUPRC (0.773) and well-performed calibration curve and decision curve in the internal validation. Conclusion This study showed that XGB model was effective in predicting the length of hospital stay, while NN model was effective in predicting the risk of prolonged hospitalization in PLWH. Based on predictive models, an intelligent medical prediction system may be developed to effectively predict the length of stay and risk of HIV patients according to their medical records, which helped reduce the waste of healthcare resources.
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Affiliation(s)
- Jialu Li
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yiwei Hao
- Division of Medical Record and Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ying Liu
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liang Wu
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongyuan Liang
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liang Ni
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Sa Wang
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yujiao Duan
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiuhua Xu
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinjing Xiao
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou, China
| | - Di Yang
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Guiju Gao
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yi Ding
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chengyu Gao
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiang Xiao
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxin Zhao
- Clinical and Research Center of AIDS, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Ma R, Zhang Q, Zhao CS, Zhao R, Zhang Y, Zhang YS, Hai Y, Wei G, Pu Y, Hu LQ, Song Y, Zhang Y, Hu BY, Xin S. The consensus guideline of perioperative antiviral therapy for AIDS patients in China based on clinical practice. Front Med (Lausanne) 2023; 10:1267236. [PMID: 38126075 PMCID: PMC10731030 DOI: 10.3389/fmed.2023.1267236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023] Open
Abstract
The prevalence of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has emerged as a major public health concern in China. When patients with HIV infection undergo surgical treatment, there are two main challenges. Firstly, medical staff face a high risk of HIV infection due to occupational exposure. Secondly, the patient's immune function is impaired, increasing the risk of opportunistic infections and postoperative complications. The surgical treatment of such patients is unique, and the risk of occupational exposure during the operation primarily depends upon the viral load of HIV/AIDS patients. Therefore, perioperative antiretroviral therapy is of paramount importance in order to standardize the perioperative antiretroviral therapy (ART) for HIV/AIDS patients. The Surgery Group of the Chinese Association of STD and AIDS Prevention and Control, in collaboration with the Treatment Association, and Surgery Group of the Chinese Medical Association of Tropical Diseases and Parasitology, has developed an expert consensus on perioperative antiretroviral therapy for HIV/AIDS patients. This consensus encompasses various aspects, including surgical risk assessment, selection of perioperative antiretroviral therapy regimens, prevention of opportunistic infections, and the crucial focus on rapid preoperative viral load reduction and immune function reconstruction for HIV/AIDS patients.
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Affiliation(s)
- Rui Ma
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chang song Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rugang Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao shen Zhang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Guo Wei
- Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Yu Pu
- Public Health and Clinical Center of Chengdu, Chengdu, China
| | - Li qiang Hu
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanzheng Song
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yu Zhang
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Bo yong Hu
- Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Shijie Xin
- The First Affiliated Hospital of China Medical University, Shenyang, China
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Getaneh Y, Getnet F, Rashid A, Kang L, Chu Q, Li S, Yi F, Shao Y. The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia. Emerg Microbes Infect 2023; 12:2271065. [PMID: 37824698 PMCID: PMC10614708 DOI: 10.1080/22221751.2023.2271065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/11/2023] [Indexed: 10/14/2023]
Abstract
ABBREVIATIONS AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University.
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Affiliation(s)
- Yimam Getaneh
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fentabil Getnet
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- T.H. Chan School of Public Health, Boston, MA, USA
| | - Abdur Rashid
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Li Kang
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Qingfei Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Sisi Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Feng Yi
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yiming Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
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Yuan J, Wang Y, Wang L, Wang H, Ren Y, Yang W. What do the clinical features of positive nontuberculous mycobacteria isolates from patients with HIV/AIDS in China reveal? A systematic review and meta-analysis. J Glob Health 2023; 13:04093. [PMID: 37651639 PMCID: PMC10472018 DOI: 10.7189/jogh.13.04093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background China has a high burden of nontuberculous mycobacterial (NTM) infections. Immunocompromised populations, such as those with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), are at a higher risk of being infected with NTM than immunocompetent individuals. Yet, there is a paucity of information on the clinical features of positive NTM isolates from patients with HIV/AIDS in China. To address this gap, we conducted a systematic review and meta-analysis of existing studies, comparing them against current expert consensus to provide guidance for clinical practice. Methods Two researchers independently searched eight databases (SinoMed, China National Knowledge Infrastructure, Wanfang, VIP, Cochrane Library, PubMed, Embase, and Web of Science) from inception to 26 December 2022 to retrieve published Chinese- and English-language studies reporting clinical features of NTM-positive isolates among patients with HIV/AIDS in China. Results We included 28 studies with 1861 patients. The rate of positive NTM isolates detected from men among all patients was 87.3%. NTM species distribution was mainly Mycobacterium avium complex (64.3%), which was predominant in different regions. The five most common clinical symptoms were fever (68.5%), cough or expectoration (67.0%), appetite loss (49.4%), weight loss (45.5%), and superficial lymphadenectasis (41.1%). The prevalence of laboratory tests were as follows: albumin <35 g/L (55.6%), erythrocyte sedimentation rate >20 mm/h (91.4%), anaemia (59.0%), predominantly mild, CD4+ T cell count ≤50 pieces/μL (70.3%), and CD4+ T cell count 51-200 pieces/μL (22.1%). Lesion manifestations in thoracic imaging mainly included bilateral lung involvement (83.8%), showed stripe shadows (60.3%), patchy shadows (42.9%), nodules (40.6%), and bronchiectasis (38.6%). Accompanied signs included thoracic lymph node enlargement (49.5%). Seventy per cent of symptoms improved after treatment. Conclusions Focusing on clinical symptoms, laboratory tests, and thoracic imaging helps with initial screening for NTM infections. Physicians should raise awareness of the diagnosis and treatment of Mycobacterium avium complex, providing guidance for experimental treatment, screening of priority populations for NTM infections, and prophylactic treatment of NTM disease. Registration PROSPERO CRD42023388185.
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Affiliation(s)
- Jianwei Yuan
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yan Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Lin Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Hongxia Wang
- Department of Infection, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Yuan Ren
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Wenzhe Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
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Parra-Lara LG, Arango-Ibañez JP, Martínez-Arboleda JJ, Bravo JC, Zambrano ÁR, Collazos P, Andino F, Badillo A, Estrada S, Rosso F. Survival of patients living with HIV and cancer in Cali, Colombia. Colomb Med (Cali) 2023; 54:e2015558. [PMID: 38098512 PMCID: PMC10719985 DOI: 10.25100/cm.v54i3.5588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/22/2023] [Accepted: 09/21/2023] [Indexed: 12/17/2023] Open
Abstract
Background People living with HIV have an increased risk of cancer compared to the general population. However, with the increase in life expectancy and advances in antiretroviral therapy, the survival of patients with cancer and HIV has changed. Objective To determine the survival of patients living with HIV and cancer in Cali, Colombia. Methods A retrospective cohort study was conducted at the Fundación Valle del Lili, Cali, Colombia. Data from the HIV database was crossed with data from the hospital and population-based cancer registries between 2011-2019. Patients <18 years, limited available clinical information on the diagnosis and treatment of HIV and cancer, and non-oncological tumor diagnosis were excluded. Results A total of 173 patients were included. The frequencies of AIDS-defining neoplasms were: Non-Hodgkin lymphoma (42.8%), Kaposi sarcoma (27.8%), and cervical cancer (4.6%). Overall survival was 76.4% (95% CI 68.9-82.3) at five years. Poorer survival was found in patients with AIDS-defining infections (56.9% vs. 77.8%, p=0.027) and non-AIDS-defining infections (57.8% vs. 84.2%, p=0.013), while there was better survival in patients who received antiretroviral therapy (65.9% vs. 17.9%, p=0.021) and oncological treatment (66.7% vs. 35.4%, p<0.001). The presence of non-AIDS-defining infections increases the risk of dying (HR = 2.39, 95% CI 1.05-5.46, p=0.038), while oncological treatment decreases it (HR = 0.33, 95% CI 0.14-0.80, p=0.014). Conclusions In people living with HIV, Non-Hodgkin lymphoma and Kaposi sarcoma are the most common neoplasms. Factors such as AIDS-associated and non-AIDS-associated infections have been identified as determinants of survival. Cancer treatment seems to improve survival.
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Affiliation(s)
- Luis Gabriel Parra-Lara
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | | | - Juan C. Bravo
- Fundación Valle del Lili, Departamento de Patología y Laboratorio Clínico, Cali, Colombia
| | - Ángela R. Zambrano
- Fundación Valle del Lili, Departamento de Medicina Interna, Servicio de Hematología & Oncología Clínica, Cali, Colombia
| | - Paola Collazos
- Universidad del Valle, Facultad de Salud, Registro Poblacional de Cáncer de Cali (RPCC), Cali, Colombia
| | - Francisco Andino
- Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Angélica Badillo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Sebastián Estrada
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Fernando Rosso
- Universidad Icesi, Facultad de Ciencias de la Salud, Cali, Colombia
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
- Fundación Valle del Lili, Departamento de Medicina Interna, Servicio de Infectología, Cali, Colombia
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Yang N, He J, Li J, Zhong Y, Song Y, Chen C. Predictors of death among TB/HIV co-infected patients on tuberculosis treatment in Sichuan, China: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e32811. [PMID: 36749231 PMCID: PMC9901956 DOI: 10.1097/md.0000000000032811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Mycobacterium tuberculosis is the most common opportunistic infection among patients with human immunodeficiency virus (HIV) infection, and it is also the leading cause of death, causing approximately one-third of acquired immune deficiency syndrome deaths worldwide. China is on the World Health Organization's global list of 30 high-tuberculosis (TB) burden countries. The objective of this study was to evaluate the mortality rate, survival probabilities, and factors associated with death among patients with TB/HIV co-infection undergoing TB treatment in Sichuan, China. A retrospective cohort study was conducted using the Chinese National TB Surveillance System data of TB/HIV co-infected patients enrolled in TB treatment from January 2020 to December 2020. We calculated the mortality rate and survival probabilities using the Kaplan-Meier estimator, and a Cox proportional hazard model was conducted to identify independent risk factors for TB/HIV co-infection mortality. Hazard ratios and their respective 95% confidence intervals were also reported in this study. Of 828 TB/HIV co-infected patients, 44 (5.31%) died during TB treatment, and the crude mortality rate was 7.76 per 1000 person-months. More than half of the deaths (n = 23) occurred in the first 3 months of TB treatment. Overall survival probabilities were 97.20%, 95.16%, and 91.75% at 3rd, 6th, and 12th month respectively. The independent risk factors for mortality among TB/HIV co-infected patients were having extra-pulmonary TB and pulmonary TB co-infection, history of antiretroviral therapy interruption, and baseline cluster of differentiation 4 T-lymphocyte counts <200 cells/μL at the time of HIV diagnosis. Antiretroviral therapy is important for the survival of TB/HIV co-infected patients, and it is recommended to help prolong life by restoring immune function and preventing extra-pulmonary TB.
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Affiliation(s)
- Ni Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Jinge He
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
- * Correspondence: Jinge He, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041, China(e-mail: )
| | - Jing Li
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yin Zhong
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Yang Song
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Chuang Chen
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan, China
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Chiou JS, Chou CH, Ho MW, Tien N, Liang WM, Chiu ML, Tsai FJ, Wu YC, Chou IC, Lu HF, Lin TH, Liao CC, Huang SM, Li TM, Lin YJ. Effect of Chinese herbal medicine therapy on risks of all-cause mortality, infections, parasites, and circulatory-related mortality in HIV/AIDS patients with neurological diseases. Front Pharmacol 2023; 14:1097862. [PMID: 36937878 PMCID: PMC10020503 DOI: 10.3389/fphar.2023.1097862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction: Long-term living with human immunodeficiency virus (HIV) and/or antiretroviral therapy (ART) is associated with various adverse effects, including neurocognitive impairment. Heterogeneous neurocognitive impairment remains an important issue, affecting between 15-65% of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) patients and resulting in work performance, safety, and health-related outcomes that have a heavy economic burden. Methods: We identified 1,209 HIV/AIDS patients with neurological diseases during 2010-2017. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model were used to analyze 308 CHM users and 901 non-CHM users within this population. Major CHM clusters were determined using association rule mining and network analysis. Results and Discussion: Results showed that CHM users had a 70% lower risk of all-cause mortality (adjusted hazard ratio (aHR) = 0.30, 95% confidence interval (CI):0.16-0.58, p < 0.001) (p = 0.0007, log-rank test). Furthermore, CHM users had an 86% lower risk of infections, parasites, and circulatory-related mortality (aHR = 0.14, 95% confidence interval (CI):0.04-0.46, p = 0.001) (p = 0.0010, log-rank test). Association rule mining and network analysis showed that two CHM clusters were important for patients with neurological diseases. In the first CHM cluster, Huang Qin (HQ; root of Scutellaria baicalensis Georgi), Gan Cao (GC; root of Glycyrrhiza uralensis Fisch.), Huang Lian (HL; root of Coptis chinensis Franch.), Jie Geng (JG; root of Platycodon grandiflorus (Jacq.) A.DC.), and Huang Bai (HB; bark of Phellodendron amurense Rupr.) were identified as important CHMs. Among them, the strongest connection strength was identified between the HL and HQ. In the second CHM cluster, Suan-Zao-Ren-Tang (SZRT) and Ye Jiao Teng (YJT; stem of Polygonum multiflorum Thunb.) were identified as important CHMs with the strongest connection strength. CHMs may thus be effective in treating HIV/AIDS patients with neurological diseases, and future clinical trials are essential for the prevention of neurological dysfunction in the population.
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Affiliation(s)
- Jian-Shiun Chiou
- PhD Program for Health Science and Industry, College of Healthcare, China Medical University, Taichung, Taiwan
| | - Chen-Hsing Chou
- PhD Program for Health Science and Industry, College of Healthcare, China Medical University, Taichung, Taiwan
| | - Mao-Wang Ho
- Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Internal Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Ni Tien
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Wen-Miin Liang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Mu-Lin Chiu
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
- Department of Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan
| | - Yang-Chang Wu
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - I-Ching Chou
- Department of Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hsing-Fang Lu
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Ting-Hsu Lin
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Chu Liao
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Shao-Mei Huang
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Te-Mao Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- *Correspondence: Te-Mao Li, ; Ying-Ju Lin,
| | - Ying-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Genetic Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- *Correspondence: Te-Mao Li, ; Ying-Ju Lin,
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8
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Meng S, Tang Q, Xie Z, Wu N, Qin Y, Chen R, Chen X, Chen X, Li Y, Shi M, Ye L, Liang H, Jiang J, Zhou B, Lin J. Spectrum and mortality of opportunistic infections among HIV/AIDS patients in southwestern China. Eur J Clin Microbiol Infect Dis 2023; 42:113-120. [PMID: 36413338 PMCID: PMC9816182 DOI: 10.1007/s10096-022-04528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
We describe the opportunistic infections (OIs) of HIV/AIDS to understand the spectrum, mortality, and frequency of multiple coinfected OIs among HIV/AIDS patients in southern China, where OIs are severe. We carried out a retrospective cohort study of hospitalized HIV-infected individuals at the Fourth People's Hospital of Nanning, Guangxi, China, from Jan. 2011 to May. 2019. The chi-square test was used to analyze cross-infection; the Kaplan‒Meier analysis was used to compare mortality. A total of 12,612 HIV-infected patients were admitted to this cohort study. Among them, 8982 (71.2%) developed one or more OIs. The overall in-hospital mortality rate was 9.0%. Among the patients, 35.6% coinfected one OI, and 64.4% coinfected more than two OIs simultaneously. Almost half of the patients (60.6%) had CD4 + T-cell counts < 200 cells/μL. Pneumonia (39.8%), tuberculosis (35.3%), and candidiasis (28.8%) were the most common OIs. Coinfected cryptococcal meningitis and dermatitis are the most common combined OIs. The rate of anaemia (17.0%) was highest among those common HIV-associated complications. Multiple OIs are commonly found in hospitalized HIV/AIDS patients in southwestern China, which highlights the need for improved diagnosis and treatment.
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Affiliation(s)
- Sirun Meng
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
| | - Qiao Tang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Zhiman Xie
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
| | - Nianning Wu
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
| | - Yingmei Qin
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
| | - Rongfeng Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xiaoyu Chen
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
| | - Xiu Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Yueqi Li
- Joint Laboratory for Emerging Infections Diseases in China (Guangxi)-ASEAN, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi China
| | - Minjuan Shi
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Hao Liang
- Joint Laboratory for Emerging Infections Diseases in China (Guangxi)-ASEAN, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi China
| | - Junjun Jiang
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China ,Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Bo Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Jianyan Lin
- The Fourth People’s Hospital of Nanning, Nanning, 530023 Guangxi China
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9
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Incidence and predictors of common opportunistic infection among HIV -infected children attending antiretroviral treatment clinic at Northeast Ethiopia, public hospitals 2022: A multicenter retrospective follow-up study. Ann Med Surg (Lond) 2022; 84:104910. [DOI: 10.1016/j.amsu.2022.104910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022] Open
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Liu L, Yuan M, Sun S, Wang J, Shi Y, Yu Y, Su X. The Performance of Metagenomic Next-Generation Sequence in the Diagnosis of Suspected Opportunistic Infections in Patients with Acquired Immunodeficiency Syndrome. Infect Drug Resist 2022; 15:5645-5653. [PMID: 36187731 PMCID: PMC9518679 DOI: 10.2147/idr.s378249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background For acquired immunodeficiency syndrome (AIDS) patients with suspected opportunistic infections, the rapid and accurate identification of pathogens remains a challenge. Metagenomic next-generation sequencing (mNGS) has emerged as a pan-pathogen assay for infectious diseases diagnosis, but its guiding significance for diagnosis and antimicrobials treatment in AIDS patients with suspected opportunistic infections is still not well established. In this study, we compared the microbiological diagnostic value of mNGS with that of conventional microbiological tests (CMTs) in AIDS patients with suspected opportunistic infections. Methods From January 2018 to February 2021, a retrospective study was performed at four tertiary teaching hospitals in China and data of 86 AIDS patients with suspected opportunistic infections were collected. The pathogen detection performance of mNGS and CMTs were compared. Results Positive agreement between mNGS and clinical diagnosis was significantly higher than that of CMTs (65/86 (75.6%) vs 37/86 (43.0%)). In addition, mNGS identified more bacterial (25 vs 2), fungal (5 vs 3), viral (9 vs 2) organisms compared with CMTs. Mixed infection were detected in 34 patients by mNGS combined with CMTs. Viruses (94.1%, 32/34) and fungi (94.1%, 32/34) were commonly seen in the mixed infection cases. mNGS helped identify the pathogen or guide appropriate treatment in 49/86 (57%) patients. Meanwhile, CMTs also contributed in the decision of appropriate treatment in 28 patients. The successful de-escalation or discontinuation of treatment was supported in 37 patients with the help of mNGS. We observed a significant reduction in the number of patients being prescribed foscarnet (52.3% vs 23.26%, p < 0.001), moxifloxacin (34.9% vs 10.5%, p = 0.005), and levofloxacin (32.6% vs 14%, p = 0.001) before and after mNGS. Conclusion For AIDS patients with suspected opportunistic infections, mNGS can provide early, noninvasive, and rapid microbiological diagnosis. mNGS may lead to a more precise antimicrobial treatment and reduced the unreasonable use of antimicrobials.
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Affiliation(s)
- Li Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China
- Department of Infectious Disease, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, People’s Republic of China
| | - Mingjuan Yuan
- Department of Infectious Disease, The Central Hospital of Yueyang, Yueyang, Hunan Province, People’s Republic of China
| | - Siqing Sun
- Department of General Medicine, The Second Hospital of Nanjing, Nanjing Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Jinrong Wang
- Department of Respiratory and Critical Care Medicine, Hengshui People’s hospital, Hengshui, Hebei Province, People’s Republic of China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Yamin Yu
- Department of Nephrology, Ningxiang People’s Hospital, Changsha, Hunan Province, People’s Republic of China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
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11
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Li CB, Zhou Y, Wang Y, Liu S, Wang W, Lu X, Sun CM, Liu P, Hu QH, Wen Y. In-hospital Mortality and Causes of Death in People Diagnosed With HIV in a General Hospital in Shenyang, China: A Cross-Sectional Study. Front Public Health 2021; 9:774614. [PMID: 34917579 PMCID: PMC8669430 DOI: 10.3389/fpubh.2021.774614] [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] [Received: 09/12/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Acquired immune deficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV) infection, is a serious public health issue. This study investigated the correlated factors and possible changing trend of in-hospital death in patients diagnosed with HIV in the past decade in our hospital. Methods: We retrospectively collected data of firstly hospitalized patients with HIV in the Department of Infectious Disease in the First Affiliated Hospital of China Medical University from January 1, 2010 to December 31, 2019, and compared various factors that correlated with in-hospital death, including age, sex, opportunistic infections, and antiretroviral therapy (ART) status. Cox regression analysis was used to identify the risk factors for death. Results: In total, 711 patients were recruited for this study, and 62 patients died in the hospital. The in-hospital mortality rate was 8.72%. Tuberculosis (TB), malignancies, and thrombocytopenia were associated with mortality. Antiviral treatment before admission was found to be a protective factor. There was a declining trend in in-hospital mortality from 19.2% in 2010 to 6.3% in 2019 (linear-by-linear association test, p < 0.001), partly due to intensified medical care strategy. Conclusions: Till date, AIDS-defining illnesses remain the major cause of hospital admission and in-hospital mortality. TB and malignancies were correlated risk factors for in-hospital mortality. ART before admission was found to be beneficial, and considering the decreasing rate of in-hospital mortality, the implementation of intensified medical care strategy requires further effort.
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Affiliation(s)
- Cheng Bo Li
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Zhou
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yu Wang
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Sheng Liu
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen Wang
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xu Lu
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Cui Ming Sun
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Pei Liu
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Wen
- Infectious Diseases Department, The First Affiliated Hospital of China Medical University, Shenyang, China
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12
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Sun J, Sun W, Tang Y, Zhang R, Liu L, Shen Y, Wang J, Chen J, Qi T, Wang Z, Song W, Lin Y, Xu S, Lu H. Clinical characteristics and risk factors for poor prognosis among HIV patients with Talaromyces marneffei bloodstream infection. BMC Infect Dis 2021; 21:514. [PMID: 34074256 PMCID: PMC8170804 DOI: 10.1186/s12879-021-06232-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Talaromyces marneffei (TM) bloodstream infection is common in Acquired Immunodeficiency Syndrome (AIDS) patients with extreme immunodeficiency in Southeast Asia and South China, however, clinical case study on TM bloodstream infection is scarce. We retrospectively analyzed the clinical characteristics of TM bloodstream infection in hospitalized AIDS patients and determined the outcomes of hospitalization after diagnosis in our hospital over the past 5 years. Methods From January 2015 to July 2020, 87 cases of TM detected by blood culture in patients admitted to our center were collected. The admission complaints, blood cells, biochemistry, CD4 and CD8 cell counts and 1,3-β-D-glucan (BDG), procalcitonin (PCT), CRP level on the day of blood culture test, and outcomes during hospitalization were analyzed. Logistic regression analysis was performed for the risk factors for poor prognosis (60 cases). Spearman correlation analysis was used to analyze the correlation between peripheral blood cells, albumin and the time required for TM turnaround in blood culture. The difference was statistically significant when the P value was < 0.05. Results A total of 87 patients were collected, with a median age of 34 years, a median hemoglobin of 94 g/L and CD4 count of 7/μl. The rate of TM bloodstream infection among all in-hospital patients increased from 0.99% in 2015 to 2.09% in 2020(half year). Patients with TM bloodstream infection with CD8 count < 200/μl had a 12.6-fold higher risk of poor prognosis than those with CD8 count > 200/μl (p = 0.04), and those with BDG < 100 pg/mL had a 34.9-fold higher risk of poor prognosis than those with BDG > 100 pg/mL (p = 0.01). Conclusions TM bloodstream infection is becoming more common in advanced AIDS patients in endemic areas. For those patients with extremely low CD4 and CD8 cell counts below 200/μl is with an increased risk of poor prognosis.
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Affiliation(s)
- Jianjun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Weiwei Sun
- Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Yang Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jiangrong Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Tangkai Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Zhenyan Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Wei Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Yixiao Lin
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Shuibao Xu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China
| | - Hongzhou Lu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Shanghai, China. .,Department of Infectious Disease, Huashan Hospital Affiliated to Fudan University, Shanghai, China. .,Department of Internal Medicine, Shanghai Medical College, Fudan University, Shanghai, China.
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13
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Chanie ES, Bayih WA, Birhan BM, Belay DM, Asmare G, Tiruneh T, Aynalem YAA, Abat BB, Asnakew S, Mekie M, Yitbarek GY, GebreEyesus FA. Incidence of advanced opportunistic infection and its predictors among HIV infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized hospitals, Northwest Ethiopia, 2020: A multicenter retrospective follow-up study. Heliyon 2021; 7:e06745. [PMID: 33912717 PMCID: PMC8063747 DOI: 10.1016/j.heliyon.2021.e06745] [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] [Received: 12/23/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study is aimed to assess the incidence of advanced opportunistic infections (OIs) and its predictors among Human Immunodeficiency Virus (HIV) infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized Hospitals, Northwest Ethiopia, 2020. Methods A retrospective follow-up study was conducted from June 1, 2010, to May 30, 2020. A total of 349 children under the age of 15 who had received Anti-Retroviral Therapy (ART) were included in the study. Data were entered into Epi info version 7.2 and then exported to Stata 14.0 for analysis. Kaplan Meier curve and Log-rank test were used to determine the median survival time and the discrepancy of different categorical variables. The Cox regression model was used to identify the predictors of advanced opportunistic infections. The Adjusted hazard ratio (AHR) at 95% confidence interval (CI) was used to declare statistical significance. Result The incidence rate of advanced opportunistic infection was 5.53 per 100 (95% CI: 4.7, 6.9) Person per year observation (PYO). The median survival time was 113 months and the total follow-up periods were yielding 18882 months. Children presenting with treatment failure, Cotrimoxazole Preventive Therapy (CPT) non-user, low hemoglobin level (<10 mg/dl), and poor/fair level of adherence to ART were less free survival time as compared to their counterparts for advanced opportunistic infections. Conclusion In this study, the median of advanced OIs free survival time was found to be low and the incidence rate was found to be high. The incidence advanced OIs was associated with anemia, treatment failure, and poor/fair level of adherence, cotrimoxazole preventive therapy non-users. Further research should conduct to evaluate and to improve the quality of care in the study area.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhan
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getnet Asmare
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yared Asmare Aynalem Aynalem
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Biruk Beletew Abat
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sintayehu Asnakew
- Department Psychiatric, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Maru Mekie
- Department Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getache Yideg Yitbarek
- Department of Biomedical, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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The Prevalence of Blastocystis Infection in Pediatric Patients with Malignancy: A Single-Center Study in Ahvaz, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.104068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Blastocystis spp. is known as one of the few intestinal parasites, prevalent in more than 5% and 30 - 60% of the population in industrialized and developing countries, respectively. In this respect, immunocompromised individuals, such as patients undergoing chemotherapy or those with malignancies, are at risk of the clinical symptoms of Blastocystis infection; however, the given condition is often self-limiting in healthy individuals. Objectives: The current study aimed at evaluating the prevalence of Blastocystis infection in children with malignancies receiving chemo drugs. Methods: The current descriptive, cross-sectional study was conducted on 52 stool specimens collected from patients with cancer admitted to the Oncology Ward of Shahid Baqaei 2 Hospital, Ahvaz, Iran, for six months. A standardized questionnaire was filled out for all cases. Each specimen was also prepared using direct smear, the Lugol iodine staining, and the formalin-ether condensation method. Results: Blastocystis spp. was detected in 21.1% of the cases among them, 11.5% demonstrated gastrointestinal symptoms; therefore, a significant relationship was observed between Blastocystis infection and gastrointestinal symptoms. Conclusion: Patients undergoing chemotherapy should be screened for opportunistic parasitic infections such as Blastocystis to avoid potentially life-threatening outcomes. Besides, further studies are required to identify the subtypes of Blastocystis.
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Sun JJ, Liu L, Wang JR, Shen YZ, Qi TK, Wang ZY, Tang Y, Song W, Chen J, Zhang RF. Clinical outcomes of people living with human immunodeficiency virus (HIV) with diffuse large B-cell lymphoma (DLBCL) in Shanghai, China. Chin Med J (Engl) 2020; 133:2796-2802. [PMID: 33273327 PMCID: PMC7717822 DOI: 10.1097/cm9.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus (HIV). However, little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV (PLHIV). Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) with standard cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab(R-CHOP) as front line therapy for PLHIV with diffuse large B-cell lymphoma (DLBCL) receiving modern combined antiretroviral therapy (cART). METHODS A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019. The demographic and clinical data were collected, and overall survival (OS) and progression-free survival (PFS) analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis. Additionally, a Cox multiple regression model was constructed to identify related factors for OS. RESULTS A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months (interquartile range [IQR]: 8-29 months). The proportion of high international prognostic index (IPI) patients was much larger in the DA-EPOCH-R group (n = 29) than that in the R-CHOP group (n = 25). The CD4 cell counts and HIV RNA levels were not significantly different between the two groups. The 2-year OS for all patients was 73%. However, OS was not significantly different between the two groups, with a 2-year OS rate of 78% for the DA-EPOCH-R group and 66% for the R-CHOP group. Only an IPI greater than 3 was associated with a decrease in OS, with a hazard ratio of 5.0. The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups. CONCLUSIONS Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy. No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.
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Affiliation(s)
- Jian-Jun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Xia H, Gao L, Gong X, Zaongo SD, Zhang T, Wu H, Ma P, Huang X. The Challenge of Potential Drug-Drug Interactions Among People Living With HIV on Antiretroviral Therapy: A Cross-Sectional Study in Selected Provinces in China. Front Pharmacol 2020; 11:800. [PMID: 32536872 PMCID: PMC7266979 DOI: 10.3389/fphar.2020.00800] [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] [Received: 02/19/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Potential drug–drug interactions (DDIs) are a significant therapeutic threat among human immunodeficiency virus (HIV)-positive individuals on antiretroviral (ARV) medications. DDIs involving ARV drugs in mainland China are unknown and insufficiently described. Herein, we investigated the prevalence and frequencies of potential ARV DDIs in Chinese people living with HIV (PLWH), then we assessed the risk factors associated with potential DDIs. Methods This study was conducted with HIV-positive adults undergoing ARV medications from multiple centers across China. The latest prescription of each participant was evaluated for potential DDIs using the Liverpool HIV drug interaction database. Multivariable logistic regressions were used to evaluate the factors associated with DDIs. Results Among 600 PLWH recruited, at least one non-HIV co-medication was observed in 511 (85.2%) individuals. A total of 2566 DDIs were identified, of which 11 (0.43%) and 311 (12.89%) were of contraindicated (red-flags) and dosage/timing adjustment required (orange-flags), respectively. Multivariate regression analysis revealed a higher risk of clinically significant DDIs (red- and orange-flagged comedication) associated with: the use of boosted protease inhibitors (p < 0.0001), boosted integrase strand transfer inhibitors (p < 0.0001), and non-nucleoside reverse transcriptase inhibitors-based ARV regimen (p < 0.0001); or the use of antiinfectives for systemic use (p < 0.0001), cardiovascular system drugs (p < 0.0001), nervous system drugs (p < 0.0001), fungal infection (p = 0.0071), and Herpes simplex virus infection (p = 0.0231). Conclusions Potential DDIs and inappropriate medications constitute a burden for people living with HIV in China. The knowledge of DDIs patterns and the scan for DDIs is crucial. Indeed, they can help to prevent drug-related adverse outcomes in such immunodeficient population.
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Affiliation(s)
- Huan Xia
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Liying Gao
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaowen Gong
- Department of Biostatistics, Tianjin Medical University, Tianjin, China
| | - Silvere D Zaongo
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China.,International School of Medicine, Tianjin Medical University, Tianjin, China
| | - Tong Zhang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ping Ma
- Department of Infectious Diseases, Nankai University Second People's Hospital, Tianjin, China
| | - Xiaojie Huang
- Department of Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
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Zhang Y, Cooper B, Gui X, Sherer R, Cao Q. Clinical diversity of invasive cryptococcosis in AIDS patients from central China: report of two cases with review of literature. BMC Infect Dis 2019; 19:1003. [PMID: 31775716 PMCID: PMC6882200 DOI: 10.1186/s12879-019-4634-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
Background Although antiretroviral therapy (ART) has greatly improved the prognosis of acquired immunodeficiency syndrome (AIDS) patients globally, opportunistic infections (OIs) are still common in Chinese AIDS patients, especially cryptococcosis. Case presentation We described here two Chinese AIDS patients with cryptococcal infections. Case one was a fifty-year-old male. At admission, he was conscious and oriented, with papulonodular and umbilicated skin lesions, some with ulceration and central necrosis resembling molluscum contagiosum. The overall impression reminded us of talaromycosis: we therefore initiated empirical treatment with amphotericin B, even though the case history of this patient did not support such a diagnosis. On the second day of infusion, the patient complained of intermittent headache, but the brain CT revealed no abnormalities. On the third day, a lumbar puncture was performed. The cerebral spinal fluid (CSF) was turbid, with slightly increased pressure. India ink staining was positive, but the cryptococcus antigen latex agglutination test (CrAgLAT: IMMY, USA) was negative. Two days later, the blood culture showed a growth of Cryptococcus neoformans, and the same result came from the skin culture. We added fluconazole to the patient’s treatment, but unfortunately, he died three days later. Case two was a sixty-four-year-old female patient with mild fever, productive cough, dyspnea upon movement, and swelling in both lower limbs. The patient was empirically put on cotrimoxazole per os and moxifloxacin by infusion. A bronchofibroscopy was conducted with a fungal culture, showing growth of Cryptococcus laurentii colonies. Amphotericin B was started thereafter but discontinued three days later in favor of fluconazole 400 mg/d due to worsening renal function. The patient became afebrile after 72 h of treatment with considerable improvement of other comorbidities and was finally discharged with continuing oral antifungal therapy. Conclusions Our cases illustrate that cryptococcal disease is an important consideration when treating immunocompromised individuals such as AIDS patients. Life threatening meningitis or meningoencephalitis caused by C. neoformansmay still common in these populations and can vary greatly in clinical presentations, especially with regard to skin lesions. Pulmonary cryptococcosis caused by C. laurentii is rare, but should also be considered in certain contexts. Guidelines for its earlier diagnosis, treatment and prophylaxis are needed.
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Affiliation(s)
- Yongxi Zhang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Brian Cooper
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Xi'en Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Renslow Sherer
- Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, MC5065, Chicago, IL, 60637, USA
| | - Qian Cao
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China.
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Li H, Wei Y, Zhang S, Xu L, Jiang J, Qiu Y, Mangin E, Zhao XM, Xie S. Pharmacokinetics and Safety of Posaconazole Administered by Intravenous Solution and Oral Tablet in Healthy Chinese Subjects and Effect of Food on Tablet Bioavailability. Clin Drug Investig 2019; 39:1109-1116. [PMID: 31432392 DOI: 10.1007/s40261-019-00833-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES New intravenous and solid oral formulations of the antifungal agent posaconazole have been developed. This randomized, open-label, crossover study in 18 healthy adult Chinese male and female subjects evaluated the pharmacokinetics of single-dose posaconazole (oral 300-mg posaconazole tablet fasted, intravenous 300-mg posaconazole solution fasted, and oral 300-mg posaconazole tablet with standard high-fat breakfast). Primary objectives were to determine the single-dose pharmacokinetics of posaconazole in healthy Chinese subjects when administered as an intravenous solution and as an oral tablet under fasted conditions and the effect of food on the absorption of posaconazole. METHODS The three treatments consisted of the following: a single oral dose of posaconazole 300 mg (fasted), a single oral dose of posaconazole 300 mg (high-fat breakfast), and a single intravenous dose of posaconazole 300 mg (fasted). Blood samples for pharmacokinetic analysis were collected before dosing and at regular intervals after dosing. Adverse events were monitored throughout. The pharmacokinetic population included the per-protocol population. The safety population included all subjects who received one or more doses of the study drug. RESULTS Time to maximum plasma concentration of intravenous posaconazole coincided with the end of infusion; the half-life (t½) was 25.76 h. Geometric mean (% coefficient of variation) values of area under the plasma concentration-time curve from time 0 extrapolated to infinity (AUC0-∞) and maximum plasma concentration (Cmax) were 59,925 (36.2%) h·ng/mL and 3999 (28.5%) ng/mL, respectively. The posaconazole tablet had a time to maximum plasma concentration of 4 h and a t½ of 25.21 h after fasting. Geometric mean (coefficient of variation) values of AUC0-∞ and Cmax were 25,263 (39.9%) h·ng/mL and 674.5 (29.6%) ng/mL, respectively. Standard high-fat breakfast increased the exposure of posaconazole approximately twofold with geometric mean ratios (high-fat breakfast/fasted) for AUC0-∞ and Cmax of 2.06 (90% confidence interval 1.86-2.30) and 1.95 (90% confidence interval 1.65-2.31), respectively. The geometric mean absolute bioavailability of the tablet formulation was 42.2% in the fasted state and 87.1% under high-fat breakfast conditions. The most commonly reported adverse events were nausea, vomiting, dizziness, and first-degree atrioventricular block for intravenous posaconazole 300 mg and nausea for oral posaconazole 300 mg (high-fat breakfast). All adverse events were mild and resolved without sequelae. CONCLUSIONS Posaconazole was generally well tolerated in healthy Chinese male and female subjects. The safety and the high-fat breakfast and fasted pharmacokinetics of posaconazole in healthy Chinese subjects are within exposures demonstrated to be generally well tolerated and efficacious and compare reasonably well with the overall posaconazole data across Western countries.
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Affiliation(s)
- Haiyan Li
- Peking University 3rd Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Yudong Wei
- Peking University 3rd Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shuang Zhang
- Peking University 3rd Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lin Xu
- Peking University 3rd Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Jun Jiang
- MSD China, Building 21 Rongda Road, Chaoyang District, Beijing, 100012, China
| | - Yanping Qiu
- MSD China, Building 21 Rongda Road, Chaoyang District, Beijing, 100012, China
| | - Eric Mangin
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Xu Min Zhao
- MSD China, Building 21 Rongda Road, Chaoyang District, Beijing, 100012, China
| | - Shuang Xie
- MSD China, Building 21 Rongda Road, Chaoyang District, Beijing, 100012, China
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19
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Du L, Lin Y, Wang M, Yan L, Bai L, Feng P, Tang H. Mortality-related risks in treatment-naive hospitalized AIDS patients with opportunistic infections in Southwest China. Future Virol 2019. [DOI: 10.2217/fvl-2019-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: We aimed to profile the characteristics and analyze the risk factors related to mortality in treatment-naive hospitalized AIDS patients with opportunistic infections (OIs) in Southwest China. Materials & methods: Two hundred and four treatment-naive patients diagnosed with AIDS-related OIs that were hospitalized in our hospital were enrolled. Their demographics, medical data and prognosis were described and analyzed. Result: Most patients were middle-aged married or cohabiting males. The infections in the respiratory system were the major OIs and leading cause of mortality. High CRP and IL-6 were identified as independent risk factors predicting mortality. Conclusion: Middle-aged treatment-naive males were the major victims of AIDS-related OIs. Respiratory infection should be monitored, and early intervention should be applied to improve prognosis if there is high CRP or IL-6 found.
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Affiliation(s)
- Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Yixiao Lin
- Department of Infectious Diseases and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR China
| | - Ming Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Libo Yan
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Ping Feng
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, PR China
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20
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Zhang Z, Xu L, Pang X, Zeng Y, Hao Y, Wang Y, Wu L, Gao G, Yang D, Zhao H, Xiao J. A Clinical scoring model to predict mortality in HIV/TB co-infected patients at end stage of AIDS in China: An observational cohort study. Biosci Trends 2019; 13:136-144. [PMID: 30930360 DOI: 10.5582/bst.2018.01309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We construct and validate a non-invasive clinical scoring model to predict mortality in HIV/TB patients at end stage of AIDS in China. There were 1,007 HIV/TB patients admitted to Beijing Ditan Hospital from August 2009 to January 2018 included in this study, who were randomly assigned to form derivation cohort and validation cohort. A clinical scoring model was developed based on predictors associated with mortality identified with Cox proportional hazard models. The discrimination and accuracy of model were further validated using the area under the ROC curves. The derivation and validation cohort consisted of 807 and 200 patients in 8:2 ratio, respectively. In derivation cohort, anemia (HGB < 90g/L), tuberculous meningitis, severe pneumonia, hypoalbuminemia, unexplained infections or space-occupying lesions, and malignancies remained independent risk factors of mortality in HIV/TB co-infected patients, and included in this clinical scoring model. The model indicated good discrimination, including AUC = 0.858 (95% CI: 0.782-0.943) in the derivation cohort, and AUC = 0.867 (95% CI: 0.832-0.902) in validation cohort, respectively. The predicted scores were categorized into two groups to predict the mortality: low-risk (0-2 points with mortality with 3.6-9.1%) and high-risk (4-16 points with mortality with 26.42-74.62%), in which 54.55% and 74.62% of patients with score of 5 to 11 and 12-16 were died among high-risk group. Kaplan-Meier curve indicated a significant difference in the cumulative mortality in the two groups by log-rank test (p < 0.001). A clinical scoring model to assess the prognosis in HIV/TB patients at end stage of AIDS was constructed based on simple laboratory and clinical features available at admission, which may be an easy-to-use tool for physicians to evaluate the prognosis and treatment outcome in HIV/TB co-infected patients. The model was also applicable for predicting the death of end-stage HIV/TB patients within a 12 months period after discharge.
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Affiliation(s)
- Zhe Zhang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Ling Xu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College
| | - Xiaoli Pang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Yongqin Zeng
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Health Science Center, Beijing University
| | - Yiwei Hao
- Division of Medical Records and Statistics, Beijing Ditan Hospital, Capital Medical University
| | - Yu Wang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Liang Wu
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Guiju Gao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Di Yang
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Hongxin Zhao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
| | - Jiang Xiao
- Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University.,The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University
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21
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Jiang J, Qin F, Meng S, Nehl EJ, Huang J, Liu Y, Zou J, Dong W, Huang J, Chen H, Zang N, Liang B, Ning C, Liao Y, Luo C, Liu H, Liu X, Wang J, Zhou O, Le T, Ye L, Wu F, Liang H. Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/AIDS patients receiving antiretroviral therapy: a retrospective cohort study. Emerg Microbes Infect 2019; 8:367-376. [PMID: 31851879 PMCID: PMC6455230 DOI: 10.1080/22221751.2019.1588078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folic acid synthesis which is important for the survival of many bacteria, protozoa, and fungi and has been used to prevent several opportunistic infections among HIV/AIDS patients. We question whether CTX is effective in preventing TM infection. To investigate this question, we conducted an 11-year (2005-2016) retrospective observational cohort study of all patients on the Chinese national antiretroviral therapy (ART) programme in Guangxi, a province with high HIV and TM burden in China. Survival analysis was conducted to investigate TM cumulative incidence, and Cox regression and propensity score matching (PSM) were used to evaluate the effect of CTX on TM incidence. Of the 3359 eligible individuals contributing 10,504.66 person-years of follow-up, 81.81% received CTX within 6 months after ART initiation, and 4.73% developed TM infection, contributing 15.14/1,000 person-year TM incidence rate. CTX patients had a significantly lower incidence of TM infection than non-CTX patients (4.11% vs. 7.53%; adjusted hazard ratio (aHR) = 0.50, 95% CI 0.35-0.73). CTX reduced TM incidence in all CD4+ cell subgroups (<50 cells/μL, 50-99 cells/μL, 100-199 cells/μL), with the highest reduction observed in patients with a baseline CD4+ cell count <50 cells/μL in both Cox regression and the PSM analyses. In conclusion, in addition to preventing other HIV-associated opportunistic infections, CTX prophylaxis has the potential to prevent TM infection in HIV/AIDS patients receiving ART.
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Affiliation(s)
- Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Fengxiang Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Sirun Meng
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Eric J. Nehl
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jinping Huang
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Yanfen Liu
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Jun Zou
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Wenyi Dong
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Hui Chen
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Ning Zang
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Chuanyi Ning
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Yanyan Liao
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Chaolian Luo
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Huifang Liu
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Xin Liu
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China
| | - Jian Wang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Oulu Zhou
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China
| | - Thuy Le
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China, Li Ye Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021, People’s Republic of China; Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Fengyao Wu
- Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China,Fengyao Wu Fourth People’s Hospital of Nanning, Nanning, Guangxi530021, People’s Republic of China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, People’s Republic of China,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People’s Republic of China,Hao Liang Guangxi Key Laboratory of AIDS Prevention and Treatment & Guangxi Universities Key Laboratory of Prevention and Control of Highly Prevalent Disease, School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021, People’s Republic of China; Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
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22
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Yang S, Li M, Cheng J, Wan G, Zhou Y, Jia H, Wei H, Song R, Sheng L, Wang H, Wang L, Hua W. Diagnostic determination of Norovirus infection as one of the major causes of infectious diarrhea in HIV patients using a multiplex polymerase chain reaction assay. Int J STD AIDS 2019; 30:550-556. [PMID: 30722749 DOI: 10.1177/0956462418824912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although infectious diarrhea is one of the most common complications in human immunodeficiency virus (HIV)-infected patients, robust diagnostic methods for determining potential pathogens are still limited in the clinic. Norovirus, a type of calicivirus, has been shown to be the most common cause of gastroenteritis. Here, we used multiplex polymerase chain reaction as a diagnostic tool to verify Norovirus as the diarrhea-related pathogen in HIV-infected patients with unknown etiological information. Stool specimens obtained from 81 HIV-infected patients with diarrhea were analyzed by BioFire FilmArray Gastrointestinal (GI) panel. Among 26 HIV-infected patients with unknown etiological information, we detected Norovirus in 14 stool specimens of these patients with 100% sensitivity and specificity as confirmed by reverse transcription polymerase chain reaction (RT-PCR), and one specimen showed both Norovirus and enterotoxigenic Escherichia coli infection. Among the remaining 55 patients with verified Clostridium difficile infection, nine patients also detected positive for Norovirus infection. In conclusion, using FilmArray GI panel and RT-PCR, we determined that Norovirus infection as one of the main pathogens responsible for diarrhea in HIV patients.
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Affiliation(s)
- Siyuan Yang
- 1 The Laboratory of Infectious Diseases Centre, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Li
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jingwei Cheng
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Gang Wan
- 3 Medical Information Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yunao Zhou
- 4 Department of Research and Education, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongyu Jia
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongshan Wei
- 5 Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rui Song
- 6 Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Linjun Sheng
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huizhu Wang
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Linghang Wang
- 7 Department of Emergency, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wenhao Hua
- 2 Clinical Laboratory of Beijing Ditan Hospital, Capital Medical University, Beijing, China
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23
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Pang W, Shang P, Li Q, Xu J, Bi L, Zhong J, Pei X. Prevalence of Opportunistic Infections and Causes of Death among Hospitalized HIV-Infected Patients in Sichuan, China. TOHOKU J EXP MED 2018; 244:231-242. [PMID: 29563388 DOI: 10.1620/tjem.244.231] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Opportunistic infections (OIs) are the most significant complication of human immunodeficiency virus (HIV) infection. The prevalence of OIs differs among various countries in part due to different climates and socio-economic conditions. We, therefore, carried out the retrospective study at the Public Health Clinical Center of Chengdu, Sichuan to comprehensively investigate the prevalence of OIs, predictors of OIs, and risk factors for in-hospital death among HIV-infected patients. Sichuan in West China is characterized by the largest population living with HIV/Acquired immunodeficiency syndrome (AIDS) across China. In total, we reviewed 954 cases of HIV infection, admitted to the hospital during January 2014 to December 2015, and found that bacterial pneumonia (25.8%) was the most common OIs, followed by candida infection (18.3%), Pneumocystis jiroveci pneumonia (11.9%), tuberculosis (11.5%), infectious diarrhoea (9.3%), cryptococcus infection (7.3%), cytomegalovirus infection (4.9%), toxoplasmosis (4.6%), hepatitis C (4.0%), nontuberculous mycobacteria desease (2.2%) and Penicillium marneffei infection (0.3%). We also found two strongest risk factors for in-hospital mortality: CD4+T cell counts of less than 100 cells/μL and not receiving antiretroviral therapy. Moreover, the study revealed the specific pathogens causing bacterial pneumonia and/or candida infection, the effect of tuberculosis on CD4+T cell counts, and the drug resistance of Mycobacterium tuberculosis among HIV-infected and non-HIV-infected patients. The present findings may aid in the clinical diagnosis and treatment of HIV-infected patients, and could help developing efficient public health strategies in China.
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Affiliation(s)
- Wenwen Pang
- Department of West China School of Public Health, No.4 West China Teaching Hospital, Sichuan University
| | - Pengcheng Shang
- Department of Laboratory, Public Health Clinical Center of Chengdu
| | - Qingfeng Li
- Department of Laboratory, Public Health Clinical Center of Chengdu
| | - Jiao Xu
- Department of Laboratory, Public Health Clinical Center of Chengdu
| | - Lei Bi
- Department of Laboratory, Public Health Clinical Center of Chengdu
| | - Jing Zhong
- Department of Laboratory, Public Health Clinical Center of Chengdu
| | - Xiaofang Pei
- Department of West China School of Public Health, No.4 West China Teaching Hospital, Sichuan University
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24
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Raberahona M, Razafinambinintsoa T, Andriananja V, Ravololomanana N, Tongavelona J, Rakotomalala R, Andriamamonjisoa J, Andrianasolo RL, Rakotoarivelo RA, Randria MJDD. Hospitalization of HIV positive patients in a referral tertiary care hospital in Antananarivo Madagascar, 2010-2016: Trends, causes and outcome. PLoS One 2018; 13:e0203437. [PMID: 30161228 PMCID: PMC6117088 DOI: 10.1371/journal.pone.0203437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND During the last few years, significant efforts have been made to improve access to antiretroviral therapy which led to dramatic reduction in AIDS-related events and mortality in HIV positive patients at the global level. However, current data in Africa suggested modest impact of widespread antiretroviral therapy scale-up especially regarding HIV-related hospitalization. In this study, we aimed to describe causes of hospitalization and factors associated with AIDS-defining events and inpatient mortality. MATERIALS AND METHODS A retrospective study was performed on medical records of HIV positive patients admitted for at least 24 hours in the Infectious Diseases Unit of the University Hospital Joseph Raseta Befelatanana Antananarivo. Cause of hospitalization was considered as the main diagnosis related to the symptoms at admission. Diagnostic criteria were based on criteria described in WHO guidelines. AIDS-defining events were defined as diseases corresponding to WHO stage 4 or category C of CDC classification. RESULTS From 2010 to 2016, 236 hospital admissions were included. AIDS-defining events were the most frequent cause of hospitalization (61.9%) with an increasing trend during the study period. Tuberculosis (28.4%), pneumocystis pneumonia (11.4%), cerebral toxoplasmosis (7.2%) and cryptococcosis (5.5%) were the most frequent AIDS-defining events. Tuberculosis was also the most frequent cause of overall hospitalization. In multivariate analysis, recent HIV diagnosis (aOR = 2.0, 95% CI: 1.0-3.9), CD4<200 cells/μl (aOR = 4.0, 95%CI: 1.9-8.1), persistent fever (aOR = 4.4, 95%CI: 2.1-9.0), duration of symptoms≥ 6 weeks (aOR = 2.6, 95%CI: 1.2-5.4) were associated with AIDS-defining events. Overall inpatient mortality was 19.5%. Age≥55 years (aOR = 4.9, 95%CI: 1.5-16.6), neurological signs (aOR = 3.2, 95%CI: 1.5-6.9) and AIDS-defining events (aOR = 2.9, 95%CI: 1.2--7.2) were associated with inpatient mortality. CONCLUSIONS AIDS-defining events were the most frequent cause of hospitalization during the study period. Factors associated with AIDS-defining events mostly reflected delay in HIV diagnosis. Factors associated with mortality were advanced age, neurological signs and AIDS-defining events.
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Affiliation(s)
- Mihaja Raberahona
- Infectious Diseases Unit, University Hospital Joseph Raseta Befelatanana, University Hospital of Antananarivo, Antananarivo, Madagascar
- * E-mail:
| | | | - Volatiana Andriananja
- Infectious Diseases Unit, University Hospital Joseph Raseta Befelatanana, University Hospital of Antananarivo, Antananarivo, Madagascar
| | | | - Juliana Tongavelona
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
- Infectious Diseases Unit, University Hospital of Tambohobe, Fianarantsoa, Madagascar
| | - Rado Rakotomalala
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
| | | | | | - Rivonirina Andry Rakotoarivelo
- Infectious Diseases Unit, University Hospital of Tambohobe, Fianarantsoa, Madagascar
- University of Fianarantsoa, Fianarantsoa, Madagascar
| | - Mamy Jean de Dieu Randria
- Infectious Diseases Unit, University Hospital Joseph Raseta Befelatanana, University Hospital of Antananarivo, Antananarivo, Madagascar
- Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar
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25
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Song J, Wang G, Hoenerhoff MJ, Ruan J, Yang D, Zhang J, Yang J, Lester PA, Sigler R, Bradley M, Eckley S, Cornelius K, Chen K, Kolls JK, Peng L, Ma L, Chen YE, Sun F, Xu J. Bacterial and Pneumocystis Infections in the Lungs of Gene-Knockout Rabbits with Severe Combined Immunodeficiency. Front Immunol 2018; 9:429. [PMID: 29593714 PMCID: PMC5854650 DOI: 10.3389/fimmu.2018.00429] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/16/2018] [Indexed: 01/07/2023] Open
Abstract
Using the CRISPR/Cas9 gene-editing technology, we recently produced a number of rabbits with mutations in immune function genes, including FOXN1, PRKDC, RAG1, RAG2, and IL2RG. Seven founder knockout rabbits (F0) and three male IL2RG null (-/y) F1 animals demonstrated severe combined immunodeficiency (SCID), characterized by absence or pronounced hypoplasia of the thymus and splenic white pulp, and absence of immature and mature T and B-lymphocytes in peripheral blood. Complete blood count analysis showed severe leukopenia and lymphocytopenia accompanied by severe neutrophilia. Without prophylactic antibiotics, the SCID rabbits universally succumbed to lung infections following weaning. Pathology examination revealed severe heterophilic bronchopneumonia caused by Bordetella bronchiseptica in several animals, but a consistent feature of lung lesions in all animals was a severe interstitial pneumonia caused by Pneumocystis oryctolagi, as confirmed by histological examination and PCR analysis of Pneumocystis genes. The results of this study suggest that these SCID rabbits could serve as a useful model for human SCID to investigate the disease pathogenesis and the development of gene and drug therapies.
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Affiliation(s)
- Jun Song
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Guoshun Wang
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Mark J. Hoenerhoff
- In Vivo Animal Core, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jinxue Ruan
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Dongshan Yang
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jifeng Zhang
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jibing Yang
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Patrick A. Lester
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Robert Sigler
- In Vivo Animal Core, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Michael Bradley
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Samantha Eckley
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kelsey Cornelius
- Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kong Chen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jay K. Kolls
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Li Peng
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Liang Ma
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Yuqing Eugene Chen
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Fei Sun
- Wayne State University School of Medicine, Detroit, MI, United States
| | - Jie Xu
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, University of Michigan Medical School, Ann Arbor, MI, United States
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Styczynski J. Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation. Infect Dis Ther 2017; 7:1-16. [PMID: 29204910 PMCID: PMC5840099 DOI: 10.1007/s40121-017-0180-z] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Indexed: 01/15/2023] Open
Abstract
Cytomegalovirus (CMV) is an agent of global infection, and its acquisition in a population is characterized by an age-dependent rise in seropositivity. After primary infection, CMV remains in the host cells in latent form, and it can reactivate in the case of immune suppression. The risk of CMV recurrence is dependent on the level of incompetency of the immune system, manifested as an impairment of T-cell immunity, including the presence and function of CMV-specific cytotoxic T lymphocytes. This article presents data on the incidence of CMV recurrence in groups of immunocompromised patients, including allogeneic hematopoietic stem cell transplantation (HSCT) patients and other groups of patients, based on a summary of reported data. The median rate of CMV recurrence in HSCT recipients was estimated as 37% after allogeneic transplant and 12% after autologous transplant, 5% in patients with nontransplant hematological malignancies, 14% in recipients of anti-CD52 therapy, 30% in solid organ transplant recipients, 21% in patients with primary immunodeficiencies, 20% during active replication in HIV-positive patients and 3.3% during antiretroviral therapy, 7% in patients with chronic kidney disease, 0.6% in patients with congenital infection, and 0.6% in neonates with primary infection. The highest risk of CMV recurrence and CMV disease is reported for HSCT CMV-seropositive recipients, regardless of donor serostatus. The odds ratio (OR) for CMV recurrence is higher for recipient-positive versus recipient-negative CMV serostatus transplants (OR 8.0), donor-negative/recipient-positive versus donor-positive/recipient-positive CMV serostatus transplants (OR 1.2), unrelated/mismatched versus matched-family donor transplants (OR 1.6), and acute graft-versus-host-disease versus other diseases (OR 3.2). Other risk factors have minor significance.
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Affiliation(s)
- Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
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27
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de Azevedo MI, Da Silva AS, Ferreiro L, Doleski PH, Tonin AA, Casali EA, Moritz CE, Schirmbeck GH, Cardoso VV, Flores MM, Fighera R, Santurio JM. Serum and brain purine levels in an experimental systemic infection of mice by Cryptococcus neoformans : Purinergic immunomodulatory effects. Microb Pathog 2017; 113:124-128. [DOI: 10.1016/j.micpath.2017.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/04/2017] [Accepted: 10/12/2017] [Indexed: 12/20/2022]
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28
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Li Z, Du S, Xiao Z, Xiao J. Clinical complications of antiretroviral therapy in HIV/TB patients in referral hospital, China. Future Virol 2017. [DOI: 10.2217/fvl-2016-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Aim: The aim was to highlight the clinical complications and to evaluate risk factors of mortality in Chinese HIV/TB patients. Methods: The etiology of clinical deterioration of Chinese HIV/TB patients were evaluated in 180 HIV-infected patients admitted in the Beijing Ditan Hospital between 1 January 2012 and 30 April 2014. Results & conclusion: AIDS-defining illnesses (20.0%) were the most common complication, followed by TB-associated immune reconstitution inflammatory syndrome (16.6%), drug-induced liver injury (11.1%), drug rash (11.1%), non-AIDS-defining illness (5.6%), as well as highly active antiretroviral therapy resistance (3.3%). The risk factors for mortality were tuberculous meningitis associated immune reconstitution inflammatory syndrome (OR: 152.614; CI: 18.324–1263.615; p < 0.001) and non-AIDS-defining illnesses (OR: 114.133; CI: 12.939–1006.752; p < 0.001), which will help remind physicians of the risk of clinical deterioration in HIV/TB patients after antiretroviral therapy in China.
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Affiliation(s)
- Ziyuan Li
- Wuhan Iron & Steel Corporation (WISCO) Worker's Hospital (Huarun-WISCO Hospital), Baiyushan Street, Qingshan District, Wuhan 430085, China
| | - Shuxu Du
- Beijing Shijitan Hospital, Capital Medical University, No.10 Tieyi Road, Haidian District, Beijing 100020, China
| | - Zhengyun Xiao
- Wuhan Iron & Steel Corporation (WISCO) Worker's Hospital (Huarun-WISCO Hospital), Baiyushan Street, Qingshan District, Wuhan 430085, China
| | - Jiang Xiao
- The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing 100015, China
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