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Zdanowicz MM, Valdes B, Salani D. Management of HIV in the older adults: Clinical and public health challenge. Public Health Nurs 2024; 41:406-415. [PMID: 38323718 DOI: 10.1111/phn.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024]
Abstract
As a result of significant advances in antiretroviral therapy (ART), the number of people living with human immunodeficiency virus (PLWH) who are alive well into their senior years has increased significantly in recent years. While increased life expectancy is a highly desired outcome for PLWH, it brings with it a number of challenges that are only now starting to be understood and fully appreciated. These challenges include higher rates of co-morbidities, polypharmacy, drug side effects, and cognitive deficits, as well as numerous psychosocial issues such as stigma, loneliness, and depression. Older PLWH also face challenges related to housing, health insurance, and long-term care. This review will discuss many of the challenges faced by older PLWH and present clinical and public health responses with suggested interventions that may improve outcomes for this population.
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Affiliation(s)
- Martin M Zdanowicz
- Professor of Phamaceutical and Appplied Life Science, Keck Graduate Institute, School of Pharmacy and Health Sciences, Claremont, California, USA
| | - Beatriz Valdes
- Associate Professor of Clinical, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA
| | - Deborah Salani
- Professor of Clinical, University of Miami School of Nursing and Health Studies, Coral Gables, Florida, USA
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Wang Y, Liu S, Zhang W, Zheng L, Li E, Zhu M, Yan D, Shi J, Bao J, Yu J. Development and Evaluation of a Nomogram for Predicting the Outcome of Immune Reconstitution Among HIV/AIDS Patients Receiving Antiretroviral Therapy in China. Adv Biol (Weinh) 2024; 8:e2300378. [PMID: 37937390 DOI: 10.1002/adbi.202300378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/12/2023] [Indexed: 11/09/2023]
Abstract
This study aims to develop and evaluate a model to predict the immune reconstitution among HIV/AIDS patients after antiretroviral therapy (ART). A total of 502 HIV/AIDS patients are randomized to the training cohort and evaluation cohort. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analysis are performed to identify the indicators and establish the nomogram for predicting the immune reconstitution. Decision curve analysis (DCA) and clinical impact curve (CIC) are used to evaluate the clinical effectiveness of the nomogram. Predictive factors included white blood cells (WBC), baseline CD4+ T-cell counts (baseline CD4), ratio of effector regulatory T cells to resting regulatory T cells (eTreg/rTreg) and low-density lipoprotein cholesterol (LDL-C) and are incorporated into the nomogram. The area under the curve (AUC) is 0.812 (95% CI, 0.767∼0.851) and 0.794 (95%CI, 0.719∼0.857) in the training cohort and evaluation cohort, respectively. The calibration curve shows a high consistency between the predicted and actual observations. Moreover, DCA and CIC indicate that the nomogram has a superior net benefit in predicting poor immune reconstitution. A simple-to-use nomogram containing four routinely collected variables is developed and internally evaluated and can be used to predict the poor immune reconstitution in HIV/AIDS patients after ART.
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Affiliation(s)
- Yi Wang
- Institute of Hepatology and Epidemiology, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Shourong Liu
- Department of Infection, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Wenhui Zhang
- Department of Infection, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
- Department of Nursing, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Liping Zheng
- Department of Nursing, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Er Li
- Department of Nursing, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Mingli Zhu
- Medical Laboratory, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, 310023, China
| | - Dingyan Yan
- Department of Infection, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
- Department of Nursing, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Jinchuan Shi
- Department of Infection, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Jianfeng Bao
- Institute of Hepatology and Epidemiology, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
| | - Jianhua Yu
- Department of Infection, Affiliated Xixi Hospital in Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China
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Factors Influencing Survival Status of HIV/AIDS after HAART in Huzhou City, Eastern China. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:2787731. [PMID: 36249590 PMCID: PMC9560853 DOI: 10.1155/2022/2787731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
Background Highly active antiretroviral therapy (HAART) can effectively reduce the risk of death and opportunistic infections in patients with HIV/AIDS. The aim of this study was to analyse the survival status and its influencing factors in HIV/AIDS after HAART. Methods The data on patients' sociodemographic characteristics, treatment information, and follow-up results from the Information Management System of the Chinese Center for Disease Control and Prevention were obtained. Bivariate and stepwise multivariate Cox proportional hazards regression model analyses were performed. Results A total of 1812 participants were included in this study, of which 1716 were still alive (survival group) and 96 had died (death group). The results indicated that respondents who were elderly (HR = 1.053, 95% CI: 1.037–1.069, P < 0.01), who had heterosexual transmission (HR = 2.422, 95% CI: 1.314–4.465, P < 0.01) and whose current WHO clinical stage was stage III or IV (HR = 2.399, 95% CI: 1.215–4.735, P < 0.05) were more likely to have died; respondents whose baseline CD4+ T-lymphocyte count was equal to or more than 200 cells/μL (HR = 0.412, 95% CI: 0.275–0.616, P < 0.05) were unlikely to have died. Conclusions It is recommended that HAART be provided to HIV/AIDS patients at an early clinical stage and that the health services for HIV/AIDS patients after taking medicines be strengthened, which will help promote adherence to therapeutic regimens and improve quality of life.
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