HIV in Colombia: an Epidemiologic Point of View

Prevalence and patterns of comorbidities in individuals with epilepsy: A nationwide analysis using colombian healthcare registry data

INTRODUCTION

Epilepsy is a multifaceted neurological disorder that extends beyond seizure episodes, with substantial comorbidities impacting patients' quality of life. This study quantifies the burden and association patterns of epilepsy-related comorbidities in the Colombian population.

METHODS

This descriptive, cross-sectional study analyzed data from the nationwide Colombian healthcare registry (RIPS) from 2019 to 2023. We estimated the prevalence of epilepsy and selected comorbidities including neurological conditions (migraine, multiple sclerosis, stroke, Alzheimer's disease in individuals 65+), psychiatric disorders (depression, major depression, anxiety, schizophrenia), trauma (general and head trauma), and infectious diseases (HIV, neurocysticercosis). Prevalence ratios (PRs) were calculated comparing individuals with epilepsy to those without, with stratification by sex and age groups. Chi-squared tests were conducted to assess statistical significance of differences in prevalence, with p < 0.05 considered significant.

RESULTS

Among 53,785,138 individuals in the Colombian healthcare system, 461,118 were diagnosed with epilepsy (prevalence 8.57 per 1000), with the highest prevalence in older adults (11.37 per 1000 in ages 65+). Neurological comorbidities were common, with migraine present in 6.86 % of epilepsy patients versus 3.89 % in the general population (p < 0.001), multiple sclerosis in 0.152 % versus 0.021 % (p < 0.001), and stroke in 6.04 % versus 0.75 % (p < 0.001). Among psychiatric conditions, depression affected 5.84 % of epilepsy patients compared to 1.87 % in the general population (p < 0.001), while schizophrenia was diagnosed in 4.13 % of epilepsy patients versus 0.41 % in the general population (p < 0.001). Trauma was present in 25.0 % of epilepsy patients compared to 16.4 % generally (p < 0.001), with head trauma specifically in 7.1 % versus 2.5 % (p < 0.001). Neurocysticercosis, though rare overall (0.0064 % in general population), was notably more prevalent in epilepsy patients (0.289 %, p < 0.001). Significant sex differences were observed, with females showing higher prevalence of migraine (9.82 % vs 3.89 % in males) and depression (7.33 % vs 4.34 %) within the epilepsy population, while males had higher rates of schizophrenia (4.81 % vs 3.46 %) and head trauma (8.93 % vs 5.32 %).

CONCLUSION

This study provides critical insights into the burden of epilepsy-related comorbidities in Colombia, highlighting the importance of targeted interventions. The substantial comorbidity burden demonstrated across neurological, psychiatric, traumatic, and infectious domains underscores the importance of interdisciplinary, patient-centered care approaches that extend beyond seizure control. By addressing these comorbidities through integrated care models, clinicians can significantly improve both health outcomes and quality of life for people living with epilepsy.

The impact of disasters on contraception in OECD member countries: a scoping review

OBJECTIVES

Review evidence is lacking about how contraception is affected by severe social disruption, such as that caused by the COVID-19 pandemic. The purpose of this scoping review was to explore the impact of natural and man-made disasters on contraception in OECD member countries.

METHODS

Manual searches and systematic searches in six electronic databases were conducted with no language restrictions. All articles were screened by at least two researchers. The data were analysed thematically.

RESULTS

108 articles were included. Most focussed on the Zika virus outbreak (n = 50) and the COVID-19 pandemic (n = 28). Four key themes were identified: importance of contraception during disasters, impact of disasters on contraceptive behaviour, barriers to contraception during disasters and ways of improving use of contraception during disasters. Despite efforts to increase access to contraception including by transforming ways of delivery, barriers to use meant that unmet need persisted.

CONCLUSIONS

To prevent adverse health outcomes and reduce health costs as a result of failure to have access to contraception during disasters, there is a need to intensify efforts to remove barriers to use. This should include increasing access and information on methods of contraception and their side effects (e.g., menstrual suppression) and making contraception freely available.

Outcomes and complications of hospitalised patients with HIV-TB co-infection

BACKGROUND

Tuberculosis is one of the most common causes of hospitalisation in patients with HIV. Despite this, hospital outcomes of patients with this co-infection have rarely been described since antiretroviral therapy became widely available.

METHODS

Prospective cohort study of HIV-infected adult patients hospitalised with TB in six referral hospitals in Medellin, Colombia, from August 2014 to July 2015.

RESULTS

Among 128 HIV-infected patients hospitalised with tuberculosis, the mean age was 38.4 years; 79.7% were men. HIV was diagnosed on admission in 28.9% of patients. The median CD4 + T-cell count was 125 (±158 SD) cells/µL. Only 47.3% of patients with a known diagnosis of HIV upon admission were on antiretroviral therapy, and only 11.1% had a tuberculin skin test in the previous year. Drug toxicity due to tuberculosis medications occurred in 11.7% of patients. Mean length of stay was 23.2 days, and 10.7% of patients were readmitted. Mortality was 5.5%.

CONCLUSIONS

Hospital mortality attributable to tuberculosis in patients with HIV is low in reference hospitals in Colombia. Cases of tuberculosis in HIV-infected patients occur mainly in patients with advanced HIV, or not on antiretroviral therapy, despite a known diagnosis of HIV. Only one of every 10 patients in this cohort had active screening for latent tuberculosis, possibly reflecting missed treatment opportunities.