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Jang Y, Kim T, Choi Y, Ahn KH, Kim JH, Seong H, Kim YJ, Kim SW, Choi JY, Kim HY, Song JY, Choi HJ, Kim SI, Sohn JW, Chin B, Choi BY, Park B. Association between obesity and cancer risk in adults with HIV in Korea. AIDS 2024; 38:1386-1394. [PMID: 38597513 PMCID: PMC11216375 DOI: 10.1097/qad.0000000000003904] [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: 12/10/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION This study aimed to investigate the association between obesity and cancer risk as well as site-specific cancer risks in adults with HIV using a nationwide health screening database in Korea. METHODS Of the 16,671 adults with a new diagnosis of HIV from 2004 to 2020, 456 incident cancer cases and 1814 individually matched controls by sex, year of birth, year of HIV diagnosis, and follow-up duration (1 : 4 ratio) were included in this nested case-control study. The association between obesity (BMI ≥25 kg/m 2 ) and cancer risks was estimated and presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Of the 456 cancer incident cases, there were 146 AIDS-defining cancer cases and 310 non-AIDS-defining cancer cases. Compared with nonobese adults with HIV, obese adults with HIV were at higher risk of non-AIDS-defining cancer (OR = 1.478, 95% CI = 1.118-1.955). Otherwise, the overall risk of AIDS-defining cancer (OR = 0.816, 95% CI = 0.520-1.279) and each type of AIDS-defining cancer (Kaposi sarcoma and non-Hodgkin's lymphoma) were not high in obese adults with HIV. Of the specific types of non-AIDS-defining cancers, obesity was associated with an increased risk of colorectal cancer (OR = 3.090, 95% CI = 1.110-8.604) and liver, bile duct, and pancreatic cancers (OR = 2.532, 95% CI = 1.141-5.617). CONCLUSION Obesity, which is one of the important health concerns in HIV management, was associated with an increased risk of non-AIDS-defining cancer but not AIDS-defining cancer.
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Affiliation(s)
- Yoonyoung Jang
- Department of Preventive Medicine, Hanyang University College of Medicine
- Department of Agricultural Economics and Rural Development, Seoul National University
| | - Taehwa Kim
- Department of Preventive Medicine, Hanyang University College of Medicine
- Department of Psychology, Sungkyunkwan University
| | - Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Kyoung Hwan Ahn
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Jung Ho Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Jun Yong Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine
| | - Hyo Youl Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Hee Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University College of Medicine
| | - Sang Il. Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Bo-Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine
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Nazari I, Feinstein MJ. Evolving mechanisms and presentations of cardiovascular disease in people with HIV: implications for management. Clin Microbiol Rev 2024; 37:e0009822. [PMID: 38299802 PMCID: PMC10938901 DOI: 10.1128/cmr.00098-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
People with HIV (PWH) are at elevated risk for cardiovascular diseases (CVDs), including myocardial infarction, heart failure, and sudden cardiac death, among other CVD manifestations. Chronic immune dysregulation resulting in persistent inflammation is common among PWH, particularly those with sustained viremia and impaired CD4+ T cell recovery. This inflammatory milieu is a major contributor to CVDs among PWH, in concert with common comorbidities (such as dyslipidemia and smoking) and, to a lesser extent, off-target effects of antiretroviral therapy. In this review, we discuss the clinical and mechanistic evidence surrounding heightened CVD risks among PWH, implications for specific CVD manifestations, and practical guidance for management in the setting of evolving data.
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Affiliation(s)
- Ilana Nazari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J. Feinstein
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology in the Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abrantes R, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção B, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, Gomes da Silva E, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, Saraiva da Cunha J, Soares J, Fernandes S, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, Correia de Abreu R, Côrte-Real R, Serrão R, Sarmento e Castro R, Nunes S, Faria T, Baptista T, Simões D, Mendão L, Martins MRO, Gomes P, Pingarilho M, Abecasis AB. Determinants of HIV late presentation among men who have sex with men in Portugal (2014-2019): who's being left behind? Front Public Health 2024; 12:1336845. [PMID: 38500732 PMCID: PMC10947991 DOI: 10.3389/fpubh.2024.1336845] [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: 11/11/2023] [Accepted: 01/26/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction HIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019. Methods We included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP). Results The median age was 31 years, 51% had a current income between 501-1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP. Conclusion Our study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.
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Affiliation(s)
- Ricardo Abrantes
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Mafalda N. S. Miranda
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Bianca Ascenção
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Sta Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina 1.4, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina 2, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - José Saraiva da Cunha
- Serviço de Infeciologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sandra Fernandes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital Curry Cabral, Centro Hospitalar de Lisboa, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- U. Imunodeficiência, Hospital Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Dr. Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina 3, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Luis Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - M. Rosário O. Martins
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Almada, Portugal
| | - Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
| | - Ana B. Abecasis
- Global Health and Tropical Medicine (GHTM), Associate Laboratory in Translation and Innovation Towards Global Health (LA-REAL), Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT/UNL), Lisbon, Portugal
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Vallée A, Majerholc C, Zucman D, Livrozet JM, Laurendeau C, Bouée S, Prevoteau du Clary F. Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18. Eur J Public Health 2024:ckae031. [PMID: 38409963 DOI: 10.1093/eurpub/ckae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France. METHODS Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models. RESULTS During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)]. CONCLUSION Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, France
| | - Catherine Majerholc
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - David Zucman
- Department of Internal Medicine, Réseau Ville-Hôpital Val de Seine, Foch Hospital, Suresnes, France
| | - Jean-Michel Livrozet
- Department of Infectious and Tropical Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Kanitkar T, Dissanayake O, Bakewell N, Symonds M, Rimmer S, Adlakha A, Lipman MC, Bhagani S, Sabin CA, Agarwal B, Miller RF. Changes in short-term (in-ICU and in-hospital) mortality following intensive care unit admission in adults living with HIV: 2000-2019. AIDS 2023; 37:2169-2177. [PMID: 37605448 PMCID: PMC10621640 DOI: 10.1097/qad.0000000000003683] [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: 04/24/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Limited data suggest intensive care unit (ICU) outcomes have improved in people with HIV (PWH). We describe trends in in-ICU/in-hospital mortality among PWH following admission to ICU in a single UK-based HIV referral centre, from 1 January 2000 to 31 December 2019. METHODS Modelling of associations between ICU admission and calendar year of admission was done using logistic regression with adjustment for age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, CD4 + T-cell count and diagnosis of HIV at/within the past 3 months. RESULTS Among 221 PWH (71% male, median [interquartile range (IQR)] age 45 years [38-53]) admitted to ICU, median [IQR] APACHE II score and CD4 + T-cell count were 19 [14-25] and 122 cells/μl [30-297], respectively; HIV-1 viral load was ≤50 copies/ml in 46%. The most common ICU admission diagnosis was lower respiratory tract infection (30%). In-ICU and in-hospital, mortality were 29 and 38.5%, respectively. The odds of in-ICU mortality decreased over the 20-year period by 11% per year [odds ratio (OR): 0.89 (95% confidence interval (CI): 0.84-0.94)] with in-hospital mortality decreasing by 14% per year [0.86 (0.82-0.91)]. After adjusting for patient demographics and clinical factors, both estimates were attenuated, however, the odds of in-hospital mortality continued to decline over time [in-ICU mortality: adjusted OR: 0.97 (0.90-1.05); in-hospital mortality: 0.90 (0.84-0.97)]. CONCLUSION Short-term mortality of critically ill PWH admitted to ICU has continued to decline in the ART era. This may result from changing indications for ICU admission, advances in critical care and improvements in HIV-related immune status.
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Affiliation(s)
- Tanmay Kanitkar
- Intensive Care Unit
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
| | - Oshani Dissanayake
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
| | - Nicholas Bakewell
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health
| | - Maggie Symonds
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
| | | | | | - Marc C.I. Lipman
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
- UCL Respiratory, Division of Medicine, University College London
- Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust
| | - Sanjay Bhagani
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
| | - Caroline A. Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections
| | | | - Robert F. Miller
- HIV Services, Royal Free Hospital, Royal Free London NHS Foundation Trust
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
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Ahmed A, Dujaili JA, Chuah LH, Hashmi FK, Le LKD, Chatha ZF, Khanal S, Awaisu A, Chaiyakunapruk N. Cost-Effectiveness Analysis of Pharmacist Adherence Interventions in People Living with HIV/AIDS in Pakistan. Healthcare (Basel) 2023; 11:2453. [PMID: 37685487 PMCID: PMC10487586 DOI: 10.3390/healthcare11172453] [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: 07/21/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Evidence has shown the positive impact of pharmacist involvement on the adherence and health outcomes of people living with HIV/AIDS. However, whether such intervention provides value for money remains unclear. This study aims to fill this gap by assessing the cost-effectiveness of pharmacist interventions in HIV care in Pakistan. Methods: A Markov decision analytic model was constructed, considering clinical inputs, utility data, and cost data obtained from a randomized controlled trial and an HIV cohort of Pakistani origin. The analysis was conducted from a healthcare perspective, and the incremental cost-effectiveness ratio (ICER) was calculated and presented for the year 2023. Additionally, a series of sensitivity analyses were performed to assess the robustness of the results. Results: Pharmacist intervention resulted in higher quality-adjusted life years (4.05 vs. 2.93) and likewise higher annual intervention costs than usual care (1979 USD vs. 429 USD) (532,894 PKR vs. 115,518 PKR). This yielded the ICER of 1383 USD/quality-adjusted life years (QALY) (372,406 PKR/QALY), which is well below the willingness-to-pay threshold of 1658 USD (446,456 PKR/QALY) recommended by the World Health Organization Choosing Interventions that are Cost-Effective. Probabilistic sensitivity analysis reported that more than 68% of iterations were below the lower limit of threshold. Sensitivity analysis reported intervention cost is the most important parameter influencing the ICER the most. Conclusion: The study suggests that involving pharmacists in HIV care could be a cost-effective approach. These findings could help shape healthcare policies and plans, possibly making pharmacist interventions a regular part of care for people with HIV in Pakistan.
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Affiliation(s)
- Ali Ahmed
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
- Swansea University Medical School, Singleton Campus, Swansea University, Wales SA1 8EN, UK
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Subang Jaya 47500, Selangor, Malaysia
| | - Furqan Khurshid Hashmi
- Punjab University College of Pharmacy, University of Punjab, Allama Iqbal Campus, Lahore 54000, Pakistan
| | - Long Khanh Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Zeenat Fatima Chatha
- Department of Community Medicine and Global Health, University of Oslo, 0318 Oslo, Norway
| | - Saval Khanal
- Health Economics Consulting, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Ahmed Awaisu
- Department of Clinical Pharmacy & Practice, College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
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Croxford SE, Martin V, Lucas SB, Miller RF, Post FA, Anderson J, Apea VJ, Asboe D, Brough G, Chadwick DR, Collins S, Corkin H, Dean G, Delpech VC, Gogia M, Gold D, Kafkalias A, Korkodilos M, Kowalska JD, Lindo J, Lundgren JD, Lynch L, Martinez E, McDougall N, North S, Rockstroh JK, Sabin C, Vidal-Read M, Waters LJ, Sullivan AK. Recommendations for defining preventable HIV-related mortality for public health monitoring in the era of Getting to Zero: an expert consensus. Lancet HIV 2023; 10:e195-e201. [PMID: 36610439 DOI: 10.1016/s2352-3018(22)00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023]
Abstract
Getting to Zero is a commonly cited strategic aim to reduce mortality due to both HIV and avoidable deaths among people with HIV. However, no clear definitions are attached to these aims with regard to what constitutes HIV-related or preventable mortality, and their ambition is limited. This Position Paper presents consensus recommendations to define preventable HIV-related mortality for a pragmatic approach to public health monitoring by use of national HIV surveillance data. These recommendations were informed by a comprehensive literature review and agreed by 42 international experts, including clinicians, public health professionals, researchers, commissioners, and community representatives. By applying the recommendations to 2019 national HIV surveillance data from the UK, we show that 30% of deaths among people with HIV were HIV-related or possibly HIV-related, and at least 63% of these deaths were preventable or potentially preventable. The application of these recommendations by health authorities will ensure consistent monitoring of HIV elimination targets and allow for the identification of inequalities and areas for intervention.
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Affiliation(s)
| | | | | | - Robert F Miller
- Central and North West London NHS Foundation Trust, London, UK; Royal Free London NHS Foundation Trust, London, UK; Institute of Global Health, University College London, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK; Department of Inflammation Biology, King's College London, London, UK
| | | | - Vanessa J Apea
- Barts Health NHS Trust, London, UK; British Association for Sexual Health and HIV, London, UK
| | - David Asboe
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Garry Brough
- Fast-Track Cities Initiative London, London, UK; Positively UK, London, UK; UK Community Advisory Board, London, UK
| | - David R Chadwick
- British HIV Association, London, UK; South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Simon Collins
- UK Community Advisory Board, London, UK; HIV i-Base, London, UK
| | | | - Gillian Dean
- University Hospitals Sussex NHS Trust, Brighton, UK
| | | | - Maka Gogia
- European AIDS Treatment Group, Brussels, Belgium
| | | | | | | | - Justyna D Kowalska
- Medical University of Warsaw, Warsaw, Poland; European AIDS Clinical Society, Brussels, Belgium
| | | | - Jens D Lundgren
- European AIDS Clinical Society, Brussels, Belgium; Centre of Excellence of Health, Immunity and Infections, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | | | - Esteban Martinez
- European AIDS Clinical Society, Brussels, Belgium; Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Sarah North
- European AIDS Treatment Group, Brussels, Belgium
| | - Juergen K Rockstroh
- European AIDS Clinical Society, Brussels, Belgium; University Hospital Bonn, Bonn, Germany
| | - Caroline Sabin
- Institute of Global Health, University College London, London, UK; British HIV Association, London, UK; National Institute for Health and Care Research Health Protection Research Unit in Blood-Borne and Sexually Transmitted Infections, London, UK
| | | | - Laura J Waters
- Central and North West London NHS Foundation Trust, London, UK; British HIV Association, London, UK
| | - Ann K Sullivan
- UK Health Security Agency, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; British HIV Association, London, UK; European AIDS Clinical Society, Brussels, Belgium
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8
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Aso K, Ito K, Takemura N, Tsukada K, Inagaki F, Mihara F, Oka S, Kokudo N. Outcomes following cholecystectomy in human immunodeficiency virus-positive patients treated with antiretroviral therapy: A retrospective cohort study. Glob Health Med 2022; 4:309-314. [PMID: 36589218 PMCID: PMC9773219 DOI: 10.35772/ghm.2022.01051] [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: 07/16/2022] [Revised: 12/02/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
The number of the human immunodeficiency virus (HIV)-positive patients are increasing worldwide, and more HIV-positive patients are undergoing urgent or elective cholecystectomy. There is still insufficient evidence on the relationship between surgical complications of cholecystectomy and antiviral status in HIV-positive patients. The purpose of the present study is to evaluate surgical outcomes after cholecystectomy in HIV-positive patients. Records of consecutive HIV-positive patients who underwent cholecystectomy between January 2010 and December 2020 were reviewed retrospectively. Patients were divided into urgent and elective surgery groups. Urgent surgery was defined as surgery within 48 hours of admission. Postoperative complications were evaluated according to the Clavien-Dindo classification. A total of 30 HIV-positive patients underwent urgent (n = 7) or elective (n = 23) cholecystectomy. Four complications (13.3%) occurred, and the rate was significantly higher in the urgent group than in the elective group (p = 0.008). However, all complications were minor (3 cases of grade I and one case of grade II), and there were no severe postoperative complications. There was no significant difference in CD4+ lymphocyte status in all patients and between the 2 groups before and after surgery (p = 0.133). No cases of postoperative deterioration in the control of HIV infection were observed. In conclusion, cholecystectomy in HIV-positive patients with controlled HIV under recent antiretroviral therapy may be performed safely even in an emergency situation.
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Affiliation(s)
- Kenta Aso
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kyoji Ito
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan;,Address correspondence to:Nobuyuki Takemura, Hepato-Biliary Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162- 8655, Japan. E-mail:
| | - Kunihisa Tsukada
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
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9
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Burgos J, Moreno-Fornés S, Reyes-Urueña J, Bruguera A, Martín-Iguacel R, Raventos B, Llibre JM, Imaz A, Peraire J, Orti AJ, Dalmau D, Casabona J, Miró JM, Falcó V, Esteve A, Fanjul F, Falcó V, Knobel H, Mallolas J, Tiraboschi J, Curran A, Burgos J, Revollo B, Gracia M, Gutierrez MDM, Murillas J, Homar F, Fernández-Montero JV, González E, Peraire J, Force L, Leon E, Hortos M, Vilaró I, Orti A, Dalmau D, Jaen À, Lazzari ED, Berrocal L, Rodríguez L, Gargoulas F, Vanrell T, Carlos J, Vilà J, Martínez M, Morell B, Tamayo M, Palacio J, Ambrosioni J, Laguno M, Martínez-Rebollar M, Blanco JL, Garcia F, Torres B, Mora LDL, Inciarte A, Ugarte A, Chivite I, González-Cordon A, Leal L, Jou A, Negredo E, Saumoy M, Silva A, Scévola S, Suanzes P, Alvarez P, Mur I, Jaume MR, García-Gasalla M, Ribas MÀ, Campins AA, Peñaranda M, Martin ML, Haydee H, Calzado S, Cervantes M, Navarro M, Payeras A, Cifuentes C, Villoslada A, Sorní P, Molero M, Abdulghani N, Comella T, Sola R, Vargas M, Viladés C, Martí A, Yeregui E, Rull A, Barrufet P, Arbones L, Chamarro E, Escrig C, Cairó M, Martinez-Lacasa X, Font R, Macorigh L, Hernández J. Mortality and immunovirological outcomes in patients with advanced HIV disease on their first antiretroviral treatment: differential impact of antiretroviral regimens. J Antimicrob Chemother 2022; 78:108-116. [PMID: 36308326 DOI: 10.1093/jac/dkac361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To assess the clinical and immunovirological outcomes among naive patients with advanced HIV presentation starting an antiretroviral regimen in real-life settings. METHODS This was a multicentre, prospective cohort study. We included all treatment-naive adults with advanced HIV disease (CD4+ T cell count < 200 cells/mm3or presence of an AIDS-defining illness) who started therapy between 2010 and 2020. The main outcomes were mortality, virological effectiveness (percentage of patients with viral load of ≤50 copies/mL) and immune restoration (percentage of patients with CD4+ T cell count above 350 cells/mm3). Competing risk analysis and Cox proportional models were performed. A propensity score-matching procedure was applied to assess the impact of the antiretroviral regimen. RESULTS We included 1594 patients with advanced HIV disease [median CD4+T cell count of 81 cells/mm3and 371 (23.3%) with AIDS-defining illness] and with a median follow-up of 4.44 years. The most common ART used was an integrase strand transfer inhibitor (InSTI) regimen (46.9%), followed by PI (35.7%) and NNRTI (17.4%), with adjusted mortality rates at 3 years of 3.1% (95% CI 1.8%-4.3%), 4.7% (95% CI 2.2%-7.1%) and 7.6% (95% CI 5.4%-9.7%) (P = 0.001), respectively. Factors associated with increased mortality included older age and history of injection drug use, whilst treatment with an InSTI regimen was a protective factor [HR 0.5 (95% CI 0.3-0.9)]. A sensitivity analysis with propensity score procedure confirms these results. Patients who started an InSTI achieved viral suppression and CD4+ T cell count above 350 cells/mm3significantly earlier. CONCLUSIONS In this large real-life prospective cohort study, a significant lower mortality, earlier viral suppression and earlier immune reconstitution were observed among patients with advanced HIV disease treated with InSTIs.
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Affiliation(s)
- Joaquin Burgos
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Sergio Moreno-Fornés
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain
| | - Juliana Reyes-Urueña
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreu Bruguera
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain
| | - Raquel Martín-Iguacel
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Berta Raventos
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Arkaitz Imaz
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, L'Hospitales de Llobregat, Spain
| | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitaria Pere Virgili (IISPV), Tarragona, Spain
| | | | - David Dalmau
- Hospital Universitari MutuaTerrassa, Terrassa, University of Barcelona (Catalonia), Spain
| | - Jordi Casabona
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, Badalona, Spain.,Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain.,Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep M Miró
- Infectious Diseases Clínic. Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Vicenç Falcó
- Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Research Institute (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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10
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Bakewell N, Kanitkar T, Dissanayake O, Symonds M, Rimmer S, Adlakha A, Lipman MC, Bhagani S, Agarwal B, Miller RF, Sabin CA. Estimating the risk of mortality attributable to recent late HIV diagnosis following admission to the intensive care unit: A single-centre observational cohort study. HIV Med 2022; 23:1163-1172. [PMID: 36404292 PMCID: PMC10099479 DOI: 10.1111/hiv.13436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Despite improvements in survival of people with HIV admitted to the intensive care unit (ICU), late diagnosis continues to contribute to in-ICU mortality. We quantify the population attributable fraction (PAF) of in-ICU mortality for recent late diagnosis among people with HIV admitted to a London ICU. METHODS Index ICU admissions among people with HIV were considered from 2000 to 2019. Recent late diagnosis was a CD4 T-cell count < 350 cells/μL and/or AIDS-defining illness at/within 6 months prior to ICU admission. Univariate comparisons were conducted using Wilcoxon rank-sum/Cochran-Armitage/χ2 /Fisher's exact tests. We used Poisson regression (robust standard errors) to estimate unadjusted/adjusted (age, sex, calendar year of ICU admission) risk ratios (RRs) and regression standardization to estimate the PAF. RESULTS In all, 207 index admissions were included [median (interquartile range) age: 46 (38-53) years; 72% male]; 58 (28%) had a recent late diagnosis, all of whom had a CD4 count < 350 cells/μL, and 95% had advanced HIV (CD4 count < 200 cells/μL and/or AIDS at admission) as compared with 57% of those who did not have a recent late diagnosis (p < 0.001). In-ICU mortality was 27% (55/207); 38% versus 22% in those who did and did not have a recent late diagnosis, respectively (p = 0.02). Recent late diagnosis was independently associated with increased in-ICU mortality risk (adjusted RR = 1.75) (95% confidence interval: 1.05-2.91), with 17.08% (16.04-18.12%) of deaths being attributable to this. CONCLUSIONS There is a need for improved public health efforts focused on HIV testing and reporting of late diagnosis to better understand potentially missed opportunities for earlier HIV diagnosis in healthcare services.
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Affiliation(s)
- Nicholas Bakewell
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Tanmay Kanitkar
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Oshani Dissanayake
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Maggie Symonds
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Stephanie Rimmer
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Amit Adlakha
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Marc C Lipman
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK.,Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Banwari Agarwal
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Robert F Miller
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
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11
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Park B, Choi Y, Kim JH, Seong H, Kim YJ, Lee M, Seong J, Kim SW, Song JY, Choi HJ, Park DW, Kim HY, Choi JY, Kim SI, Choi BY. Mortality and Causes of Death among Individuals Diagnosed with Human Immunodeficiency Virus in Korea, 2004-2018: An Analysis of a Nationwide Population-Based Claims Database. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11788. [PMID: 36142061 PMCID: PMC9517230 DOI: 10.3390/ijerph191811788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
The mortality rate and causes of death among individuals diagnosed with human immunodeficiency virus (HIV) infection in Korea were described and compared to those of the general population of Korea using a nationwide population-based claims database. We included 13,919 individuals aged 20-79 years newly diagnosed with HIV between 2004 and 2018. The patients' vital status and cause of death were linked until 31 December 2019. Standardized mortality ratios (SMRs) for all-cause death and specific causes of death were calculated. By the end of 2019, 1669 (12.0%) of the 13,919 HIV-infected participants had died. The survival probabilities of HIV-infected individuals at 1, 5, 10, and 15 years after diagnosis in Korea were 96.2%, 91.6%, 85.9%, and 79.6%, respectively. The main causes of death during the study period were acquired immunodeficiency syndrome (AIDS; 59.0%), non-AIDS-defining cancer (8.2%), suicide (7.4%), cardiovascular disease (4.9%), and liver disease (2.7%). The mortality rate of men and women infected with HIV was 5.60-fold (95% CI = 5.32-5.89) and 6.18-fold (95% CI = 5.30-7.09) that of men and women in the general population, respectively. After excluding deaths due to HIV, the mortality remained significantly higher, with an SMR of 2.16 (95% CI = 1.99-3.24) in men and 3.77 (95% CI = 3.06-4.48) in women. HIV-infected individuals had a higher overall mortality than the general population, with AIDS the leading cause of mortality. Additionally, mortality due to non-AIDS-related causes was higher in HIV-infected individuals.
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Affiliation(s)
- Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Yunsu Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- AIDS Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Youn Jeong Kim
- Division of Infectious Disease, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro Bupyeong-gu, Incheon 21431, Korea
| | - Myungsun Lee
- Division of Clinical Research, Center for Emerging Virus Research, National Institute of Infectious Diseases, Korea National Institute of Health, Osong Health Technology Administration Complex, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28159, Korea
| | - Jaehyun Seong
- Division of Clinical Research, Center for Emerging Virus Research, National Institute of Infectious Diseases, Korea National Institute of Health, Osong Health Technology Administration Complex, 187, Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si 28159, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Deagu 41944, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Hee-Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Anam-dong 5-ga, Seongbuk-gu, Seoul 08308, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 26426, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- AIDS Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
| | - Bo-Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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12
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Lee CY, Lin YP, Tu HP, Wang SF, Lu PL. Sex stratification of the trends and risk of mortality among individuals living with HIV under different transmission categories. Sci Rep 2022; 12:9266. [PMID: 35661129 PMCID: PMC9166722 DOI: 10.1038/s41598-022-13294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
We retrospectively examined 33,142 persons living with HIV (PLWH) in Taiwan from a nationwide database to assess sex-stratified trends and risk of all-cause mortality under different transmission categories from 1984 to 2016. Overall, 61.25% were men who have sex with men (MSM), 14.37% were men who have sex with women (MSW), 18.32% were male persons who inject drugs (M-PWID), 3.30% were women who have sex with men (WSM), and 2.74% were female PWID (F-PWID). All-cause mortality (per 100 person-years) among heterosexual people and PWID was higher in men (4.04 and 3.39, respectively) than in women (2.93 and 2.18, respectively). In each sex-stratified transmission category, the all-cause mortality reduced substantially from 1984–1996 to 2012–2016, but evolved distinctly from 2007–2011 to 2012–2016. Since 2007–2011, the decline in all-cause mortality has slowed notably in the groups with sexually transmitted HIV, but has increased in PWID, surpassing even that among groups with sexually transmitted HIV in 2012–2016. PLWH with sexually transmitted HIV had lower risks of all-cause mortality than PWID, regardless of sex. Sex and transmission category did not interact significantly on all-cause mortality. Understanding the reasons for the distinct evolving trends of all-cause mortality in each transmission category serves as a reference for developing strategies to reduce mortality in PLWH in Taiwan further.
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Affiliation(s)
- Chun-Yuan Lee
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.).,M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.)
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.). .,School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.). .,Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).
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13
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Morales DR, Moreno-Martos D, Matin N, McGettigan P. Health conditions in adults with HIV compared with the general population: A population-based cross-sectional analysis. EClinicalMedicine 2022; 47:101392. [PMID: 35497059 PMCID: PMC9046106 DOI: 10.1016/j.eclinm.2022.101392] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Life expectancy in adults with human immunodeficiency virus (HIV) has increased and managing other health conditions is increasingly important for patients and healthcare planning. The aim of this study was to examine the prevalence and association between different health conditions and HIV status. METHODS We performed a cross-sectional analysis of adult UK Clinical Practice Research Datalink primary care electronic medical records linked to hospital admissions as of Nov 30, 2015. We examined 47 health condition groups and 304 physical and mental health conditions by HIV status, after adjustment for age, sex, social deprivation status using logistic regression. FINDINGS There were 964 patients with HIV (61.7% male; 92.8% aged <65 years) and 941,113 non-HIV patients (49.4% male; 75.2% aged <65 years). Condition groups with the greatest prevalence in HIV that were also highly prevalent in adults without HIV included: lipid disorder (41.4% vs 40.2%), and hypertension (19.1% vs 24.6%). Following adjustment, 18 (37.5%) condition groups were more likely in adults with HIV and ten (20.8%) were less likely. Individual conditions that were less likely in adults with HIV included: atrial fibrillation (odds ratio [OR] 0.37 [95% CI 0.20-0.64]) and hypertension (OR_0.78 [0.65-0.94]); rheumatoid arthritis (OR 0.27 [0.05-0.84]); asthma (OR_0.65 (0.53-0.80]); and certain eye diseases such as macular degeneration (OR_0.30 [0.09-0.70]). Meanwhile individual conditions that were more likely included: liver fibrosis, sclerosis, and cirrhosis (OR_3.23 [1.85-5.20]); pulmonary embolism (OR_2.06 [1.15-3.36]); male infertility (OR_2.23 [1.50-3.16]) and female infertility (OR_2.01 [1.34-2.88]); bipolar disorder (OR_2.93 [1.52-5.05]) and depression (OR_1.49 [1.28-1.71]); cervical malignancy (OR_4.64 [1.15-12.15]); and infections. INTERPRETATION Comorbidity is common in adults with HIV, with physical and mental health conditions spanning a wide spectrum. HIV management should consider multidisciplinary care models to provide optimal patient care. FUNDING The project was funded by the Bart's Charity; DRM was funded by a Wellcome Trust Clinical Research Career Development Fellowship; DRM and DMM received funding from the HDR-UK Precision therapeutics programme.
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Affiliation(s)
- Daniel R. Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
- Department of Public Health, University of Southern Denmark, Denmark
- Corresponding author at: Division of Population Health and Genomics, University of Dundee, Dundee, United Kingdom.
| | - David Moreno-Martos
- Division of Population Health and Genomics, University of Dundee, United Kingdom
| | - Nashaba Matin
- Barts Health NHS Trust, Grahame Hayton Unit, Royal London Hospital, London, United Kingdom
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
- Corresponding author.
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Cubas-Vega N, López Del-Tejo P, Baia-da-Silva DC, Sampaio VS, Jardim BA, Santana MF, Lima Ferreira LC, Safe IP, Alexandre MAA, Lacerda MVG, Monteiro WM, Val F. Early Antiretroviral Therapy in AIDS Patients Presenting With Toxoplasma gondii Encephalitis Is Associated With More Sequelae but Not Increased Mortality. Front Med (Lausanne) 2022; 9:759091. [PMID: 35280886 PMCID: PMC8914028 DOI: 10.3389/fmed.2022.759091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Evidence on the optimal time to initiate antiretroviral therapy (ART) in the presence of toxoplasmic encephalitis (TE) is scarce. We compared the impact of early vs. delayed ART initiation on mortality and neurologic complications at discharge in a Brazilian population co-infected with HIV and TE. Methods We retrospectively evaluated data from 9 years of hospitalizations at a referral center in Manaus, Amazonas. All ART-naïve hospitalized patients were divided into early initiation treatment (EIT) (0-4 weeks) and delayed initiation treatment (DIT) (>4 weeks). The groups were compared using chi-square test and mortality at 16 weeks. Results Four hundred sixty nine patients were included, of whom 357 (76.1%) belonged to the EIT group. The median CD4+ lymphocyte count and CD4+/CD8+ ratio were 53 cells/mm3 and 0.09, respectively. Mortality rate and presence of sequelae were 4.9% (n = 23) and 41.6% (n = 195), respectively. Mortality was similar between groups (p = 0.18), although the EIT group had the highest prevalence of sequelae at discharge (p = 0.04). The hazard ratio for death at 16 weeks with DIT was 2.3 (p = 0.18). The necessity for intensive care unit admission, mechanical ventilation, and cardiopulmonary resuscitation were similar between groups. Conclusion In patients with AIDS and TE, early ART initiation might have a detrimental influence on the occurrence of sequelae.
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Affiliation(s)
- Nadia Cubas-Vega
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Paola López Del-Tejo
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Djane C. Baia-da-Silva
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Gerência de Endemias, Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
| | - Bruno Araújo Jardim
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Monique Freire Santana
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Luiz Carlos Lima Ferreira
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Departameto de Patologia e Medicina Legal, Universidade Federal do Amazonas, Manaus, Brazil
- Departamento Clínico, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Izabella Picinin Safe
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Departamento Clínico, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Marcus Vinícius Guimarães Lacerda
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas and Maria Deane, Fiocruz-Amazonas, Manaus, Brazil
- Departamento Clínico, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fernando Val
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Amazonas, Manaus, Brazil
- Departamento Clínico, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- *Correspondence: Fernando Val
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Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, Leo YS, Chow A. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore) 2021; 100:e26507. [PMID: 34190180 PMCID: PMC8257899 DOI: 10.1097/md.0000000000026507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Vernon Jian Ming Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Elgalib A, Shah S, Al-Wahaibi A, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, Al-Rawahi B, Al-Abri S. The Epidemiology of HIV in Oman, 1984-2018: A Nationwide Study from the Middle East. J Epidemiol Glob Health 2021; 10:222-229. [PMID: 32954713 PMCID: PMC7509104 DOI: 10.2991/jegh.k.191208.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/01/2019] [Indexed: 12/28/2022] Open
Abstract
We used population-based data on all diagnosed people living with Human Immunodeficiency (HIV) reported to the National AIDS Programme in 1984–2018 to describe the HIV epidemiology in Oman. A total of 3060 Omanis were diagnosed with HIV from 1984 to 2018. The proportions of new infections attributed to sexual contact accounted for 56.3% (376/668) in 1984–1996 compared with 80.7% (630/780) in 2013–2018. Of 1417 patients with a documented CD4 count at the entry of care, 45.3% had a baseline CD4 count of <200 cells/mm3. Compared with heterosexuals, homosexuals had higher rates of advanced HIV disease [42.7% (388/908) vs 50.4% (136/270), respectively]. Rates of advanced disease and death within a year of HIV diagnosis rose consistently with age at diagnosis. Approximately half (48.8%) of the patients diagnosed in 1984–2018 had died by December 2018. The majority (85.6%; 572/668) of people who were diagnosed in 1984–1997 had died compared with 12.7% (99/780) of those diagnosed in 2013–2018. However, people died more recently had a higher proportion of death within a year of HIV diagnosis [74.7% (74/99) in 2013–2018 compared with 13.8% (79/572) in 1984–1996]. This study shows that the HIV epidemic in Oman is a low-prevalence one. Of concern, a large proportion of new HIV diagnoses continued to present late, which has resulted in a substantial increase in short-term mortality over the past 20 years. Nevertheless, we observed a remarkable decline in overall mortality over time, which may be explained by the improvement in the quality of HIV care in Oman.
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Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Adil Al-Wahaibi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Hanan Al-Kindi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
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Ajidahun AT, Myezwa H, Ibeneme SC, Magobotha S, Fortwengel G, Jingo M, Milner B, Ravat S, Okoye I, Schnaid E, Bischoff F. Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23206. [PMID: 33327237 PMCID: PMC7738028 DOI: 10.1097/md.0000000000023206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).
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Affiliation(s)
- Adedayo Tunde Ajidahun
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Sam Chidi Ibeneme
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus. Nigeria
| | - Sebastian Magobotha
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Gerhard Fortwengel
- Hochschule Hannover – University of Applied Sciences and Arts, Hannover, Germany
| | - Maxwell Jingo
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Brenda Milner
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Sadiya Ravat
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa
| | - Ifeoma Okoye
- University of Nigeria Teaching Hospital Enugu (UNTH), Ituku-Ozalla, Enugu State, Nigeria
| | - Edward Schnaid
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Faith Bischoff
- Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Chimbetete C, Shamu T, Roelens M, Bote S, Mudzviti T, Keiser O. Mortality trends and causes of death among HIV positive patients at Newlands Clinic in Harare, Zimbabwe. PLoS One 2020; 15:e0237904. [PMID: 32853215 PMCID: PMC7451579 DOI: 10.1371/journal.pone.0237904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/05/2020] [Indexed: 12/30/2022] Open
Abstract
Background We report trends in mortality patterns and causes among HIV positive patients, who initiated antiretroviral therapy (ART), at an urban clinic in Harare, Zimbabwe. Methods A retrospective cohort study was conducted in which routinely collected data for patients enrolled and followed up between February 2004 and December 2017 were assessed. Patients follow up was from the day of the treatment initiation until exit by death, transfer out or loss to follow up. Two doctors categorized causes of death (COD) as tuberculosis (TB), communicable AIDS, non-communicable diseases (NCDs), malignancies, others and unknown. We used competing risk survival analysis, first to estimate all-causes and cause-specific mortality rates over time, and then to assess risk factors of different causes of death. Results A total of 4 868 patients were followed up for 27 527 person years (PY). Among the 506 patients who died, COD was unknown for 76 patients (15%) and common COD were TB (n = 71, 14%), Malignancies (n = 54, 10.7%) Meningitis (n = 39, 7.7%) and NCDs (n = 60, 11.9%). 49.4% of the deaths were within the first year of starting ART. Median age at death was 36 years (IQR:19–46). There was a near threefold increase in proportion of deaths due to NCDs and malignancies over the period of follow up. Low baseline CD4 cell count and WHO stages 3 & 4 were significant risk factors for all-cause mortality. Conclusions TB remains the leading cause of death among HIV infected people. Deaths due to NCDs and malignancies increased over time. ART facilities need to incorporate management of NCDs including cancer as part of comprehensive care of PLHIV to reduce mortality.
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Affiliation(s)
- Cleophas Chimbetete
- Newlands Clinic, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- * E-mail:
| | | | - Maroussia Roelens
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Tinashe Mudzviti
- Newlands Clinic, Harare, Zimbabwe
- School of Pharmacy, University of Zimbabwe, Harare, Zimbabwe
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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John Nutor J, Duodu PA, Agbadi P, Duah HO, Oladimeji KE, Gondwe KW. Predictors of high HIV+ prevalence in Mozambique: A complex samples logistic regression modeling and spatial mapping approaches. PLoS One 2020; 15:e0234034. [PMID: 32497145 PMCID: PMC7272061 DOI: 10.1371/journal.pone.0234034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/18/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction The burden of HIV infection in southern Africa is a public health concern with an increasing number of new infections. This study sought to investigate the predictors of HIV prevalence in Mozambique through a complex samples logistic regression and spatial mapping approach using nationally representative data. Methods We conducted a secondary data analysis using the 2015 Mozambique Demographic and Health Survey and AIDS Indicator Survey. The analysis performed in four stages while incorporating population survey sampling weights did the following: i) created a complex sample plan file in SPSS, ii) performed the weighted estimate of HIV prevalence, iii) performed complex sample chi-square test of independence, and then iv) performed complex sample logistic regression modeling. Results Out of 11,270 participants, 1,469 (13.0%) tested positive for HIV. The prevalence of HIV infection was higher in females (15.1%) than males (10.2%). We found that urban dwellers were more likely to be HIV-positive compared to rural dwellers (AOR: 1.70; CI: 1.27, 2.27). We observed provincial variations in HIV prevalence, with Maputo Cidade (17.4%), Maputo Provincia (22.6%), Gaza (25.2%) recording higher prevalence above the national estimate. Other independent predictors of HIV infection in Mozambique included age, education level, marital status, total lifetime sexual partners, and having had an STI in the last 12 months. Conclusions The study revealed associations between high-risk sexual behavior and HIV infection. Results from our spatial mapping approach can help health policy makers to better allocate resources for cost-effective HIV/AIDS interventions. Pre-Exposure Prophylaxis (PrEP) campaigns among high-risk groups should be pursued to lower the reservoir of HIV among high-risk groups.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Eastern Cape, South Africa
| | - Kaboni Whitney Gondwe
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
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Mortality and causes of death in people living with HIV in the era of combination antiretroviral therapy compared with the general population in Japan. AIDS 2020; 34:913-921. [PMID: 32039993 PMCID: PMC7170431 DOI: 10.1097/qad.0000000000002498] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives: To determine the mortality and causes of death in people living with HIV (PLHIV) in Japan. Design: A prospective cohort study at AIDS Clinical Center, Tokyo, which treats approximately 10% of PLHIV in care in Japan. Methods: Either PLHIV who visited our center for the first time between January 2005 and December 2014 or PLHIV who started their regular visit before January 2005 and visited us between January and March 2005 were included and followed by the end of 2016. Causes of death were defined according to the CoDe protocol. Results: Two thousand, seven hundred and ninety-seven PLHIV were analysed with total of 18 858 person-years of follow-up, which constitutes 14% of the estimated number of PLHIV in care in Japan. One hundred and sixty-five (5.9%) PLHIV died with all-cause mortality rate of 8.75 per 1000 person-years. All-cause mortality rate for PLHIV in care in Japan was estimated to be 8.75 per 1000 person-years (95% CI 5.53–12.0). Among causes of death, AIDS-defining illnesses accounted for 39% and malignancy contributed to 47%. Standardized mortality ratio (SMR) for all-cause mortality, malignancy-related mortality, and suicide were 5.96 (95% CI 5.05–6.87), 7.76 (95% CI 6.02–9.51), and 3.24 (95% CI 1.54–4.94), respectively. Even among the patients who were diagnosed early or without history of AIDS, SMR was four times higher than the general population. Conclusion: Mortality of PLHIV, even among those with early diagnosis, is substantially higher than that of the general population in Japan, highlighting the importance of further efforts towards prevention, early diagnosis and prompt treatment initiation.
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Xia Q, Ramaswamy C, Torian LV. USE OF MEDIAN AGE AT DEATH TO ASSESS HIV MORTALITY. Am J Epidemiol 2019; 188:1868-1869. [PMID: 31318019 DOI: 10.1093/aje/kwz164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Qiang Xia
- Bureau of HIV Prevention and Control, New York City Department of Health and Hygiene, New York, NY
| | - Chitra Ramaswamy
- Bureau of HIV Prevention and Control, New York City Department of Health and Hygiene, New York, NY
| | - Lucia V Torian
- Bureau of HIV Prevention and Control, New York City Department of Health and Hygiene, New York, NY
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Jose S, Delpech V, Howarth A, Burns F, Hill T, Porter K, Sabin CA. A continuum of HIV care describing mortality and loss to follow-up: a longitudinal cohort study. Lancet HIV 2019; 5:e301-e308. [PMID: 29893243 PMCID: PMC5990495 DOI: 10.1016/s2352-3018(18)30048-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
Background The cross-sectional HIV care continuum is widely used to assess the success of HIV care programmes among populations of people with HIV and the potential for ongoing transmission. We aimed to investigate whether a longitudinal continuum, which incorporates loss to follow-up and mortality, might provide further insights about the performance of care programmes. Methods In this longitudinal cohort study, we included individuals who entered the UK Collaborative HIV Cohort (CHIC) study between Jan 1, 2000, and Dec 31, 2004, and were linked to the national HIV cohort database (HIV and AIDS Reporting System). For each month during a 10 year follow up period, we classified individuals into one of ten distinct categories according to engagement in care, antiretroviral therapy (ART) use, viral suppression, loss to cohort follow-up and loss to care, and mortality, and assessed the proportion of person-months of follow-up spent in each stage of the continuum. 5 year longitudinal continuums were also constructed for three separate cohorts (baseline years of entry 2000–03, 2004–07, and 2008–09) to compare changes over time. Findings We included 12 811 people contributing 1 537 320 person-months in our analysis. During 10 years of follow-up, individuals spent 811 057 (52·8%) of 1 537 320 person-months on ART. Of the 811 057 person-months spent on ART, individuals had a viral load of 200 copies per mL or less for 607 185 (74·9%) person-months. 10 years after cohort entry, 3612 (28·1%) of 12 811 individuals were lost to follow-up, 954 (26·4%) of whom had transferred to a non-CHIC UK clinic for care. By 10 years, 759 (5·9%) of 12 811 participants who entered the cohort had died. Loss to follow-up decreased and the proportion of person-months that individuals spent virally suppressed increased over calendar time. Interpretation Loss to follow-up in HIV care programmes was high and rates of viral suppression were lower than previously reported. Complementary information provided by a longitudinal continuum might highlight areas for intervention along the HIV care pathway, however, transfers outside the cohort must be accounted for. Funding Medical Research Council, UK.
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Affiliation(s)
- Sophie Jose
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Valerie Delpech
- Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Alison Howarth
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Teresa Hill
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK
| | - Kholoud Porter
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, London, UK.
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Krentz HB, Vu Q, Gill MJ. The Impact of "Churn" on Plasma HIV Burden Within a Population Under Care. Open Forum Infect Dis 2019; 6:ofz203. [PMID: 31205974 PMCID: PMC6557304 DOI: 10.1093/ofid/ofz203] [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: 02/01/2019] [Accepted: 04/25/2019] [Indexed: 01/15/2023] Open
Abstract
Background Cross-sectional reporting of viral suppression rates within a population underestimates the community viral load (VL) burden. Longitudinal approaches, while addressing cumulative effects, may still underestimate viral burden if “churn” (movement in and out of care) is not incorporated. We examined the impact of churn on the cumulative community HIV viral burden. Methods All HIV+ patients followed in 2016–2017 at the Southern Alberta Clinic (Calgary, Canada) were categorized as follows: (1) in continuous care, (2) newly diagnosed, (3) diagnosed elsewhere transferring care, (4) returning to care, (5) lost-to-follow-up, (6) moved care elsewhere, or (7) died. Patient days were classified by VL as suppressed (≤200copies/ml), unsuppressed (>200 copies/ml), and transmittable (>1500 copies/ml). Results Of 1934 patients, 78.4% had suppressed VL; 21.4% had ≥1 unsuppressed VL, and 18.7% ≥1 transmittable VL. Of 1 276 507 total patient days in care, 92.1% were spent suppressed, 7.9% unsuppressed (101 459 days), and 6.4% (81 847 days) transmittable. 88.7% of category 1 patients had suppressed VL, 11.3% ≥1 unsuppressed VL, and 8.9% ever a transmittable VL. Of category 2 patients, 90% became suppressed on treatment (mean – 62 days). 38.5% of category 3 patients presented with a transmittable VL. Category 4 and 5 patients combined had high rates of unsuppressed (54.5%) and transmittable (51.2%) VL and, while representing only 6.2% of all patients, they accounted for 37.1% of unsuppressed and 41.5% of all transmittable days. Conclusion Focus on VL of patients continuously in care misses those with unsuppressed and transmittable VL in a community. Patients moving in and out of care pose an underappreciated risk for HIV transmissions.
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Affiliation(s)
- Hartmut B Krentz
- Southern Alberta Clinic, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
| | - Quang Vu
- Southern Alberta Clinic, Calgary, Canada
| | - M John Gill
- Southern Alberta Clinic, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
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24
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Burchell AN, Raboud J, Donelle J, Loutfy MR, Rourke SB, Rogers T, Rosenes R, Liddy C, Kendall CE. Cause-specific mortality among HIV-infected people in Ontario, 1995-2014: a population-based retrospective cohort study. CMAJ Open 2019; 7:E1-E7. [PMID: 30622108 PMCID: PMC6350837 DOI: 10.9778/cmajo.20180159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk factors for cause-specific mortality have not been widely studied among people with HIV infection. Our objectives were to estimate rates of and risk factors for all-cause and cause-specific mortality from 1995 to 2014 among HIV-infected people in Ontario. METHODS We conducted a population-based retrospective cohort study using provincial health databases of people with HIV infection who were aged 16 years or more, were residents of Ontario between 1995 and 2014, and had HIV infection according to a previously validated algorithm. We used International Classification of Diseases codes to classify the underlying cause of death and estimated age-adjusted mortality rates per 100 person-years for 1995 to 2014. We used descriptive statistics to characterize the cohort at baseline and calculated adjusted mortality rate ratios (RRs) using generalized estimating equations. RESULTS Among 23 043 people, the all-cause mortality rate declined from 6.69 to 1.53 per 100 person-years over the study period, and the rate of death from HIV/AIDS declined from 4.75 to 0.46 per 100 person-years. Concomitantly, the proportions of deaths due to cancer, cardiovascular disease and other noncommunicable diseases rose; however, rates remained constant or declined. Compared to males, females had higher mortality due to cardiovascular disease (adjusted RR 1.36, 95% confidence interval [CI] 1.04-1.77), noncommunicable causes (adjusted RR 1.75, 95% CI 1.39-2.20) and, by 2010-2014, any cause (adjusted RR 1.19, 95% CI 1.02-1.38). Residing in a low-income neighbourhood was associated with increased risk for most causes, including HIV/AIDS (adjusted RR in 2010-2014 1.86, 95% CI 1.49-2.31). Rural residence was associated with increased mortality due to malignant disease (adjusted RR 1.60, 95% CI 1.10-2.34) and noncommunicable disease (adjusted RR 1.86, 95% CI 1.25-2.77). Being an immigrant was associated with lower risk of death from all causes. INTERPRETATION Over the study period, death was increasingly due to common chronic conditions rather than to HIV infection itself. Care should incorporate the prevention and management of these conditions, especially among females and those residing in rural and low-income areas.
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Affiliation(s)
- Ann N Burchell
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Janet Raboud
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Jessy Donelle
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Mona R Loutfy
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Sean B Rourke
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Tim Rogers
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Ron Rosenes
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Clare Liddy
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont
| | - Claire E Kendall
- Centre for Urban Health Solutions (Burchell, Rourke), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Department of Family and Community Medicine (Burchell), University of Toronto; ICES (Burchell, Loutfy); Toronto General Hospital Research Institute (Raboud), Toronto, Ont.; ICES uOttawa (Donelle, Kendall), Ottawa Hospital Research Institute, Civic Campus, Ottawa Ont.; Maple Leaf Medical Clinic (Loutfy); Women's College Research Institute (Loutfy), Women's College Hospital; Department of Medicine (Loutfy), University of Toronto; Canadian AIDS Treatment Information Exchange (Rogers), Toronto, Ont.; C.T. Lamont Primary Health Care Research Centre (Rosenes, Kendall), Bruyère Research Institute; Department of Family Medicine (Liddy), University of Ottawa; Bruyère Research Institute (Liddy), Ottawa, Ont.
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25
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Vallecillo G, Robles MJ, Durán X, Lerma E, Horcajada JP, Torrens M. Trends in AIDS Mortality, Retention in Opioid Agonist Therapy, and HIV RNA Suppression in HIV-Infected People Who Injected Drugs from 2000 to 2015. AIDS Behav 2018; 22:2766-2772. [PMID: 29372455 DOI: 10.1007/s10461-018-2033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIDS is a major cause of preventable mortality in HIV-infected people who inject drugs (HIV-PWID). An observational study was conducted to examine trends in AIDS mortality and related factors among HIV-infected individuals who died between 2000 and 2015 at an urban hospital. Overall HIV-mortality was 6.5% (413/6307) with no changes over time (p 0.76). AIDS mortality dropped in HIV-PWID (p 0.02) although it represented 26.4% at the end of study period. Age (per one-year increase) [odds ratio (OR) 0.95], third study period (2010-2015) (OR 0.54), HIV-PWID on opioid agonist therapy (OAT) (OR 0.39), and HIV RNA suppression (OR 0.15) were associated with AIDS mortality. OAT was reported in 58.3% (161/276) and RNA suppression in 30.9% (85/276) of HIV-PWID. OAT non-retention was due to drop-outs [85.2% (98/115)] and rejection [14.8% (17/115)] in HIV-PWID. Therefore, additional strategies are required to improve OAT retention and HIV RNA suppression to continue reducing AIDS mortality.
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Affiliation(s)
- G Vallecillo
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - M J Robles
- Geriatric Unit, Hospital del Mar, Barcelona, Spain
| | - X Durán
- Department of Methodological Advice in Biomedical Research (AMIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - E Lerma
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Infectious Disease Department, Hospital del Mar, Barcelona, Spain
| | - M Torrens
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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26
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Weldegebreal T, Ahmed I, Muhiye A, Belete S, Bekele A, Kaba M. Magnitude of opportunistic diseases and their predictors among adult people living with HIV enrolled in care: national level cross sectional study, Ethiopia. BMC Public Health 2018; 18:820. [PMID: 29970047 PMCID: PMC6029130 DOI: 10.1186/s12889-018-5733-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Opportunistic diseases cause morbidity and mortality among human immunodeficiency virus (HIV) infected persons. There is dearth of evidence on the magnitude and predictors of opportunistic diseases among PLHIV in Ethiopia. This study was conducted to determine the magnitude and predictors of opportunistic diseases among adults enrolled in the national HIV/AIDS care and treatment services and generate information for program planning and medicine quantification in the country. Methods A health facility-based cross-sectional study was conducted. Probability proportional to size and random sampling methods were employed to select health facilities and medical records of adult HIV-infected patients respectively. A total of 7826 medical records were reviewed from 60 health facilities nationwide. Socio-demographic and clinical data including diagnosis of opportunistic diseases were collected from the medical records. Period prevalence of opportunistic diseases over one year period was determined. Bivariate and multivariate logistic regression was used to measure associations between independent variables and the dependent variable, occurrence of opportunistic diseases. Results Of the total of 7826 study participants, 3748 (47.9%) were from hospitals and 4078 were from health centers. The majority (61.8%) were female. The median age was 32 years with interquartile range (IQR) of 27–40. The median duration of stay in HIV care was 56 (IQR = 28–80) months; 7429 (94.9%) were on antiretroviral treatment. A total of 1665 cases of opportunistic diseases were recorded with an overall prevalence estimated at 21.3% (95% confidence interval (CI): 20.36, 22.18%). Skin diseases (4.1%), diarrhea (4.1%), bacterial pneumonia (3.6%), recurrent upper respiratory tract infections (3.1%) and tuberculosis (2.7%) were the leading opportunistic diseases. Isoniazid preventive therapy coverage among eligible patients was 24.8%. Persons with a CD4 count < 200 cells/mm3 [adjusted odds ratio (AOR) 1.80, 95% CI: 1.45, 2.23]; and who were bed ridden or ambulatory functional status [AOR (95% CI) = 3.19 (2.32, 4.39)] were independent predictors of diagnosis of opportunistic diseases. Conclusion Opportunistic diseases were found to be pervasive among HIV infected adults in Ethiopia. Proactive identification and management, and prevention of opportunistic diseases should be strengthened especially among females, ambulatory or bed-ridden, and patients with low CD4 cell count.
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Affiliation(s)
- Teklu Weldegebreal
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia
| | - Ismael Ahmed
- U.S. Centers for Disease Control and Prevention- Ethiopia, Addis Ababa, Ethiopia.
| | - Abiyou Muhiye
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | | | | | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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27
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Rumbwere Dube BN, Marshall TP, Ryan RP, Omonijo M. Predictors of human immunodeficiency virus (HIV) infection in primary care among adults living in developed countries: a systematic review. Syst Rev 2018; 7:82. [PMID: 29859533 PMCID: PMC5985063 DOI: 10.1186/s13643-018-0744-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Early diagnosis of human immunodeficiency virus (HIV) is important because antiretroviral therapies are more effective if infected individuals are diagnosed early. Diagnosis of HIV relies on laboratory testing and determining the demographic and clinical characteristics of undiagnosed HIV-infected patients may be useful in identifying patients for testing. This systematic review aims to identify characteristics of HIV-infected adults prior to diagnosis that could be used in a prediction model for early detection of patients for HIV testing in UK primary care. METHODS The population of interest was adults aged ≥ 18 years in developed countries. The exposures were demographic, socio-economic or clinical characteristics associated with the outcome, laboratory confirmed HIV/AIDS infection. Observational studies with a comparator group were included in the systematic review. Electronic searches for articles from January 1995 to April 2016 were conducted on online databases of EMBASE, MEDLINE, The Cochrane Library and grey literature. Two reviewers selected studies for inclusion. A checklist was developed for quality assessment, and a data extraction form was created to collate data from selected studies. RESULTS Full-text screening of 429 articles identified 17 cohort and case-control studies, from 26,819 retrieved articles. Demographic and socio-economic characteristics associated with HIV infection included age, gender and measures of deprivation. Lifestyle choices identified were drug use, binge-drinking, number of lifetime partners and having a partner with risky behaviour. Eighteen clinical features and comorbid conditions identified in this systematic review are included in the 51 conditions listed in the British HIV Association guidelines. Additional clinical features and comorbid conditions identified but not specified in the guidelines included hyperlipidemia, hypertension, minor trauma and diabetes. CONCLUSION This systematic review consolidates existing scientific evidence on characteristics of HIV-infected individuals that could be used to inform decision making in prognostic model development. Further exploration of availability of some of the demographic and behavioural predictors of HIV, such as ethnicity, number of lifetime partners and partner characteristics, in primary care records will be required to determine whether they can be applied in the prediction model.
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Affiliation(s)
| | - Tom P. Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Ronan P. Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Modupe Omonijo
- Public Health England, Health and Wellbeing Directorate, London, UK
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28
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Bhatta DN, Subedi A, Sharma N. Tobacco smoking and alcohol drinking among HIV infected people using antiretroviral therapy. Tob Induc Dis 2018; 16:16. [PMID: 31516416 PMCID: PMC6659491 DOI: 10.18332/tid/86716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tobacco smoking, common in people living with human immunodeficiency virus (HIV), is associated with increased mortality and morbidity. This study aimed to determine the proportion of current smokers, as well as assess the factors associated with tobacco smoking and drinking alcohol, among people living with HIV (PLHIV) in Nepal. METHODS A cross-sectional study was conducted at an antiretroviral therapy (ART) clinic in Kathmandu, Nepal between September and December 2014. Data were collected among 132 HIV infected individuals using a random sampling technique and face-to-face interview. Binary logistic regression analysis was performed to estimate the factors associated with current tobacco smoking and drinking of alcohol. RESULTS Among the HIV infected people, the proportion of current tobacco smoking was 26.5% (95% Confidence Interval (CI): 18.9-34.1), while drinking of alcohol was 22.7% (95% CI: 15.5-30.0). The respondents who were infected with HIV, after sexual contact with sex workers, were more likely to smoke tobacco (OR=15.2, 95% CI: 4.35-53.08) and drink alcohol (OR=4.50, 95% CI: 1.70-11.93) than those who were infected from drug needle use and blood transfusion. HIV infected individuals, who forgot to take ART medication, were three times more likely (OR=3.17, 95% CI: 1.36-7.38) to drink alcohol than those who did not forget to take ART medication. CONCLUSIONS Proportion of people who smoke tobacco and drink alcohol is high among the HIV infected individuals who had sexual contact with sex workers in Nepal. There is an urgent need to develop immediate, sustainable and efficient programs to control tobacco smoking and alcohol drinking among vulnerable populations in low and middle-income countries like Nepal. ABBREVIATIONS HIV: Human Immunodeficiency Virus, AIDS: Acquired Immunodeficiency Syndrome, ART: Antiretroviral Therapy, PLHIV: People Living with Human Immunodeficiency Virus, CI: Confidence Interval, STIDH: Sukraraj Tropical and Infectious Disease Hospital, OR: Odds Ratio, SD: Standard Deviation
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Affiliation(s)
- Dharma N Bhatta
- Department of Community Medicine and Public Health, People's Dental College, Tribhuvan University, Kathmandu, Nepal.,Center for Tobacco Control Research and Education, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, United States
| | - Arjun Subedi
- Program Planning Department, Society for Local Integrated Development (SOLID Nepal), Kathmandu, Nepal
| | - Narbada Sharma
- HIV/AIDS Treatment, Prevention and Control Center, Sukraraj Tropical and Infectious Disease Hospital, Ministry of Health and Population, Kathmandu, Nepal
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29
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Sezgin E, Van Natta ML, Thorne JE, Puhan MA, Jabs DA. Secular trends in opportunistic infections, cancers and mortality in patients with AIDS during the era of modern combination antiretroviral therapy. HIV Med 2018; 19:411-419. [PMID: 29573311 DOI: 10.1111/hiv.12609] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to estimate the incidence of, determine risk factors for, and investigate the consequences of opportunistic infections (OIs) and malignancies among patients with the acquired immune deficiency syndrome (AIDS) in the era of modern combination antiretroviral therapy (cART). METHODS Three enrolment periods (1998-2002, 2003-2005 and 2006-2012), corresponding to changes in predominant cART regimens, were compared among 1889 participants enrolled in a prospective cohort study, the Longitudinal Study of Ocular Complications of AIDS (LSOCA). Incidences of AIDS-related OIs and cancers were estimated. Multivariate logistic and Cox regression models were used to determine the effect of demographic and clinical characteristics on OIs and mortality. RESULTS Between participants enrolled in the 1998-2002 and 2006-2012 enrolment periods, the incidence of OIs decreased from 27 per 1000 person-years (PY) to 11 per 1000 PY (P < 0.001), and mortality decreased from 41 per 1000 PY to 18 per 1000 PY (P < 0.0001), corresponding to improvements in cART regimens. CONCLUSIONS Improvements in cART regimens led to a progressive decline in the incidence of OIs and mortality between 1999 and 2013 among patients with AIDS in the era of modern cART.
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Affiliation(s)
- E Sezgin
- Laboratory of Nutrigenomics and Epidemiology, Department of Food Engineering, Izmir Institute of Technology, Izmir, Turkey.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - M L Van Natta
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - J E Thorne
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M A Puhan
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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30
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Nosyk B, Min JE, Krebs E, Zang X, Compton M, Gustafson R, Barrios R, Montaner JSG. The Cost-Effectiveness of Human Immunodeficiency Virus Testing and Treatment Engagement Initiatives in British Columbia, Canada: 2011-2013. Clin Infect Dis 2018; 66:765-777. [PMID: 29028964 PMCID: PMC5850008 DOI: 10.1093/cid/cix832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023] Open
Abstract
Background Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
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Affiliation(s)
- Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Faculty of Health Sciences, Simon Fraser University, Burnaby
| | - Jeong E Min
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | | | - Xiao Zang
- BC Centre for Excellence in HIV/AIDS, Vancouver
| | - Miranda Compton
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reka Gustafson
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S G Montaner
- BC Centre for Excellence in HIV/AIDS, Vancouver
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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31
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Harding R, Marchetti S, Onwuteaka-Philipsen BD, Wilson DM, Ruiz-Ramos M, Cardenas-Turanzas M, Rhee Y, Morin L, Hunt K, Teno J, Hakanson C, Houttekier D, Deliens L, Cohen J. Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data. BMC Infect Dis 2018; 18:55. [PMID: 29370765 PMCID: PMC5785855 DOI: 10.1186/s12879-018-2951-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. Methods In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased’s demographic characteristics, place of death, healthcare supply. Results i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%–5.7%), nursing home (0%–17.6%) and home (5.9%–26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico. Conclusions With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a “good death” for people with HIV, alongside efforts to optimise treatment. Electronic supplementary material The online version of this article (10.1186/s12879-018-2951-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Harding
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, SE59PJ, London, UK.
| | | | - Bregje D Onwuteaka-Philipsen
- Department of public and occupational health, VU University Medical Center, EMGO Institute for health and care research, Amsterdam, Netherlands
| | | | - Miguel Ruiz-Ramos
- Consejería de Igualdad, Salud y Políticas Sociales de Andalucía, Seville, Spain
| | - Maria Cardenas-Turanzas
- The University of Texas Health Science Center in Houston, Mac Govern Medical School, Houston, TX, USA
| | | | - Lucas Morin
- Observatoire National de la Fin de Vie, Paris, France Ageing Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Joan Teno
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA
| | - Cecilia Hakanson
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal University College, Stockholm, Sweden.,Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Ding Y, Lin H, Liu X, Zhang Y, Wong FY, Sun YV, Marconi VC, He N. Hypertension in HIV-Infected Adults Compared with Similar but Uninfected Adults in China: Body Mass Index-Dependent Effects of Nadir CD4 Count. AIDS Res Hum Retroviruses 2017; 33:1117-1125. [PMID: 28562067 DOI: 10.1089/aid.2017.0008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hypertension is a growing problem in the HIV population. The relationship between low nadir CD4 count and hypertension in the HIV-infected population has been reported. However, the effect of nadir CD4 on hypertension due to a different body mass index (BMI) is yet to be fully elucidated. In this cross-sectional study, 345 HIV-infected participants aged ≥40 years were recruited. They were frequency matched and compared with age, sex, and education with HIV-uninfected adults (n = 345). Hypertension prevalence was lower in HIV-infected than in HIV-uninfected participants (23.8% vs. 31.9%; p = .011), but this association was not significant after adjusting for potential confounders. Among HIV-infected individuals, older age, overweight, with a family history of cardiovascular diseases, and nadir CD4 count <50 cells/μl were independently associated with hypertension. Stratifying individuals with BMI category revealed that nadir CD4 count-regardless if it was operationalized as a dichotomous variable (<50 cells/μl) or continuous variable-was found to be associated with hypertension among individuals who were underweight and obese, but not among those who were normal weight and overweight. Among HIV-uninfected individuals, older age and having a waist circumference above cutoff were significantly associated with hypertension. This is one of the first studies to demonstrate that the association of nadir CD4 and hypertension is observed in underweight and obese HIV-infected patients. While these results suggest that the relationship between nadir CD4 count and hypertension might be mediated by body weight, future longitudinal studies will be needed to validate the findings, including its causal pathways.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Haijiang Lin
- Department of AIDS/STD Control and Prevention, Taizhou City Center for Disease Control and Prevention, Taizhou City, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yucheng Zhang
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Frank Y. Wong
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, Hawaii
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vincent C. Marconi
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | - Na He
- Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
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MicroRNA-210, MicroRNA-331, and MicroRNA-7 Are Differentially Regulated in Treated HIV-1-Infected Individuals and Are Associated With Markers of Systemic Inflammation. J Acquir Immune Defic Syndr 2017; 74:e104-e113. [PMID: 27749601 DOI: 10.1097/qai.0000000000001191] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Inflammation may contribute to an increased risk of cardiovascular disease (CVD) in HIV-1 infection. MicroRNAs (miRNAs) are involved in the regulation of inflammation. In treated HIV-1-infected individuals, we aimed to identify differentially expressed miRNAs with known roles in inflammation and CVD risk and to investigate associations between these and systemic inflammation. METHODS In a screening cohort including 14 HIV-1-infected individuals and 9 uninfected controls, microarray profiling was performed using peripheral blood mononuclear cells (PBMCs). Differentially regulated miRNAs previously related to inflammation and CVD were validated using real-time quantitative reverse-transcription polymerase chain reaction in 26 HIV-1-infected individuals and 20 uninfected controls. Validated miRNAs were measured in PBMCs, CD4 and CD8 T cells. Interleukin-6, tumor necrosis factor-alpha, high-sensitivity C-reactive protein, lipopolysaccharide (LPS), cytomegalovirus immunoglobulin G, lipids, and fasting glucose were measured, and associations with validated miRNAs were assessed with multiple linear regression analysis. RESULTS Upregulation of miR-210, miR-7, and miR-331 was found in PBMCs from HIV-1-infected individuals when compared with those from uninfected controls (P < 0.005). In contrast, miR-210 and miR-331 were downregulated in CD8 T cells. In multivariate analysis, miR-210 in CD8 T cells was negatively associated with LPS (P = 0.023) and triglycerides (P = 0.003) but positively associated with tumor necrosis factor-alpha (P = 0.004). MiR-7 in PBMC was positively associated with interleukin-6 (P = 0.025) and fasting glucose (P = 0.005), whereas miR-331 was negatively associated with LPS (P = 0.006). In PBMCs from HIV-1-infected individuals with low cytomegalovirus immunoglobulin G, miR-7, miR-29a, miR-221, and miR-222 were downregulated. CONCLUSION In 2 independent cohorts, miR-210, miR-7, and miR-331 were differentially regulated in treated HIV-1-infected individuals and associated with markers of systemic inflammation.
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Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, Burns F, Copas A, Brown AE, Sullivan AK, Delpech V. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. LANCET PUBLIC HEALTH 2016; 2:e35-e46. [PMID: 29249478 DOI: 10.1016/s2468-2667(16)30020-2] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Deaths in HIV-positive people have decreased since the introduction of highly active antiretroviral therapy (HAART) in 1996. Fewer AIDS-related deaths and an ageing cohort have resulted in an increase in the proportion of HIV patients dying from non-AIDS-related disorders. Here we describe mortality and causes of death in people diagnosed with HIV in the HAART era compared with the general population. METHODS In this observational analysis, we linked cohort data collected by Public Health England (PHE) for individuals aged 15 years and older, diagnosed with HIV in England and Wales from 1997 to 2012, to the Office for National Statistics (ONS) national mortality register. Cohort inclusion began at diagnosis with follow-up clinical information collected every year from all 220 National Health Service (NHS) HIV outpatient clinics nationwide. To classify causes of death we used a modified Coding Causes of Death in HIV (CoDe) protocol, which uses death certificate data and clinical markers. We applied Kaplan-Meier analysis for survival curves and mortality rate estimation and Cox regression to establish independent predictors of all-cause mortality, adjusting for sex, infection route, age at diagnosis, region of birth, year of diagnosis, late diagnosis, and history of HAART. We used standardised mortality ratios (SMRs) to make comparisons with the general population. FINDINGS Between 1997 and 2012, 88 994 people were diagnosed with HIV, contributing 448 839 person-years of follow up. By the end of 2012, 5302 (6%) patients had died (all-cause mortality 118 per 10 000 person-years, 95% CI 115-121). In multivariable analysis, late diagnosis was a strong predictor of death (hazard ratio [HR] 3·50, 95% CI 3·13-3·92). People diagnosed more recently had a lower risk of death (2003-07: HR 0·66, 95% CI 0·62-0·70; 2008-12: HR 0·65, 95% CI 0·60-0·71). Cause of death was determinable for 4808 (91%) of 5302 patients; most deaths (2791 [58%] of 4808) were attributable to AIDS-defining illnesses. Cohort mortality was significantly higher than the general population for all causes (SMR 5·7, 95% CI 5·5-5·8), particularly non-AIDS infections (10·8, 9·8-12·0) and liver disease (3·7, 3·3-4·2). All-cause mortality was highest in the year after diagnosis (SMR 24·3, 95% CI 23·4-25·2). INTERPRETATION Despite the availability of free treatment and care in the UK, AIDS continues to account for the majority of deaths in HIV-positive people, and mortality remains higher in HIV-positive people than in the general population. These findings highlight the importance of prompt diagnosis, care engagement, and optimum management of comorbidities in reducing mortality in people with HIV. FUNDING Public Health England.
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Affiliation(s)
- Sara Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK.
| | - Aileen Kitching
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Sarika Desai
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Meaghan Kall
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Michael Edelstein
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Andrew Skingsley
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Fiona Burns
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Alison E Brown
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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de Miguel-Díez J, López-de-Andrés A, Jiménez-García R, Puente-Maestu L, Jiménez-Trujillo I, Hernández-Barrera V, Resino S, Álvaro-Meca A. Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997-2012). PLoS One 2016; 11:e0166421. [PMID: 27846297 PMCID: PMC5112896 DOI: 10.1371/journal.pone.0166421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/30/2016] [Indexed: 02/02/2023] Open
Abstract
Purpose The aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012). Methods A retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection). Results 1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD. Conclusions Incidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era.
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Affiliation(s)
- Javier de Miguel-Díez
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- * E-mail:
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Luis Puente-Maestu
- Pneumology Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Salvador Resino
- National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Alejandro Álvaro-Meca
- Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions. Alcohol Clin Exp Res 2016; 40:2056-2072. [PMID: 27696523 PMCID: PMC5119641 DOI: 10.1111/acer.13204] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/28/2016] [Indexed: 12/20/2022]
Abstract
Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.
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Affiliation(s)
- Emily C Williams
- Veterans Health Administration (VA) Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Judith A Hahn
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Kendall Bryant
- Consortiums for HIV/AIDS and Alcohol Research Translation (CHAART) National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Marlene C Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. .,Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
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Rumbwere Dube BN, Marshall TP, Ryan RP. Predictors of human immunodeficiency virus (HIV) infection in primary care: a systematic review protocol. Syst Rev 2016; 5:158. [PMID: 27646712 PMCID: PMC5029066 DOI: 10.1186/s13643-016-0333-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antiretroviral therapies for human immunodeficiency virus are more effective if infected individuals are diagnosed early, before they have irreversible immunologic damage. A large proportion of patients that are diagnosed with HIV, in United Kingdom, would have seen a general practitioner (GP) within the previous year. Determining the demographic and clinical characteristics of HIV-infected patients prior to diagnosis of HIV may be useful in identifying patients likely to be HIV positive in primary care. This could help inform a strategy of early HIV testing in primary care. This systematic review aims to identify characteristics of HIV-infected adults prior to diagnosis that could be used in a prediction model for early detection of HIV in primary care. METHODS The systematic review will search for literature, mainly observational (cohort and case-control) studies, with human participants aged 18 years and over. The exposures are demographic, socio-economic or clinical risk factors or characteristics associated with HIV infection. The comparison group will be patients with no risk factors or no comparison group. The outcome is laboratory-confirmed HIV/AIDS infection. Evidence will be identified from electronic searches of online databases of EMBASE, MEDLINE, The Cochrane Library and grey literature search engines of Open Grey, Web of Science Conference Proceedings Citation Index and examination of reference lists from selected studies (reference searching). Two reviewers will be involved in quality assessment and data extraction of the review. A data extraction form will be developed to collate data from selected studies. A checklist for quality assessment will be adapted from the Scottish Intercollegiate Guidelines Network (SIGN). DISCUSSION This systematic review will identify and consolidate existing scientific evidence on characteristics of HIV infected individuals that could be used to inform decision-making in prognostic model development. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016042427.
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Affiliation(s)
| | - Tom P. Marshall
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Ronan P. Ryan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study. Lancet HIV 2016; 3:e490-8. [PMID: 27658875 PMCID: PMC5084911 DOI: 10.1016/s2352-3018(16)30052-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mortality in HIV-infected individuals might differ by sex and mode of HIV acquisition. We aimed to study mortality in HIV-infected women, heterosexual men, and men who have sex with men (MSM) in a cohort from Rio de Janeiro, Brazil. METHODS In this observational cohort study, we included HIV-infected women, heterosexual men, and MSM (aged ≥18 years) from the Instituto Nacional de Infectologia Evandro Chagas database who were enrolled between Jan 1, 2000, and Oct 30, 2011, and who had at least 60 days of follow-up. Causes of deaths, defined with the Coding of Death in HIV protocol, were documented. Cox proportional hazards models accounting for competing risks were used to explore risk factors for AIDS-related and non-AIDS-related deaths. FINDINGS We had 10 142 person-years of follow-up from 2224 individuals: 817 (37%) women, 554 (25%) heterosexual men, and 853 (38%) MSM. Of 103 deaths occurred, 64 were AIDS related, 31 were non-AIDS related, and eight were of unknown causes. In unadjusted analyses, compared with women, the hazard of AIDS-related deaths was higher for heterosexual men (hazard ratio [HR] 3·52, 95% CI 1·30-9·08; p=0·009) and for MSM (2·30, 0·89-5·94; p=0·084). After adjustment for age, CD4 cell counts, last HIV viral load, antiretroviral therapy use, and AIDS-defining infection, AIDS-defining malignant disease, and hospital admission during follow-up, the excess risk of AIDS-related death decreased for heterosexual men (adjusted HR 1·99, 0·75-5·25; p=0·163) but was unchanged for MSM (2·24, 0·82-6·11; p=0·114). Non-AIDS-related mortality did not differ by group. INTERPRETATION Compared with women, increased risk of AIDS-related death in heterosexual men was partly mitigated by risk factors for AIDS mortality, whereas the excess risk in MSM was unchanged. Further study of reasons for disparity in AIDS-related mortality by mode of transmission is needed. FUNDING US National Institutes of Health, Brazilian National Council of Technological and Scientific Development (CNPq), and Research Funding Agency of the State of Rio de Janeiro (FAPERJ).
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Lartey M, Asante-Quashie A, Essel A, Kenu E, Ganu V, Neequaye A. Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era. Ghana Med J 2016; 49:7-11. [PMID: 26339078 DOI: 10.4314/gmj.v49i1.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To establish the cause(s) of death among persons with HIV and AIDS admitted to the Fevers Unit of the Korle-Bu Teaching Hospital (KBTH) in 2007 and to determine whether they were AIDS-related in the era of availability of HAART. METHOD Retrospective chart review of all deaths that occurred in the year 2007 among inpatients with HIV infection. Cause of Death (COD) was established with post mortem diagnosis, where not available ICD-10 was reviewed independently by two physicians experienced in HIV medicine and a consensus reached as to the most likely COD. RESULTS In the year under review, 215 (97%) of the 221 adult deaths studied were caused by AIDS and HIV-associated illnesses. Of these, 123 (55.7%) were due to an AIDS-defining illness as described in CDC Category 3 or WHO stage 4. Infections accounted for most of the deaths 158 (71.5%), many of them opportunistic 82 (51.8%). Tuberculosis was the commonest COD. Clinical diagnosis of TB was accurate in 54% of deaths, but was not validated by autopsy in 36% of deaths. There were few deaths (14.5%) in patients on HAART. CONCLUSION In a developing country like Ghana where HAART was still not fully accessible, AIDS-related events remained the major causes of death in persons living with HIV. Total scale-up of the ART programme with continuous availability of antiretrovirals is therefore imperative to reduce deaths from AIDS and HIV associated illnesses. There is need for interventions for early diagnosis as well as reduction in late presentation and also better diagnostic tools for tuberculosis.
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Affiliation(s)
- M Lartey
- Department of Medicine, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra, Ghana ; Department of Medicine, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | | | - A Essel
- Department of Community Health, University of Ghana Medical School, Korle Bu
| | - E Kenu
- Department of Medicine, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - V Ganu
- Department of Medicine, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - A Neequaye
- Department of Medicine, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra, Ghana ; Department of Medicine, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
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Sobrino-Vegas P, Moreno S, Rubio R, Viciana P, Bernardino JI, Blanco JR, Bernal E, Asensi V, Pulido F, del Amo J, Hernando V. Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004-2013. J Infect 2016; 72:587-96. [PMID: 26920789 DOI: 10.1016/j.jinf.2016.01.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004-2013). METHODS Cox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS. RESULTS Of 7165 new HIV diagnoses, 46.9% (CI95%:45.7-48.0) were LP, 240 patients died. First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5-19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2-3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7-3.1). First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004-05) to 39.4% (2012-13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women. Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2-1.7]); age (OR31-40.vs.<30 = 1.6[1.4-1.8], OR41-50.vs.<30 = 2.2[1.8-2.6], OR>50.vs.<30 = 3.6[2.9-4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0-3.8]; ORHeterosexual.vs.MSM = 2.2[1.7-3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1-2.0], ORLowerSecondary.vs.University = 1.3[1.1-1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3-2.0], ORLatin-American.vs.Spain = 1.4[1.2-1.8]). CONCLUSIONS LP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women.
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Affiliation(s)
- Paz Sobrino-Vegas
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | | | - Rafael Rubio
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | | | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Julia del Amo
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Victoria Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Rubaihayo J, Tumwesigye NM, Konde-Lule J, Makumbi F, Nakku EJ, Wamani H, Etukoit MB. Trends and Predictors of Mortality Among HIV Positive Patients in the Era of Highly Active Antiretroviral Therapy in Uganda. Infect Dis Rep 2015; 7:5967. [PMID: 26500739 PMCID: PMC4593885 DOI: 10.4081/idr.2015.5967] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
Knowledge of mortality trends and predictors among HIV-positive patients in the era of highly active antiretroviral therapy (HAART) in resource poor settings is still limited. The aim of this study was to describe trends and predictors of mortality among HIV-positive patients in the era of HAART in Uganda. Data from 2004 to 2013 for adult HIV-positive patients (≥15 years) obtaining care and treatment from the AIDS Support Organization in Uganda were reviewed for mortality. Descriptive statistics were analyzed by frequencies and cross tabulations. Calendar period was used as a proxy measure for HAART exposure and a time plot of the proportion of HIV-positive patients reporting dead per year was used to describe the trends. Logistic regression was used to determine the predictors of mortality at bivariate and multivariate levels, respectively. We included in the analysis 95,857 HIV positive patients; 64% were female with median age of 33 years (interquartile range 27-40). Of these 36,133 (38%) were initiated on ART and a total of 4279 (4.5%) died; 19.5% (835/4279) of those who died had an opportunistic infection. Overall, mortality first increased between 2004 and 2006 and thereafter substantially declined (X2trend=211.9, P<0.001). Mortality was relatively higher in Eastern Uganda compared to other geographical areas. Male gender, older age (>45 years), being from Eastern or Northern Uganda, having none or primary education, being unemployed, advanced immunodeficiency (CD4 count <100 cell/µL or WHO stage III or IV) and underweight (<45 kg weight) at HAART initiation and calendar period 2004-2008 were significant predictors of mortality (P<0.001). Overall, the expanding coverage of HAART is associated with a declining trend in mortality among HIV positive patients in Uganda. However, mortality trends differed significantly by geographical area and men remain potentially at higher risk of death probably because of delayed initiation on ART. There is urgent need for men targeted interventions for improved ART performance.
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Affiliation(s)
- John Rubaihayo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda ; Department of Public Health, School of Health Sciences, Mountains of the Moon University , Fort Portal, Uganda
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda
| | - Joseph Konde-Lule
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda
| | - Edith J Nakku
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda
| | - Henry Wamani
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University , Kampala, Uganda
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Nikolopoulos GK, Paraskevis D, Psichogiou M, Hatzakis A. HBV-DNA levels predict overall mortality in HIV/HBV coinfected individuals. J Med Virol 2015; 88:466-73. [PMID: 26288334 DOI: 10.1002/jmv.24357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 12/15/2022]
Abstract
The coinfection of Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) has been associated with increased death rates. However, the relevant research has mostly relied on serologic HBV testing [HBV surface antigen (HBsAg)]. The aim of this work was to explore the relationship of HBV viraemia with overall mortality among HIV/HBV coinfected individuals. The analysis included 1,609 HIV seropositives of a previously described cohort (1984-2003) with limited exposure to tenofovir (12%) and a median follow-up of approximately 5 years. Those with persistent expression of HBsAg were further tested for HBV-DNA. The data were analyzed using Poisson regression models. Totally, 101 participants were chronic carriers of HBsAg (6.28%). Of these, 81 were tested for HBV-DNA. The median HBV-DNA levels were 3.81 log (base-10) International Units (IU)/ml. A third (31%) of those tested for HBV-DNA had received tenofovir. Before developing acquired immune deficiency syndrome (AIDS), the adjusted incidence rate ratio (IRR) for all-cause mortality of coinfected patients with HBV viraemia above the median value versus the HIV monoinfected group was 3.44 [95% confidence interval (CI): 1.05-11.27]. Multivariable regressions in the coinfected group only (n = 81) showed that one log-10 increase in HBV-DNA levels was associated with an elevated risk for death (IRR: 1.24, 95%CI: 1.03-1.49). HBV-DNA levels predict overall mortality in the setting of HIV/HBV coinfection, especially during the period before developing AIDS, and could thus help prioritize needs and determine the frequency of medical monitoring.
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Affiliation(s)
- Georgios K Nikolopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece.,Hellenic Center for Disease Control and Prevention, Amarousio, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Mina Psichogiou
- First Department of Propaedeutic Medicine, Laiko General Hospital, Medical School, University of Athens, Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
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Zenner D, Abubakar I, Conti S, Gupta RK, Yin Z, Kall M, Kruijshaar M, Rice B, Thomas HL, Pozniak A, Lipman M, Delpech V. Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland. Thorax 2015; 70:566-73. [PMID: 25805209 DOI: 10.1136/thoraxjnl-2014-206452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/18/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The impact of TB disease on survival in people living with HIV in high resource settings is not well documented in the antiretroviral treatment (ART) era. We calculated TB incidence rates and compared the mortality of persons with and without HIV-TB in a UK HIV cohort in the post-ART era, to determine the impact of HIV-TB on survival in the UK. METHODS We linked the national cohort of persons (aged ≥15 years) diagnosed with HIV between 2000 and 2008 in England, Wales and Northern Ireland with the national TB register and deaths from the Office of National Statistics. We compared all-cause and AIDS-specific mortality in patients with and without TB by estimating HRs using Cox regression modelling allowing for potential predictors. RESULTS Overall, 3188 (7.2%) individuals developed TB infection among a cohort of 44 050 HIV-diagnosed persons and 149 663 person-years. The cumulative TB incidence rate was 2.13 per 100 person-years with a spike within the first 6 months after HIV diagnosis. TB coinfected patients comprised 18% of the 1880 deaths during follow-up and 79% of deaths (n=967) in the year following HIV diagnosis. TB coinfection (HR 4.77, 95% CI 4.11 to 5.54) was significantly associated with increased all-cause mortality. Analysis of AIDS-related survival showed similar results. DISCUSSION The unexpected high mortality in patients with HIV-TB in a population with good healthcare access and ART availability highlights the importance of improving active and latent TB case-finding among patients with HIV, and HIV-testing among patients with TB, to ensure appropriate and prompt treatment initiation for both diseases.
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Affiliation(s)
- Dominik Zenner
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Ibrahim Abubakar
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Stefano Conti
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Rishi K Gupta
- Division of Medicine, University College London, London, UK
| | - Zheng Yin
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Meaghan Kall
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Michelle Kruijshaar
- Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Brian Rice
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - H Lucy Thomas
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Anton Pozniak
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Division of Medicine, University College London, London, UK
| | - Valerie Delpech
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Raffetti E, Albini L, Gotti D, Segala D, Maggiolo F, di Filippo E, Saracino A, Ladisa N, Lapadula G, Fornabaio C, Castelnuovo F, Casari S, Fabbiani M, Pierotti P, Donato F, Quiros-Roldan E. Cancer incidence and mortality for all causes in HIV-infected patients over a quarter century: a multicentre cohort study. BMC Public Health 2015; 15:235. [PMID: 25884678 PMCID: PMC4364101 DOI: 10.1186/s12889-015-1565-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/17/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aimed to assess cancer incidence and mortality for all-causes and factors related to risk of death in an Italian cohort of HIV infected unselected patients as compared to the general population. METHODS We conducted a retrospective (1986-2012) cohort study on 16 268 HIV infected patients enrolled in the MASTER cohort. The standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were computed using cancer incidence rates of Italian Cancer Registries and official national data for overall mortality. The risk factors for death from all causes were assessed using Poisson regression models. RESULTS 1,195 cancer cases were diagnosed from 1986 to 2012: 700 AIDS-defining-cancers (ADCs) and 495 non-AIDS-defining-cancers (NADCs). ADC incidence was much higher than the Italian population (SIR = 30.8, 95% confidence interval 27.9-34.0) whereas NADC incidence was similar to the general population (SIR = 0.9, 95% CI 0.8-1.1). The SMR for all causes was 11.6 (11.1-12.0) in the period, and it decreased over time, mainly after 1996, up to 3.53 (2.5-4.8) in 2012. Male gender, year of enrolment before 1993, older age at enrolment, intravenous drug use, low CD4 cell count, AIDS event, cancer occurrence and the absence of antiretroviral therapy were all associated independently with risk of death. CONCLUSIONS In HIV infected patients, ADC but not NADC incidence rates were higher than the general population. Although overall mortality in HIV infected subjects decreased over time, it is about three-fold higher than the general population at present.
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Affiliation(s)
- Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Laura Albini
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daria Gotti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daniela Segala
- Department of Infectious Diseases of Nuovo Polo Ospedaliero S.Anna di Cona, Ferrara, Italy.
| | - Franco Maggiolo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Elisa di Filippo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Nicoletta Ladisa
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Giuseppe Lapadula
- Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
| | - Chiara Fornabaio
- Clinic of Infectious Diseases of Istituti Ospitalieri of Cremona, Cremona, Italy.
| | - Filippo Castelnuovo
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Salvatore Casari
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases of Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy.
| | - Piera Pierotti
- Department of Infectious Diseases of SM, Annunziata Hospital of Florence, Florence, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Abstract
This study examined the time trend and pattern of HIV/AIDS-related deaths in China. Data on HIV deaths and AIDS deaths were provided by the Chinese Ministry of Health. Time trend of the overall death rates over the period 2000-2012 was examined using Poisson regression models. Pattern of AIDS deaths was examined for the period 2006-2012, using the age-, gender-, and region-specific death rates. The results indicated that HIV/AIDS-related death rate increased significantly in China over the past decade, with an average annual percentage change of 22.3%. A vast majority of the deaths occurred among those aged between 20 and 65 years, with two age peaks. The death rate was higher for males than females and in rural areas than urban areas. A total of 83% of the deaths occurred among rural residents and 67% among males. The upward trend and distribution pattern of HIV/AIDS-related deaths depicted in the present study not only provides valuable information for additional understanding of the dynamics of the HIV/AIDS epidemic in China, but also has implications for evidence-based public health intervention strategies and policies as well as for further studies.
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Affiliation(s)
- Chong-Wen Wang
- a Centre on Behavioral Health , The University of Hong Kong , Hong Kong SAR , China
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Abstract
Background: Cardiovascular disease and non-AIDS malignancies have become major causes of death among HIV-infected individuals. The relative impact of lifestyle and HIV-related factors are debated. Methods: We estimated associations of smoking with mortality more than 1 year after antiretroviral therapy (ART) initiation among HIV-infected individuals enrolled in European and North American cohorts. IDUs were excluded. Causes of death were assigned using standardized procedures. We used abridged life tables to estimate life expectancies. Life-years lost to HIV were estimated by comparison with the French background population. Results: Among 17 995 HIV-infected individuals followed for 79 760 person-years, the proportion of smokers was 60%. The mortality rate ratio (MRR) comparing smokers with nonsmokers was 1.94 [95% confidence interval (95% CI) 1.56–2.41]. The MRRs comparing current and previous smokers with never smokers were 1.70 (95% CI 1.23–2.34) and 0.92 (95% CI 0.64–1.34), respectively. Smokers had substantially higher mortality from cardiovascular disease, non-AIDS malignancies than nonsmokers [MRR 6.28 (95% CI 2.19–18.0) and 2.67 (95% CI 1.60–4.46), respectively]. Among 35-year-old HIV-infected men, the loss of life-years associated with smoking and HIV was 7.9 (95% CI 7.1–8.7) and 5.9 (95% CI 4.9–6.9), respectively. The life expectancy of virally suppressed, never-smokers was 43.5 years (95% CI 41.7–45.3), compared with 44.4 years among 35-year-old men in the background population. Excess MRRs/1000 person-years associated with smoking increased from 0.6 (95% CI –1.3 to 2.6) at age 35 to 43.6 (95% CI 37.9–49.3) at age at least 65 years. Conclusion: Well treated HIV-infected individuals may lose more life years through smoking than through HIV. Excess mortality associated with smoking increases markedly with age. Therefore, increases in smoking-related mortality can be expected as the treated HIV-infected population ages. Interventions for smoking cessation should be prioritized.
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Moniuszko M, Moniuszko A, Puciłowska J, Kisluk K, Jeznach M, Grzeszczuk A, Flisiak R, Bodzenta-Lukaszyk A. Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report. J Med Case Rep 2014; 8:104. [PMID: 24666756 PMCID: PMC3978083 DOI: 10.1186/1752-1947-8-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/23/2014] [Indexed: 11/10/2022] Open
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Chkhartishvili N, Sharvadze L, Chokoshvili O, Bolokadze N, Rukhadze N, Kempker RR, Gamkrelidze A, DeHovitz JA, Del Rio C, Tsertsvadze T. Mortality and causes of death among HIV-infected individuals in the country of Georgia: 1989-2012. AIDS Res Hum Retroviruses 2014; 30:560-6. [PMID: 24472093 DOI: 10.1089/aid.2013.0219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Since 2004, the country of Georgia has provided antiretroviral therapy (ART) to all patients in need. A nationwide retrospective cohort study was conducted to assess the effect of universal access to ART on patterns of mortality and causes of death among HIV-infected individuals in Georgia. All known HIV-infected adult individuals (age ≥18 years) diagnosed from 1989 through 2012 were included. Rates and causes of death were determined using routinely collected data from the national HIV/AIDS database. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Between 1989 and 2012, 3,554 HIV-infected adults were registered in Georgia contributing to 13,572 person-years (PY) of follow-up. A total of 779 deaths were registered during follow-up. The mortality rate peaked in 2004 with 10.74 deaths per 100 PY (95% CI: 7.92-14.24) and significantly decreased after the universal availability of ART to 4.02 per 100 PY (95% CI: 3.28-4.87) in 2012. In multivariate analysis the strongest predictor of mortality was having AIDS at the time of HIV diagnosis (hazard ratio: 5.69, 95% CI: 4.72-6.85). AIDS-related diseases accounted for the majority of deaths (n=426, 54.7%). Tuberculosis (TB) was the leading cause of death accounting for 21% of the total deaths reported. Universal access to ART significantly reduced mortality among HIV-infected patients in Georgia. However, overall mortality rates remain high primarily due to late diagnosis, and TB remains a significant cause of death. Improving rates of early HIV diagnosis and ART initiation may further decrease mortality as well as prevent new HIV and TB infections.
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Affiliation(s)
| | - Lali Sharvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
- Faculty of Medicine, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Otar Chokoshvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Natalia Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | - Carlos Del Rio
- School of Medicine, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
- Faculty of Medicine, I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
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Delpech V, Brown AE, Croxford S, Chau C, Polavarapu V, Cooper N, Rooney G, Yin Z. Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis. HIV Med 2014; 14 Suppl 3:19-24. [PMID: 24033898 DOI: 10.1111/hiv.12070] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis. METHODS National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis. RESULTS In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late (CD4 count < 350 cells/μL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15-24 years (31%). Sixty-four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men (MSM) (P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1-year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011. CONCLUSIONS The National Health Service provides high-quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8-fold increased risk of 1-year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK.
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Affiliation(s)
- V Delpech
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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