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de Moraes L, Santos LA, Arruda LB, da Silva MDPP, Silva MDO, Silva JAG, Ramos A, dos Santos MB, Torres FG, Orge C, Teixeira AMDS, Vieira TS, Ramírez L, Soto M, Grassi MFR, de Siqueira IC, Costa DL, Costa CHN, Andrade BDB, Akrami K, de Oliveira CI, Boaventura VS, Barral-Netto M, Barral A, Vandamme AM, Van Weyenbergh J, Khouri R. High seroprevalence of Leishmania infantum is linked to immune activation in people with HIV: a two-stage cross-sectional study in Bahia, Brazil. Front Microbiol 2023; 14:1221682. [PMID: 37601355 PMCID: PMC10436095 DOI: 10.3389/fmicb.2023.1221682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Visceral leishmaniasis is an opportunistic disease in HIV-1 infected individuals, unrecognized as a determining factor for AIDS diagnosis. The growing geographical overlap of HIV-1 and Leishmania infections is an emerging challenge worldwide, as co-infection increases morbidity and mortality for both infections. Here, we determined the prevalence of people living with HIV (PWH) with a previous or ongoing infection by Leishmania infantum and investigated the virological and immunological factors associated with co-infection. We adopted a two-stage cross-sectional cohort (CSC) design (CSC-I, n = 5,346 and CSC-II, n = 317) of treatment-naïve HIV-1-infected individuals in Bahia, Brazil. In CSC-I, samples collected between 1998 and 2013 were used for serological screening for leishmaniasis by an in-house Enzyme-Linked Immunosorbent Assay (ELISA) with SLA (Soluble Leishmania infantum Antigen), resulting in a prevalence of previous or ongoing infection of 16.27%. Next, 317 PWH were prospectively recruited from July 2014 to December 2015 with the collection of sociodemographic and clinical data. Serological validation by two different immunoassays confirmed a prevalence of 15.46 and 8.20% by anti-SLA, and anti-HSP70 serology, respectively, whereas 4.73% were double-positive (DP). Stratification of these 317 individuals in DP and double-negative (DN) revealed a significant reduction of CD4+ counts and CD4+/CD8+ ratios and a tendency of increased viral load in the DP group, as compared to DN. No statistical differences in HIV-1 subtype distribution were observed between the two groups. However, we found a significant increase of CXCL10 (p = 0.0076) and a tendency of increased CXCL9 (p = 0.061) in individuals with DP serology, demonstrating intensified immune activation in this group. These findings were corroborated at the transcriptome level in independent Leishmania- and HIV-1-infected cohorts (Swiss HIV Cohort and Piaui Northeast Brazil Cohort), indicating that CXCL10 transcripts are shared by the IFN-dominated immune activation gene signatures of both pathogens and positively correlated to viral load in untreated PWH. This study demonstrated a high prevalence of PWH with L. infantum seropositivity in Bahia, Brazil, linked to IFN-mediated immune activation and a significant decrease in CD4+ levels. Our results highlight the urgent need to increase awareness and define public health strategies for the management and prevention of HIV-1 and L. infantum co-infection.
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Affiliation(s)
- Laise de Moraes
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Luciane Amorim Santos
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, United Kingdom
| | | | - Márcio de Oliveira Silva
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - José Adriano Góes Silva
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | - André Ramos
- Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa, Secretaria de Saúde do Estado da Bahia, Salvador, Brazil
| | | | | | - Cibele Orge
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | - Laura Ramírez
- Departamento de Biología Molecular, Facultad de Ciencias, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Soto
- Departamento de Biología Molecular, Facultad de Ciencias, Centro de Biología Molecular Severo Ochoa, Consejo Superior de Investigaciones Científicas, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Fernanda Rios Grassi
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | - Dorcas Lamounier Costa
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Carlos Henrique Nery Costa
- Laboratório de Leishmanioses, Instituto de Doenças Tropicais Natan Portella, Universidade Federal do Piauí, Teresina, Brazil
| | - Bruno de Bezerril Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Kevan Akrami
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Camila Indiani de Oliveira
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Viviane Sampaio Boaventura
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Hospital Santa Izabel, Salvador, Brazil
| | - Manoel Barral-Netto
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Aldina Barral
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Anne-Mieke Vandamme
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
- Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
| | - Ricardo Khouri
- Programa de Pós-graduação em Ciências da Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
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Bishop K, Balogun S, Eynstone-Hinkins J, Moran L, Martin M, Banks E, Rao C, Joshy G. Analysis of Multiple Causes of Death: A Review of Methods and Practices. Epidemiology 2023; 34:333-344. [PMID: 36719759 PMCID: PMC10069753 DOI: 10.1097/ede.0000000000001597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics-reflecting increasing multimorbidity and complex causation patterns-is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes. METHODS We searched Medline, PubMed, Scopus, and Web of Science from their incept ion to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles. RESULTS Most articles we reviewed (76%, n = 332) were published since 2001. The majority of articles examined mortality by "any- mention" of the cause of death (87%, n = 377) and assessed pairwise combinations of causes (57%, n = 245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n = 9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n = 5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently. CONCLUSION This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
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Affiliation(s)
- Karen Bishop
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Saliu Balogun
- From the National Centre for Epidemiology and Population Health, Australian National University
| | | | - Lauren Moran
- Australian Bureau of Statistics, Canberra, Australia
| | - Melonie Martin
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Emily Banks
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Chalapati Rao
- From the National Centre for Epidemiology and Population Health, Australian National University
| | - Grace Joshy
- From the National Centre for Epidemiology and Population Health, Australian National University
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Cavallera V, Lancaster G, Gladstone M, Black MM, McCray G, Nizar A, Ahmed S, Dutta A, Anago RKE, Brentani A, Jiang F, Schönbeck Y, McCoy DC, Kariger P, Weber AM, Raikes A, Waldman M, van Buuren S, Kaur R, Pérez Maillard M, Nisar MI, Khanam R, Sazawal S, Zongo A, Pacifico Mercadante M, Zhang Y, Roy AD, Hepworth K, Fink G, Rubio-Codina M, Tofail F, Eekhout I, Seiden J, Norton R, Baqui AH, Khalfan Ali J, Zhao J, Holzinger A, Detmar S, Kembou SN, Begum F, Mohammed Ali S, Jehan F, Dua T, Janus M. Protocol for validation of the Global Scales for Early Development (GSED) for children under 3 years of age in seven countries. BMJ Open 2023; 13:e062562. [PMID: 36693690 PMCID: PMC9884878 DOI: 10.1136/bmjopen-2022-062562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Children's early development is affected by caregiving experiences, with lifelong health and well-being implications. Governments and civil societies need population-based measures to monitor children's early development and ensure that children receive the care needed to thrive. To this end, the WHO developed the Global Scales for Early Development (GSED) to measure children's early development up to 3 years of age. The GSED includes three measures for population and programmatic level measurement: (1) short form (SF) (caregiver report), (2) long form (LF) (direct administration) and (3) psychosocial form (PF) (caregiver report). The primary aim of this protocol is to validate the GSED SF and LF. Secondary aims are to create preliminary reference scores for the GSED SF and LF, validate an adaptive testing algorithm and assess the feasibility and preliminary validity of the GSED PF. METHODS AND ANALYSIS We will conduct the validation in seven countries (Bangladesh, Brazil, Côte d'Ivoire, Pakistan, The Netherlands, People's Republic of China, United Republic of Tanzania), varying in geography, language, culture and income through a 1-year prospective design, combining cross-sectional and longitudinal methods with 1248 children per site, stratified by age and sex. The GSED generates an innovative common metric (Developmental Score: D-score) using the Rasch model and a Development for Age Z-score (DAZ). We will evaluate six psychometric properties of the GSED SF and LF: concurrent validity, predictive validity at 6 months, convergent and discriminant validity, and test-retest and inter-rater reliability. We will evaluate measurement invariance by comparing differential item functioning and differential test functioning across sites. ETHICS AND DISSEMINATION This study has received ethical approval from the WHO (protocol GSED validation 004583 20.04.2020) and approval in each site. Study results will be disseminated through webinars and publications from WHO, international organisations, academic journals and conference proceedings. REGISTRATION DETAILS Open Science Framework https://osf.io/ on 19 November 2021 (DOI 10.17605/OSF.IO/KX5T7; identifier: osf-registrations-kx5t7-v1).
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Affiliation(s)
- Vanessa Cavallera
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life COurse and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Maureen M Black
- International Education, RTI International, Research Triangle Park, North Carolina, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Ambreen Nizar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Arup Dutta
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
| | | | - Alexandra Brentani
- Department of Pediatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Fan Jiang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shangai, People's Republic of China
| | - Yvonne Schönbeck
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Dana C McCoy
- Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Patricia Kariger
- Center for Effective Global Action, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | - Abbie Raikes
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Marcus Waldman
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Stef van Buuren
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, University of Utrecht, Utrecht, Netherlands
| | - Raghbir Kaur
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Michelle Pérez Maillard
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Muhammad Imran Nisar
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sunil Sazawal
- Center for Public Health Kinetics, CPHK Global, Pemba, Zanzibar, Tanzania
| | - Arsène Zongo
- IPA Côte d'Ivoire, Innovations for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Yunting Zhang
- Child Health Advocacy Institute, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | | | - Katelyn Hepworth
- Health Promotion, University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA
| | - Günther Fink
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Marta Rubio-Codina
- Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iris Eekhout
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Jonathan Seiden
- Education Policy and Program Evaluation, Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Rebecca Norton
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jin Zhao
- Department of Developmental and Behavioural Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shangai, People's Republic of China
| | - Andreas Holzinger
- IPA Francophone West Africa, Innovations for Poverty Action, Abidjan, Côte d\'Ivoire
| | - Symone Detmar
- Department of Child Health, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | | | - Farzana Begum
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Said Mohammed Ali
- Institution Head, Public Health Laboratory, Pemba, Zanzibar, Tanzania
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
- Paediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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McCray G, McCoy D, Kariger P, Janus M, Black MM, Chang SM, Tofail F, Eekhout I, Waldman M, van Buuren S, Khanam R, Sazawal S, Nizar A, Schönbeck Y, Zongo A, Brentani A, Zhang Y, Dua T, Cavallera V, Raikes A, Weber AM, Bromley K, Baqui A, Dutta A, Nisar I, Detmar SB, Anago R, Mercadante P, Jiang F, Kaur R, Hepworth K, Rubio-Codina M, Kembou SN, Ahmed S, Lancaster GA, Gladstone M. The creation of the Global Scales for Early Development (GSED) for children aged 0-3 years: combining subject matter expert judgements with big data. BMJ Glob Health 2023; 8:bmjgh-2022-009827. [PMID: 36650017 PMCID: PMC9853147 DOI: 10.1136/bmjgh-2022-009827] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/02/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION With the ratification of the Sustainable Development Goals, there is an increased emphasis on early childhood development (ECD) and well-being. The WHO led Global Scales for Early Development (GSED) project aims to provide population and programmatic level measures of ECD for 0-3 years that are valid, reliable and have psychometrically stable performance across geographical, cultural and language contexts. This paper reports on the creation of two measures: (1) the GSED Short Form (GSED-SF)-a caregiver reported measure for population-evaluation-self-administered with no training required and (2) the GSED Long Form (GSED-LF)-a directly administered/observed measure for programmatic evaluation-administered by a trained professional. METHODS We selected 807 psychometrically best-performing items using a Rasch measurement model from an ECD measurement databank which comprised 66 075 children assessed on 2211 items from 18 ECD measures in 32 countries. From 766 of these items, in-depth subject matter expert judgements were gathered to inform final item selection. Specifically collected were data on (1) conceptual matches between pairs of items originating from different measures, (2) developmental domain(s) measured by each item and (3) perceptions of feasibility of administration of each item in diverse contexts. Prototypes were finalised through a combination of psychometric performance evaluation and expert consensus to optimally identify items. RESULTS We created the GSED-SF (139 items) and GSED-LF (157 items) for tablet-based and paper-based assessments, with an optimal set of items that fit the Rasch model, met subject matter expert criteria, avoided conceptual overlap, covered multiple domains of child development and were feasible to implement across diverse settings. CONCLUSIONS State-of-the-art quantitative and qualitative procedures were used to select of theoretically relevant and globally feasible items representing child development for children aged 0-3 years. GSED-SF and GSED-LF will be piloted and validated in children across diverse cultural, demographic, social and language contexts for global use.
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Affiliation(s)
| | - Dana McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | | | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA,RTI International, Research Triangle Park, North Carolina, USA
| | - Susan M Chang
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iris Eekhout
- Department of Child Health, TNO, Leiden, The Netherlands
| | - Marcus Waldman
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Rasheda Khanam
- Department of International Health, Johns Hopkins, Baltimore, Maryland, USA
| | - Sunil Sazawal
- Center for Public Health Kinetics, New Delhi, New Delhi, India
| | - Ambreen Nizar
- Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Arsène Zongo
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Alexandra Brentani
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Yunting Zhang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China,National Children's Medical Center, Shanghai Children's Medical Center affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tarun Dua
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Vanessa Cavallera
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Abbie Raikes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ann M Weber
- School of Public Health, University of Nevada Reno, Reno, Nevada, USA
| | | | - Abdullah Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Imran Nisar
- Paediatrics, Aga Khan University, Karrachi, Pakistan
| | | | - Romuald Anago
- Innovations for Poverty Action, Washington, District of Columbia, USA
| | - Pacifico Mercadante
- Pediatrics, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Fan Jiang
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China
| | - Raghbir Kaur
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneve, Switzerland
| | - Katelyn Hepworth
- University of Nebraska-Lincoln College of Education and Human Sciences, Lincoln, Nebraska, USA
| | | | - Samuel N Kembou
- Innovations for Poverty Action, Washington, District of Columbia, USA
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Taborelli M, Suligoi B, Serraino D, Frova L, Grande E, Toffolutti F, Regine V, Pappagallo M, Pugliese L, Grippo F, Zucchetto A. Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006-2018. BMJ Open 2022; 12:e064970. [PMID: 36456002 PMCID: PMC9716863 DOI: 10.1136/bmjopen-2022-064970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population without AIDS (non-PWA). DESIGN Population-based, retrospective cohort study. SETTING AND PARTICIPANTS We conducted a nationwide study including 9481 Italian PWA, aged 15-74 years, reported to the National AIDS Registry between 2006 and 2018. METHODS Vital status and causes of death were retrieved by record linkage with the National Register of Causes of Death up to 2018. Excess mortality for PWA versus non-PWA was estimated through sex-standardised and age-standardised mortality ratios (SMRs) with corresponding 95% CIs. RESULTS Among 2613 deceased PWA, 262 (10.0%) reported at least one urinary tract disease at death, including 254 (9.7%) non-cancer diseases-mostly renal failures (225 cases, 8.6%)-and 9 cancers (0.3%). The overall SMR for non-cancer urinary tract diseases was 15.3 (95% CI 13.4 to 17.3) with statistically significant SMRs for acute (SMR=22.3, 95% CI 18.0 to 27.4), chronic (SMR=8.4, 95% CI 6.0 to 11.3), and unspecified renal failure (SMR=13.8, 95% CI 11.2 to 16.8). No statistically significant excess mortality was detected for urinary tract cancers (SMR=1.7, 95% CI 0.8 to 3.3). The SMRs were particularly elevated among PWA aged <50 years, injecting drug users, or those with the first HIV-positive test >6 months before AIDS diagnosis. CONCLUSIONS The excess mortality related to non-cancer kidney and other urinary tract diseases reported among PWA highlights the importance of implementing the recommendation for screening, diagnosis and management of such conditions among this population.
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Affiliation(s)
- Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luisa Frova
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Enrico Grande
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Marilena Pappagallo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Lucia Pugliese
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Francesco Grippo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Antonella Zucchetto
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Perumal N, Saleh A, Muhihi A, McCoy D, Seiden J, Bakari M, Ndesangia V, Ulenga N, Sudfeld CR, Manji KP. School readiness among children born to women living with HIV in Dar es Salaam, Tanzania: a cohort study protocol. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001572. [PMID: 36645758 PMCID: PMC9628665 DOI: 10.1136/bmjpo-2022-001572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Children who are born to women living with HIV are at a greater risk of suboptimal neurodevelopment; however, evidence from sub-Saharan Africa is limited and functional developmental outcomes are rarely assessed in this vulnerable population. The School Readiness among HIV-Exposed Children (SRHEC) cohort study aims to assess the school readiness of preschool aged children born to women living with HIV and to identify the biological, environmental and social factors that contribute to school readiness in this population. METHODS AND ANALYSIS The SRHEC cohort is an observational follow-up study of children born to HIV-infected pregnant women who were previously enrolled in a maternal vitamin D supplementation randomised, placebo-controlled trial in Dar es Salaam, Tanzania. This parent trial enrolled 2300 pregnant women and followed mothers and infants up to 1-year postpartum. Mother/caregiver and child pairs will be eligible for the SRHEC follow-up study if the child is between 3 and 6.5 years of age at assessment, and the mother/caregiver provides informed consent. The International Development and Early Learning Assessment tool will be used to assess children's school readiness, including their early literacy, early numeracy, motor, socialemotional, and executive function skills. Data on maternal and child health and nutritional status (eg, anthropometry, blood pressure and diet) will be collected using standardised instruments and survey-based questionnaires. Data on maternal/caregiver depression and anxiety, maternal exposure to intimate partner violence, and HIV-related stigma will also be collected. Generalised linear and logistic regressions will be used to assess the relationship between child school readiness and biological, social, environmental factors. ETHICS AND DISSEMINATION This study received ethical clearance from the Tanzanian National Institute of Medical Research, the Muhimbili University of Health and Allied Sciences, and the Harvard T.H. Chan School of Public Health. We will disseminate our results in the form of scientific conference presentations and peer-reviewed publications.
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Affiliation(s)
- Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alfa Muhihi
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Management and Development for Health, Dar es Salaam, Tanzania
| | - Dana McCoy
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Jonathan Seiden
- Harvard Graduate School of Education, Cambridge, Massachusetts, USA
| | - Mohamed Bakari
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Veneranda Ndesangia
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusettes, USA
| | - Karim P Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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A long-term nationwide study on chronic kidney disease-related mortality in Italy: trends and associated comorbidity. J Nephrol 2021; 35:505-515. [PMID: 34357572 DOI: 10.1007/s40620-021-01132-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/24/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Chronic kidney diseases (CKDs) represent a major public health concern worldwide with increasing incidence and prevalence. However, the epidemiological dimension of CKD in Italy is still under evaluation. By analyzing all the conditions reported on death certificates (multiple causes of death), we aimed to investigate the real burden of CKD mortality in Italy over 15 years and identify the main conditions contributing to death in association with CKD. METHODS Death certificates of all deaths occurring in Italy from 2003 to 2017 were analyzed. Certificates reporting CKD were identified as CKD-related deaths. CKD-related mortality was investigated through age-standardized mortality rates, by sex and age. Conditions associated with CKD were identified through an indicator (age-standardized proportion ratio) measuring the excess proportion (value > 1) of having such conditions mentioned in the death certificate with and without CKD. RESULTS From 2003 to 2017, multiple-cause-based CKD mortality rates increased by 60% in males and by 54% in females. The overall increase was mostly attributable to people aged 80 years or more. Several conditions were associated with CKD, the most relevant being diabetes (age-standardized proportion ratio = 2.2), obesity (2.1), systemic connective tissue disorders (2.3), anemia (2.7), and genitourinary system diseases (2.6). CONCLUSIONS Multiple-cause-of-death data revealed a significant increase in CKD-related mortality in recent years, providing a measure of the burden of CKD on overall mortality in Italy. Moreover, multiple cause analysis allowed to identify the main conditions contributing to death in association with CKD, which should be aggressively targeted by clinicians to prevent CKD adverse outcomes.
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Baadani AM, Ballool S, Alhemyadi S, Sallam L, ALsufyani E, Alghamdi A, Alfahad W. The clinical outcome of HIV infection at a tertiary care center in Riyadh, Saudi Arabia. Saudi Med J 2021; 41:965-970. [PMID: 32893278 PMCID: PMC7557546 DOI: 10.15537/smj.2020.9.25274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To investigate clinical characteristics and the outcome of people living with HIV (PLWHIV) at tertiary care center in Riyadh, Saudi Arabia. Methods: The present retrospective, observational study was carried between 2000-2019 at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. The demographic and clinical characteristics of 137 PLWHIV patients were collected by reviewing the medical data record. Results: Of the total 137 PLWHIV, 78.8% were male and 21.2% were female. At care entry, the most opportunistic infections found were the cytomegalovirus infections. cytomegalovirus (CMV) infections in 13.8% of patients, tuberculosis (8%), AIDS associated malignancy (10.9%), hepatitis B (5.8%), NTM (3.6%), hepatitis C (2.2%). In the present study, more than half of the patients received integrase based combination therapy. The highest number (n=20) of patients were diagnosed in 2018. Conclusions: Our findings describe the clinical characteristics and outcomes of PLWHIV at a major tertiary referral hospital in Saudi Arabia. The non AIDS related disease is the major cause of death in HIV infected patients. Early diagnosis and initiation of antiretroviral therapy resulted in a significant decrease in morbidity and mortality.
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Affiliation(s)
- Abeer M Baadani
- Division of Infectious Diseases, Department of Medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Taborelli M, Suligoi B, Toffolutti F, Frova L, Grande E, Grippo F, Pappagallo M, Pugliese L, Regine V, Serraino D, Zucchetto A. Excess liver-related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death. HIV Med 2020; 21:642-649. [PMID: 32876382 DOI: 10.1111/hiv.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liver diseases have become a leading cause of death among people with AIDS (PWA). This study aimed to investigate whether PWA experienced excess mortality related to liver diseases as compared to the general population (non-PWA), using a multiple cause of death (MCoD; i.e. all conditions reported on death certificates) approach. METHODS A population-based, nationwide, retrospective cohort study was conducted among Italian people, aged 15-74 years, who had been diagnosed with AIDS since 2006. Date of death and MCoD data were retrieved, up to December 2015, by individual record linkage with national mortality data. Sex- and age-standardized mortality ratios (SMRs), with 95% confidence intervals (CIs), were estimated by dividing the observed number of deaths related to a specific condition among PWA to the expected number, based on non-PWA mortality rates. RESULTS Among 7912 PWA (34 184 person-years), 2076 deaths occurred. The number of death certificates reporting liver diseases among MCoDs was 583 (28.1%), including 382 (18.4%) reporting viral hepatitis, 370 (17.8%) reporting nonviral liver diseases, and 41 (2.0%) reporting liver cancers. The corresponding SMRs were 40.4 (95% CI 37.2-43.8) for all liver diseases, 131.1 (95% CI 118.3-145.0) for viral hepatitis, 29.9 (95% CI 27.0-33.1) for nonviral liver diseases, and 11.2 (95% CI 8.1-15.3) for liver cancers. Particularly elevated SMRs emerged among PWA aged 15-49 years and those infected by injecting drug use. CONCLUSIONS The high excess liver-related mortality observed among PWA warrants preventive actions to limit the burden of viral hepatitis coinfections, alcohol abuse, and metabolic disorders, especially among younger PWA and injecting drug users.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - B Suligoi
- National AIDS Unit, National Health Institute, Rome, Italy
| | - F Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - L Frova
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - E Grande
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - F Grippo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - M Pappagallo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - L Pugliese
- National AIDS Unit, National Health Institute, Rome, Italy
| | - V Regine
- National AIDS Unit, National Health Institute, Rome, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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De Socio GV, Pasqualini M, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Taramasso L, Francisci D, Bonfanti P, Vichi F, dell'Omo M, Pieroni L. Smoking habits in HIV-infected people compared with the general population in Italy: a cross-sectional study. BMC Public Health 2020; 20:734. [PMID: 32434482 PMCID: PMC7238525 DOI: 10.1186/s12889-020-08862-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tobacco use is a leading cause of preventable diseases and death for all individuals, even more so for people living with HIV (PLWH), due to their status of chronic inflammation. To date, in Italy no study was performed to compare smoking habits in PLWH and the general population. We aimed to investigate smoking habits in PLWH, as compared to the general population. Methods Multi-center cross-sectional study. Smoking habits were compared between PLWH and the general population. PLWH were enrolled in the STOPSHIV Study. The comparison group from the general population was derived from a survey performed by the National Statistics Institute (ISTAT), with a stratified random sampling procedure matching 2:1 general population subjects with PLWH by age class, sex, and macro-area of residence. Results The total sample consisted of 1087 PLWH (age 47.9 ± 10.8 years, male 73.5%) and 2218 comparable subjects from the general population. Prevalence of current smokers was 51.6% vs 25.9% (p < 0.001); quitting smoking rate was 27.1% vs. 50.1% (p < 0.001) and the mean number of cigarettes smoked per day was 15.8 vs. 11.9 (p < 0.001), respectively for PLWH and the general population. Smoking and heavy smoking rates amongst PLWH were significantly higher even in subjects who reported diabetes, hypertension and extreme obesity (p < 0.001). Logistic regressions showed that PLWH were more likely current smokers (adjusted Odds Ratio, aOR = 3.11; 95% Confidence Interval (CI) =2.62–3.71; p < 0.001) and heavy smokers (> 20 cigarettes per day) (aOR = 4.84; 95% CI = 3.74–6.27; p < 0.001). PLWH were less likely to have quitted smoking (aOR = 0.36; 95% CI = 0.29–0.46; p < 0.001). Conclusion HIV-infected patients showed a higher rate of current smokers, a larger number of cigarettes smoked and a lower quitting rate than the general population. Our findings emphasize the need for smoking cessation strategies targeting HIV persons.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy. .,Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy.
| | - Marta Pasqualini
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Maggi
- Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giancarlo Orofino
- Division I Infectious and Tropical Diseases, ASL Città di Torino, Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Infectious Diseases Unit, ASST della Valle Olona - Busto Arsizio (VA), Busto Arsizio, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Lucia Taramasso
- Department of Health Science (DISSAL), Infectious Disease Clinic, University of Genova, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Francisci
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy
| | - Marco dell'Omo
- Department of Medicine, Perugia University, Perugia, Italy
| | - Luca Pieroni
- Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
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Grande E, Grippo F, Frova L, Pantosti A, Pezzotti P, Fedeli U. The increase of sepsis-related mortality in Italy: a nationwide study, 2003-2015. Eur J Clin Microbiol Infect Dis 2019; 38:1701-1708. [PMID: 31187308 DOI: 10.1007/s10096-019-03601-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022]
Abstract
The true burden of sepsis is largely unknown. Conventional underlying cause of death (UCoD) statistics largely underestimates sepsis-related mortality. This study aims to analyze all the conditions mentioned in the death certificates (multiple causes of death-MCoD) to estimate the nationwide burden of sepsis-related mortality in Italy, to investigate time trends and main comorbidities in sepsis-related deaths. All death certificates mentioning sepsis from 2003 to 2015 were analyzed. Age-standardized mortality rates were calculated for sepsis as both UCoD and MCoD, by gender and broad age groups. The ratio of the age-standardized proportions of any mention of sepsis in the presence/absence of associated chronic diseases (ASPR) was computed. The number of certificates reporting sepsis increased from 18,939 in 2003 to 49,010 in 2015 (from 3 to 8% of all deaths). The increase in sepsis mortality rates was larger for UCoD (males, + 200%; females, + 175%) than for MCoD-based figures (+ 100%; + 90%); MCoD rates remained noticeably higher than UCoD rates (2015, 87.3 per 100,000 vs. 16.3 for males; 54.9 vs. 11.8 for females). The largest increase was observed among the very elderly. The association between sepsis and chronic diseases was stronger for subjects aged less than 75 years. The increased awareness within the medical community in addition to the growing susceptible elderly population and the spread of antimicrobial resistance could have contributed to the sepsis-related mortality increase. MCoD statistics could help in recognizing sepsis not only as a clinical challenge, but also as a major public health issue.
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Affiliation(s)
- Enrico Grande
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy.
| | - Francesco Grippo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Luisa Frova
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Viale Liegi 13, 00198, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, Padova, Italy
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Abstract
Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) remain a common end-organ manifestation of viral infection. Subclinical and mild symptoms lead to neurocognitive and behavioral abnormalities. These are associated, in part, with viral penetrance and persistence in the central nervous system. Infections of peripheral blood monocytes, macrophages, and microglia are the primary drivers of neuroinflammation and neuronal impairments. While current antiretroviral therapy (ART) has reduced the incidence of HIV-associated dementia, milder forms of HAND continue. Depression, comorbid conditions such as infectious liver disease, drugs of abuse, antiretroviral drugs themselves, age-related neurodegenerative diseases, gastrointestinal maladies, and concurrent social and economic issues can make accurate diagnosis of HAND challenging. Increased life expectancy as a result of ART clearly creates this variety of comorbid conditions that often blur the link between the virus and disease. With the discovery of novel biomarkers, neuropsychologic testing, and imaging techniques to better diagnose HAND, the emergence of brain-penetrant ART, adjunctive therapies, longer life expectancy, and better understanding of disease pathogenesis, disease elimination is perhaps a realistic possibility. This review focuses on HIV-associated disease pathobiology with an eye towards changing trends in the face of widespread availability of ART.
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Suligoi B, Virdone S, Taborelli M, Frova L, Grande E, Grippo F, Pappagallo M, Regine V, Pugliese L, Serraino D, Zucchetto A. Excess mortality related to circulatory system diseases and diabetes mellitus among Italian AIDS patients vs. non-AIDS population: a population-based cohort study using the multiple causes-of-death approach. BMC Infect Dis 2018; 18:428. [PMID: 30153797 PMCID: PMC6114052 DOI: 10.1186/s12879-018-3336-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/15/2018] [Indexed: 12/21/2022] Open
Abstract
Background Chronic diseases, chiefly cancers and circulatory system diseases (CSDs), have become the leading non-AIDS-related causes of death among HIV-infected people, as in the general population. After our previous report of an excess mortality for several non-AIDS-defining cancers, we now aim to assess whether people with AIDS (PWA) experience also an increased mortality for CSDs and diabetes mellitus (DM), as compared to the non-AIDS general population (non-PWA). Methods A nationwide, population-based, retrospective cohort study was conducted including 5285 Italians, aged 15−74 years, who were diagnosed with AIDS between 2006 and 2011. Multiple cause-of-death (MCoD) data, i.e. all conditions reported in death certificates, were retrieved through record-linkage with the National Register of Causes of Death up to 2011. Using MCoD data, sex- and age-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated by dividing the observed number of PWA reporting a specific disease among MCoD to the expected number, estimated on the basis of mortality rates (based on MCoD) of non-PWA. Results Among 1229 deceased PWA, CSDs were mentioned in 201 (16.4%) certificates and DM in 46 (3.7%) certificates among the various causes of death. These values corresponded to a 13-fold higher mortality related to CSDs (95% CI 10.8–14.4) and DM (95% CI: 9.5–17.4) as compared to 952,019 deceased non-PWA. Among CSDs, statistically significant excess mortality emerged for hypertension (23 deaths, SMR = 6.3, 95% CI: 4.0–9.4), ischemic heart diseases (39 deaths, SMR = 6.1, 95% CI: 4.4–8.4), other forms of heart diseases (88 deaths, SMR = 13.4, 95% CI: 10.8–16.5), and cerebrovascular diseases (42 deaths, SMR = 13.4, 95% CI: 9.7–18.2). The SMRs were particularly elevated among PWA aged < 50 years and those infected through drug injection. Conclusions The use of MCoD data disclosed the fairly high mortality excess related to several CSDs and DM among Italian PWA as compared to non-PWA. Study findings also indicate to start preventive strategies for such diseases at a younger age among AIDS patients than in the general population and with focus on drug users.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Saverio Virdone
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Martina Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Luisa Frova
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Enrico Grande
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Francesco Grippo
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Marilena Pappagallo
- Integrated system for health, social assistance, welfare and justice, Istituto Nazionale di Statistica, viale Liegi 13, 00198, Rome, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Lucia Pugliese
- Centro Operativo AIDS, Istituto Superiore di Sanità, via Regina Elena 299, 00161, Rome, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy
| | - Antonella Zucchetto
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano, IRCCS, via Gallini 2, 33081, Aviano, PN, Italy.
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Cammarota S, Citarella A, Manzoli L, Flacco ME, Parruti G. Impact of comorbidity on the risk and cost of hospitalization in HIV-infected patients: real-world data from Abruzzo Region. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:389-398. [PMID: 30087571 PMCID: PMC6061204 DOI: 10.2147/ceor.s162625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Due to the success of antiretroviral therapy, human immunodeficiency virus (HIV) infection has been transformed into a lifelong condition. In Italy, little is known about the impact of comorbidities (CMs) on the risk of hospitalization and related costs for people who live with HIV (PWLHIV). The objective of the study was to quantify the risk of hospitalization and costs associated with CMs in an Italian cohort of PWLHIV. Methods The study population included subjects aged ≥18 years with HIV infection, identified in the Abruzzo’s hospital discharge database among files stored from 2004 until 2013 and then followed up until December 2015. Patients’ CMs (Charlson Comorbidity Index [CCI)] were extracted from International Classification of Diseases, Ninth Revision, Clinical Modification codes in the hospital discharge abstracts. Poisson regression was used to compare the incidence rate of hospital admissions in patients with and without each CM class. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were adjusted for age, sex and the other CMs. A generalized linear model under gamma distribution was used to estimate adjusted mean hospital costs. Costs were derived from official Italian Diagnosis-related group (DRG) based reimbursements. Results Among 1,026 HIV patients identified (mean age 47 years), 30% had at least one CM and 14.5% underwent hospital admission during the follow-up period. The risk of acute hospitalization significantly increased among patients with hepatitis C virus (HCV) coinfection (adjusted IRR 1.98; 95% CI: 1.59–2.47), renal (adjusted IRR 2.27; 95% CI: 1.45–3.56), liver (adjusted IRR 2.21; 1.57–3.13) and chronic pulmonary CMs (adjusted IRR 2.31; 1.63–3.32). Adjusted mean hospital costs were €2,494 in patients without CMs and €4,422 and €9,734 in those with CCI=1 or CCI ≥2, respectively. Conclusion The presence of renal, liver and chronic pulmonary CMs, as well as HCV coinfection doubled the risk of hospitalization in the PWLHIV cohort. A CCI ≥2 is associated with a fourfold increase in hospitalization costs. Our study provides new evidence that CMs in PWLHIV increase the risk of hospitalization and local health service facilities.
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Affiliation(s)
- Simona Cammarota
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Anna Citarella
- LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Naples, Italy
| | - Lamberto Manzoli
- Department of Medicine Sciences, University of Ferrara, Ferrara, Italy.,Regional Healthcare Agency of Abruzzo, Pescara, Italy
| | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy,
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