Development and internal validation of the HIV In-hospital Mortality Prediction (HIV-IMP) risk score

TheU-shape association between on-admission resting heart rate and 60-day all-cause mortality of AIDS inpatients in Fujian China: a retrospective cohort study

BACKGROUND

An elevated resting heart rate (RHR) is associated with poor outcomes in both healthy individuals and those with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). This study aimed to investigated the association between on admission resting heart rate (RHR) and 60-day mortality.

METHODS

This single-center retrospective cohort study evaluated the effect of RHR on the 60-day mortality of patient with AIDS in Southeast China. A total of 2188 patients with AIDS admitted for the first time between January 2016 and December 2021 were included. The RHR was categorized into tertiles. Disease progression was estimated using 60-day mortality rates. Cox proportional hazards regression models were used to evaluate the RHR with disease progression, and a two-piecewise Cox regression model was used to reveal the RHR effect at admission on 60-day mortality.

RESULTS

We observed a U-shape relationship between RHR and 60-day mortality. For a above 90 bpm, the 60-day mortality rose rapidly with a multivariable adjusted odds ratio (OR) of 1.032 (95% confidence interval [CI 1.016-1.048, P < 0.001). Below the threshold, 60 days mortality decreased as the RHR increased to 90 bpm with a multivariate-adjusted OR of 0.943 (95% CI 0.904-0.984, P = 0.0065).

CONCLUSIONS

This study identified a U-shape relationship between RHR and 60-day mortality in HIV/AIDS patients. Further research is needed to characterize the role of RHR in the timely prevention of mortality in HIV/AIDS patients.

Association between admission serum albumin and 12-weeks mortality in patients with late AIDS/HIV diagnosis: a retrospective cohort study

This study investigated the association between serum albumin concentration and 12-weeks mortality of HIV/AIDS with late diagnosis in China. This retrospective cohort study included, 1079 inpatients diagnosis with late HIV/AIDS between January 2018 and December 2021. Disease progression was estimated based on the 12-weeks mortality rate. Cox proportional hazards regression models were used to evaluate the relationship between serum albumin levels and disease progression. The effects of serum albumin levels on mortality was estimated via Kaplan-Meier curves. The mortality risk decreased by 7% with every 1 g/L increase in serum albumin after adjustment ([HR] = 0.93, 95% CI: 0.88-0.97). Compared with that of the low (< 28 g/L) serum albumin group, the middle (28-34 g/L) group's mortality risk decreased by 70% (HR = 0.30, 95% CI: 0.15-0.59), and that of the high (≥ 34 g/L) group decreased by 40% (HR = 0.6, 95% CI: 0.29-1.23) after adjustment. Our findings suggest a positive correlation between the increase in serum albumin levels upon admission and a decrease in mortality at 12 weeks post-discharge among patients with late AIDS/HIV diagnosis. Further research is needed to characterize the role of serum albumin in 12-weeks mortality prevention in patients with a late diagnosis.

Development and validation of a risk score for predicting inconsistent condom use with women among men who have sex with men and women

BACKGROUND

Men who have sex with men and women (MSMW) are the most important bridge population for HIV transmission. Condom use plays an important role for HIV infection. However the predictors for condom ues with females are not well characterized.

METHODS

This was a cross-sectional study. Participants were enrolled by four community-based organizations (CBOs) by offline (bathrooms, bars), and online (gay applications, chat room) from April to December 2019. Electronic questionnare was fulfilled after a face-to-face training led by CBOs. We identified predictors of inconsistent condom use with females by creating a risk score based on regression coefficients. We externally validated this score via an independent cross-sectional survey conducted in Zhejiang Province in 2021. A total of 917, 615 MSMW were included in analysis in 2019 and 2021, seperately.

RESULTS

Among 917 MSMW, 73.2% reported heterosexual behavior in the prior 6 months and 38.3% reported inconsistent condom use with females (ICUF) over that time. Compared with heterosexual/unsure MSMW, bisexual MSMW reported more male and female sex partners, higher proportion of inconsistent condom use with males, less commercial sex with males (p < 0.05). Four risky predictors of ICUF were identified: Duration of local residence ≦6 months; more than one male partner in the prior 6 months; inconsistent condom use with males in the prior 6 months; and never heard post-exposure prophylaxis (PEP). The proportions of respondents indicating ICUF in the low- (0), medium- (2-4) and high-risk (6-20) groups (according to our risk scoring system) were 11.7% (14/120), 26.9% (96/357), and 78.1% (125/160), respectively (P_trend < 0.001). In the validation survey, the respective proportions of those reporting ICUF were 13.4% (15/112), 17.8% (24/185) and 87.3% (96/110) (P_trend < 0.001).

CONCLUSIONS

We developed and validated a predictive risk score for ICUF among MSMW; four factors were identified, of which inconsistent condom use with men was the most important. Risk reduction intervention programs should focus on MSM who report inconsistent condom use with males, never heard PEP, having multiple partners and living in local less than 6 months.