scholarly journals Epidemiology of Human Immunodeficiency Virus–Associated Opportunistic Infections in the United States in the Era of Highly Active Antiretroviral Therapy

2000 ◽  
Vol 30 (s1) ◽  
pp. S5-S14 ◽  
Author(s):  
Jonathan E. Kaplan ◽  
Debra Hanson ◽  
Mark S. Dworkin ◽  
Toni Frederick ◽  
Jeanne Bertolli ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
The United States ◽  
Highly Active ◽  
Immunodeficiency Virus

scholarly journals Trends in Mortality From Human Immunodeficiency Virus Infection, 1984–2016: An Autopsy-Based Study

2019 ◽  
Vol 144 (5) ◽  
pp. 572-579 ◽  
Author(s):  
Sobia Nizami ◽  
Cameron Morales ◽  
Kelly Hu ◽  
Robert Holzman ◽  
Amy Rapkiewicz
Keyword(s):  
New York ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Opportunistic Infections ◽  
City Hospital ◽  
Aids Epidemic ◽  
Highly Active ◽  
Immunodeficiency Virus

Context.— With increasing use and efficacy of antiretroviral therapy for human immunodeficiency virus (HIV) infection, deaths from acquired immunodeficiency syndrome (AIDS)–defining conditions have decreased. Objective.— To examine trends in the cause of death of HIV-infected patients who underwent autopsy at a major New York City hospital from 1984 to 2016, a period including the major epochs of the AIDS epidemic. Design.— Retrospective review of autopsy records and charts with modeling of trends by logistic regression using polynomial models. Results.— We identified 252 autopsies in adult patients with AIDS (by 1982 definition) or HIV infection. Prior to widespread use of highly active antiretroviral therapy, in 1984–1995, on average 13 autopsies per year were done. Post–highly active antiretroviral therapy, the average number of autopsies declined to 4.5 per year. The fitted mean age at death was 35 years in 1984 and increased curvilinearly to 46 years (95% CI, 43–49) in 2016 (P < .001). By regression analysis, mean CD4+ T-cell count increased from 6 in 1992 to 64 in 2016 (P = .01). The proportion of AIDS-defining opportunistic infections decreased, from 79% in 1984–1987 to 41% in 2008–2011 and 29% in 2012–2016 (P = .04). The frequency of nonopportunistic infections, however, increased from 37% in 1984–1987 to 73% in 2008–2011 and 57% in 2012–2016 (P = .001). The frequency of AIDS-defining and other malignancies did not change significantly during the study period. The prevalence of atherosclerosis at autopsy rose dramatically, from 21% in 1988–1991 to 54% in 2008–2011 (P < .001). Conclusions.— Despite limitations of autopsy studies, many trends in the evolution of the HIV/AIDS epidemic are readily discernable.

scholarly journals Successful Orthotopic Heart Transplantation and Immunosuppressive Management in 2 Human Immunodeficiency Virus–Seropositive Patients

2016 ◽  
Vol 43 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Antonio Hernandez Conte ◽  
Michelle M. Kittleson ◽  
Deanna Dilibero ◽  
W. David Hardy ◽  
Jon A. Kobashigawa ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Heart Transplantation ◽  
Highly Active Antiretroviral Therapy ◽  
The United States ◽  
Orthotopic Heart Transplantation ◽  
Term Survival ◽  
Heart Transplantations ◽  
Highly Active ◽  
Immunodeficiency Virus

Few orthotopic heart transplantations have been performed in patients infected with the human immunodeficiency virus since the first such case was reported in 2001. Since that time, advances in highly active antiretroviral therapy have resulted in potent and durable suppression of the causative human immunodeficiency virus—accompanied by robust immune reconstitution, reversal of previous immunodeficiency, a marked decrease in opportunistic and other infections, and near-normal long-term survival. Although human immunodeficiency virus infection is not an absolute contraindication, few centers in the United States and Canada have performed heart transplantations in this patient population; these patients have been de facto excluded from this procedure in North America. Re-evaluation of the reasons for excluding these patients from cardiac transplantation is warranted in light of such significant advances in antiretroviral therapy. This case report documents successful orthotopic heart transplantation in 2 patients infected with human immunodeficiency virus, and we describe their antiretroviral therapy and immunosuppressive management challenges. Both patients were doing well without sequelae 43 and 38 months after transplantation.

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