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Groenewald P, Thomas J, Clark SJ, Morof D, Joubert JD, Kabudula C, Li Z, Bradshaw D. Agreement between cause of death assignment by computer-coded verbal autopsy methods and physician coding of verbal autopsy interviews in South Africa. Glob Health Action 2023; 16:2285105. [PMID: 38038664 PMCID: PMC10795603 DOI: 10.1080/16549716.2023.2285105] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The South African national cause of death validation (NCODV 2017/18) project collected a national sample of verbal autopsies (VA) with cause of death (COD) assignment by physician-coded VA (PCVA) and computer-coded VA (CCVA). OBJECTIVE The performance of three CCVA algorithms (InterVA-5, InSilicoVA and Tariff 2.0) in assigning a COD was compared with PCVA (reference standard). METHODS Seven performance metrics assessed individual and population level agreement of COD assignment by age, sex and place of death subgroups. Positive predictive value (PPV), sensitivity, overall agreement, kappa, and chance corrected concordance (CCC) assessed individual level agreement. Cause-specific mortality fraction (CSMF) accuracy and Spearman's rank correlation assessed population level agreement. RESULTS A total of 5386 VA records were analysed. PCVA and CCVAs all identified HIV/AIDS as the leading COD. CCVA PPV and sensitivity, based on confidence intervals, were comparable except for HIV/AIDS, TB, maternal, diabetes mellitus, other cancers, and some injuries. CCVAs performed well for identifying perinatal deaths, road traffic accidents, suicide and homicide but poorly for pneumonia, other infectious diseases and renal failure. Overall agreement between CCVAs and PCVA for the top single cause (48.2-51.6) indicated comparable weak agreement between methods. Overall agreement, for the top three causes showed moderate agreement for InterVA (70.9) and InSilicoVA (73.8). Agreement based on kappa (-0.05-0.49)and CCC (0.06-0.43) was weak to none for all algorithms and groups. CCVAs had moderate to strong agreement for CSMF accuracy, with InterVA-5 highest for neonates (0.90), Tariff 2.0 highest for adults (0.89) and males (0.84), and InSilicoVA highest for females (0.88), elders (0.83) and out-of-facility deaths (0.85). Rank correlation indicated moderate agreement for adults (0.75-0.79). CONCLUSIONS Whilst CCVAs identified HIV/AIDS as the leading COD, consistent with PCVA, there is scope for improving the algorithms for use in South Africa.
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Affiliation(s)
- Pam Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jason Thomas
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Diane Morof
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Durban, South Africa
- United States Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Jané D. Joubert
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Chodziwadziwa Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa
| | - Zehang Li
- Department of Statistics, University of California Santa Cruz, Santa Cruz, California, USA
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Public Health Medicine, School of Public Health, University of Cape Town, Cape Town, South Africa
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Shikanai-Yasuda MA, Mediano MFF, Novaes CTG, de Sousa AS, Sartori AMC, Santana RC, Correia D, de Castro CN, Severo MMDS, Hasslocher-Moreno AM, Fernandez ML, Salvador F, Pinazo MJ, Bolella VR, Furtado PC, Corti M, Neves Pinto AY, Fica A, Molina I, Gascon J, Viñas PA, Cortez-Escalante J, Ramos AN, de Almeida EA. Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the "Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions". PLoS Negl Trop Dis 2021; 15:e0009809. [PMID: 34591866 PMCID: PMC8483313 DOI: 10.1371/journal.pntd.0009809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/μL and median viral load was 17,000 copies/μL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
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Affiliation(s)
- Maria Aparecida Shikanai-Yasuda
- Departament of Infectious and Parasitic, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- Laboratory of Immunology, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- * E-mail: ,
| | - Mauro Felippe Felix Mediano
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | | | - Andréa Silvestre de Sousa
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Health Ministry, Rio de Janeiro, Brazil
| | - Ana Marli Christovam Sartori
- Division of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Carvalho Santana
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Dalmo Correia
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | | | | | | - Marisa Liliana Fernandez
- Hospital de Infecciosas, Buenos Aires, Argentina
- National Institute of Parasitology, Departament of Clinics, Pathology and Treatment, Health Ministry, Buenos Aires, Argentina
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Valdes Roberto Bolella
- Division of Infectious Diseases, Department of Internal Medicine, Ribeirão Preto Medical School University of São Paulo, Ribeirão Preto, Brazil
| | - Pedro Carvalho Furtado
- Discipline of Infectious and Parasitic Diseases, Department of Internal Medicine, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Marcelo Corti
- Hospital de Infecciosas, Buenos Aires, Argentina
- Departamento de Medicina, Asignatura Enfermedades Infecciosas, Facultad de Medicina, Universidad Buenos Aires, Buenos Aires, Argentina
| | - Ana Yecê Neves Pinto
- Evandro Chagas Institute, Health Surveillance Secretary, Health Ministry, Belém, Brazil
| | - Alberto Fica
- Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Israel Molina
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Gascon
- ISGlobal, Universitat de Barcelona, Hospital Clínic, Barcelona, Spain
| | - Pedro Albajar Viñas
- WHO Technical Group IVb on prevention, control and management of non congenital infections of the Global Network for Chagas Disease Elimination, WHO, Geneva, Switzerland
- Department of Control of Neglected Tropical Diseases, World Health Organization, WHO, Geneva, Switzerland
| | - Juan Cortez-Escalante
- Pan American Health Organization (PAHO), World Health Organization (WHO), Brasília, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Eros Antonio de Almeida
- Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Yang WJ, Liu Y, Li J, Ma YM, Li N. [Analysis on mortality in HIV/AIDS cases aged 15 years and older under antiretroviral treatment in Henan province, 2002-2019]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:1594-1600. [PMID: 34814589 DOI: 10.3760/cma.j.cn112338-20210308-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To analyze the mortality in HIV/AIDS cases aged ≥15 years under antiretroviral treatment (ART) in Henan province from 2002 to 2019, and provide evidence for reducing the mortality rate of HIV/AIDS and AIDS prevention and treatment. Methods: Data of HIV/AIDS cases aged ≥15 years who received ART in Henan from 2002 to 2019 were obtained from "Infectious Disease Surveillance System - Basic Information on AIDS Prevention and Control". In this retrospective study, Cox proportional risk model was used to analyze the influencing factors for HIV/AIDS related deaths. Software SPSS 23.0 was used for statistical analysis. Results: From 2002 to 2019, a total of 72 986 HIV/AIDS cases aged ≥15 years received ART, in whom, 16 634 died during this period. Most of the death cases were aged ≥40 years old (68.5%,11 393/16 634), males (62.6%,10 419/16 634), infected through blood-borne transmission (71.7%,11 927/16 634), and farmers or migrant workers (91.7%,15 249/16 634). Most of the deaths were due to AIDS related diseases (73.7%, 12 261/16 634), and the case fatality rate was 16.8% (12 261/72 986). A total of 34.6% (4 237/12 261) of HIV/AIDS cases died of AIDS-related diseases in the first year of ART, and the cumulative survival rates at 10 and 18 years of ART were 78.3% and 71.8%, respectively. The proportion of the HIV/AIDS cases with baseline CD4+T lymphocyte (CD4) counts <200 cells/μl at age 15 years when ART started was 45.5% (30 432/66 898). Cox proportional risk regression model showed that, compared with the cases with baseline CD4 counts ≥350 cells/μl, the risk of death was 1.78 times higher than in the cases with CD4 counts <200 cells/μl (95%CI: 1.64-1.94) and 1.24 times higher in the cases with CD4 counts ≥200 cells/μl (95%CI: 1.13-1.36), respectively. The risk of death in symptomatic cases at baseline survey was 1.25 times higher than that in asymptomatic cases (95%CI: 1.16-1.35). The cases with a latest viral load ≥1 000 copies/ml had 7.09 times higher risk of death than those with a last viral load<1 000 copies/ml (95%CI: 6.65-7.54). Conclusions: The majority of HIV/AIDS deaths occurred in the cases aged ≥15 years receiving ART in Henan province during 2002-2019, who were infected through blood-borne transmission and farmers/migrant workers, and AIDS-related diseases were the main causes of the deaths. With the gradual implementation of ART policy, the high survival rate in HIV/AIDS cases can be maintained for a long time in Henan. To reduce the case fatality rate and improve the quality of life of HIV/AIDS patients, CD4 counts test should be further strengthened and eligible HIV/AIDS patients should be covered by standard ART in a timely manner.
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Affiliation(s)
- W J Yang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - Y Liu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - J Li
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - Y M Ma
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - N Li
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
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Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, Leo YS, Chow A. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore) 2021; 100:e26507. [PMID: 34190180 PMCID: PMC8257899 DOI: 10.1097/md.0000000000026507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore
| | | | - Chen Seong Wong
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Vernon Jian Ming Lee
- National University of Singapore, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Angela Chow
- National Centre for Infectious Diseases, Singapore
- National University of Singapore, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Musarandega R, Machekano R, Pattinson R, Munjanja SP. Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study. PLoS One 2021; 16:e0252106. [PMID: 34081727 PMCID: PMC8174727 DOI: 10.1371/journal.pone.0252106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe-an SSA country. METHODS In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007-2008 and 2018-2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. DISCUSSION This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007-2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.
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Affiliation(s)
- Reuben Musarandega
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Rhoderick Machekano
- Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert Pattinson
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, SAMRC Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa
| | - Stephen Peter Munjanja
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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da Silva Prates G, Malta FM, de Toledo Gonçalves F, Monteiro MA, Fonseca LAM, R Veiga AP, M C Magri M, Duarte AJS, Casseb J, Assone T. AIDS incidence and survival in a hospital-based cohort of HIV-positive patients from São Paulo, Brazil: The role of IFN-λ4 polymorphisms. J Med Virol 2021; 93:3601-3606. [PMID: 32449798 DOI: 10.1002/jmv.26054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022]
Abstract
Few studies have reported the prognosis of human immunodeficiency virus (HIV)-positive patients followed for a long time in Brazil, particularly those including pre and post-HAART eras. The polymorphisms of interferon (IFN)-λ4 have been postulated as possibly associated with the pathogenesis of HIV infection. The aim of this study was to describe the incidence and mortality from a cohort of HIV-positive patients as well as whether IFN-λ4 gene polymorphisms (SNP rs8099917 and SNP rs12979860) were associated with HIV/acquired immune deficiency syndrome (AIDS) progression. We followed 402 patients for up to 30 years; 347 of them began follow-up asymptomatic, without any AIDS-defining opportunistic disease and/or a lymphocytes T CD4+ count of 350 cells/mm3 or lower. We determined the probability of the asymptomatic subjects to remain AIDS-free, and the risk of death for those entering the study already with an AIDS diagnosis, as well as for subjects developing AIDS during follow-up. We compared the prognosis of patients with two different polymorphisms for the genes encoding for IFN-λ4, variants rs8099917 and rs12979860. The follow-up time of the 347 asymptomatic-at-entry subjects was 3687 person-years. IFN-λ4 rs8099917 polymorphisms were not associated with AIDS progression, but IFN-λ4 rs12979860 wild type genotype (CC) was associated with higher mortality compared to CT and TT, with an increased probability of death from AIDS (P = .01). In conclusion, genetic variations in IFN-λ4 on rs12979860 polymorphisms in HIV-infected patients may drive mortality risk.
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Affiliation(s)
- Gabriela da Silva Prates
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda M Malta
- Departamento de Gastroenterologia, Laboratório de Gastroenterologia e Hepatologia Tropical, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda de Toledo Gonçalves
- Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana A Monteiro
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Luiz Augusto M Fonseca
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula R Veiga
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Marcello M C Magri
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Alberto J S Duarte
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Jorge Casseb
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Tatiane Assone
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Zhou C, Liang S, Li YP, Yang Y, Liao LJ, Xing H, Ruan YH, Yuan D. [Influencing factors on the death of HIV/AIDS patients treated with antiviral treatment in Butuo county, Liangshan Yi Autonomous Prefecture, 2010-2019]. Zhonghua Liu Xing Bing Xue Za Zhi 2021; 42:886-890. [PMID: 34814483 DOI: 10.3760/cma.j.cn112338-20200902-01115] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To understand influencing factors on the deaths of HIV/AIDS patients receiving antireviral treatment in Butuo county of Liangshan Yi Autonomous Prefecture (Liangshan) from 2010 to 2019, to provide data for drug replacement and sustainable antiviral treatment strategy. Methods: A matched case-control study was used to collect basic and follow-up information on AIDS death patients receiving antiviral treatment in Butuo county of Liangshan from 2010 to 2019. The control group was formed by sampling twice the number of cases. The logistic regression model was used to analyze the risk factors affecting mortality. Results: In 3 355 patients of HIV/AIDS treated with antiviral therapy, 1 179 cases in the death group and 2 176 cases in the control group. Including 81.34% were 30-49 years old, 69.09%males, 99.55% Yi nationality, 91.12% were married or cohabitated, 95.77% had junior high school education or below, and 88.41% peasants. Amultivariate logistic stepwise regression model showed that among the death risk factors, age ≥50 years old was 5.08 times (95%CI:3.05-8.48) that of the 18-29, female was 0.70 times (95%CI: 0.52-0.94) than male, the transmission rate of intravenous drug use was 1.43 times (95%CI: 1.06-1.91) that of heterosexual transmission, CD4+T lymphocyte (CD4) count ≥350 cells/μl before treatment was 0.38 times (95%CI: 0.30-0.48) that of CD4 <200 cells/μl before treatment, the most recent antiviral treatment regimen containing LPV/r was 0.04 times (95%CI: 0.01-0.18) than that of stavudine (d4T) + lamivudine (3TC) + nevirapine (NVP)/efavirenz (EFV) regimen, drug resistance was 3.40 times (95%CI: 2.13-5.42) of non-drug resistance, non-viral load and non-drug resistance test results were 12.98 times (95%CI: 10.28-16.40) of non-drug resistance. Conclusions: Age, gender, transmission route, CD4 before treatment, the latest antiviral treatment program, and drug resistance test after antiviral therapy were the influencing factors of HIV/AIDS death in Butuo county. It is necessary to expand the coverage of viral load and drug resistance test to change the antiviral therapeutic schedule scientifically and carry out publicity and education on the compliance of patients with antiviral treatment and medical staff training in order to reduce the mortality of patients with antiviral treatment.
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Affiliation(s)
- C Zhou
- Sichuan Center for Disease Control and Prevention, Chengdu 610000, China
| | - S Liang
- Sichuan Center for Disease Control and Prevention, Chengdu 610000, China
| | - Y P Li
- Sichuan Center for Disease Control and Prevention, Chengdu 610000, China
| | - Y Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu 610032, China
| | - L J Liao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - H Xing
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Y H Ruan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - D Yuan
- Sichuan Center for Disease Control and Prevention, Chengdu 610000, China
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Bayarsaikhan S, Jagdagsuren D, Gunchin B, Sandag T. Survival, CD4 T lymphocyte count recovery and immune reconstitution pattern during the first-line combination antiretroviral therapy in patients with HIV-1 infection in Mongolia. PLoS One 2021; 16:e0247929. [PMID: 33684169 PMCID: PMC7939265 DOI: 10.1371/journal.pone.0247929] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Mongolia has a low incidence of human immunodeficiency virus (HIV) infection, with 281 cases reported at the end of 2019 and an estimated incidence rate of <0.01 cases per 1000 population. However, no study has analyzed the association between antiretroviral therapy (ART) outcomes and pretreatment characteristics of patients with HIV/acquired immunodeficiency syndrome (AIDS) in Mongolia. This retrospective study aimed to determine the survival, CD4 T cell recovery, and immune reconstitution pattern during ART in HIV patients and to determine baseline patient characteristics associated with ART outcomes. Based on three different World Health Organization (WHO) guidelines, we analyzed the 3-year observation data of 166 patients with HIV/AIDS who received treatment between 2010 and 2017. An increase of >50 cells/μL indicated CD4 T cell count recovery, and a cell count of ≥500 cells/μL in patients with a baseline cell count of <500 cells/μL indicated immune reconstitution. In this study, the 3- and 1-year mortality rates were 5.4% (survival rate: 94.6%) and 3.6%, respectively. A total of 83% of deaths that occurred in the observation time occurred within the first 3 months. The CD4 T cell count recovery rates at 3, 12, and 36 months were 62.7%, 80.7%, and 89.2%, respectively. The CD4 T cell count increased to >500 cells/μL in 95 of 145 (65.5%) patients with a baseline cell count of <500 cells/μL after 36 months of ART. The baseline CD4 T cell count was found to be a sensitive indicator for immune reconstitution. An advanced pretreatment clinical stage of HIV infection (as classified by the WHO classification), a low CD4 T cell count in the peripheral blood, and a high viral load before the initiation of the first-line ART accurately predicted survival, CD4 T cell count recovery, and immune reconstitution in Mongolian patients with HIV/AIDS.
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Affiliation(s)
- Solongo Bayarsaikhan
- AIDS/ STI Research and Surveillance Division, National Center for Communicable Diseases, MoH, Ulaanbaatar, Mongolia
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Davaalkham Jagdagsuren
- Department of Immunology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batbaatar Gunchin
- AIDS/ STI Research and Surveillance Division, National Center for Communicable Diseases, MoH, Ulaanbaatar, Mongolia
| | - Tsogtsaikhan Sandag
- AIDS/ STI Research and Surveillance Division, National Center for Communicable Diseases, MoH, Ulaanbaatar, Mongolia
- * E-mail:
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Wang Z, Zhang R, Gong Z, Liu L, Shen Y, Chen J, Qi T, Song W, Tang Y, Sun J, Lin Y, Xu S, Yang J, Lu H. Real-world outcomes of AIDS-related Burkitt lymphoma: a retrospective study of 78 cases over a 10-year period. Int J Hematol 2021; 113:903-909. [PMID: 33594656 DOI: 10.1007/s12185-021-03101-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/12/2023]
Abstract
We investigated the clinical characteristics and outcomes of acquired immunodeficiency syndrome-related Burkitt lymphoma (AIDS-BL). A single-center retrospective study was performed of 78 cases over a 10-year period. The baseline characteristics of enrolled patients included the following: median age, 46 years; median CD4+ T lymphocyte count, 156 cells/μL; advanced stage, 74.3%; > 1 extranodal site, 55.1%; international prognostic index (IPI) > 1, 85.9%; and elevated serum lactate dehydrogenase, 82.1%. The 1-year and 2-year overall survival (OS) rates were 52.2 ± 5.9% and 42.7 ± 6.2%, respectively. A prognostic analysis of 65 patients who had undergone chemotherapy showed that B symptoms (with vs. without fever, night sweat or weight loss), number of extranodal sites (0, 1 vs. > 1), level of serum albumin (≥ 35 g/L vs. < 35 g/L), hemoglobin (≥ 110 g/L vs. < 110 g/L), and IPI score (≤ 2 vs. > 1) were all associated with OS. However, only B symptoms (HR = 4.036, 95% CI 1.821-8.948, p = 0.001), serum albumin level < 35 g/L (HR = 2.131, 95% CI 1.013-4.483, p = 0.046), and chemotherapy without rituximab (HR = 2.286, 95% CI 1.108-4.714, p = 0.025) were independent predictors of OS after multivariate adjustment. Patients with AIDS-BL were likely to present with high-risk features, and their clinical outcomes were relatively poor, especially those with B symptoms and lower serum albumin levels.
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Affiliation(s)
- Zhenyan Wang
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Zhangyun Gong
- School of Clinical Medicine, Jiamusi University, Jiamusi, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
- Department of Medical Administration, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Tangkai Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Wei Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yang Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Jianjun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Yixiao Lin
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Shuibao Xu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Junyang Yang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China
| | - Hongzhou Lu
- Fudan University (Shanghai Public Health Clinical Center), 130 Dongan Road, Xuhui District, Shanghai, 200032, China.
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Jinshan District, Shanghai, 201508, China.
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10
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Aellah G. Understanding men, mood, and avoidable deaths from AIDS in Western Kenya. Cult Health Sex 2020; 22:1398-1413. [PMID: 31944171 DOI: 10.1080/13691058.2019.1685131] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
A person diagnosed with HIV today might never experience AIDS, nor transmit HIV. Advances in treatment effectiveness and coverage has made the UN 2030 vision for the 'end of AIDS' thinkable. Yet drug adherence and resistance are continuing challenges, contributing to avoidable deaths in high burden African countries, especially among men. The mood of global policy rhetoric is hopeful, though cautious. The mood of people living with HIV struggling to adhere to life-saving medication is harder to capture, but vital to understand. This paper draws on ethnographic fieldwork with a high burden population in Kenya to explore specific socio-economic contexts that lead to a potent mixture of fatalism and ambition among men now in their thirties who came of age during the devastating 1990s AIDS crisis. It seeks to understand why some HIV-positive members of this bio-generation find it hard to take their life-saving medication consistently, gambling with their lives and the lives of others in pursuit of a life that counts. It argues that mood - here understood as a shared generational consciousness and collective affect created by experiencing specific historical moments - should be taken seriously as legitimate evidence in HIV programming decisions.
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Affiliation(s)
- Gemma Aellah
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study. J Korean Med Sci 2020; 35:e355. [PMID: 33107229 PMCID: PMC7590652 DOI: 10.3346/jkms.2020.35.e355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. METHODS A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan-Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. RESULTS Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate (P = 0.228), causes of death (P = 0.771), or survival analysis (P = 0.089) between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. CONCLUSION Being diagnosed with CD4 < 200 cells/mm³ at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm³ group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin Woo Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyun Ha Chang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sohyun Bae
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Madut DB, Park LP, Yao J, Reddy EA, Njau B, Ostermann J, Whetten K, Thielman NM. Predictors of mortality in treatment experienced HIV-infected patients in northern Tanzania. PLoS One 2020; 15:e0240293. [PMID: 33031434 PMCID: PMC7544106 DOI: 10.1371/journal.pone.0240293] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background While factors that drive early mortality among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in sub-Saharan Africa (SSA) have been described, less is known about the predictors of long-term mortality for those with ART experience. Methods PLWH and on ART attending two HIV treatment clinics in Moshi, Tanzania were enrolled from 2008 through 2009 and followed for 3.5 years. Demographic, psychosocial, and clinical information were collected at enrollment. Plasma HIV RNA measurements were collected annually. Cause of death was adjudicated by two independent reviewers based on verbal autopsy information and medical records. Bivariable and multivariable analyses were conducted using Cox proportional hazard models to identify predictors of mortality. Results The analysis included 403 participants. The median (IQR) age in years was 42 (36–48) and 277 (68.7%) participants were female. The proportion of participants virologically suppressed during the 4 collection time points was 88.5%, 94.7%, 91.5%, and 94.5%. During follow-up, 24 participants died; the overall mortality rate was 1.8 deaths per 100 person-years. Of the deaths, 14 (58.3%) were suspected to be HIV/AIDS related. Predictors of mortality (adjusted hazard ratio, 95% confidence interval) were male sex (2.63, 1.01–6.83), secondary or higher education (7.70, 3.02–19.60), receiving care at the regional referral hospital in comparison to the larger zonal referral hospital (6.33, 1.93–20.76), and moderate to severe depression symptoms (6.35, 1.69–23.87). Conclusions As ART coverage continues to expand in SSA, HIV programs should recognize the need for interventions to promote HIV care engagement for men and the integration of mental health screening and treatment with HIV care. Facility-level barriers may contribute to challenges faced by PLWH as they progress through the HIV care continuum, and further understanding of these barriers is needed. The association of higher educational attainment with mortality merits further investigation.
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Affiliation(s)
- Deng B. Madut
- Department of Medicine, Duke University, Durham, NC, United States of America
- * E-mail:
| | - Lawrence P. Park
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Jia Yao
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Elizabeth A. Reddy
- Division of Infectious Disease, SUNY Upstate Medical University, Syracuse, NY, United States of America
| | - Bernard Njau
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Kathryn Whetten
- Duke Global Health Institute, Durham, NC, United States of America
- Center for Health Policy and Inequalities Research, Durham, NC, United States of America
- Duke Sanford School of Public Policy, Duke University, Durham, NC, United States of America
| | - Nathan M. Thielman
- Department of Medicine, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
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Kim YC, Ahn JY, Kim HY, Song JY, Park DW, Kim MJ, Choi HJ, Kim SW, Kee MK, Han MG, Yoo M, Kim SM, Choi Y, Choi BY, Kim SI, Choi JY. Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015. Yonsei Med J 2020; 61:705-711. [PMID: 32734734 PMCID: PMC7393295 DOI: 10.3349/ymj.2020.61.8.705] [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: 05/27/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. MATERIALS AND METHODS Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation. RESULTS Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5-303] in 2001-2003 to 273 (IQR, 108-399) in 2013-2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per 1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35-5.84] and low CD4 counts (<100 cells/mm³: adjusted hazard ratio, 2.99; 95% CI, 1.44-6.23) were significant risk factors for mortality. CONCLUSION Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.
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Affiliation(s)
- Yong Chan Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Youl Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Shin Woo Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Mee Kyung Kee
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myung Guk Han
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Myeongsu Yoo
- Division of Viral Disease Research, Center for Infectious Disease Research, Korea National Institute of Health, Cheongju, Korea
| | - Soo Min Kim
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Yunsu Choi
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Golin R, Godfrey C, Firth J, Lee L, Minior T, Phelps BR, Raizes EG, Ake JA, Siberry GK. PEPFAR's response to the convergence of the HIV and COVID-19 pandemics in Sub-Saharan Africa. J Int AIDS Soc 2020; 23:e25587. [PMID: 32767707 PMCID: PMC7405155 DOI: 10.1002/jia2.25587] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemic would have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. This commentary reviews PEPFAR's COVID-19 technical guidance and provides country-specific examples of programme adaptions in sub-Saharan Africa. DISCUSSION The COVID-19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over-burdened health systems. Although there is currently limited understanding of how COVID-19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID-19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in-person home and facility visits and other direct contact when COVID-19 control measures are in effect. PEPFAR-supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID-19 in sub-Saharan Africa. CONCLUSIONS As community transmission of COVID-19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data-driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID-19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.
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Affiliation(s)
- Rachel Golin
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Catherine Godfrey
- Office of the U.S. Global AIDS Coordinator and Health DiplomacyWashingtonDCUSA
| | - Jacqueline Firth
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Lana Lee
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - Thomas Minior
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | - B Ryan Phelps
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
| | | | - Julie A Ake
- U.S. Military HIV Research ProgramWalter Reed Army Institute of ResearchSilver SpringMDUSA
| | - George K Siberry
- Office of HIV/AIDSUnited States Agency for International DevelopmentWashingtonDCUSA
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Belaunzarán-Zamudio PF, Caro-Vega YN, Shepherd BE, Rebeiro PF, Crabtree-Ramírez BE, Cortes CP, Grinsztejn B, Gotuzzo E, Mejia F, Padgett D, Pape JW, Rouzier V, Veloso V, Cardoso SW, McGowan CC, Sierra-Madero JG. The Population Impact of Late Presentation With Advanced HIV Disease and Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin America. Am J Epidemiol 2020; 189:564-572. [PMID: 31667488 DOI: 10.1093/aje/kwz252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 12/25/2022] Open
Abstract
Late presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001-2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of <200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.
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Li Y, Zeng YM, Lu YQ, Qin YY, Chen YK. A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections. Medicine (Baltimore) 2020; 99:e20146. [PMID: 32443329 PMCID: PMC7253700 DOI: 10.1097/md.0000000000020146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND An increased frequency of toxoplasma encephalitis, caused by Toxoplasma gondii, has been reported in AIDS patients, especially in those with CD4+ T cell counts <100 cells/μL. Several guidelines recommend the combination of pyrimethamine, sulfadiazine, and leucovorin as the preferred regimen for AIDS-associated toxoplasma encephalitis. However, it is not commonly used in China due to limited access to pyrimethamine and sulfadiazine. The synergistic sulfonamides tablet formulation is a combination of trimethoprim (TMP), sulfadiazine and sulfamethoxazole (SMX), and is readily available in China. Considering its constituent components, we hypothesize that this drug may be used as a substitute for sulfadiazine and TMP-SMX. We have therefore designed the present trial, and propose to investigate the efficacy and safety of synergistic sulfonamides combined with clindamycin for the treatment of toxoplasma encephalitis. METHODS/DESIGN This study will be an open-labeled, multi-center, prospective, randomized, and controlled trial. A total of 200 patients will be randomized into TMP-SMX plus azithromycin group, and synergistic sulfonamides plus clindamycin group at a ratio of 1:1. All participants will be invited to participate in a 48-week follow-up schedule once enrolled. The primary outcomes will be clinical response rate and all-cause mortality at 12 weeks. The secondary outcomes will be clinical response rate and all-cause mortality at 48 weeks, and adverse events at each visit during the follow-up period. DISCUSSION We hope that the results of this study will be able to provide reliable evidence for the efficacy and safety of synergistic sulfonamides for its use in AIDS patients with toxoplasma encephalitis. TRIAL REGISTRATION This study was registered as one of 12 clinical trials under the name of a general project at chictr.gov on February 1, 2019, and the registration number of the general project is ChiCTR1900021195. This study is still recruiting now, and the first patient was screened on March 22, 2019.
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Roy B, Kiefe CI, Jacobs DR, Goff DC, Lloyd-Jones D, Shikany JM, Reis JP, Gordon-Larsen P, Lewis CE. Education, Race/Ethnicity, and Causes of Premature Mortality Among Middle-Aged Adults in 4 US Urban Communities: Results From CARDIA, 1985-2017. Am J Public Health 2020; 110:530-536. [PMID: 32078342 PMCID: PMC7067110 DOI: 10.2105/ajph.2019.305506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 01/31/2023]
Abstract
Objectives. To assess causes of premature death and whether race/ethnicity or education is more strongly and independently associated with premature mortality in a diverse sample of middle-aged adults in the United States.Methods. The Coronary Artery Risk Development in Young Adults study (CARDIA) is a longitudinal cohort study of 5114 participants recruited in 1985 to 1986 and followed for up to 29 years, with rigorous ascertainment of all deaths; recruitment was balanced regarding sex, Black and White race/ethnicity, education level (high school or less vs. greater than high school), and age group (18-24 and 25-30 years). This analysis included all 349 deaths that had been fully reviewed through month 348. Our primary outcome was years of potential life lost (YPLL).Results. The age-adjusted mortality rate per 1000 persons was 45.17 among Black men, 25.20 among White men, 17.63 among Black women, and 10.10 among White women. Homicide and AIDS were associated with the most YPLL, but cancer and cardiovascular disease were the most common causes of death. In multivariable models, each level of education achieved was associated with 1.37 fewer YPLL (P = .007); race/ethnicity was not independently associated with YPLL.Conclusions. Lower education level was an independent predictor of greater YPLL.
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Affiliation(s)
- Brita Roy
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Catarina I Kiefe
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - David R Jacobs
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - David C Goff
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Donald Lloyd-Jones
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - James M Shikany
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jared P Reis
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Penny Gordon-Larsen
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Cora E Lewis
- Brita Roy is with the Department of Internal Medicine, Yale School of Medicine, New Haven, CT. Catarina I. Kiefe is with the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. David R. Jacobs is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. During the time of the study, David C. Goff was with the Colorado School of Public Health, University of Colorado, Aurora, and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD. Donald Lloyd-Jones is with the Feinberg School of Medicine, Northwestern University, Evanston, IL. James M. Shikany is with the Division of Preventive Medicine, University of Alabama at Birmingham. Jared P. Reis is with the National Heart, Lung, and Blood Institute. Penny Gordon-Larsen is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina-Chapel Hill. Cora E. Lewis is with the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
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Azevedo LN, Ximenes RADA, Monteiro P, Montarroyos UR, Miranda-Filho DDB. Factors associated to modification of first-line antiretroviral therapy due to adverse events in people living with HIV/AIDS. Braz J Infect Dis 2019; 24:65-72. [PMID: 31835018 PMCID: PMC9392020 DOI: 10.1016/j.bjid.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/10/2019] [Accepted: 11/24/2019] [Indexed: 12/02/2022] Open
Abstract
Antiretroviral therapy (ART) has modified the outcome of patients with HIV infection, providing virological control and reducing mortality. However, there are several reasons as to why patients may discontinue their antiretroviral therapy, with adverse events being one of the main reasons reported in the literature. This is a case-control nested in a cohort of people living with HIV/AIDS, conducted to identify the incidence of ART modification due to adverse events and the associated factors, in two referral services in Recife, Brazil, between 2011 and 2014. Of the modifications occurred in the first year of ART, 25.7% were driven by adverse events. The median time elapsed between initiating ART and the first modification due to adverse events was 70.5 days (95% CI: 26-161 days). The main adverse events were dermatological, neuropsychiatric and gastrointestinal. Dermatological events were the earliest to appear after initiating ART. Efavirenz was the most prescribed and most modified drug during the study period. The group of participants who used zidovudine, lamivudine, and efavirenz had a 2-fold greater chance (adjusted OR: 2.16 95% CI: 1.28-3.65) of switching ART due to adverse events when compared to the group that used tenofovir with lamivudine and efavirenz.
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Affiliation(s)
| | | | - Polyana Monteiro
- Universidade de Pernambuco, Faculdade de Ciências Médicas, Serviço de Doenças Infecciosas, Recife, PE, Brazil
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Misgina KH, Weldu MG, Gebremariam TH, Weledehaweria NB, Alema HB, Gebregiorgis YS, Tilahun YG. Predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy at Suhul Hospital, Tigrai, Northern Ethiopia: a retrospective follow-up study. J Health Popul Nutr 2019; 38:37. [PMID: 31783924 PMCID: PMC6883545 DOI: 10.1186/s41043-019-0194-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Ethiopia is striving to achieve a goal of "zero human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS)-related deaths." However, little has been documented on the factors that hamper the progress towards achieving this goal. Therefore, the ultimate aim of this study was to determine predictors of mortality among adult people living with HIV/AIDS on antiretroviral therapy (ART). METHODS A retrospective follow-up study was employed on all adult HIV/AIDS patients who started ART between January 1 and December 30, 2010, at Suhul Hospital, Tigrai Region, Northern Ethiopia. Data were collected by trained fourth-year Public Health students using a checklist. Finally, the collected data were entered into SPSS version 16. Then after, Kaplan-Meier curves were used to estimate survival probability, the log-rank test was used for comparing the survival status, and Cox proportional hazards model were applied to determine predictors of mortality. RESULTS The median follow-up period was 51 months (ranging between 1 and 60 months, inter-quartile range (IQR) = 14 months). At the end of follow-up, 37 (12.5%) patients were dead. The majority of these cumulative deaths, 19 (51.4%) and 29 (78.4%), occurred within 3 and 4 years of ART initiation respectively. Consuming alcohol (adjusted hazard ratio (AHR) = 2.23, 95% CI = 1.15, 4.32), low body weight (AHR = 2.38, 95% CI = 1.03, 5.54), presence of opportunistic infections (AHR = 2.18, 95% CI = 1.09, 4.37), advanced WHO clinical stage (AHR = 2.75, 95% CI = 1.36, 5.58), and not receiving isoniazid prophylactic therapy (AHR = 3.00, 95% CI = 1.33, 6.74) were found to be independent predictors of mortality. CONCLUSION The overall mortality was very high. Baseline alcohol consumption, low body weight, advanced WHO clinical stage, the presence of opportunistic infections, and not receiving isoniazid prophylactic therapy were predictors of mortality. Strengthening behavioral and nutritional counseling with close clinical follow-up shall be given much more emphasis in the ART care and support program.
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Affiliation(s)
| | | | | | | | | | | | - Yonas Girma Tilahun
- Center of International Reproductive Health Training (CIRHT), Bahir Dar University, Bahir Dar, Ethiopia
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Quattrochi J, Salomon JA, Hill K, Castro MC. Measuring and correcting bias in indirect estimates of under-5 mortality in populations affected by HIV/AIDS: a simulation study. BMC Public Health 2019; 19:1516. [PMID: 31718615 PMCID: PMC6852778 DOI: 10.1186/s12889-019-7780-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.
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Affiliation(s)
- John Quattrochi
- Department of Public Health, Simmons University, 300 The Fenway, Boston, MA 02115 USA
| | - Joshua A. Salomon
- Center for Health Policy and Center for Primary Care Outcomes and Research, Stanford University, 616 Serra Street, Stanford, CA 94305 USA
| | - Kenneth Hill
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA 02115 USA
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Ave., Boston, MA 02115 USA
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Ressler AM, Abdo M, MaWhinney S, Johnson SC, Erlandson KM. Examining Mortality to Identify Opportunities for Improved Care Among Adults with HIV in a Single Academic Medical Center. AIDS Res Hum Retroviruses 2019; 35:1082-1088. [PMID: 31432692 PMCID: PMC6862946 DOI: 10.1089/aid.2019.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Mortality for people living with HIV (PLWH) has dramatically decreased since the mid-1990s and the proportion of deaths attributable to non-AIDS-related conditions has increased. Deceased PLWH were identified from a single academic medical center through provider survey and electronic medical record query. Cause of death was determined using the Coding Causes of Death in HIV tool following review of available medical records. Chart review of comorbidities, demographics, laboratory values, and previous completion of screening tests for malignancies was conducted for deaths during the period of 2013-2017. The proportion of AIDS-related deaths decreased markedly between 1995 and 2017, while the proportion of deaths from non-AIDS malignancies increased. From 2013 to 2017, 30 of 121 deaths were attributed to AIDS-related conditions, 32 to non-AIDS malignancies, 14 to suicide/homicide or sudden death, 10 to cardiac causes, 28 to other non-HIV causes, and 7 to unknown causes. Those who died of non-AIDS-related malignancies were older than AIDS-related deaths [mean age 55.8 (7.6) vs. 47.3 (13.5), p value = .003]. Less than half of potentially eligible patients had documented colon cancer screening. The number of individuals dying from AIDS-related conditions has decreased significantly and non-AIDS-related causes, particularly non-AIDS-related malignancies, have become more prominent causes of death. As our patients age, a greater focus needs to be placed on management of comorbid illnesses and screening and prevention of malignancy.
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Affiliation(s)
- Adam M. Ressler
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mona Abdo
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samantha MaWhinney
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven C. Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Rebeiro PF, Pettit AC, Sizemore L, Mathieson SA, Wester C, Kipp A, Shepherd BE, Sterling TR. Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996-2016. Am J Public Health 2019; 109:1266-1272. [PMID: 31318589 PMCID: PMC6687251 DOI: 10.2105/ajph.2019.305180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/04/2022]
Abstract
Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years.Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event.Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals.Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.
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Affiliation(s)
- Peter F Rebeiro
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - April C Pettit
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Lindsey Sizemore
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Samantha A Mathieson
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Carolyn Wester
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Aaron Kipp
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Bryan E Shepherd
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
| | - Timothy R Sterling
- Peter F. Rebeiro is with the Department of Biostatistics and the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN. April C. Pettit and Timothy R. Sterling are with the Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine. Lindsey Sizemore, Samantha A. Mathieson, and Carolyn Wester are with the HIV/STD/Viral Hepatitis Program, Tennessee Department of Health, Nashville. Aaron Kipp is with the Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine. Bryan E. Shepherd is with the Department of Biostatistics, Vanderbilt University School of Medicine
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Tamraz B, Reisner L, French AL, King ST, Fischl MA, Ofotokun I, Kashuba A, Milam J, Murphy K, Augenbraun M, Liu C, Finley PR, Aouizerat B, Cocohoba J, Gange S, Bacchetti P, Greenblatt RM. Association between Use of Methadone, Other Central Nervous System Depressants, and QTc Interval-Prolonging Medications and Risk of Mortality in a Large Cohort of Women Living with or at Risk for Human Immunodeficiency Virus Infection. Pharmacotherapy 2019; 39:899-911. [PMID: 31332819 PMCID: PMC7000174 DOI: 10.1002/phar.2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE To evaluate the association between use of methadone, other central nervous system (CNS) depressants, and QTc interval-prolonging medications and risk of mortality among human immunodeficiency virus (HIV)-infected and at-risk HIV-uninfected women. DESIGN Multicenter, prospective, observational cohort study (Women's Interagency HIV Study [WIHS]). PARTICIPANTS A total of 4150 women enrolled in the WIHS study between 1994 and 2014 who were infected (3119 women) or not infected (1031 women) with HIV. MEASUREMENTS AND MAIN RESULTS Data on medication utilization were collected from all study participants via interviewer-administered surveys at 6-month intervals (1994-2014). Mortality was confirmed by National Death Index data. With age defining the time scale for the analysis, Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality in HIV-infected and -uninfected women and non-acquired immunodeficiency syndrome (AIDS) deaths in HIV-infected women. A total of 1046 deaths were identified, of which 429 were considered non-AIDS deaths. Use of benzodiazepines, CNS depressants (excluding methadone), and number of medications with conditional QTc interval-prolonging effects were each associated with all-cause mortality in multivariate models of HIV-infected women: hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.01-1.60, p=0.037; HR 1.61, 95% CI 1.35-1.92, p<0.0001; and HR 1.15 per drug, 95% CI 1.00-1.33, p=0.047, respectively. Other explanatory variables for all-cause mortality in this model included HIV viral load, CD4+ cell count, renal function, hemoglobin and albumin levels, HIV treatment era, employment status, existence of depressive symptoms, ever use of injection drugs, and tobacco smoking. Of interest, use of CNS depressants (excluding methadone) was also associated with non-AIDS deaths (HR 1.49, 95% CI 1.49-2.2, p<0.0001). Although use of benzodiazepines and conditional QT interval-prolonging medications were associated with increased risk of non-AIDS mortality (HR 1.32 and 1.25, respectively), the effect was not statistically significant (p>0.05). CONCLUSION In this cohort of HIV-infected and at-risk HIV-uninfected women, use of benzodiazepines, CNS depressants, and conditional QTc interval-prolonging medications were associated with a higher risk of mortality independent of methadone and other well-recognized mortality risk factors. Care must be taken to assess risk when prescribing these medications in this underserved and at-risk patient population.
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Affiliation(s)
- Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Lori Reisner
- Department of Neurological Surgery, University of California, San Francisco, CA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, IL
| | - S. Travis King
- University of Mississippi School of Pharmacy, Department of Pharmacy Practice, Jackson, MS
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, FL
| | - Igho Ofotokun
- Emory University, School of Medicine, Department of Medicine, Division of Infectious Diseases Atlanta, GA
| | - Angela Kashuba
- University of North Carolina (UNC) Center for AIDS Research, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Joel Milam
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kerry Murphy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Michael Augenbraun
- Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, NY
| | - Chenglong Liu
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Patrick R. Finley
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Bradley Aouizerat
- New York University School of Dentistry and Bluestone Center for Clinical Research, New York, NY
| | - Jennifer Cocohoba
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Peter Bacchetti
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Ruth M. Greenblatt
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Curry SJ, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 321:2326-2336. [PMID: 31184701 DOI: 10.1001/jama.2019.6587] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Approximately 1.1 million persons in the United States are currently living with HIV, and more than 700 000 persons have died of AIDS since the first cases were reported in 1981. There were approximately 38 300 new diagnoses of HIV infection in 2017. The estimated prevalence of HIV infection among persons 13 years and older in the United States is 0.4%, and data from the Centers for Disease Control and Prevention show a significant increase in HIV diagnoses starting at age 15 years. An estimated 8700 women living with HIV give birth each year in the United States. HIV can be transmitted from mother to child during pregnancy, labor, delivery, and breastfeeding. The incidence of perinatal HIV infection in the United States peaked in 1992 and has declined significantly following the implementation of routine prenatal HIV screening and the use of effective therapies and precautions to prevent mother-to-child transmission. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for HIV infection in adolescents, adults, and pregnant women. EVIDENCE REVIEW The USPSTF reviewed the evidence on the benefits and harms of screening for HIV infection in nonpregnant adolescents and adults, the yield of screening for HIV infection at different intervals, the effects of initiating antiretroviral therapy (ART) at a higher vs lower CD4 cell count, and the longer-term harms associated with currently recommended ART regimens. The USPSTF also reviewed the evidence on the benefits (specifically, reduced risk of mother-to-child transmission of HIV infection) and harms of screening for HIV infection in pregnant persons, the yield of repeat screening for HIV at different intervals during pregnancy, the effectiveness of currently recommended ART regimens for reducing mother-to-child transmission of HIV infection, and the harms of ART during pregnancy to the mother and infant. FINDINGS The USPSTF found convincing evidence that currently recommended HIV tests are highly accurate in diagnosing HIV infection. The USPSTF found convincing evidence that identification and early treatment of HIV infection is of substantial benefit in reducing the risk of AIDS-related events or death. The USPSTF found convincing evidence that the use of ART is of substantial benefit in decreasing the risk of HIV transmission to uninfected sex partners. The USPSTF also found convincing evidence that identification and treatment of pregnant women living with HIV infection is of substantial benefit in reducing the rate of mother-to-child transmission. The USPSTF found adequate evidence that ART is associated with some harms, including neuropsychiatric, renal, and hepatic harms, and an increased risk of preterm birth in pregnant women. The USPSTF concludes with high certainty that the net benefit of screening for HIV infection in adolescents, adults, and pregnant women is substantial. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends screening for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened. (A recommendation) The USPSTF recommends screening for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. (A recommendation).
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
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Zang E, Zheng H, Yang YC, Land KC. Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns. Int J Epidemiol 2019; 48:934-944. [PMID: 30508118 PMCID: PMC6934031 DOI: 10.1093/ije/dyy255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear. METHODS Using official mortality data, we study US annual mortality rates for ages 25-54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities. RESULTS We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns. CONCLUSIONS We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.
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Affiliation(s)
- Emma Zang
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Hui Zheng
- Department of Sociology, Ohio State University, Columbus, OH, USA
| | - Yang Claire Yang
- Department of Sociology, Lineberger Cancer Center, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kenneth C Land
- Department of Sociology and Social Science Research Institute, Duke University, Durham, NC, USA
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26
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Affiliation(s)
- Wafaa M El-Sadr
- From ICAP at Columbia University Mailman School of Public Health, New York (W.M.E., M.R.); the Fenway Institute, Boston (K.H.M.); and the University of West Virginia, Morgantown (S.L.H.)
| | - Kenneth H Mayer
- From ICAP at Columbia University Mailman School of Public Health, New York (W.M.E., M.R.); the Fenway Institute, Boston (K.H.M.); and the University of West Virginia, Morgantown (S.L.H.)
| | - Miriam Rabkin
- From ICAP at Columbia University Mailman School of Public Health, New York (W.M.E., M.R.); the Fenway Institute, Boston (K.H.M.); and the University of West Virginia, Morgantown (S.L.H.)
| | - Sally L Hodder
- From ICAP at Columbia University Mailman School of Public Health, New York (W.M.E., M.R.); the Fenway Institute, Boston (K.H.M.); and the University of West Virginia, Morgantown (S.L.H.)
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Abstract
BACKGROUND Kaposi's sarcoma (KS) represents the most common AIDS-defining neoplasm. Only very few studies regarding the course and treatment of human immunodeficiency virus (HIV)-associated KS have been carried out in Germany. OBJECTIVE In this study the course of HIV-associated KS was observed in patients from the cohort database of the competence network for HIV/AIDS. MATERIAL AND METHODS Data from HIV-associated KS patients from 9 German core centers from 1987 to 2011 were retrospectively collected. Kaplan-Meier curves for the recurrence and survival probability were calculated. RESULTS In 222 patients KS was diagnosed at a median age of 38.5 ± 10.1 years. Men were almost exclusively affected (97.7%). The HIV viral load at the time of diagnosis was in 7.4% <50 copies/ml. Of the patients 55.5% developed KS with a CD4 cell count of <200 cells/μl and 9.5% with >500 cells/μl. In 68 patients KS therapy consisted exclusively of the optimization or initiation of antiretroviral therapy (ART). In addition, 71 patients were treated with pegylated liposomal doxorubicin. During the median follow-up period of 8.9 ± 4.9 years, 80.2% of the patients were free of KS recurrence. Survival rates after 5 and 10 years were 96.8% and 91.3%, respectively. CONCLUSION Even with a good immune status HIV-associated KS occurred. An effective ART was the most important mainstay of therapy. With appropriate therapy, HIV-positive patients with KS showed a good survival rate.
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Affiliation(s)
- R-E Klingenberg
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
| | - S Esser
- Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - N H Brockmeyer
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - C Michalik
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
- Zentrum für klinische Studien, Köln, Deutschland
| | - A Skaletz-Rorowski
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland
- Kompetenznetz HIV/AIDS, Bochum, Deutschland
| | - A Potthoff
- Interdisziplinäre Immunologische Ambulanz, Zentrum für Sexuelle Gesundheit und Medizin, WIR - Walk In Ruhr, Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Große Beck Str. 12, 44787, Bochum, Deutschland.
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28
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Jabs DA, Van Natta ML, Trang G, Jones NG, Milush JM, Cheu R, Klatt NR, Danis RP, Hunt PW. Association of Age-related Macular Degeneration With Mortality in Patients With Acquired Immunodeficiency Syndrome; Role of Systemic Inflammation. Am J Ophthalmol 2019; 199:230-237. [PMID: 30552890 DOI: 10.1016/j.ajo.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/19/2018] [Accepted: 12/01/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the relationships among age-related macular degeneration (AMD), mortality, and biomarkers of systemic inflammation in patients with acquired immunodeficiency syndrome (AIDS). DESIGN Case-control study. METHODS In participants with intermediate-stage AMD at enrollment in the Longitudinal Study of the Ocular Complications of AIDS (LSOCA) and 2:1 controls matched for age and sex, cryopreserved baseline plasma specimens were assayed for biomarkers of inflammation, including high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, interferon-γ inducible protein (IP)-10, soluble CD14 (sCD14), soluble CD163 (sCD163), kynurenine/tryptophan (KT) ratio, and intestinal fatty acid binding protein (I-FABP). Main outcome measure was mortality. RESULTS The study included 189 patients with AMD and 385 controls. In the unadjusted analysis, AMD was associated with mortality (hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02, 2.15; P = .04). In an adjusted analysis, CRP (HR 1.36; 95% CI 1.08, 1.71; P = .009), IL-6 (HR 1.45; 95% CI 1.11, 1.90; P = .006), and IP-10 (HR 1.41; 95% CI 1.08, 1.84; P = .01) were associated with mortality. In a Cox regression analysis adjusted for human immunodeficiency virus load, blood CD4+ T cell level, CRP, IL-6, and IP-10, the association of AMD with mortality was attenuated (HR 1.08; 95% CI 0.73, 1.59; P = .70), primarily by the addition of the inflammatory biomarkers. CONCLUSIONS These data suggest that the increased mortality observed in patients with AIDS with AMD is, at least in part, a result of systemic inflammation.
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Affiliation(s)
- Douglas A Jabs
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Mark L Van Natta
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Garrett Trang
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Norman G Jones
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Jeffrey M Milush
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Ryan Cheu
- Department of Pharmaceutics, University of Washington, Seattle, Washington, USA
| | - Nichole R Klatt
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ronald P Danis
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, The University of Wisconsin, Madison, Madison, Wisconsin, USA
| | - Peter W Hunt
- Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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Abstract
OBJECTIVE The purpose of this study was to identify the major risk factors, which contributed to shortened survival time to death of HIV patients on antiretroviral therapy. Six-hundred HIV patients were included from two hospitals and six health centers record from January 2003 to December 2017. Kaplan-Meier and Cox proportional hazard model were implemented. RESULTS From the Kaplan-Meier, log-rank test result indicated that there was a significant difference between tuberculosis comorbidity (P = .000), occupation (P = .027), and WHO clinical stage (P = .012) on the survival experience of patients at 5% statistical significance level. From the Cox regression result, the risk of death for patients who lived with tuberculosis was about 2.872-fold times higher than those patients who were negative. Most of the HIV/AIDS patients on antiretroviral therapy were died in a short period due to tuberculosis comorbidity, began with lower amount of CD4, being underweight, merchant, and being on WHO clinical stage IV.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia.
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30
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Dwomoh D, Tambaa C, Ayisi Addo S, Wiah E, Abdulai M, Bosomprah S. Effect of antiretroviral therapy on all-cause mortality among people living with HIV/AIDS in Ghana using Mahalanobis distant metric matching within propensity score caliper analysis: A retrospective cohort study. PLoS One 2018; 13:e0203461. [PMID: 30192892 PMCID: PMC6128569 DOI: 10.1371/journal.pone.0203461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022] Open
Abstract
Several health interventions have been put in place to improve health outcomes of people living with HIV/AIDS (PLHIV) in Ghana. We evaluated the impact of Antiretroviral Therapy (ART) on all-cause mortality in Ghana using matching procedures. This was a retrospective cohort study of 12,881 HIV/AIDS patients initiated on ART at 40 sentinel sites and 199 treatment centers between 2013 and 2016 countrywide. Patients were included if they had date of ART initiation and if they had mortality outcome recorded. Mahalanobis distant metric matching within propensity score caliper and other matching procedures were used to evaluate the effectiveness of ART in reducing the risk of all-cause mortality among PLHIV in Ghana. We performed sensitivity analysis using different matching procedures including Kernel weighting adjustment and Mahalanobis distance metric matching with nearest neighbour to ascertain the robustness of our results in the presence of unmeasured covariates. The proportion of patients on ART was 60.3% (95% CI: 59.5-61.1). The total number of mortalities reported was only 734 representing 4.6% (95% CI: 4.2-4.9) of the studied population. The risk of all-cause mortality has reduced by 11.6 percentage point among HIV/AIDS patients who were on ART compared to those who were not on ART (95% CI: 9.6-13.4). ART was associated with a decreased risk of all-cause mortality. Effort being made by Government and non-Governmental organizations in support of ART treatment in Ghana should continue unabated to help reduce mortality rate and improve health outcomes among HIV/AIDS. To reduce bias to the barest minimum between treatment and intervention group when evaluating the effectiveness of health interventions, it is recommended to use matching procedures especially when the study design is not a randomized control trial.
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Affiliation(s)
- Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Ekow Wiah
- National AIDS/STI Control Programme, Accra, Ghana
| | | | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
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Vallecillo G, Robles MJ, Durán X, Lerma E, Horcajada JP, Torrens M. Trends in AIDS Mortality, Retention in Opioid Agonist Therapy, and HIV RNA Suppression in HIV-Infected People Who Injected Drugs from 2000 to 2015. AIDS Behav 2018; 22:2766-2772. [PMID: 29372455 DOI: 10.1007/s10461-018-2033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIDS is a major cause of preventable mortality in HIV-infected people who inject drugs (HIV-PWID). An observational study was conducted to examine trends in AIDS mortality and related factors among HIV-infected individuals who died between 2000 and 2015 at an urban hospital. Overall HIV-mortality was 6.5% (413/6307) with no changes over time (p 0.76). AIDS mortality dropped in HIV-PWID (p 0.02) although it represented 26.4% at the end of study period. Age (per one-year increase) [odds ratio (OR) 0.95], third study period (2010-2015) (OR 0.54), HIV-PWID on opioid agonist therapy (OAT) (OR 0.39), and HIV RNA suppression (OR 0.15) were associated with AIDS mortality. OAT was reported in 58.3% (161/276) and RNA suppression in 30.9% (85/276) of HIV-PWID. OAT non-retention was due to drop-outs [85.2% (98/115)] and rejection [14.8% (17/115)] in HIV-PWID. Therefore, additional strategies are required to improve OAT retention and HIV RNA suppression to continue reducing AIDS mortality.
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Affiliation(s)
- G Vallecillo
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - M J Robles
- Geriatric Unit, Hospital del Mar, Barcelona, Spain
| | - X Durán
- Department of Methodological Advice in Biomedical Research (AMIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - E Lerma
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Infectious Disease Department, Hospital del Mar, Barcelona, Spain
| | - M Torrens
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Ginsburg C, Bocquier P, Béguy D, Afolabi S, Kahn K, Obor D, Tanser F, Tomita A, Wamukoya M, Collinson MA. Association between internal migration and epidemic dynamics: an analysis of cause-specific mortality in Kenya and South Africa using health and demographic surveillance data. BMC Public Health 2018; 18:918. [PMID: 30049267 PMCID: PMC6062880 DOI: 10.1186/s12889-018-5851-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries are facing a double burden of disease with persisting high levels of infectious disease, and an increasing prevalence of non-communicable disease (NCD). Within these settings, complex processes and transitions concerning health and population are underway, altering population dynamics and patterns of disease. Understanding the mechanisms through which changing socioeconomic and environmental contexts may influence health is central to developing appropriate public health policy. Migration, which involves a change in environment and health exposure, is one such mechanism. METHODS This study uses Competing Risk Models to examine the relationship between internal migration and premature mortality from AIDS/TB and NCDs. The analysis employs 9 to 14 years of longitudinal data from four Health and Demographic Surveillance Systems (HDSS) of the INDEPTH Network located in Kenya and South Africa (populations ranging from 71 to 223 thousand). The study tests whether the mortality of migrants converges to that of non-migrants over the period of observation, controlling for age, sex and education level. RESULTS In all four HDSS, AIDS/TB has a strong influence on overall deaths. However, in all sites the probability of premature death (45q15) due to AIDS/TB is declining in recent periods, having exceeded 0.39 in the South African sites and 0.18 in the Kenyan sites in earlier years. In general, the migration effect presents similar patterns in relation to both AIDS/TB and NCD mortality, and shows a migrant mortality disadvantage with no convergence between migrants and non-migrants over the period of observation. Return migrants to the Agincourt HDSS (South Africa) are on average four times more likely to die of AIDS/TB or NCDs than are non-migrants. In the Africa Health Research Institute (South Africa) female return migrants have approximately twice the risk of dying from AIDS/TB from the year 2004 onwards, while there is a divergence to higher AIDS/TB mortality risk amongst female migrants to the Nairobi HDSS from 2010. CONCLUSION Results suggest that structural socioeconomic issues, rather than epidemic dynamics are likely to be associated with differences in mortality risk by migrant status. Interventions aimed at improving recent migrant's access to treatment may mitigate risk.
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Affiliation(s)
- Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- INDEPTH Network, Accra, Ghana
| | - Philippe Bocquier
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- Centre de Recherches en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Donatien Béguy
- African Population and Health Research Centre, Nairobi, Kenya
| | - Sulaimon Afolabi
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - David Obor
- KEMRI & CDC - Centre for Global Health Research, Kisumu, Kenya
| | - Frank Tanser
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa
- Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Mark A. Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193 South Africa
- INDEPTH Network, Accra, Ghana
- Department of Science and Technology/ Medical Research Council, South African Population Research Infrastructure Network, Johannesburg, South Africa
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Jung TH, Kyriakides T, Holodniy M, Esserman D, Peduzzi P. A joint frailty model provides for risk stratification of human immunodeficiency virus-infected patients based on unobserved heterogeneity. J Clin Epidemiol 2018; 98:16-23. [PMID: 29432857 PMCID: PMC5964003 DOI: 10.1016/j.jclinepi.2018.02.007] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 01/30/2018] [Accepted: 02/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the association between recurrent AIDS-defining events and a semicompeting risk of death in patients with advanced, multidrug-resistant human immunodeficiency virus infection and to identify individuals at increased risk for these events using a joint frailty model. STUDY DESIGN AND SETTING Three hundred sixty-eight patients with antiretroviral treatment failure in the Options in Management of Antiretrovirals Trial randomized to two antiretroviral treatment strategies using a 2 × 2 factorial design, intensive vs. standard and interruption vs. continuation, and followed for development of AIDS-defining events and death. RESULTS Participants were heterogeneous for risk of AIDS-defining events and death (P < 0.001), and AIDS-defining events were strongly associated with death (P < 0.001), irrespective of treatment. The frailty model was used to classify individuals into high- and low-risk groups based on unobserved heterogeneity. Low-risk individuals were unlikely to die (0%) or have an AIDS-defining event (<4%), whereas high-risk individuals had event rates approaching 70%. About one-third of high-risk individuals had accelerated mortality, all who died before experiencing an AIDS-defining event. High-risk was associated with being immunocompromised and higher predicted 5-year mortality. CONCLUSION The joint frailty model permits classification of individuals into risk groups based on unobserved heterogeneity that may be identifiable based on observed covariates, providing advantages over the traditional Cox model.
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Affiliation(s)
- Tae Hyun Jung
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, 300 George Street, New Haven, CT 06520, USA
| | - Tassos Kyriakides
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, 300 George Street, New Haven, CT 06520, USA; VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Mark Holodniy
- VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Denise Esserman
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, 300 George Street, New Haven, CT 06520, USA
| | - Peter Peduzzi
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, 300 George Street, New Haven, CT 06520, USA; VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
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Affiliation(s)
- Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - David Wilson
- Global HIV/AIDS Program Director, The World Bank, Washington, DC, USA
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de Paula AA, Pires DF, Filho PA, de Lemos KRV, Barçante E, Pacheco AG. A comparison of accuracy and computational feasibility of two record linkage algorithms in retrieving vital status information from HIV/AIDS patients registered in Brazilian public databases. Int J Med Inform 2018; 114:45-51. [PMID: 29673602 DOI: 10.1016/j.ijmedinf.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE While cross-referencing information from people living with HIV/AIDS (PLWHA) to the official mortality database is a critical step in monitoring the HIV/AIDS epidemic in Brazil, the accuracy of the linkage routine may compromise the validity of the final database, yielding to biased epidemiological estimates. We compared the accuracy and the total runtime of two linkage algorithms applied to retrieve vital status information from PLWHA in Brazilian public databases. METHODS Nominally identified records from PLWHA were obtained from three distinct government databases. Linkage routines included an algorithm in Python language (PLA) and Reclink software (RlS), a probabilistic software largely utilized in Brazil. Records from PLWHA1 known to be alive were added to those from patients reported as deceased. Data were then searched into the mortality system. Scenarios where 5% and 50% of patients actually dead were simulated, considering both complete cases and 20% missing maternal names. RESULTS When complete information was available both algorithms had comparable accuracies. In the scenario of 20% missing maternal names, PLA2 and RlS3 had sensitivities of 94.5% and 94.6% (p > 0.5), respectively; after manual reviewing, PLA sensitivity increased to 98.4% (96.6-100.0) exceeding that for RlS (p < 0.01). PLA had higher positive predictive value in 5% death proportion. Manual reviewing was intrinsically required by RlS in up to 14% register for people actually dead, whereas the corresponding proportion ranged from 1.5% to 2% for PLA. The lack of manual inspection did not alter PLA sensitivity when complete information was available. When incomplete data was available PLA sensitivity increased from 94.5% to 98.4%, thus exceeding that presented by RlS (94.6%, p < 0.05). RlS spanned considerably less processing time compared to PLA. CONCLUSION Both linkage algorithms presented interchangeable accuracies in retrieving vital status data from PLWHA. RlS had a considerably lesser runtime but intrinsically required manually reviewing a fastidious proportion of the matched registries. On the other hand, PLA spent quite more runtime but spared manual reviewing at no expense of accuracy.
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Affiliation(s)
| | | | - Pedro Alves Filho
- Rio de Janeiro State Health Secretariat, Rua México, 128, Rio de Janeiro, Brazil.
| | | | - Eduardo Barçante
- DataUERJ/UERJ, Rua São Francisco Xavier, 524, Rio de Janeiro, Brazil.
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Abstract
Many survival studies have error-contaminated covariates due to the lack of a gold standard of measurement. Furthermore, the error distribution can depend on the true covariates but the structure may be difficult to characterize; heteroscedasticity is a common manifestation. We suggest a novel dependent measurement error model with minimal assumptions on the dependence structure, and propose a new functional modeling method for Cox regression when an instrumental variable is available. This proposal accommodates much more general error contamination than existing approaches including nonparametric correction methods of Huang and Wang (2000, Journal of the American Statistical Association 95, 1209-1219; 2006, Statistica Sinica 16, 861-881). The estimated regression coefficients are consistent and asymptotically normal, and a consistent variance estimate is provided for inference. Simulations demonstrate that the procedure performs well even under substantial error contamination. Illustration with a clinical study is provided.
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Affiliation(s)
- Yijian Huang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, U.S.A
| | - Ching-Yun Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, U.S.A
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Abstract
OBJECTIVES To quantify HIV/AIDS mortality attributable to alcohol use in the adult general population of South Africa in 2012 by socioeconomic status (SES). DESIGN Comparative risk assessment based on secondary individual data, aggregate data and risk relations reported in the literature. SETTING South African adult general population. PARTICIPANTS For metrics of alcohol use by SES, sex and age: 27 070 adults that participated in a nationally representative survey in 2012. For HRs of dying from HIV/AIDS by SES: 87 029 adults that participated in a cohort study (years 2000 to 2014) based out of the Umkhanyakude district, KwaZulu-Natal. MAIN OUTCOME MEASURES Alcohol-attributable fractions for HIV/AIDS mortality by SES, age and sex were calculated based on the risk of engaging in condom-unprotected sex under the influence of alcohol and interactions between SES and alcohol use. Age-standardised HIV/AIDS mortality rates attributable to alcohol by SES and sex were estimated using alcohol-attributable fractions and SES-specific and sex-specific death counts. Rate ratios were calculated comparing age-standardised rates in low versus high SES by sex. RESULTS The age-standardised HIV/AIDS mortality rate attributable to alcohol was 31.0 (95% uncertainty interval (UI) 21.6 to 41.3) and 229.6 (95% UI 108.8 to 351.6) deaths per 100 000 adults for men of high and low SES, respectively. For women the respective rates were 10.8 (95% UI 5.5 to 16.1) and 75.5 (95% UI 31.2 to 144.9). The rate ratio was 7.4 (95% UI 3.4 to 13.2) for men and 7.0 (95% UI 2.8 to 18.2) for women. Sensitivity analyses corroborated marked differences in alcohol-attributable HIV/AIDS mortality, with rate ratios between 2.7 (95% UI 0.8 to 7.6; women) and 15.1 (95% UI 6.8 to 27.7; men). CONCLUSIONS The present study showed that alcohol use contributed considerably to the socioeconomic differences in HIV/AIDS mortality. Targeting HIV infection under the influence of alcohol is a promising strategy for interventions to reduce the HIV/AIDS burden and related socioeconomic differences in South Africa.
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Affiliation(s)
- Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Cole SR, Edwards JK, Hall HI, Brookhart MA, Mathews WC, Moore RD, Crane HM, Kitahata MM, Mugavero MJ, Saag MS, Eron JJ. Incident AIDS or Death After Initiation of Human Immunodeficiency Virus Treatment Regimens Including Raltegravir or Efavirenz Among Adults in the United States. Clin Infect Dis 2018; 64:1591-1596. [PMID: 28498892 DOI: 10.1093/cid/cix199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/16/2017] [Indexed: 12/20/2022] Open
Abstract
Background. The long-term effectiveness of human immunodeficiency virus (HIV) treatments containing integrase inhibitors is unknown. Methods. We use observational data from the Centers for AIDS Research Network of Integrated Clinical Systems and the Centers for Disease Control and Prevention to estimate 4-year risk of AIDS and all-cause mortality among 415 patients starting a raltegravir regimen compared to 2646 starting an efavirenz regimen (both regimens include emtricitabine and tenofovir disoproxil fumarate). We account for confounding and selection bias as well as generalizability by standardization for measured variables, and present both observational intent-to-treat and per-protocol estimates. Results. At treatment initiation, 12% of patients were female, 36% black, 13% Hispanic; median age was 37 years, CD4 count 321 cells/µL, and viral load 4.5 log10 copies/mL. Two hundred thirty-five patients incurred an AIDS-defining illness or died, and 741 patients left follow-up. After accounting for measured differences, the 4-year risk was similar among those starting both regimens (ie, intent-to treat hazard ratio [HR], 0.96 [95% confidence interval {CI}, .63-1.45]; risk difference, -0.9 [95% CI, -4.5 to 2.7]), as well as among those remaining on regimens (ie, per-protocol HR, 0.95 [95% CI, .59-1.54]; risk difference, -0.5 [95% CI, -3.8 to 2.9]). Conclusions. Raltegravir and efavirenz-based initial antiretroviral therapy have similar 4-year clinical effects. Vigilance regarding longer-term comparative effectiveness of HIV regimens using observational data is needed because large-scale experimental data are not forthcoming.
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Affiliation(s)
- Stephen R Cole
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | | | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | | | | | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham; and
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill
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Urban & Vogel. [In Process Citation]. MMW Fortschr Med 2015; 157 Suppl 2:1. [PMID: 26048108 DOI: 10.1007/s15006-015-3152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Judd A, Chappell E, Turkova A, Le Coeur S, Noguera-Julian A, Goetghebuer T, Doerholt K, Galli L, Pajkrt D, Marques L, Collins IJ, Gibb DM, González Tome MI, Navarro M, Warszawski J, Königs C, Spoulou V, Prata F, Chiappini E, Naver L, Giaquinto C, Thorne C, Marczynska M, Okhonskaia L, Posfay-Barbe K, Ounchanum P, Techakunakorn P, Kiseleva G, Malyuta R, Volokha A, Ene L, Goodall R. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study. PLoS Med 2018; 15:e1002491. [PMID: 29381702 PMCID: PMC5790238 DOI: 10.1371/journal.pmed.1002491] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand. METHODS AND FINDINGS Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997-2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997-2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. CONCLUSIONS In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.
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Affiliation(s)
| | - Ali Judd
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
- * E-mail:
| | - Elizabeth Chappell
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Anna Turkova
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Sophie Le Coeur
- Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France
- Institut de Recherche pour le Developpement (IRD), UMI 174/PHPT, Chiang Mai, Thailand
| | - Antoni Noguera-Julian
- Unitat d’Infectologia, Servei de Pediatria, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | | | - Katja Doerholt
- St George’s Healthcare NHS Trust, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Intira J. Collins
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | | | - Marisa Navarro
- Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Josiane Warszawski
- Institut National de la Santé et de la Recherche (INSERM), Paris, France
| | - Christoph Königs
- University Hospital Frankfurt, Department of Paediatrics, Goethe University, Frankfurt, Germany
| | - Vana Spoulou
- University of Athens Medical School, Athens, Greece
| | | | - Elena Chiappini
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Giaquinto
- Paediatric European Network for the Treatment of AIDS (PENTA), Padova, Italy
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | | | | | | | - Galina Kiseleva
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Ruth Goodall
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
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Traisathit P, Delory T, Ngo-Giang-Huong N, Somsamai R, Techakunakorn P, Theansavettrakul S, Kanjanavanit S, Mekmullica J, Ngampiyaskul C, Na-Rajsima S, Lallemant M, Cressey TR, Jourdain G, Collins IJ, Le Coeur S. Brief Report: AIDS-Defining Events and Deaths in HIV-Infected Children and Adolescents on Antiretrovirals: A 14-Year Study in Thailand. J Acquir Immune Defic Syndr 2018; 77:17-22. [PMID: 29040162 PMCID: PMC6047734 DOI: 10.1097/qai.0000000000001571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6 months of ART and of the composite outcome of new/recurrent AIDS-defining event or death >6 months after ART start (late AIDS/death) and their associated factors. METHODS Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for lost to-follow-up and included baseline and time-updated variables. RESULTS Among 619 children, "early" mortality incidence was 99 deaths per 1000 person-years of follow-up [95% confidence interval (CI): 69 to 142] and "late" mortality 6 per 1000 person-years of follow-up (95% CI: 4 to 9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2%, and HIV-RNA load 5.1 log10 copies/mL. Thirty-eight (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining events (10 subsequently died). Factors independently associated with late AIDS/death were current age ≥13 years (adjusted subdistribution hazard ratio 4.9; 95% CI: 2.4 to 10.1), HIV-RNA load always ≥400 copies/mL (12.3; 95% CI: 4.0 to 37.6), BMI-z-score always <-2 SD (13.7; 95% CI: 3.4 to 55.7), and hemoglobin <8 g/dL at least once (4.6; 95% CI: 2.0 to 10.5). CONCLUSIONS After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status, and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia.
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Affiliation(s)
- Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Thailand
| | - Tristan Delory
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- APHP, Service de maladies infectieuses et tropicales, hôpital Saint Louis, F-75010, Paris, France
| | - Nicole Ngo-Giang-Huong
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | | | | | | | | | | | - Marc Lallemant
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tim R Cressey
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular & Clinical Pharmacology, University of Liverpool, UK
| | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Intira Jeannie Collins
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, UK
| | - Sophie Le Coeur
- Institut de recherche pour le développement (IRD) UMI 174-PHPT, Marseille, France
- Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institut national d’études démographiques (INED), F-75020 Paris, France
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Szmulik K, Zakrzewska K, Niedźwiedzka-Stadnik M, Rosińska M. HIV and AIDS in Poland in 2016. Przegl Epidemiol 2018; 72:175-187. [PMID: 30111080] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases in Poland in 2016 in comparison to the previous years. MATERIALS AND METHODS Descriptive analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. Data from the Department of Demographic and Labor Market Research of the Central Statistical Office on deaths due to HIV / AIDS were also used. RESULTS In 2016 there were 1,313 HIV cases newly diagnosed in Poland (diagnosis rate: 3.42 per 100,000), including 44 among non-Polish citizens. The number of newly detected HIV infections increased by nearly 10% compared to the previous year and by almost 19% compared to the median in 2010-2014. The total number of AIDS cases was 102 (incidence 0.27 per 100,000), and 102 people died of HIV disease (0.27 per 100,000). New HIV diagnoses were reported mainly in men (87.3%) and among people aged 20 to 39 years (71.2%). 81.2% of cases in men with known transmission category concerned men who had sexual contact with men (MSM). CONCLUSIONS The majority of new HIV cases are diagnosed in the MSM group. However, the assessment of the epidemiological situation is limited by the missing data on the likely route of transmission of newly detected HIV infections.
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Affiliation(s)
- Katarzyna Szmulik
- National Institute of Public Health – National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Karolina Zakrzewska
- National Institute of Public Health – National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Marta Niedźwiedzka-Stadnik
- National Institute of Public Health – National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance
| | - Magdalena Rosińska
- National Institute of Public Health – National Institute of Hygiene, Department of Epidemiology of Infectious Diseases and Surveillance
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da Silva LR, Araújo ETH, Carvalho ML, Almeida CAPL, Oliveira ADDS, de Carvalho PMG, Rodrigues TS, Campelo V. Epidemiological situation of acquired immunodeficiency syndrome (AIDS)-related mortality in a municipality in northeastern Brazil. A retrospective cross-sectional study. SAO PAULO MED J 2018; 136:37-43. [PMID: 29340503 PMCID: PMC9924163 DOI: 10.1590/1516-3180.2017.0130100917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/10/2017] [Indexed: 02/16/2023] Open
Abstract
CONTEXT AND OBJECTIVE The number of acquired immunodeficiency syndrome (AIDS)-related deaths covers different segments of the population differently, making monitoring of this mortality essential. The aim of this study was to describe the epidemiological situation of AIDS-related mortality in a municipality in the northeastern region of Brazil. DESIGN AND SETTING Retrospective cross-sectional study based on data from death certificates in the mortality information system of the Health Information Center, Municipal Health Foundation, Brazil. METHODS Between 2003 and 2013, we investigated death certificates on which AIDS-related mortality was reported. Sociodemographic data, year, place, type of establishment where death occurred and underlying and associated causes that led to AIDS-related death were described. The Mann-Kendall test was used to verify the growth trend of the standardized mortality rate over the period studied. RESULTS Among the 1,066 AIDS-related deaths, 69.7% were among men; 47.2% of the individuals were 28-41 years of age, 32.7% had had 4-7 years of schooling, 66.9% were pardos (mixed race), 55.7% were unmarried and 15.3% were housekeepers. Hospitals were the site of 97% of the deaths, and 91% occurred at public hospitals. Respiratory failure was the main cause of death. The prevalence of infectious and parasitic diseases was 99.0%. AIDS-related mortality increased by 160% over the period studied, from 5.5/100,000 inhabitants in 2003 to 14.3/100,000 in 2013. CONCLUSION In the Brazilian municipality studied here, AIDS-related mortality was most prevalent among men and young adults of lower socioeconomic level. Over the period studied, the mortality rate increased.
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Affiliation(s)
- Luana Rodrigues da Silva
- RN. Nurse, Undergraduate Nursing Department, Centro Universitário UNINOVAFAPI, Teresina (PI), Brazil.
| | - Ellen Thallita Hill Araújo
- RN. Master’s Student, Department of Business Sciences, Fundação Sousândrade, Universidade Atlântica, São Luís (MA), Brazil.
| | - Moisés Lopes Carvalho
- RN. Doctoral Student, Department of Biochemistry and Photodynamic Therapy Applied to Biomedical Engineering, Universidade do Vale do Paraíba (UNIVAP), São José dos Campos (SP), Brazil.
| | | | | | | | - Tatyanne Silva Rodrigues
- RN. Master’s Student, Postgraduate Program on Nursing, Universidade Federal do Piauí (UFPI), Teresina (PI), Brazil.
| | - Viriato Campelo
- MD, MSc, PhD. Coordinator, Master’s Program on Science and Health, Universidade Federal do Piauí (UFPI), and Physician at the Court of Justice of the State of Piauí (TJ/PI), Teresina (PI), Brazil.
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Xu QL, Guo HJ, Jin YT, Wang J, Jiang ZQ, Li ZW, Chen XM, Liu Y, Xu LR. Advantages of Chinese Medicine for Patients with Acquired Immunodeficiency Syndrome in Rural Central China. Chin J Integr Med 2017; 24:891-896. [PMID: 28887810 DOI: 10.1007/s11655-017-2418-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the effect of Chinese medicine (CM) on mortality and quality of life (QOL) of acquired immunodefificiency syndrome (AIDS) patients treated with combined antiretroviral therapy (cART). METHODS A random sample of AIDS patients enrolled in the National Chinese Medicine Treatment Trial Program (NCMTP) that met the inclusion criteria was included in this study. NCMTP patients were included as the CM+cART group, and those not in the NCMTP were included as the cART group. Survival from September 2004 to September 2012 was analyzed by retrospective cohort study. QOL was analyzed by cross-sectional study. RESULTS The retrospective cohort study included 528 AIDS patients, 322 in the CM+cART group and 206 in the cART group. After 8 years, the mortality in the CM+cART group was 3.3/100 person-years, which was lower than the cART group of 5.3/100 person-years (P<0.05). The hazard ratio (HR) for mortality in the cART group was 1.6 times that of the CM+cART group by Cox proportional hazard model analysis. After controlling for gender, age, marital status, education, and CD4+ T-cell count, the HR was 1.9 times higher in the cART group compared with the CM+cART group (P<0.05). The cross-sectional study investigated 275 AIDS patients. The mean scores of all QOL domains except spirituality/personal beliefs were higher in the CM+cART group than in the cART group (P<0.05). CONCLUSIONS For AIDS patients, CM could help to prolong life, decrease mortality, and improve QOL. However, there were limitations in the study, so prospective studies should be carried out to confifirm our primary results.
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Affiliation(s)
- Qian-Lei Xu
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
- Henan Key Laboratory of Viral Diseases Control with Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Hui-Jun Guo
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
- Henan Key Laboratory of Viral Diseases Control with Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Yan-Tao Jin
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
- Henan Key Laboratory of Viral Diseases Control with Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Jian Wang
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China.
- Traditional Chinese Medicine Center for Acquired Immune Deficiency Syndrome Prevention and Treatment, China Academy of Traditional Chinese Medicine, Beijing, 100700, China.
| | - Zi-Qiang Jiang
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
- Henan Key Laboratory of Viral Diseases Control with Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Zheng-Wei Li
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Xiu-Min Chen
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Ying Liu
- Traditional Chinese Medicine Center for Acquired Immune Deficiency Syndrome Prevention and Treatment, China Academy of Traditional Chinese Medicine, Beijing, 100700, China
| | - Li-Ran Xu
- Department of Acquired Immune Deficiency Syndrome Treatment and Research Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
- Henan Key Laboratory of Viral Diseases Control with Traditional Chinese Medicine, Zhengzhou, 450000, China
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Hayward P. Highlights from the 9th International AIDS Society meeting. Lancet Infect Dis 2017; 17:902. [PMID: 28845795 DOI: 10.1016/s1473-3099(17)30460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Guo H, Wang J, Li Z, Jiang Z, Xu Q, Xu L. Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy. J TRADIT CHIN MED 2017; 36:411-7. [PMID: 28459235 DOI: 10.1016/s0254-6272(16)30056-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the effect of a treatment course of comprehensive intervention with
Traditional Chinese Medicine (TCM) on the mortality of patients with acquired immunodeficiency syndrome
(AIDS) treated with combined antiretroviral therapy (cART). METHODS AIDS patients who had taken cART in a national TCM human immunodeficiency virus treatment
trial program (NTCMTP) before 2009 were enrolled in this study and followed for 36 months
from November 2009. Patients enrolled in the NTCMTP in 2004 were taken as the first group, those enrolled
in 2006 as the second group, and those enrolled in 2009 as the third group. Cumulative survival
rates were calculated by the life table method. Survival curves for subgroups were compared by
the log-rank test. Hazard ratios were calculated with a Cox proportional hazards model. RESULTS A total of 1443 AIDS patients were followed for 3 years (4198 person-years). During this
period, 91 (6.3%) patients died and 13 (0.9%) were lost to follow-up. The total mortality rate was 2.17/
100 person-years. The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-
years, which was lower than that of patients enrolled in 2006 (2.23/100 person-years) and 2009
(3.48/100 person-years). After adjusting for other factors, a shorter time of treatment with TCM, male
sex, older age, lower CD4 + T-cell counts, and long-term treatment with cART were risk factors of
mortality. CONCLUSION Long-term treatment with TCM decreased the mortality risk of AIDS patients. Factors
such as being male, older age, CD4 + T-cell counts, and time of treatment with TCM and cART were correlated
with mortality.
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da Silva Escada RO, Velasque L, Ribeiro SR, Cardoso SW, Marins LMS, Grinsztejn E, da Silva Lourenço MC, Grinsztejn B, Veloso VG. Mortality in patients with HIV-1 and tuberculosis co-infection in Rio de Janeiro, Brazil - associated factors and causes of death. BMC Infect Dis 2017; 17:373. [PMID: 28558689 PMCID: PMC5450415 DOI: 10.1186/s12879-017-2473-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/18/2017] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Tuberculosis is the most frequent opportunistic infection and the leading cause of death among persons living with HIV in several low and middle-income countries. Mortality rates during tuberculosis treatment and death causes among HIV-1/TB co-infected patients may differ based on the immunosuppression severity, timing of diagnosis and prompt initiation of tuberculosis and antiretroviral therapy. METHODS This was a retrospective observational study conducted in the clinical cohort of patients with HIV-1/Aids of the National Institute of Infectious Diseases Evandro Chagas, Rio de Janeiro, Brazil. All HIV-1 infected patients who started combination antiretroviral therapy up to 30 days before or within 180 days after the start of tuberculosis treatment from 2000 to 2010 were eligible. Causes of death were categorized according to the "Coding Causes of Death in HIV" (CoDe) protocol. The Cox model was used to estimate the hazard ratio (HR) of selected mortality variables. RESULTS A total of 310 patients were included. Sixty-four patients died during the study period. Mortality rate following tuberculosis treatment initiation was 44 per 100 person-years within the first 30 days, 28.1 per 100 person-years within 31 and 90 days, 6 per 100 person-years within 91 and 365 days and 1.6 per 100 person-years after 365 days. Death probability within one year from tuberculosis treatment initiation was approximately 13%. In the adjusted analysis the associated factors with mortality were: CD4 ≤ 50 cells/mm3 (HR: 3.10; 95% CI: 1.720 to 5.580; p = 0.00); mechanical ventilation (HR: 2.81; 95% CI: 1.170 to 6.760; p = 0.02); and disseminated tuberculosis (HR: 3.70; 95% CI: 1.290 to 10.590, p = 0.01). Invasive bacterial disease was the main immediate cause of death (46.9%). CONCLUSION Our results evidence the high morbidity and mortality among patients co-infected with HIV-1 and tuberculosis in Rio de Janeiro, Brazil. During the first year following tuberculosis diagnosis, mortality was the highest within the first 3 months, being invasive bacterial infection the major cause of death. In order to successfully intervene in this scenario, it is utterly necessary to address the social determinants of health contributing to the inequitable health care access faced by this population.
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Affiliation(s)
| | - Luciane Velasque
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Departamento de Matemática e Estatística, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sayonara Rocha Ribeiro
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Eduarda Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Quesada JA, Melchor I, Nolasco A. Point process methods in epidemiology: application to the analysis of human immunodeficiency virus/acquired immunodeficiency syndrome mortality in urban areas. Geospat Health 2017; 12:506. [PMID: 28555483 DOI: 10.4081/gh.2017.506] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
The analysis of spatio-temporal patterns of disease or death in urban areas has been developed mainly from the ecological studies approach. These designs may have some limitations like the ecological fallacy and instability with few cases. The objective of this study was to apply the point process methodology, as a complement to that of aggregated data, to study HIV/AIDS mortality in men in the city of Alicante (Spain). A case-control study in residents in the city during the period 2004-2011 was designed. Cases were men who died from HIV/AIDS and controls represented the general population, matched by age to cases. The risk surfaces of death over the city were estimated using the log-risk function of intensities, and we contrasted their temporal variations over the two periods. High risk significant areas of death by HIV/AIDS, which coincide with the most deprived areas in the city, were detected. Significant spatial change of the areas at risk between the periods studied was not detected. The point process methodology is a useful tool to analyse the patterns of death by HIV/AIDS in urban areas.
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Affiliation(s)
- Jose Antonio Quesada
- Research Unit on Mortality Analysis and Health Statistics, Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante.
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Colón-López V, Miranda-De León S, Machin-Rivera M, Marrero E, Rolón-Colón Y, Valencia-Torres IM, Suárez E. Mortality Disparities among HIV+ Men and Women in Puerto Rico: Data from the HIV/AIDS Surveillance System 2003-2014. P R Health Sci J 2017; 36:24-28. [PMID: 28266696] [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] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Describe the trend of the indirect standardized death rate of HIV for different modes of HIV transmission from 2003 to 2014 in Puerto Rico. Estimate the magnitude of the association between mode of HIV transmission and mortality at different time periods in Puerto Rico. METHODS ISDRs by sex and mode of transmission were computed using data from the PR National HIV/AIDS Surveillance System (2003-2014). Poisson models were used to assess the annual percent change of the ISDRs and RRs by sex. RESULTS Injection drug users (IDUs) showed the highest decrease in ISDR (-10.56, for men; -9.32 for women). Compared to men who have sex with men (MSM), IDU men also had the highest RR, representing an increase of 93% (2009-2011) (RRIDU vs MSM: 1.93, 95% CI: 1.66-2.23). Compared to women who were IDUs, heterosexual (HET) women had less risk of dying (48% for the period of 2006 to 2008). CONCLUSION Mortality has been decreasing in each mode of transmission for both sexes. In addition, though IDUs present the highest decrease of ISDR, it is still the group whose members have the highest risk of dying, both men and women. To better describe health disparities as related to HIV/AIDS mortality, future analyses should be performed using specific causes of death and the evaluation of other relevant clinical and sociodemographic factors. Such data might increase our understanding of mortality in people with HIV/AIDS on the island, as well as help in future efforts to develop intervention strategies for the aforementioned risk groups.
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Affiliation(s)
- Vivian Colón-López
- Population Sciences Division, Puerto Rico Comprehensive Cancer Center, San Juan, PR; Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | | | - Mark Machin-Rivera
- Population Sciences Division, Puerto Rico Comprehensive Cancer Center, San Juan, PR
| | - Edna Marrero
- Puerto Rico HIV Surveillance System, Department of Health, San Juan, PR
| | | | | | - Erick Suárez
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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Safarnejad A, Izazola-Licea JA. Direct and indirect effects of enablers on HIV testing, initiation and retention in antiretroviral treatment and AIDS related mortality. PLoS One 2017; 12:e0172569. [PMID: 28225790 PMCID: PMC5321283 DOI: 10.1371/journal.pone.0172569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/04/2017] [Indexed: 01/29/2023] Open
Abstract
Background An enabling environment is believed to have significant and critical effects on HIV and AIDS program implementation and desired outcomes. This paper estimates the paths, directionality, and direct and indirect associations between critical enablers with antiretroviral treatment (ART) coverage and to AIDS-related mortality. Methods Frameworks that consider the role of enablers in HIV and AIDS programs were systematically reviewed to develop a conceptual model of interaction. Measurements for constructs of the model were pooled from the latest publicly available data. A hypothetical model, including latent/unobserved factors and interaction of enablers, program activities and outcomes, was analyzed cross-sectionally with structural equation modeling. Coefficients of the model were used to estimate the indirect associations of enablers to treatment coverage and the subsequent associated impact on AIDS related mortality. Findings The model’s fit was adequate (RMSEA = 0·084, 90% CI [0·062, 0·104]) and the indirect effects of enablers on outcomes were measured. Enablers having significant associations with increased ART coverage were social/financial protection, governance, anti-discrimination, gender equality, domestic AIDS spending, testing service delivery, and logistics. Interpretation Critical enablers are significantly correlated to outcomes like ART coverage and AIDS related mortality. Even while this model does not allow inference on causality, it provides directionality and magnitude of the significant associations.
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Affiliation(s)
- Ali Safarnejad
- Evaluation team, Evaluation and Economics Division, Strategic Information and Evaluation Department, United Nations Programme on AIDS (UNAIDS), Geneva, Switzerland
| | - Jose-Antonio Izazola-Licea
- Chief of the Evaluation and Economics Division, Strategic Information and Evaluation Department, Programme Branch, United Nations Programme on AIDS (UNAIDS), Geneva, Switzerland
- * E-mail:
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