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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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Kardas P, Aarnio E, Agh T, van Boven JFM, Dima AL, Ghiciuc CM, Kamberi F, Petrova GI, Nabergoj Makovec U, Trečiokienė I. New terminology of medication adherence enabling and supporting activities: ENABLE terminology. Front Pharmacol 2023; 14:1254291. [PMID: 37900155 PMCID: PMC10613051 DOI: 10.3389/fphar.2023.1254291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction: Medication non-adherence negatively affects the effectiveness of evidence-based therapies and sustainability of healthcare systems. Lack of agreed terminology of medication adherence enabling and supporting activities leads to underuse of the available tools. The ENABLE COST Action was aimed at proposing a new terminology for these activities in order to help both scientific research and its clinical application. Methods: Initial discussions within the ENABLE Working Groups allowed for the conceptualization of four interlinked terms related to adherence, i.e., "medication adherence technology", "medication adherence enhancing intervention", "best practice" and "reimbursement". The iterative process of internal discussion was structured around two dedicated international workshops. Moreover, extensive stakeholder consultations have been organised, including an interactive online survey used to assess the level of agreement with, and the clarity of relevant terms and definitions proposed. Results: Detailed analysis of the results of this process allowed for fine-tuning of the items, and finally, for proposing the final set of definitions. Across all the three phases of this process, the definitions were substantially modified to better reflect the concepts, simplify the language, and assure completeness and cohesiveness of terminology. Feedback obtained from the stakeholders helped this process and confirmed that the final terms and definitions were well received by the experts active in the field of medication adherence. Discussion: Covering the gap in the existing terminology, this work proposes a cohesive set of terms and definitions applicable to medication adherence enabling and supporting activities. Promoting evidence-based approach to this field, this terminology may help research, clinical practice and policy.
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Affiliation(s)
- Przemyslaw Kardas
- Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Emma Aarnio
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alexandra Lelia Dima
- Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu (IRSJD), Esplugues de Llobregat, Spain
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, Iași, Romania
| | - Fatjona Kamberi
- Scientific Research Centre for Public Health, Faculty of Health, University of Vlore “Ismail Qemali”, Vlore, Albania
| | | | | | - Indrė Trečiokienė
- Pharmacy and Pharmacology Center, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Schulze AB, Mohr M, Sackarnd J, Schmidt LH, Tepasse PR, Rosenow F, Evers G. Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital. Viruses 2023; 15:v15051164. [PMID: 37243250 DOI: 10.3390/v15051164] [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: 04/29/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pneumology, Respiratory Medicine and Thoracic Oncology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
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Kagee A, Bantjes J, Saal W, Sterley A. Predicting caseness of major depressive disorder using the Center for Epidemiological Studies Depression Scale (CESD-R) among patients receiving HIV care. Gen Hosp Psychiatry 2020; 67:70-76. [PMID: 33059218 DOI: 10.1016/j.genhosppsych.2020.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/18/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022]
Abstract
Patients receiving HIV care at two public health facilities in South Africa were assessed using the Centres for Epidemiological Studies Depression Scale Revised (CESD-R) and the Structured Clinical Interview for DSM5 to assess major depressive disorder. Of the 688 study participants, 229 (33.3%; CI = 29.8%; 36.9%) scored in the elevated range on the CESD-R and 170 (24.7%; CI = 21.5% to 28.1%) met the diagnostic criteria for major depressive disorder (MDD). ROC curve analysis indicated that a CESD-R cut-point of 26.5 (rounded to 27) yielded optimal sensitivity (0.81) and specificity (0.82) in determining caseness for MDD. Positive and negative predictive values of the CESD-R were 60.26% and 92.98%, respectively. The AUC was 0.89 (89%) (95% CI = 0.86-0.92) indicating moderate to high accuracy. For the purpose of routine screening in the context of HIV care, the CESD-R appears to hold promise in identifying cases of MDD. Those who screen positive may then undergo a formal diagnostic interview to determine whether they are true cases for MDD, and referred for treatment.
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Affiliation(s)
- Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa.
| | | | - Wylene Saal
- Stellenbosch University, Stellenbosch, South Africa
| | - Adelle Sterley
- Helderberg Hospital, Stellenbosch University, South Africa
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