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Sanvisens A, Hernández-Rubio A, Zuluaga P, Fuster D, Papaseit E, Galan S, Farré M, Muga R. Long-Term Outcomes of Patients With Cocaine Use Disorder: A 18-years Addiction Cohort Study. Front Pharmacol 2021; 12:625610. [PMID: 33679404 PMCID: PMC7930813 DOI: 10.3389/fphar.2021.625610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Cocaine Use Disorder (CUD) has been associated with multiple complications and premature death. The purpose of the present study was to analyze the relationship between baseline medical comorbidity and long-term medical outcomes (i.e., hospitalization, death) in a cohort of patients primarily admitted for detoxification. In addition, we aimed to analyze cause-specific mortality. Methods: longitudinal study in CUD patients admitted for detoxification between 2001 and 2018. Substance use characteristics, laboratory parameters and medical comorbidity by VACS Index were assessed at admission. Follow-up and health-related outcomes were ascertained through visits and e-health records. Kaplan-Meier and Cox regression models were used to analyze survival and predictors of hospitalization and death. Results: 175 patients (77.7% men) were included. Age at admission was 35 years [IQR: 30–41 years], 59.4% of the patients being intranasal users, 33.5% injectors, and 7.1% smokers. Almost 23% of patients had concomitant alcohol use disorder, 39% were cannabis users and 9% opiate users. The median VACS Index score on admission was 10 points [IQR: 0–22]. After 12 years [IQR: 8.6–15 years] of follow-up there were 1,292 (80.7%) ED admissions and 308 (19.3%) hospitalizations. The incidence rate of ED admission and hospitalization was 18.6 × 100 p-y (95% CI: 15.8–21.8 × 100 p-y). Mortality rate was 1.4 × 100 p-y (95% CI: 0.9–2.0 × 100 p-y) and, baseline comorbidity predicted hospitalization and mortality: those with VACS Index >40 were 3.5 times (HR:3.52, 95% CI: 1.19–10.4) more likely to dye with respect to patients with VACS < 20. Conclusion: addiction care warrants optimal stratification of medical comorbidity to improve health outcomes and survival of CUD patients seeking treatment of the disorder.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Anna Hernández-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Paola Zuluaga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Daniel Fuster
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Esther Papaseit
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Sara Galan
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
| | - Magí Farré
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Robert Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol-IGTP, Universitat Autónoma de Barcelona, Department of Medicine, Badalona, Spain
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Zifodya JS, Duncan MS, So‐Armah KA, Attia EF, Akgün KM, Rodriguez‐Barradas MC, Marconi VC, Budoff MJ, Bedimo RJ, Alcorn CW, Soo Hoo GW, Butt AA, Kim JW, Sico JJ, Tindle HA, Huang L, Tate JP, Justice AC, Freiberg MS, Crothers K. Community-Acquired Pneumonia and Risk of Cardiovascular Events in People Living With HIV. J Am Heart Assoc 2020; 9:e017645. [PMID: 33222591 PMCID: PMC7763776 DOI: 10.1161/jaha.120.017645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/16/2020] [Indexed: 01/26/2023]
Abstract
Background Hospitalization with community-acquired pneumonia (CAP) is associated with an increased risk of cardiovascular disease (CVD) events in patients uninfected with HIV. We evaluated whether people living with HIV (PLWH) have a higher risk of CVD or mortality than individuals uninfected with HIV following hospitalization with CAP. Methods and Results We analyzed data from the Veterans Aging Cohort Study on US veterans admitted with their first episode of CAP from April 2003 through December 2014. We used Cox regression analyses to determine whether HIV status was associated with incident CVD events and mortality from date of admission through 30 days after discharge (30-day mortality), adjusting for known CVD risk factors. We included 4384 patients (67% [n=2951] PLWH). PLWH admitted with CAP were younger, had less severe CAP, and had fewer CVD risk factors than patients with CAP who were uninfected with HIV. In multivariable-adjusted analyses, CVD risk was similar in PLWH compared with HIV-uninfected (hazard ratio [HR], 0.89; 95% CI, 0.70-1.12), but HIV infection was associated with higher mortality risk (HR, 1.49; 95% CI, 1.16-1.90). In models stratified by HIV status, CAP severity was significantly associated with incident CVD and 30-day mortality in PLWH and patients uninfected with HIV. Conclusions In this study, the risk of CVD events during or after hospitalization for CAP was similar in PLWH and patients uninfected with HIV, after adjusting for known CVD risk factors and CAP severity. HIV infection, however, was associated with increased 30-day mortality after CAP hospitalization in multivariable-adjusted models. PLWH should be included in future studies evaluating mechanisms and prevention of CVD events after CAP.
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Affiliation(s)
- Jerry S. Zifodya
- Department of MedicineSection of Pulmonary Diseases, Critical Care, and Environmental MedicineTulane University School of MedicineNew OrleansLA
| | - Meredith S. Duncan
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of BiostatisticsCollege of Public HealthUniversity of KentuckyLexingtonKY
| | - Kaku A. So‐Armah
- Section of General Internal MedicineBoston University School of MedicineBostonMA
| | - Engi F. Attia
- Department of MedicineDivision of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWA
| | - Kathleen M. Akgün
- Department of MedicineSection of Pulmonary, Critical Care and Sleep MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
- Yale University School of MedicineNew HavenCT
| | - Maria C. Rodriguez‐Barradas
- Infectious Diseases SectionMichael E. DeBakey Veterans Affairs Medical CenterBaylor College of MedicineHoustonTX
| | - Vincent C. Marconi
- Atlanta Veterans Affairs Medical CenterDivision of Infectious DiseasesDepartment of Global HealthRollins School of Public Health and Department of MedicineEmory University School of MedicineAtlantaGA
| | - Matthew J. Budoff
- Department of CardiologyLos Angeles Biomedical Research Institute at Harbor‐UCLALos AngelesCA
| | - Roger J. Bedimo
- Department of MedicineVA North Texas Health Care System and University of Texas Southwestern Medical CenterDallasTX
| | - Charles W. Alcorn
- Department of BiostatisticsGraduate School of Public HealthUniversity of PittsburghPA
| | - Guy W. Soo Hoo
- Department of MedicinePulmonary, Critical Care and Sleep SectionVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCA
| | - Adeel A. Butt
- Veterans AffairsPittsburgh Healthcare SystemPittsburghPA
- Weill Cornell Medical CollegeNew YorkNY
- Weill Cornell Medical CollegeDohaQatar
| | - Joon W. Kim
- Critical Care MedicineJames J. Peters Veterans Affairs Medical CenterBronxNY
| | - Jason J. Sico
- Neurology Service and Clinical Epidemiology Research Center (CERC)Veterans Affairs Connecticut Healthcare SystemWest HavenCT
- Departments of Internal MedicineSection of Internal Medicine, NeurologySections of Vascular Neurology and General NeurologyCenter for NeuroEpidemiological and Clinical ResearchYale School of MedicineNew HavenCT
| | - Hilary A. Tindle
- Geriatric Research Education and Clinical Centers (GRECC)Veterans Affairs Tennessee Valley Healthcare SystemNashvilleTN
- Department of MedicineDivision of General Internal Medicine and Public HealthVanderbilt University Medical CenterNashvilleTN
| | - Laurence Huang
- Department of MedicineZuckerberg San Francisco General HospitalUniversity of California San FranciscoSan FranciscoCA
| | - Janet P. Tate
- Department of MedicineSection of Pulmonary, Critical Care and Sleep MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
- Yale University School of MedicineNew HavenCT
| | - Amy C. Justice
- Yale University School of MedicineNew HavenCT
- Department of MedicineVeterans Affairs Connecticut Healthcare SystemWest HavenCT
| | - Matthew S. Freiberg
- Department of MedicineDivision of Cardiovascular MedicineVanderbilt University Medical CenterNashvilleTN
- Department of MedicineDivision of General Internal Medicine and Public HealthVanderbilt University Medical CenterNashvilleTN
| | - Kristina Crothers
- Department of MedicineDivision of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleWA
- Veterans Affairs Puget Sound Health Care SystemSeattleWA
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Justice AC, Tate JP. Strengths and Limitations of the Veterans Aging Cohort Study Index as a Measure of Physiologic Frailty. AIDS Res Hum Retroviruses 2020; 35:1023-1033. [PMID: 31565954 DOI: 10.1089/aid.2019.0136] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Veterans Aging Cohort Study Index (VACS Index) is an index comprised of routine clinical laboratory tests that accurately and generalizably predicts all-cause mortality among those living with and without HIV infection. Increasing evidence supports its use as a measure of physiologic frailty among those aging with HIV because of its associations with frailty related outcomes including mortality, hospitalization, fragility fractures, serious falls, pneumonia, cognitive decline, delirium, and functional decline. In this review, we explore the evidence supporting the validity (construct, correlative, and predictive), responsiveness, and feasibility of the VACS Index as an early indicator of physiologic frailty. We also consider its limitations.
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Affiliation(s)
- Amy C. Justice
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Awori V, Nakigozi G, Kisakye A, Batte J, Anok A, Mayanja R, Nakasujja N, Robertson KR, Gray RH, Wawer MJ, Sacktor N, Saylor D. The Veterans Aging Cohort Study Index is not associated with HIV-associated neurocognitive disorders in Uganda. J Neurovirol 2019; 26:252-256. [PMID: 31721082 DOI: 10.1007/s13365-019-00806-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
Abstract
The Veterans Aging Cohort Study (VACS) Index has been associated with HIV-associated neurocognitive disorder (HAND) in some populations but has not been studied in sub-Saharan Africa. We investigated whether the VACS Index is associated with HAND in a rural population in Rakai, Uganda. HIV-infected (HIV+) adults on antiretroviral therapy underwent a neurocognitive battery for determination of HAND stage using Frascati criteria. VACS component scores were recorded for all participants. Out of 156 study participants, HAND stages were 49% normal cognition, 15% asymptomatic neurocognitive impairment, 31% minor neurocognitive disorder, and 7% HIV-associated dementia. There was no significant association between VACS Index and any HAND stage. In this first study of the VACS Index in sub-Saharan Africa, we found no association between VACS Index score and HAND.
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Affiliation(s)
| | | | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | - Kevin R Robertson
- Department of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Meyer 6-113, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. .,Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
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Sangarlangkarn A, Apornpong T, Justice AC, Avihingsanon A. Screening tools for targeted comprehensive geriatric assessment in HIV-infected patients 50 years and older. Int J STD AIDS 2019; 30:1009-1017. [PMID: 31431156 DOI: 10.1177/0956462419841478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Many people living with HIV (PLWH) are aging with geriatric syndromes, but few undergo comprehensive geriatric assessment (CGA) due to limited resources. Our study evaluates tools to identify aging PLWH who may forego CGA. We conducted a cross-sectional study on 357 PLWH ≥50 years old at the Red Cross, Thailand. Tools evaluated were the Veterans Aging Cohort Study Index (VACSI) and G-8, which is predictive among older cancer patients. CGA consists of eight tests: history of fall within 12 months, timed-up-and-go test (TUG), activities of daily living (ADL), instrumental ADL (IADL), Montreal cognitive assessment (MoCA), Thai depression scale (TDS), mini nutritional assessment (MNA), and HIV symptom index (HSI). We considered ≥2 impaired domains on CGA to be abnormal results. Forty-nine percent (n = 175) had ≥2 impaired domains on CGA. Few participants had experienced a fall (11%) or abnormal TUG/ADL/IADL (<2%), and only MoCA/TDS/MNA/HSI were analyzed. A VACSI < 17 produces 85% sensitivity (Se) and 30% specificity (Sp) (area under the ROC curve [AUC] = 63, 95%CI 58–69) and G-8 > 15.5 produces 90%Se and 33%Sp (AUC = 74, 95%CI 69–79) in identifying patients with <2 impaired domains. A G-8 > 13.5 produces 91%Se and 77%Sp (AUC = 89, 95%CI 86–92) in ruling out abnormal nutrition. Patients with VACSI < 17 and G-8 > 15.5 may forego CGA due to low likelihood of abnormal cognition, mood, nutrition, or symptom burden.
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Affiliation(s)
- Aroonsiri Sangarlangkarn
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Tanakorn Apornpong
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Amy C Justice
- 2 Yale University School of Medicine, West Haven, CT, USA
| | - Anchalee Avihingsanon
- 1 HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,3 Department of Medicine, Division of Allergy and Immunology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zifodya JS, Crothers K. Treating bacterial pneumonia in people living with HIV. Expert Rev Respir Med 2019; 13:771-786. [PMID: 31241378 DOI: 10.1080/17476348.2019.1634546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Bacterial pneumonia remains an important cause of morbidity and mortality in people living with HIV (PLWH) in the antiretroviral therapy (ART) era. In addition to being immunocompromised, as reflected by low CD4 cell counts and elevated HIV viral loads, PLWH often have other behaviors associated with an increased risk of pneumonia including smoking and injected drug use. As PLWH are aging, comorbid conditions such as chronic obstructive pulmonary disease (COPD), cancers, and cardiovascular, renal and liver diseases are emerging as additional risk factors for pneumonia. Pathogens are often similar to those in HIV-uninfected individuals; however, PLWH are at risk for unusual and/or multi-drug resistant organisms causing bacterial pneumonia based, in part, on their CD4 cell counts and other exposures. Areas covered: In this review, we focus on the recognition and management of bacterial community-acquired pneumonia (CAP) in PLWH. Along with antimicrobial treatment, we discuss prevention strategies such as vaccination and smoking cessation. Expert opinion: Early initiation of ART after HIV infection can decrease the risk of pneumonia. Improved efforts at vaccination, smoking cessation, and reduction of other substance use are urgently needed in PLWH to decrease the risk for bacterial pneumonia. As PLWH are aging, comorbidities are additional risk factors for bacterial CAP.
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Affiliation(s)
- Jerry S Zifodya
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
| | - Kristina Crothers
- a Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington , Seattle , Washington , USA
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Kenmoe S, Bigna JJ, Fatawou Modiyingi A, Ndangang MS, Ngoupo PA, Simo FBN, Tchatchouang S, Temfack E, Njouom R. Case fatality rate and viral aetiologies of acute respiratory tract infections in HIV positive and negative people in Africa: The VARIAFRICA-HIV systematic review and meta-analysis. J Clin Virol 2019; 117:96-102. [PMID: 31272038 DOI: 10.1016/j.jcv.2019.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/04/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022]
Abstract
This first meta-analysis compare CFR between HIV(+) and HIV(-) with ARTI in Africa We found higher rate of mortality in HIV(+) people compared to HIV(-) In subgroup analysis, the CFR was higher in HIV + children <5 compared to people >5 Viral aetiologies of ARTI were not different between HIV(+) and HIV(-)
Background To set priorities for efficient control of acute respiratory tract infection (ARTI) in Africa, it is necessary to have accurate estimate of its burden, especially among HIV-infected populations. Objectives To compare case fatality rate (CFR) and viral aetiologies of ARTI between HIV-positive and HIV-negative populations in Africa. Study design We searched PubMed, EMBASE, Web of Knowledge, Africa Journal Online, and Global Index Medicus to identify studies published from January 2000 to April 2018. Random-effect meta-analysis method was used to assess association (pooled weighted odds ratios (OR) with 95% confidence interval (CI)). Results A total of 36 studies (126,526 participants) were included. CFR was significantly higher in patients with HIV than in HIV-negative controls (OR 4.10, 95%CI: 2.63–6.27, I²: 93.7%). The risk was significantly higher among children ≤5 years (OR 5.51, 95%CI 2.83–10.74) compared to people aged >5 years (OR 1.48, 95%CI 1.17–1.89); p = 0.0002. There was no difference between children (15 years) and adults and between regions of Africa. There was no difference for viral respiratory aetiologies (Enterovirus, Adenovirus, Bocavirus, Coronavirus, Metapneumovirus, Parainfluenza, Influenza, and Respiratory Syncytial Virus) of ARTI between HIV-positive and HIV-negative people, except for Rhinovirus where being HIV-negative was associated with Rhinovirus (OR 0.70; 95%CI 0.51–0.97, I²: 63.4%). Conclusions This study shows an increased risk of deaths among HIV-infected individuals with ARTI, however with no difference in viral aetiologies compared to HIV-negative individuals in Africa. ARTI deserves more attention from HIV health-care providers for efficient control. Specific strategies are needed for HIV-positive children under 5.
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Abstract
INTRODUCTION Despite active antiretroviral therapy (ART), community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients and incurs high health costs. Areas covered: This article reviews the most recent publications on bacterial CAP in the HIV-infected population, focusing on epidemiology, prognostic factors, microbial etiology, therapy, and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert commentary: HIV-infected patients are more susceptible to bacterial CAP. Although ART improves their immune response and has reduced CAP incidence, these patients continue to present increased risk of pneumonia in part because they show altered immunity and because immune activation persists. The risk of CAP in HIV-infected patients and the probability of polymicrobial or atypical infections are inversely associated with the CD4 cell count. Mortality in HIV-infected patients with CAP ranges from 6% to 15% but in well-controlled HIV-infected patients on ART the mortality is low and similar to that seen in HIV-negative individuals. Vaccination and smoking cessation are the two most important preventive strategies for bacterial CAP in well-controlled HIV-infected patients on ART.
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Affiliation(s)
- Catia Cillóniz
- a Department of Pulmonary Medicine Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
| | - Carolina García-Vidal
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Asunción Moreno
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - José M Miro
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Antoni Torres
- a Department of Pulmonary Medicine Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
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van Gaalen S, Duff M, Arroyave LF, Rueda ZV, Kasper K, Keynan Y. Characteristics of hospital admissions for pneumonia in HIV-positive individuals in Winnipeg, Manitoba: a cross-sectional retrospective analysis. Int J STD AIDS 2017; 29:115-121. [PMID: 28661231 DOI: 10.1177/0956462417717654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Lung infection in human immunodeficiency virus (HIV)-positive individuals remains an important cause of morbidity and mortality, even in the current antiretroviral therapy era. Pneumonia is the most common cause of admission in HIV-positive individuals in our centre as reported in a previously published study. The objective of this retrospective observational study was to further characterize these admissions, with respect to index of disease severity at presentation, organisms identified, and investigations pursued including bronchoalveolar lavage (BAL). There were 123 unique patients accounting for a total of 209 admissions from 2005 to 2015. An organism was isolated in only 33% of all admissions (68/209). The most common organism was Pneumocystis jirovecii with a frequency of 29% of all admissions. Eighty-seven percent of presentations were mild, and 13% were moderate by CURB-65 criteria. A total of 39 BALs were performed, of which 27 yielded an organism (69%). Considering the burden of disease, low diagnostic yield of the current diagnostic strategy and increased morbidity and mortality caused by pneumonia in HIV-positive individuals, further methods are needed to more accurately target therapy. The preponderance of mild disease in this study suggests that better diagnostic tests may identify individuals that can be candidates for outpatient therapy.
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Affiliation(s)
- S van Gaalen
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada
| | - Michael Duff
- 2 Department of Engineering, 8664 University of Manitoba , Winnipeg, Canada
| | | | - Zulma Vanessa Rueda
- 3 27983 Universidad de Antioquia , Medellin, Colombia.,4 28025 Universidad Pontificia Bolivariana , Medellin, Colombia
| | - Ken Kasper
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
| | - Y Keynan
- 1 Department of Internal Medicine, 8664 University of Manitoba , Winnipeg, Canada.,5 Department of Infectious Diseases, 8664 University of Manitoba , Winnipeg, Canada
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