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Yarlagadda K, Werne R, Sinha N. Lung transplant in chronic HIV infection. BMJ Case Rep 2023; 16:e253855. [PMID: 37963662 PMCID: PMC10649389 DOI: 10.1136/bcr-2022-253855] [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] [Indexed: 11/16/2023] Open
Abstract
Lung transplantation is the treatment of choice for many end-stage chronic lung conditions. Chronic Human Immunodeficiency Virus (HIV) infection is considered a relative contraindication for lung transplantation. In the era of Highly Active Antiretroviral Therapy (HAART), there has been an increase in the number of HIV-positive patients living with chronic lung conditions. In this paper, we aim to summarise the available literature in the field of lung transplantation in HIV-positive patients. We also present our experience of an HIV-positive woman who underwent lung transplantation for chronic interstitial lung disease from an HIV-negative donor.Careful candidate selection, along with management focused on closer monitoring, may result in favourable outcomes, including improved longevity among HIV-positive patients with chronic lung disease.
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Affiliation(s)
- Keerthi Yarlagadda
- Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rachel Werne
- Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Neeraj Sinha
- Department of Pulmonary and Critical Care Medicine, Miami Transplant Institute, University of Miami, Jackson Health System, Miami, Florida, USA
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2
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Simon E, Bechraoui-Quantin S, Tapia S, Cottenet J, Mariet AS, Cottin Y, Giroud M, Eicher JC, Thilaganathan B, Quantin C. Time to onset of cardiovascular and cerebrovascular outcomes after hypertensive disorders of pregnancy: a nationwide, population-based retrospective cohort study. Am J Obstet Gynecol 2023; 229:296.e1-296.e22. [PMID: 36935070 DOI: 10.1016/j.ajog.2023.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The increased maternal cardiocerebrovascular risk after a pregnancy complicated by hypertensive disorders of pregnancy, is well documented in the literature. Recent evidence has suggested a shorter timeframe for the development of these postnatal outcomes, which could have major clinical implications. OBJECTIVE This study aimed to determine the risk of and time to onset of maternal cardiovascular and cerebrovascular outcomes after a pregnancy complicated by hypertensive disorders of pregnancy. STUDY DESIGN This study included 2,227,711 women, without preexisting chronic hypertension, who delivered during the period 2008 to 2010: 37,043 (1.66%) were diagnosed with preeclampsia, 34,220 (1.54%) were diagnosed with gestational hypertension, and 2,156,448 had normotensive pregnancies. Hospitalizations for chronic hypertension, heart failure, coronary heart disease, cerebrovascular disease, and peripheral arterial disease were studied. A classical Cox regression was performed to estimate the average effect of hypertensive disorders of pregnancy over 10 years compared with normotensive pregnancy; moreover, an extended Cox regression was performed with a step function model to estimate the effect of the exposure variable in different time intervals: <1, 1 to 3, 3 to 5, and 5 to 10 years of follow-up. RESULTS The risk of chronic hypertension after a pregnancy complicated by preeclampsia was 18 times higher in the first year (adjusted hazard ratio, 18.531; 95% confidence interval, 16.520-20.787) to only 5 times higher at 5 to 10 years after birth (adjusted hazard ratio, 4.921; 95% confidence interval, 4.640-5.218). The corresponding risks of women with gestational hypertension were 12 times higher (adjusted hazard ratio, 11.727; 95% confidence interval, 10.257-13.409]) and 6 times higher (adjusted hazard ratio, 5.854; 95% confidence interval, 5.550-6.176), respectively. For other cardiovascular and cerebrovascular outcomes, there was also a significant effect with preeclampsia (heart failure: adjusted hazard ratio, 6.662 [95% confidence interval, 4.547-9.762]; coronary heart disease: adjusted hazard ratio, 3.083 [95% confidence interval, 1.626-5.844]; cerebrovascular disease: adjusted hazard ratio, 3.567 [95% confidence interval, 2.600-4.893]; peripheral arterial disease: adjusted hazard ratio, 4.802 [95% confidence interval, 2.072-11.132]) compared with gestational hypertension in the first year of follow-up. A dose-response effect was evident for the severity of preeclampsia with the averaged 10-year adjusted hazard ratios for developing chronic hypertension after early, preterm, and late preeclampsia being 10, 7, and 6 times higher, respectively. CONCLUSION The risks of cardiovascular and cerebrovascular outcomes were the highest in the first year after a birth complicated by hypertensive disorders of pregnancy. We found a significant relationship with both the severity of hypertensive disorders of pregnancy and the gestational age of onset suggesting a possible dose-response relationship for the development of cardiovascular and cerebrovascular outcomes. These findings call for an urgent focus on research into effective postnatal screening and cardiocerebrovascular risk prevention for women with hypertensive disorders of pregnancy.
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Affiliation(s)
- Emmanuel Simon
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France
| | - Sonia Bechraoui-Quantin
- Department of Gynecology, Obstetrics, and Fetal Medicine, University Hospital of Dijon, Dijon, France; Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Solène Tapia
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Jonathan Cottenet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France
| | - Yves Cottin
- Department of Cardiology, University Hospital of Dijon, Dijon, France; Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France; Registre des Infarctus du Myocarde de Côte d'Or, University Hospital of Dijon, Dijon, France
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, Dijon, France; Dijon Stroke Registry, Department of Pathophysiology and Epidemiology of Cerebrocardiovascular Diseases, University of Burgundy, Dijon, France
| | | | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catherine Quantin
- Department of Biostatistics and Bioinformatics, University Hospital of Dijon, Dijon, France; Clinical Epidemiology and Clinical Trials Unit, Clinical Investigation Center, University Hospital of Dijon, Dijon, France; Center of Research in Epidemiology and Population Health, Université Paris-Saclay, University of Versailles Saint-Quentin-en-Yvelines, National Institute of Health and Medical Research, Villejuif, France.
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Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Deslee G, Fabry-Vendrand C, Poccardi N, Thabut G, Eteve Pitsaer C, Coriat A, Renaudat C, Maguire A, Pinto T. Use and persistence of single and multiple inhaler triple therapy prescribed for patients with COPD in France: a retrospective study on THIN database (OPTI study). BMJ Open Respir Res 2023; 10:10/1/e001585. [PMID: 37263738 DOI: 10.1136/bmjresp-2022-001585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION From 2018 single inhaler triple therapy (SITT) became available in France to treat moderate-to-severe chronic obstructive pulmonary disease (COPD). Given its simplified inhaler use compared with multiple inhaler triple therapy (MITT), this therapeutic option has the potential to offer benefit in terms of improved persistence and adherence. Given the lack of real-world evidence of the effectiveness of triple therapy, this study was designed to evaluate the use of MITT and SITT in France and compare persistence. METHODS A retrospective cohort study was performed. Patients with COPD who initiated triple therapy between 1 July 2017 and 31 December 2019 were included from The Health Improvement Network, a large electronic medical database in France, which includes pharmacy data. A 60-day treatment gap defined discontinuation and thereby persistence. RESULTS A total of 3134 patients initiated triple therapy for COPD in the study period, among them 485 with SITT. In 2019, the rate of use of SITT was 28.2%. The mean age (67.3 years) and sex (44.2% female) of patients initiating triple therapy was similar between MITT and SITT, and most patients had escalated from dual therapy (84.1%). However, SITT was more frequently initiated by a pulmonologist (59.8%) and a higher prevalence of comorbid asthma was observed for SITT (47.0% vs 37.9%). Persistence was assessed among patients who did not discontinue after a single dispensation of triple therapy (n=1674). Median persistence was 181 days for SITT and 135 days for MITT, and the covariate-adjusted HR for persistence was 1.47 (p<0.001) and the estimated persistence at 1 year was 33% for SITT compared with 18% for MITT. DISCUSSION This study suggests that persistence was higher for the patients treated with SITT compared with MITT in France. Moreover, most patients initiated with triple therapy were previously treated with dual therapy and had exacerbations in the previous year.
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Affiliation(s)
- Gaétan Deslee
- Service de Pneumologie, INSERM UMRS-1250, CHU de Reims, Université Reims Champagne-Ardenne, CHU de Reims, Reims, France
| | | | | | | | | | | | | | | | - Thomas Pinto
- Médecin généraliste, Chef de clinique universitaire, Université de Paris, Paris, France
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Abstract
PURPOSE OF REVIEW As people living with human immunodeficiency virus (HIV, PLWH) age, aging-related comorbidities have come into focus as major challenges to their overall health. In this review, an in-depth overview of the two most commonly encountered chronic lung diseases in PLWH, chronic obstructive pulmonary disease (COPD) and lung cancer, is provided. RECENT FINDINGS The risk for both COPD and lung cancer remains significantly higher in PLWH compared to the HIV-uninfected population, although fortunately rates of lung cancer appear to be declining over the last two decades. Outcomes for PLWH with these conditions, though, continue to be poor with worse survival rates in comparison to the general population. PLWH still face major barriers in accessing care for these conditions, including a higher likelihood of being underdiagnosed with COPD and a lower likelihood of being referred for lung cancer screening or treatment. A lack of evidence for optimal treatment strategies for both COPD and lung cancer still hampers the care of PLWH with these conditions. SUMMARY COPD and lung cancer represent substantial burdens of disease in PLWH. Improved access to standard-of-care screening and treatment and greater investigation into therapeutic responses specifically in this population are recommended.
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Affiliation(s)
- Janice M Leung
- Division of Respiratory Medicine, Department of Medicine
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level. Cancers (Basel) 2022; 14:cancers14225660. [PMID: 36428751 PMCID: PMC9688770 DOI: 10.3390/cancers14225660] [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: 10/03/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Cancer and obesity are well-known prognostic factors in COVID-19. Our objective was to study the effect of obesity (and its severity) on the risk of intensive care unit (ICU) admission, severe complications, and in-hospital mortality, in a population of cancer patients hospitalized with or without COVID-19. All patients hospitalized in France for cancer from 1 March 2020 to 28 February 2022 were included from the French national administrative database. The effect of obesity was estimated in COVID-19 and in non-COVID-19 cancer patients using logistic and survival regressions, taking into account age, sex, comorbidities, and different types of cancer. Among the 992,899 cancer patients, we identified 53,090 patients with COVID-19 (5.35%), of which 3260 were obese (6.1%). After adjustment, for patients with or without COVID-19, there is an increased risk of ICU admission or severe complications in obese patients, regardless of the type of obesity. Regarding in-hospital mortality, there is no excess risk associated with overall obesity. However, massive obesity appears to be associated with an increased risk of in-hospital mortality, with a significantly stronger effect in solid cancer patients without COVID-19 and a significantly stronger effect in hematological cancer patients with COVID-19. This study showed that in France, among hospitalized patients with cancer and with or without COVID-19, increased vigilance is needed for obese patients, both in epidemic and non-epidemic periods. This vigilance should be further strengthened in patients with massive obesity for whom the risk of in-hospital mortality is higher, particularly in epidemic periods for patients with hematological cancers.
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Ringheim H, Thudium RF, Jensen JUS, Rezahosseini O, Nielsen SD. Prevalence of emphysema in people living with human immunodeficiency virus in the current combined antiretroviral therapy era: A systematic review. Front Med (Lausanne) 2022; 9:897773. [PMID: 36213645 PMCID: PMC9532512 DOI: 10.3389/fmed.2022.897773] [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: 03/16/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Before introducing combination antiretroviral therapy (cART), a higher prevalence of emphysema in people living with HIV (PLWH) than in the background population was reported. This systematic literature review aimed to investigate the prevalence of emphysema in PLWH and to compare the prevalence between PLWH and controls in the current cART era. A systematic literature search was conducted in PubMed, EMBASE, Scopus, and Web of Science (WOS), searching for “human immunodeficiency virus (HIV)” and “emphysema” from January 1, 2000 to March 10, 2021. Eligible studies were published after the introduction of cART, included PLWH, and reported the prevalence of emphysema. A total of 17 studies were included, and nine studies also included controls. The weighted average prevalence of emphysema in PLWH was 23% (95% CI: 16–30). In studies including both PLWH and controls the weighted average prevalence were 22% (95% CI: 10–33) and 9.7% (95% CI: 2.3–17), respectively (p = 0.052). The prevalence of emphysema in never-smoking PLWH and controls was just reported in one study and was 18 and 4%, respectively (p < 0.01). Thirteen of the studies had a moderate risk of bias, mainly due to selection of patients. A tendency to higher prevalence of emphysema was found in PLWH in comparison to controls in the current cART era. However, in the included studies, the definition of emphysema varied largely. Thus, to have a clear overview of the prevalence, further studies with well-designed cohorts of PLWH and controls are warranted.
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Affiliation(s)
- Hedda Ringheim
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rebekka F. Thudium
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik S. Jensen
- Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Omid Rezahosseini
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D. Nielsen
- Viro-Immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Susanne D. Nielsen,
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Franquet T, Domingo P. Pulmonary Infections in People Living with HIV. Radiol Clin North Am 2022; 60:507-520. [DOI: 10.1016/j.rcl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maitre T, Cottenet J, Godet C, Roussot A, Abdoul Carime N, Ok V, Parrot A, Bonniaud P, Quantin C, Cadranel J. To code or not to code chronic pulmonary aspergillosis associated malnutrition in PMSI database: that is the problem…. Eur Respir J 2021; 59:13993003.02820-2021. [PMID: 34795041 DOI: 10.1183/13993003.02820-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Maitre
- Department of Pneumology and Reference Centre for Rare Lung Diseases, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Sorbonne Université, Paris, France.,Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, Sorbonne Université, Paris, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Cendrine Godet
- Department of Pneumology, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Nafiz Abdoul Carime
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France
| | - Vichita Ok
- Department of Parasitology and Mycology, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Sorbonne Paris Nord, Bobigny, France
| | - Antoine Parrot
- Department of Pneumology and Reference Centre for Rare Lung Diseases, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Sorbonne Université, Paris, France
| | - Philippe Bonniaud
- Department of Pneumology and Intensive Care Unit, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics department (DIM), Dijon University Hospital, Dijon, France; University of Bourgogne Franche-Comté, Dijon, France.,Inserm, CIC 1432, Dijon, France; Dijon University Hospital, Clinical Investigation Center, clinical epidemiology/ clinical trials unit, Dijon, France.,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.,These two authors contributed equally to this work
| | - Jacques Cadranel
- Department of Pneumology and Reference Centre for Rare Lung Diseases, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Sorbonne Université, Paris, France .,These two authors contributed equally to this work
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Akata K, Leung JM, Yamasaki K, Filho FSL, Yang J, Yang CX, Takiguchi H, Shaipanich T, Sahin B, Whalen BA, Yang CWT, Sin DD, van Eeden SF. Altered polarization and impaired phagocytic activity of lung macrophages in people with HIV and COPD. J Infect Dis 2021; 225:862-867. [PMID: 34610114 DOI: 10.1093/infdis/jiab506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/03/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND People with HIV (PWH) have an increased risk of developing Chronic Obstructive Pulmonary Disease (COPD). METHODS We phenotyped lung macrophages in four subgroups: M1 (CD40+CD163-), M2 (CD40-CD163+), Double Positives (CD40+CD163+), Double Negatives (CD40-CD163-) and determined their phagocytic capacity in PWH with and without COPD. RESULTS PWH with COPD have more double negative macrophages (84.1%) vs PWH without (54.3%) vs controls (23.9%) (p=0.004) and reduced phagocytosis (p=0.012). Double negative macrophages had the worst phagocytic capacity (p<0.001). CONCLUSIONS PWH with COPD have an abundance of non-polarized macrophages which have poor phagocytic capacity therefore predispose them to increased risk of disease progression.
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Affiliation(s)
- Kentaro Akata
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Japan, Fukuoka, Japan.,Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Janice M Leung
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | | | - Julia Yang
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Chen Xi Yang
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Hiroto Takiguchi
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Tawimas Shaipanich
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Basak Sahin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Beth A Whalen
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Cheng Wei Tony Yang
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stephan F van Eeden
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Maitre T, Cottenet J, Godet C, Roussot A, Abdoul Carime N, Ok V, Parrot A, Bonniaud P, Quantin C, Cadranel J. Chronic pulmonary aspergillosis: prevalence, favouring pulmonary diseases and prognosis. Eur Respir J 2021; 58:13993003.03345-2020. [PMID: 33479108 DOI: 10.1183/13993003.03345-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/03/2021] [Indexed: 12/13/2022]
Abstract
Chronic pulmonary aspergillosis (CPA) is an emerging disease in patients with common chronic pulmonary diseases (CPDs). While its prevalence is linked to tuberculosis (TB) in endemic countries, epidemiological and prognostic data are lacking in low TB incidence countries. The aim of this study was to describe these features in CPA patients hospitalised in France between 2009 and 2018.We estimated the prevalence and mortality of hospitalised CPA patients using the French nationwide administrative hospital database. We also assessed the association with CPD, thoracic interventions and malnutrition.From 2009 to 2018, 17 290 patients were hospitalised in France for CPA, with an increasing prevalence during this period. Most patients were male (63.5%) with a median age of 65 years at CPA diagnosis, living in farming regions and large cities. The proportion of underlying chronic obstructive pulmonary disease (COPD) and emphysema during the previous 5 years was 44% and 22%, respectively, whereas it was only 3% for both TB and non-TB mycobacterial (NTM) infections. The mortality rates during the first hospitalisation, at 1 year and at 5 years were 17%, 32% and 45%, respectively. In multivariate analysis, mortality rates were increased in patients aged >65 years, male patients and patients with malnutrition, diabetes or lung cancer history. The risk of mortality in patients with COPD or emphysema was higher than in those with previous mycobacterial lung infection.In France, CPA is an emerging infection commonly associated with non-mycobacterial CPD. This shift in the distribution profile of underlying CPD will likely worsen CPA mortality.
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Affiliation(s)
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics Department (DIM), Dijon University Hospital, Dijon, France.,University of Bourgogne Franche-Comté, Dijon, France
| | - Cendrine Godet
- Dept of Pneumology, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics Department (DIM), Dijon University Hospital, Dijon, France.,University of Bourgogne Franche-Comté, Dijon, France
| | - Nafiz Abdoul Carime
- Biostatistics and Bioinformatics Department (DIM), Dijon University Hospital, Dijon, France.,University of Bourgogne Franche-Comté, Dijon, France
| | - Vichita Ok
- Dept of Parasitology and Mycology, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Sorbonne Paris Nord, Bobigny, France
| | - Antoine Parrot
- Sorbonne Université, Paris, France.,Dept of Pneumology and Reference Centre for Rare Lung Diseases, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Paris, France
| | - Philippe Bonniaud
- University of Bourgogne Franche-Comté, Dijon, France.,Dept of Pneumology and Intensive Care Unit, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics Department (DIM), Dijon University Hospital, Dijon, France.,University of Bourgogne Franche-Comté, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France.,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.,Contributed equally to this work
| | - Jacques Cadranel
- Sorbonne Université, Paris, France .,Dept of Pneumology and Reference Centre for Rare Lung Diseases, Assistance Publique Hôpitaux de Paris, Tenon Hospital, Paris, France.,Contributed equally to this work
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12
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Howlett J, Benzenine E, Fagnoni P, Quantin C. Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer associated venous thromboembolism management? J Thromb Thrombolysis 2021; 50:642-651. [PMID: 32020515 DOI: 10.1007/s11239-020-02047-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don't require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management's mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients.
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Affiliation(s)
- Jennifer Howlett
- Pharmacy, Quimper Hospital, 14 avenue Yves Thepot, 29000, QUIMPER, France
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
- INSERM CIC 1432; Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France
| | - Philippe Fagnoni
- Pharmacy, Bourgogne Franche-Comté University Hospital, Dijon, France
- Unité INSERM U866, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France.
- INSERM CIC 1432; Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon University Hospital, Dijon, France.
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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13
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Ronit A, Omland LH, Kronborg G, Pedersen G, Nielsen L, Mohey R, Wiese L, Obel N, Ahlström MG. Incidence of chronic obstructive pulmonary disease in people with HIV, their parents and siblings in Denmark. J Infect Dis 2021; 225:492-501. [PMID: 34260725 DOI: 10.1093/infdis/jiab369] [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: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with HIV (PWH) may be at increased risk of several respiratory syndromes including chronic obstructive pulmonary disease (COPD). In matched cohort studies, we examined risk factors for COPD in PWH, their parents and siblings compared with population controls. METHODS Using data from national registries, competing risk regression models were constructed and used to calculate adjusted hazard ratios (aHR) for COPD. We evaluated the effect of HIV characteristics, smoking and educational attainment on COPD incidence in PWH. RESULTS A total of 226 PWH and 1029 population controls were diagnosed with COPD during 63,661 and 562,171 person years of follow up. PWH had increased risk of being diagnosed with COPD compared to controls (aHR 2.02 [95%CI: 1.75-2.33]). Parents and siblings of PWH were also more likely to be diagnosed with COPD compared to controls. CD4+ T-cell counts were not associated with COPD, but both unsuppressed viral replication, smoking status and educational attainment were associated with COPD in PWH. No COPD diagnoses were registered in PWH with high educational attainment and absence of smoking. CONCLUSIONS PWH have an increased risk of being diagnosed with COPD, as have their parents and siblings. This seems to be driven primarily by smoking and low socioeconomic status.
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Affiliation(s)
- Andreas Ronit
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre,Denmark
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg,Denmark
| | - Lars Nielsen
- Department of Infectious Diseases, Hillerød University Hospital, Hillerød,Denmark
| | - Rajesh Mohey
- Department of Infectious Diseases, Herning University Hospital, Herning,Denmark
| | - Lothar Wiese
- Department of Internal Medicine, Division of Infectious Diseases, Zealand University Hospital, Roskilde,Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigsh ospitalet,Denmark
| | - Magnus G Ahlström
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Abstract
OBJECTIVE AND DESIGN People living with HIV (PLH) suffer disproportionately from the chronic diseases exacerbated by smoking tobacco. We performed a systematic review and meta-analysis to establish the relative prevalence of smoking among PLH. METHODS We included observational studies reporting current smoking rates among PLH and comparators without HIV. We searched Medline, EMBASE, LILACS and SciELO from inception to 31 August 2019. We excluded studies that recruited participants with smoking related illness. We used a random effects model to estimate the odds ratio for current smoking in PLH and people without HIV. We used the Newcastle--Ottawa scale to assess methodological bias. We performed subgroup analysis based on sex and WHO region. We quantified heterogeneity with meta-regression and predictive distributions. PROSPERO registration:CRD42016052608. RESULTS We identified 6116 studies and included 37. Of 111 258 PLH compared with 10 961 217 HIV-negative participants pooled odds of smoking were 1.64 [(95% confidence interval, 95% CI: 1.45-1.85) (95% prediction interval: 0.66-4.10, I2 = 98.1%)]. Odds for men and women living with HIV were 1.68 [(95% CI: 1.44-1.95) (95% prediction interval: 0.71-3.98, I2 = 91.1%)] and 2.16 [(95% CI: 1.77-2.63) (95% prediction interval: 0.92-5.07, I2 = 81.7%)] respectively. CONCLUSION PLH are more likely to be smokers than people without HIV. This finding was true in subgroup analyses of men, women and in four of five WHO regions from which data were available. Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important covariate in studies of HIV-associated multimorbidity.
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15
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Verboeket SO, Boyd A, Wit FW, Verheij E, Schim van der Loeff MF, Kootstra N, van der Valk M, van Steenwijk RP, Drummond MB, Kirk GD, Reiss P. Changes in lung function among treated HIV-positive and HIV-negative individuals: analysis of the prospective AGEhIV cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e202-e211. [DOI: 10.1016/s2666-7568(21)00033-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
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16
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Devadoss D, Singh SP, Acharya A, Do KC, Periyasamy P, Manevski M, Mishra N, Tellez CS, Ramakrishnan S, Belinsky SA, Byrareddy SN, Buch S, Chand HS, Sopori M. HIV-1 Productively Infects and Integrates in Bronchial Epithelial Cells. Front Cell Infect Microbiol 2021; 10:612360. [PMID: 33614527 PMCID: PMC7890076 DOI: 10.3389/fcimb.2020.612360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The role of lung epithelial cells in HIV-1-related lung comorbidities remains unclear, and the major hurdle in curing HIV is the persistence of latent HIV reservoirs in people living with HIV (PLWH). The advent of combined antiretroviral therapy has considerably increased the life span; however, the incidence of chronic lung diseases is significantly higher among PLWH. Lung epithelial cells orchestrate the respiratory immune responses and whether these cells are productively infected by HIV-1 is debatable. METHODS Normal human bronchial epithelial cells (NHBEs) grown on air-liquid interface were infected with X4-tropic HIV-1LAV and examined for latency using latency-reversing agents (LRAs). The role of CD4 and CXCR4 HIV coreceptors in NHBEs were tested, and DNA sequencing analysis was used to analyze the genomic integration of HIV proviral genes, Alu-HIVgag-pol, HIV-nef, and HIV-LTR. Lung epithelial sections from HIV-infected humans and SHIV-infected macaques were analyzed by FISH for HIV-gag-pol RNA and epithelial cell-specific immunostaining. RESULTS AND DISCUSSION NHBEs express CD4 and CXCR4 at higher levels than A549 cells. NHBEs are infected with HIV-1 basolaterally, but not apically, by X4-tropic HIV-1LAV in a CXCR4/CD4-dependent manner leading to HIV-p24 antigen production; however, NHBEs are induced to express CCR5 by IL-13 treatment. In the presence of cART, HIV-1 induces latency and integration of HIV provirus in the cellular DNA, which is rescued by the LRAs (endotoxin/vorinostat). Furthermore, lung epithelial cells from HIV-infected humans and SHIV-infected macaques contain HIV-specific RNA transcripts. Thus, lung epithelial cells are targeted by HIV-1 and could serve as potential HIV reservoirs that may contribute to the respiratory comorbidities in PLWH.
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Affiliation(s)
- Dinesh Devadoss
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Shashi P. Singh
- Respiratory Immunology Division, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Arpan Acharya
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kieu Chinh Do
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Palsamy Periyasamy
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marko Manevski
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Neerad Mishra
- Respiratory Immunology Division, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Carmen S. Tellez
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Sundaram Ramakrishnan
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Steven A. Belinsky
- Lung Cancer Program, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
| | - Siddappa N. Byrareddy
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Shilpa Buch
- Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hitendra S. Chand
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Mohan Sopori
- Respiratory Immunology Division, Lovelace Respiratory Research Institute, Albuquerque, NM, United States
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17
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Almodovar S, Wade BE, Porter KM, Smith JM, Lopez-Astacio RA, Bijli K, Kang BY, Cribbs SK, Guidot DM, Molehin D, McNair BK, Pumarejo-Gomez L, Perez Hernandez J, Salazar EA, Martinez EG, Huang L, Kessing CF, Suarez-Martinez EB, Pruitt K, Hsue PY, Tyor WR, Flores SC, Sutliff RL. HIV X4 Variants Increase Arachidonate 5-Lipoxygenase in the Pulmonary Microenvironment and are associated with Pulmonary Arterial Hypertension. Sci Rep 2020; 10:11696. [PMID: 32678115 PMCID: PMC7366722 DOI: 10.1038/s41598-020-68060-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/18/2020] [Indexed: 01/28/2023] Open
Abstract
Pulmonary Arterial Hypertension (PAH) is overrepresented in People Living with Human Immunodeficiency Virus (PLWH). HIV protein gp120 plays a key role in the pathogenesis of HIV-PAH. Genetic changes in HIV gp120 determine viral interactions with chemokine receptors; specifically, HIV-X4 viruses interact with CXCR4 while HIV-R5 interact with CCR5 co-receptors. Herein, we leveraged banked samples from patients enrolled in the NIH Lung HIV studies and used bioinformatic analyses to investigate whether signature sequences in HIV-gp120 that predict tropism also predict PAH. Further biological assays were conducted in pulmonary endothelial cells in vitro and in HIV-transgenic rats. We found that significantly more persons living with HIV-PAH harbor HIV-X4 variants. Multiple HIV models showed that recombinant gp120-X4 as well as infectious HIV-X4 remarkably increase arachidonate 5-lipoxygenase (ALOX5) expression. ALOX5 is essential for the production of leukotrienes; we confirmed that leukotriene levels are increased in bronchoalveolar lavage fluid of HIV-infected patients. This is the first report associating HIV-gp120 genotype to a pulmonary disease phenotype, as we uncovered X4 viruses as potential agents in the pathophysiology of HIV-PAH. Altogether, our results allude to the supplementation of antiretroviral therapy with ALOX5 antagonists to rescue patients with HIV-X4 variants from fatal PAH.
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Affiliation(s)
- Sharilyn Almodovar
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Brandy E Wade
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
| | - Kristi M Porter
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Justin M Smith
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert A Lopez-Astacio
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biology, University of Puerto Rico in Ponce, Ponce, PR, USA
| | - Kaiser Bijli
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Bum-Yong Kang
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Sushma K Cribbs
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - David M Guidot
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Deborah Molehin
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Bryan K McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Pumarejo-Gomez
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jaritza Perez Hernandez
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ethan A Salazar
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Edgar G Martinez
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Laurence Huang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cari F Kessing
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | | | - Kevin Pruitt
- Department of Immunology and Molecular Microbiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Priscilla Y Hsue
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - William R Tyor
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sonia C Flores
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Roy L Sutliff
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
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18
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Abstract
PURPOSE OF REVIEW In the antiretroviral therapy era, people living with HIV (PLWH) are surviving to older ages. Chronic illnesses such as chronic obstructive pulmonary disease (COPD) occur more frequently. COPD is often described as a single entity, yet multiple manifestations may be considered phenotypes. HIV is an independent risk factor for certain COPD phenotypes, and mechanisms underlying pathogenesis of these phenotypes may differ and impact response to therapy. RECENT FINDINGS Impaired diffusing capacity, airflow obstruction, and radiographic emphysema occur in PLWH and are associated with increased mortality. Age, sex, tobacco, and HIV-specific factors likely modulate the severity of disease. An altered lung microbiome and residual HIV in the lung may also influence phenotypes. COPD is prevalent in PLWH with multiple phenotypes contributing to the burden of disease. HIV-specific factors and the respiratory microbiome influence disease pathogenesis. As tobacco use remains a significant risk factor for COPD, smoking cessation must be emphasized for all PLWH.
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Affiliation(s)
- Deepti Singhvi
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Jessica Bon
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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19
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Development and external-validation of a nomogram for predicting the survival of hospitalised HIV/AIDS patients based on a large study cohort in western China. Epidemiol Infect 2020; 148:e84. [PMID: 32234104 PMCID: PMC7189350 DOI: 10.1017/s0950268820000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to develop and externally validate a simple-to-use nomogram for predicting the survival of hospitalised human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients (hospitalised person living with HIV/AIDS (PLWHAs)). Hospitalised PLWHAs (n = 3724) between January 2012 and December 2014 were enrolled in the training cohort. HIV-infected inpatients (n = 1987) admitted in 2015 were included as the external-validation cohort. The least absolute shrinkage and selection operator method was used to perform data dimension reduction and select the optimal predictors. The nomogram incorporated 11 independent predictors, including occupation, antiretroviral therapy, pneumonia, tuberculosis, Talaromyces marneffei, hypertension, septicemia, anaemia, respiratory failure, hypoproteinemia and electrolyte disturbances. The Likelihood χ2 statistic of the model was 516.30 (P = 0.000). Integrated Brier Score was 0.076 and Brier scores of the nomogram at the 10-day and 20-day time points were 0.046 and 0.071, respectively. The area under the curves for receiver operating characteristic were 0.819 and 0.828, and precision-recall curves were 0.242 and 0.378 at two time points. Calibration plots and decision curve analysis in the two sets showed good performance and a high net benefit of nomogram. In conclusion, the nomogram developed in the current study has relatively high calibration and is clinically useful. It provides a convenient and useful tool for timely clinical decision-making and the risk management of hospitalised PLWHAs.
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