scholarly journals What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic

2018 ◽  
Author(s):  
Thomas Crellen ◽  
Charles Ssonko ◽  
Turid Piening ◽  
Marcel Mbeko Simaleko ◽  
Diemer Henri St. Calvaire ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central African Republic ◽  
Linear Models ◽  
Opportunistic Infections ◽  
Patient Specific ◽  
People Living With Hiv ◽  
Armed Groups ◽  
Conflict Setting ◽  
Hiv Patients ◽  
The Impact

AbstractBackgroundProvision of antiretroviral therapy (ART) during conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 120,000 people living with HIV and 11,000 AIDS-related deaths in 2013. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in 2010) and was subject to repeated attacks by armed groups on civilians during the observed period.MethodsConflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determine patient-level risk factors for mortality and how this varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using generalised-linear models with terms accounting for temporal autocorrelation.ResultsPatients were recruited and observed from October 2011 to May 2017. Overall 1631 patients were enrolled, giving 4107 person-years and 148 deaths. Our first model shows that patient mortality did not increase during periods of heightened conflict. The monthly risk (probability) of mortality was markedly higher at the beginning of the program (0.047 in November 2011 [95% credible interval; CrI 0.0078, 0.21]) and had declined greater than ten-fold by the end of the observed period (0.0016 in June 2017 [95% CrI 0.00042, 0.0036]). Our second model shows the risk of mortality for individual patients was highest in the first five months spent in the cohort. Male sex was associated with a higher mortality (odds ratio; OR 1.7 [95% CrI 1.2, 2.8]) along with the severity of opportunistic infections at baseline.ConclusionsOur results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient specific risk factors. In areas initiating ART for the first time, particular attention should be focussed on stabilising patients with advanced symptoms.FundingMédecins Sans Frontières

scholarly journals What drives mortality among HIV patients in a conflict setting? A prospective cohort study in the Central African Republic

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Thomas Crellen ◽  
Charles Ssonko ◽  
Turid Piening ◽  
Marcel Mbeko Simaleko ◽  
Karen Geiger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central African Republic ◽  
Patient Specific ◽  
People Living With Hiv ◽  
Armed Groups ◽  
Conflict Setting ◽  
Hiv Patients ◽  
Cell Counts ◽  
Risk Of Mortality ◽  
The Impact

Abstract Background Provision of antiretroviral therapy (ART) in conflict settings is rarely attempted and little is known about the expected patterns of mortality. The Central African Republic (CAR) continues to have a low coverage of ART despite an estimated 110,000 people living with HIV and 5000 AIDS-related deaths in 2018. We present results from a cohort in Zemio, Haut-Mboumou prefecture. This region had the highest prevalence of HIV nationally (14.8% in a 2010 survey), and was subject to repeated attacks by armed groups on civilians during the observed period. Methods Conflict from armed groups can impact cohort mortality rates i) directly if HIV patients are victims of armed conflict, or ii) indirectly if population displacement or fear of movement reduces access to ART. Using monthly counts of civilian deaths, injuries and abductions, we estimated the impact of the conflict on patient mortality. We also determined patient-level risk factors for mortality and how the risk of mortality varies with time spent in the cohort. Model-fitting was performed in a Bayesian framework, using logistic regression with terms accounting for temporal autocorrelation. Results Patients were recruited and observed in the HIV treatment program from October 2011 to May 2017. Overall 1631 patients were enrolled and 1628 were included in the analysis giving 48,430 person-months at risk and 145 deaths. The crude survival rate after 12 months was 0.92 (95% CI 0.90, 0.93). Our model showed that patient mortality did not increase during periods of heightened conflict; the odds ratios (OR) 95% credible interval (CrI) for i) civilian fatalities and injuries, and ii) civilian abductions on patient mortality both spanned unity. The risk of mortality for individual patients was highest in the second month after entering the cohort, and declined seven-fold over the first 12 months. Male sex was associated with a higher mortality (odds ratio 1.70 [95% CrI 1.20, 2.33]) along with the severity of opportunistic infections (OIs) at baseline (OR 2.52; 95% CrI 2.01, 3.23 for stage 2 OIs compared with stage 1). Conclusions Our results show that chronic conflict did not appear to adversely affect rates of mortality in this cohort, and that mortality was driven predominantly by patient-specific risk factors. The risk of mortality and recovery of CD4 T-cell counts observed in this conflict setting are comparable to those in stable resource poor settings, suggesting that conflict should not be a barrier in access to ART.

scholarly journals The Impact of Stigma and Discrimination on Adherence to Medication amongst People Living with HIV in Tiv Land, North Central Nigeria

2019 ◽  
pp. 1-9
Author(s):  
Godwin Aondohemba Timiun ◽  
Timothy J. Scrase
Keyword(s):  
People Living With Hiv ◽  
Structured Interviews ◽  
Hiv Patients ◽  
Stigma And Discrimination ◽  
Treatment Services ◽  
Adherence To Medication ◽  
Multi Stage ◽  
Living With Hiv ◽  
And Control ◽  
The Impact

In spite the identification of stigma as a factor impeding public utilisation of HIV counselling, testing, and treatment services in Nigeria, gaps still exist in knowledge on the impact of stigma, and discrimination on adherence to medication amongst people living with HIV (PLWH). This study adopted mixed methods to examine the impact of stigma and discrimination on adherence to medication amongst PLWH in Nigeria.  A sample of 1,621 respondents was collected using multi-stage and purposive sampling methods. Structured interviews using questionnaires and in-depth interviews (using a guide) were utilised for data collection. SPSS (version 21) was used for quantitative data analysis while the qualitative data was analysed thematically. There are 46.3% men and 53.7% women respondents. Generally, their income is low, 70.7% are earning less than N25, 000 (approximately $125 USD) per month. Some of the HIV patients are stigmatised. In reaction, they avoid public places, travel long distances away from their immediate community to collect drugs and to avoid been noticed around the centers. They sometimes miss taking drugs regularly as prescribed, suffer depression and die. Stigma and discrimination impede adherence to medication amongst PLHW in Nigeria. More efforts should be made to create awareness to reduce stigma and discrimination of HIV patients, while augmenting their income to meet up with the challenges of adherence to medication. The overall benefits would be enhanced mechanism of HIV prevention, treatment and control in the study area.

Abstract 141: Impact of an Aggressive Medical Management Protocol on Early Risk Factor Measures in the Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Tanya N Turan ◽  
Azhar Nizam ◽  
Michael J Lynn ◽  
Colin P Derdeyn ◽  
David Fiorella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Medical Management ◽  
Intracranial Stenosis ◽  
Patient Specific ◽  
Early Risk ◽  
Aggressive Medical Management ◽  
The Impact ◽  
Early Risk Factor

Purpose: SAMMPRIS is the first stroke prevention trial to include protocol-driven aggressive management of multiple vascular risk factors. We sought to determine the impact of this protocol on early risk factor control in the trial. Materials and Methods: SAMMPRIS randomized 451 patients with symptomatic 70%-99% intracranial stenosis to aggressive medical management or stenting plus aggressive medical management at 50 USA sites. For the primary risk factor targets (SBP < 140 mm/Hg (<130 if diabetic) and LDL < 70 mg/dL), the study neurologists follow medication titration algorithms and risk factor medications are provided to the patients. Secondary risk factors (diabetes, non-HDL, weight, exercise, and smoking cessation) are managed with assistance from the patient’s primary care physician and a lifestyle modification program (provided). Sites receive patient-specific recommendations and feedback to improve performance. Follow-up continues, but the 30-day data are final. We compared baseline to 30-day risk factor measures using paired t-tests for means and McNemar tests for percentages. Results: The differences in risk factor measures between baseline and 30 days are shown in Table 1. Conclusions: The SAMMPRIS protocol resulted in major improvements in controlling most risk factors within 30 days of enrollment, which may have contributed to the lower than expected 30 day stroke rate in the medical group (5.8%). However, the durability of this approach over time will be determined by additional follow-up.

scholarly journals 843. Targeted HIV Testing for Patients Hospitalized for COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S512-S512
Author(s):  
Michael D Virata ◽  
Merceditas Villanueva ◽  
Janet Miceli
Keyword(s):  
Risk Factors ◽  
Hiv Testing ◽  
Hiv Risk ◽  
Treatment Algorithm ◽  
Hiv Treatment ◽  
People Living With Hiv ◽  
Hiv Patients ◽  
Entire Study ◽  
Comorbidity Scores ◽  
Hiv Risk Factors

Abstract Background SARS-CoV-2 causes a severe respiratory illness known as COVID-19. Treatment options in the early portion of the COVID-19 pandemic included the use of antiretroviral agents i.e. protease inhibitors (PIs) such as lopinavir (LPV) that had been shown to have activity against the main proteases of SARS-CoV-2 in vitro but with very limited clinical data. Prior to the use of PIs, HIV testing would be indicated to ensure that patients who were not previously diagnosed with HIV would start appropriate HIV treatment. In this unique situation, HIV testing would be utilized not based on traditional HIV risk factors. Methods We performed a retrospective search from a specific systems database of patients admitted to Yale-New Haven Health System (YNHHS) with a diagnosis of COVID-19 infection. We identified a subset of patients who were HIV tested. Most were done prior to initiating PI treatment. Demographics, comorbidity scores and specific underlying conditions were also tabulated. We performed Kruskal Wallis and Chi-Squared analysis to test for significance between HIV- and HIV+ patients. Results The total no. of patients admitted to the YNHHS with COVID-19 infection between the period from January 6, 2020 to January 6, 2021 was 5776. A cohort 964 (16.7%) patients were screened for HIV. Much of the testing occurred in the early COVID periods (Figure 1) when PIs were considered as part of the treatment algorithm. Sixty-seven (0.07%) patients tested HIV+ with 3 (0.003%) being newly diagnosed (Fig 2). Compared to HIV- patients, HIV+ were more likely to be identified as Black, with higher mean Elixhauser Comorbidity scores and significant associations with conditions such as hypertension, pulmonary disease, complicated diabetes, liver disease, renal failure and depression (Table 1). These co-morbidities have been correlated with higher risk of hospitalization for people living with HIV (PWH). Figure 2. COVID Admission and HIV Status The graph represents HIV testing results over the entire study period. Table 1. Demographics and Comorbidites Represents demographics and comorbidities of HIV- & HIV+ patients Figure 1. COVID Admissions and HIV Testing COVID admissions over time and the performance of HIV testing Conclusion This is one of the first reports on targeted HIV testing for patients not using identifiable traditional HIV risk factors who were admitted to a large healthcare system for COVID19 infections. The percentage of newly HIV diagnosed patients from this cohort was considered to be &lt; known HIV infection rates for our population. The majority of PWH were already established in care prior to their COVID19 diagnosis. Disclosures All Authors: No reported disclosures

scholarly journals Presentation and outcome of COVID-19 in HIV patients with high viral loads and opportunistic infections: a case series

2020 ◽  
Vol 54 (4s) ◽  
pp. 121-124
Author(s):  
Yasmine O. Hardy ◽  
Divine A. Amenuke ◽  
Kojo A. Hutton-Mensah ◽  
David R. Chadwick ◽  
Rita Larsen-Reindorf
Keyword(s):  
Opportunistic Infections ◽  
Severe Disease ◽  
Case Series ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Viral Loads ◽  
Increased Risk ◽  
Negative Clinical Outcome ◽  
The Impact

Coronavirus disease 2019 (COVID-19) is especially severe in patients with underlying chronic conditions, with increased risk of mortality. There is concern that people living with HIV (PLWH), especially those with severe immunosuppression, and COVID-19 may have severe disease and a negative clinical outcome. Most studies on COVID-19 in PLWH are from Asia, Europe and America where population dynamics, antiretroviral treatment coverage and coexisting opportunistic infections may differ from that in sub-Saharan Africa. We report on the clinical profile and outcome of three cases of PLWH co-infected with SARS-CoV-2. They all presented with fever, cough and breathlessness and also had advanced HIV infection as evidenced by opportunistic infections, high HIV viral loads and low CD4 counts. The patients responded favourably to the standard of care and were discharged home. Our findings suggest that PLWH with advanced immunosuppression may not necessarily have an unfavourable disease course and outcome. However, case-controlled studies with a larger population size are needed to better understand the impact of COVID-19 in this patient population.

scholarly journals HIV Associated Risk Factors for Ischemic Stroke and Future Perspectives

2020 ◽  
Vol 21 (15) ◽  
pp. 5306
Author(s):  
Saifudeen Ismael ◽  
Mohammad Moshahid Khan ◽  
Prashant Kumar ◽  
Sunitha Kodidela ◽  
Golnoush Mirzahosseini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hiv Infection ◽  
Opportunistic Infections ◽  
Experimental Studies ◽  
Chronic Administration ◽  
Cerebrovascular Diseases ◽  
Vascular Abnormalities ◽  
Increased Risk ◽  
The Impact

Although retroviral therapy (ART) has changed the HIV infection from a fatal event to a chronic disease, treated HIV patients demonstrate high prevalence of HIV associated comorbidities including cardio/cerebrovascular diseases. The incidence of stroke in HIV infected subjects is three times higher than that of uninfected controls. Several clinical and postmortem studies have documented the higher incidence of ischemic stroke in HIV infected patients. The etiology of stroke in HIV infected patients remains unknown; however, several factors such as coagulopathies, opportunistic infections, vascular abnormalities, atherosclerosis and diabetes can contribute to the pathogenesis of stroke. In addition, chronic administration of ART contributes to the increased risk of stroke in HIV infected patients. Concurrently, experimental studies in murine model of ischemic stroke demonstrated that HIV infection worsens stroke outcome, increases blood brain barrier permeability and increases neuroinflammation. Additionally, residual HIV viral proteins, such as Trans-Activator of Transcription, glycoprotein 120 and Negative regulatory factor, contribute to the pathogenesis. This review presents comprehensive information detailing the risk factors contributing to ischemic stroke in HIV infected patients. It also outlines experimental evidence demonstrating the impact of HIV infection on stroke outcomes, in addition to possible novel therapeutic approaches to improve these outcomes.

MO805CAUSAL PATHWAY-BASED PHYSIOLOGICAL MODELING OF VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alhaji Cherif ◽  
Jakob Voelkl ◽  
Peter Kotanko
Keyword(s):  
Risk Factors ◽  
Vascular Calcification ◽  
Pulse Pressure ◽  
Kidney Diseases ◽  
Cardiac Insufficiency ◽  
Patient Specific ◽  
Physiological Modeling ◽  
Neutrophil Lymphocyte Ratio ◽  
Causal Pathway ◽  
The Impact

Abstract Background and Aims Vascular calcification (VC) is common sequelae in chronic and end-stage kidney diseases (CKD/ESKD), and is associated with multiple risk factors, including disturbed bone metabolism and mineral disorders (CKD-BMD), uremia, leading to increased morbidity and mortality. The mechanism involves multiple physiological processes and is not well understood. The study aims to develop a causal pathway-based physiological model describing patient-specific drivers of vascular calcification. Method We develop a causal pathway-based physiological modeling that utilizes clinical data to identify patients with high risks of progression of VC and cardiometabolic diseases to provide multifactorial intervention strategies targeting the risk factors. We investigate the response of pulse pressure (PP, a proxy for pulse wave velocity) to parathyroid hormones (PTH), calcium (Ca), phosphate (PO4), calcium-phosphate product (CaPO4), neutrophil-lymphocyte ratio (NLR), and albumin (Alb). Pulse pressure may account for both cardiac and vascular conditions (e.g., atrial fibrillation, aortic insufficiency, arterial stiffness or arteriovenous malformation, aortic valve stenosis, cardiac insufficiency or cardiac tamponade). Results We demonstrate the causal pathway of PTH, Ca, PO4, NLR, and Alb on PP, and find that there are likely paths from PTH, Ca, PO4, CaPO4, NLR to PP, where the strength of the relationships vary from patient to patient. Figure 1 shows a representative patient. Figure 1(a) shows the longitudinal data for the aforementioned clinical parameters. Using a subset of the data (1 year was used), we extracted causal relationships between the clinical (Fig. 1(b)). As shown in Fig. 1(c), some of the relationships are physiologically consistent with current knowledge of the PTH, Ca, and PO4 disturbances on CKD-BMD, vascular calcification being one of the axes. Also, NLR is a measure of inflammation, which is also known to promote vascular calcification. Further, potential pathways were also detected, namely the direct or mediated effects of Alb and PTH on PP (as shown in Figs. 1(b)-(c)). Using these pathways, a dynamic model describing these interactions can be used to prescriptive investigate the impact of the dynamics on the progression of calcification. Conclusion From the clinical variables, the method was able to extract both known and potential drivers for changes on PP for the representative patients. Additional study is needed to confirm these relationships both prospectively, clinical investigation of potential pathways, and to further observe the long-term clinical manifestation of vascular calcification.

scholarly journals 2203. Patient-Specific Risk Stratification to Identify Patients at High and Low Risk for P. aeruginosa in Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S751-S751
Author(s):  
William Justin Moore ◽  
Caroline Cruce ◽  
Karolina Harkabuz ◽  
Shereen Salama ◽  
Sarah Sutton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Stratification ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Patient Specific ◽  
Stepwise Logistic Regression ◽  
Case Status ◽  
The Impact

Abstract Background Pseudomonas aeruginosa (PsA) is an infrequent pathogen associated with poor outcomes in community-acquired pneumonia (CAP). Identifying patients at high and low-risk for PsA in CAP is necessary to reduce inappropriate and overly broad-spectrum antibiotic use. We evaluated the distribution of risk-factors in hospitalized CAP patients with and without PsA infection. Methods Design: retrospective, single-center, case–control study. Inclusion: hospitalized CAP patients admitted to the general medicine wards between January 1, 2014 and May 29, 2018. Exclusion: cystic fibrosis, ≥ 3 admissions within 30 days, CAP requiring ICU admission, and death within 48 hours of admission. Case patients had PsA in respiratory or blood cultures during the index CAP admission. Controls were randomly selected targeting a 3:1 ratio. Comorbidities, pneumonia severity index, and m-APACHE II were assessed. Gram-negative risk factors defined by Shindo et al. 2013 (PMID: 23855620) and validated by Kobayashi et al. (2018; PMID: 30349327) were scored for each patient. Stepwise logistic regression was used to identify covariates that distinguished cases from controls at a P < 0.2; these were then used to generate propensity weights (i.e., inverse-probability conditioned on covariates). Unadjusted and adjusted odds ratios for case status were estimated using logistic regression according to: the total number of risk factors present and threshold values, respectively. All analyses were conducted using IC Stata (v.14.2). Results 54 cases and 152 controls were included. The distribution of the patient-specific sum of risk factors for PsA is shown in Figure 1. The univariate OR for case status was 4.29 (95% CI:1.55–11.9) at n = 3 risk factors, which was similar after propensity weight adjustment [aOR = 4.64 (95% CI: 1.32–16.3)]. The univariate OR of case status was 2.98 among patients with ≥ 3 risk factors (95% CI: 1.34–6.62), which was similar after propensity weight adjustment [aOR = 2.8 (95% CI: 1.02–7.72)], and correct classification was 73.8%. Conclusion At a threshold of ≥ 3 PsA risk factors, cases and controls were well classified, even after adjusting for propensity weights. The impact of patient-specific PsA risk-stratification on CAP outcomes and appropriate antibiotic use should be evaluated. Disclosures All authors: No reported disclosures.

scholarly journals Treatment of HIV and Use of HAART in HIV Infected Patients with Acute Septic Shock

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S434-S434
Author(s):  
Christopher Polk ◽  
Samuel Webb ◽  
Nigel Rozario ◽  
Charity Moore ◽  
Michael Leonard
Keyword(s):  
Healthcare System ◽  
Opportunistic Infections ◽  
Tertiary Care ◽  
Hiv Positive ◽  
Virologic Suppression ◽  
Care Hospital ◽  
Research Support ◽  
Hiv Patients ◽  
Clinical Patient ◽  
The Impact

Abstract Background For HIV patients admitted with sepsis, ARVs are often stopped or held due to myriad concerns including drug interactions, acute renal failure, gastrointestinal dysfunction, or inability to administer crushed medications down feeding tubes. We seek to examine prescription patterns of HAART for HIV positive patients admitted for sepsis in our healthcare system and the impact of HAART prescription on patient outcomes. Methods We identified HIV positive patients from an institutional database of patients admitted for sepsis within our multi-hospital healthcare system and retrospectively extracted further clinical patient and laboratory information as well as information on HAART prescription by chart review. The impact of HAART prescription and immunologic and virologic parameters of HIV infection on mortality was examined. Results Inpatient mortality was 35% in HIV patients admitted for sepsis, compared with 17% for all patients with sepsis in our healthcare system. Opportunistic infections were identified in only 25% of patients while 56% had other infections identified. Only 55% of patients had HAART prescribed while inpatient. CD4 count, virologic suppression, APACHE score, presence of an opportunistic infection, admission to a tertiary care hospital, and inpatient prescription of HAART were all predictors of survival. Conclusion Immunologic and virologic status at time of admission predicted survival in HIV patients admitted for sepsis but prescription of HAART to HIV patients admitted for sepsis may increase survival. Disclosures C. Polk, Gilead Sciences: Investigator, Research support; Viiv Healthcare: Investigator, Research support

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