Death In HIV-infected Patients Research Articles

Myocardial infarction in patients with HIV infection: incidence, risk factors, pathogenesis, clinical performance and treatment

HIV infection increases the risk of premature myocardial infarction (MI) and other atherosclerotic cardiovascular diseases, which are the main noncommunicable cause of death in HIV-infected patients. The review presents the analysis of recent literature on the incidence, prevalence and risk factors of MI in HIV-infected people. It established that MI is associated with the combined effects of traditional cardiovascular risk factors, HIV infection and the cardiometabolic effects of antiretroviral therapy. Pathogenetic features of acute coronary syndrome in HIV infection under conditions of systemic immune-mediated inflammation, hypercoagulation and direct exposure to the virus are highlighted. The clinical features and coronary damage in MI are described. Methods of treating MI are compared. We concluded that the volume and quality of care for patients with HIV and MI is insufficient. From the perspective of possible drug interactions with antiretroviral therapy, effectiveness and safety of methods for secondary prevention of MI was analyzed.

Phenotypic and Genotypic Drug Resistance of Mycobacterium tuberculosis Strains Isolated from HIV-Infected Patients from a Third-Level Public Hospital in Mexico.

Drug-resistant tuberculosis (TB) is associated with higher mortality rates in patients with human immunodeficiency virus (HIV). In Mexico, the number of deaths due to TB among the HIV-positive population has tripled in recent years. Ninety-three Mycobacterium tuberculosis strains isolated from the same number of HIV-infected patients treated in a public hospital in Mexico City were studied to determine the drug resistance to first- and second-line anti-TB drugs and to identify the mutations associated with the resistance. Of the 93 patients, 82.7% were new TB cases, 86% were male, and 73% had extrapulmonary TB. Most patients (94%) with a CD4 T-lymphocyte count <350 cells/mm3 were associated with extrapulmonary TB (p <0.0001), whilst most patients (78%) with a CD4 T-lymphocyte count >350 cells/mm3 were associated with pulmonary TB (p = 0.0011). Eighty-two strains were pan-susceptible, four mono-resistant, four poly-resistant, two multidrug-resistant, and one was extensively drug-resistant. In the rifampicin-resistant strains, rpoB S531L was the mutation most frequently identified, whereas the inhA C15T and katG S315T1 mutations were present in isoniazid-resistant strains. The extensively drug-resistant strain also contained the mutation gyrA D94A. These data highlight the need to promptly diagnose the drug resistance of M. tuberculosis among all HIV-infected patients by systematically offering access to first- and second-line drug susceptibility testing and to tailor the treatment regimen based on the resistance patterns to reduce the number of deaths in HIV-infected patients.

Chronology and problems of the evolution of HIV infection in the Vologda Region in the structure of the North-West of the Russian Federation

Aim. To determine the general patterns and distinctive features of the formation of the HIV epidemic in chronology in various administrative territories of the Vologda Region.Materials and methods. The data of the epidemiological survey maps of HIV infection foci, reports «Causes of mortality of HIV-infected», statistical observations were analyzed: form No. 61 «Information on the contingent of HIV-infected patients», form No. 4 of the Federal State Statistical Observation, forms of the Vologda Regional Center for the Prevention and Control of AIDS and Infectious Diseases, materials of the North-Western District Center for the Prevention and Control of AIDS. Dynamic monitoring of the HIV epidemic in the Vologda Region (since 1995) and evaluation of the effectiveness of the national project to combat HIV infections were carried out.Results and discussion. On the territory of the Vologda Region, the trend of stability of the indicator of HIV infection remains. The prevalence of the population is increasing, accompanied by the identification of patients at late stages with the manifestation of secondary diseases. In the region, the HIV epidemic corresponds to the main trends of the epidemic process in the North-Western Federal District (NWFD) with some differences. The dominant transmission routes are parenteral (39.9% in 2021) and heterosexual. Over the past 5 years, there has been an upward trend in homosexual transmission of infection among men who have sex with a men (MSM), the share of which increased in 2021 by 2 times compared to 2017 and amounted to 3.1%. The detection rate in 2021, calculated for 100 thousand surveyed, in the Vologda Region was 111.3 (in the NWFD — 160.1). The highest detection rate of HIV infection was observed among MSM — 14.3% (in the NWFD — 4.1%), among injecting drug users (IDUs) — 1.0% (in the NWFD — 1.1%), among persons in prison — 1.8% (in the NWFD — 1.8%). One of the main causes of death in HIV-infected patients is the late detection of the disease and the initiation of antiretroviral therapy (ART). During the entire period of observation, the epidemic was most intense in Cherepovets and Vologda, since 2000 there has been a gradual spread of infection with involvement in the process in rural areas.Conclusion. The results obtained demonstrate the importance of implementing different models of the main stages of diagnosis, prevention and treatment of people in urban and rural areas, which is included in the developing concept of personalized HIV medicine. It is necessary to carry out additional measures for the active identification and registration of dispensary patients, the formation of adherence to dispensary monitoring and therapy, the timely appointment of ART, the introduction of new approaches to providing medical care to HIV-infected patients in the districts of the region.

Predictors of in-hospital mortality in HIV-infected patients with COVID-19.

Underlying immunodeficiency is associated with severe COVID-19, but the prognosis of persons with human immunodeficiency virus (HIV) (PWH) with COVID-19 is under debate. Aim: assessment of the mortality rate and major determinants of death in HIV-infected patients hospitalized with COVID-19 in Spain before vaccine availability. Design: Retrospective nationwide public database analysis. Nationwide, retrospective, observational analysis of all hospitalizations with COVID-19 during year 2020 in Spain. Stratification was made according to HIV status. The National Registry of Hospital Discharges was used with the ICD-10 coding list. A total of 117694 adults were hospitalized with COVID-19 during 2020. Only 234 (0.2%) were HIV-positives. More than 95% were on antiretroviral therapy. Compared to HIV-negatives, PWH were younger (mean age 53.2 vs. 66.5 years old; P<0.001) and more frequently male (74.8% vs. 56.6%; P<0.001). Most co-morbidities predisposing to severe COVID-19 (diabetes, hypertension, dementia and cardiovascular disease) were more frequent in HIV-negatives. In contrast, the rate of baseline liver disease was over 6-fold higher in PWH (27.4% vs. 4.4%; P<0.001). In-hospital mortality was lower in PWH (9.4% vs. 16%; P=0.004). In multivariate analysis, older age, dementia and especially advanced liver disease (relative risk (RR): 7.6) were the major determinants of death in PWH hospitalized with COVID-19. HIV-infected patients hospitalized in Spain with COVID-19 during 2020 had better survival than HIV-negatives, most likely explained by younger age and lower rate of co-morbidities. However, advanced liver disease was a major predictor of death in PWH hospitalized with COVID-19.

607. Improving Health Maintenance Among Patients with HIV by Implementing a SmartPhrase and a Care Gap in the EPIC Electronic Medical Record

BackgroundMost deaths in HIV-infected patients receiving antiretroviral therapy are now related to conditions other than AIDS. HIV infection appears to increase the risk of many non-AIDS-related conditions, highlighting the importance of preventive care, however, recommended health maintenance items unique patients with HIV (PWH) are not always accomplished. We aimed to improve health maintenance by implementing a SmartPhrase and a Care Gap package in the EPIC Electronic Medical Record (EMR). MethodsWe developed a HIV health maintenance SmartPhrase in EPIC that included the last screening dates for syphilis, gonorrhea, chlamydia, hepatitis A, hepatitis B, hepatitis C, latent tuberculosis, hyperlipidemia, diabetes and human papilloma virus and the dates of receipt of hepatitis A vaccines, hepatitis B vaccines, pneumococcal conjugate vaccines, pneumococcal polysaccharide vaccines and influenza vaccines (Figure 1). Providers can select their plan for each health maintenance item based on these data and their plans are documented in the encounter notes. Providers were educated to use the SmartPhrase in each office visit. An HIV registry was built after choosing 509 HIV related medical conditions. The health maintenance topics were displayed in a “Care Gaps” summary using the data in the HIV registry (Figure 2). Completion rates for the health maintenance items were compared before and after implementation. The health maintenance package was implemented on 3/1/2020. Figure 1. SmartPhrase .IDNOTE description and note documentation Information relevant to health maintenance and providers' plan for each health maintenance are documented in the encounter notes.Figure 2. CareGaps© 2021 Epic Systems Corporation CD4 every 6 months is displayed as a part of the health maintenance in a “Care Gaps” summary using the data in the HIV registry, whether their HIV is well controlled or not.ResultsOf the 380 patients in the registry, 162 had office visits with the ID clinic from 1/1/20 to 6/5/20. Chart review of 100 patients who had office visits after implementation was performed and compared to the 62 patients prior to implementation (Table 1). The rates of hepatitis A vaccination (P= 0.001), hepatitis B vaccination (P= 0.05) and influenza vaccination (P=0.035) were increased significantly. Pneumonia vaccine administrations and anal pap smear performance compliance remained suboptimal. Providers reported that the time they spent searching for lab results and immunization records and documenting were shortened. The rates of hepatitis A vaccination (P= 0.001), hepatitis B vaccination (P= 0.05) and influenza vaccination (P=0.035) were increased significantly.ConclusionA health maintenance package consisting of a SmartPhrase and summary display in the EMR with provider education likely helps improve health maintenance in PWH. Disclosures All Authors: No reported disclosures

Trends in hospitalizations and deaths in HIV-infected patients in Spain over two decades.

The prognosis of HIV infection dramatically improved after the introduction of triple antiretroviral therapy 25 years ago. Herein, we report the impact of further improvements in HIV management since then, looking at all hospitalizations in persons with HIV (PWH) in Spain. A retrospective study using the Spanish National Registry of Hospital Discharges. Information was retrieved since 1997-2018. From 79 647 783 nationwide hospital admissions recorded during the study period, 532 668 (0.67%) included HIV as diagnosis. The mean age of PWH hospitalized increased from 33 to 51 years (P < 0.001). The rate of HIV hospitalizations significantly declined after 2008. Comparing hospitalizations during the first (1997-2007) and last (2008-2018) decades, the rate of non-AIDS illnesses increased, mostly due to liver disease (from 35.9 to 38.3%), cardiovascular diseases (from 12.4 to 28.2%), non-AIDS cancers (from 6.4 to 15.5%), and kidney insufficiency (from 5.4 to 13%). In-hospital deaths occurred in 5.5% of PWH, declining significantly over time. Although most deaths were the result from AIDS conditions (34.8%), the most frequent non-AIDS deaths were liver disease (47.1%), cardiovascular events (29.2%), non-AIDS cancers (24.2%), and kidney insufficiency (20.7%). Hospital admissions in PWH significantly declined after 2008, following improvements in HIV management and antiretroviral therapy. Non-AIDS cancers, cardiovascular events and liver disease represent a growing proportion of hospital admissions and deaths in PWH.

Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

BackgroundCryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM).MethodsData on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The bootstrapping statistical method was used for internal validation. External validation was performed using data from 2018 to 2020.ResultsWe found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p<0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1 and 83.8%, respectively. Our scoring model showed a good discriminatory ability, with an area under the curve of 0.879 for internal validation via bootstrapping, and an area under the curve of 0.886 for external validation.ConclusionsOur developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.

Therapeutic Approach to HIV/AIDS in Integration with Nanotechnology

HIV/AIDS is a deadly disease terrifying the entire world. If the record of death of HIV infected patients is worked out, it will be considered one of the top three infectious diseases behind the fatality of a huge number of patients. No proper preventive vaccine of HIV has been found till date. But works are going on in the hope of easing the treatment procedures of HIV. The concept of nanotechnology has been taken into account in the treatment of HIV/AIDS. Nanotechnology, combining with pharmacology, has been able to develop various innovative and interesting treatment procedures of HIV, be it diagnostic approach, identification, targeting, marking or even complete killing of HIV in the patient body. This review contains a list of nano based products, approaches, machineries and procedures to successfully treat HIV in the patients.

Transcriptomic biomarker pathways associated with death in HIV-infected patients with cryptococcal meningitis

BackgroundCryptococcal meningitis (CM) is a major cause of death in HIV-infected patients in sub-Saharan Africa. Many CM patients experience cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS), which is often fatal. We sought to identify transcriptomic biomarker pathways in peripheral blood that are associated with or predict the development of death or fatal C-IRIS among patients with CM who were enrolled in the Cryptococcal Optimal ART Timing Trial.MethodsWe assessed peripheral blood gene expression using next-generation RNA sequencing in 4 groups of patients with CM: (1) no C-IRIS or Death; (2) C-IRIS survivors; (3) fatal C-IRIS; (4) Death without C-IRIS. Gene expression was assessed at the time of ART initiation, at 1, 4, and 8 weeks on ART, and at the time of C-IRIS events.ResultsWe identified 12 inflammatory and stress response pathways, including interferon type 1 signaling, that were upregulated at the time of ART initiation in patients with future fatal C-IRIS, as compared with survivors. The upregulation of transcripts involved in innate immunity (inflammasome, Toll-like receptor signaling), was observed at the time of fatal or nonfatal C-IRIS events. At the time of fatal C-IRIS events, numerous transcripts within fMLP, Rho family GTPases, HMGB1, and other acute phase response signaling pathways were upregulated, which reflects the severity of inflammation and systemic oxidative stress. Patients who died without recognized C-IRIS also had increased expression of pathways associated with oxidative stress and tissue damage.ConclusionsOur results showed that overactivated innate immunity, involving Toll-like receptor/inflammasome pathways, and inflammation-induced oxidative stress, are associated with fatal outcomes. The results of this study provide insight into the molecular drivers of death and fatal C-IRIS to inform future diagnostic test development or guide targeted treatments.

Relationship Between Drug Resistance and Death in HIV-Infected Patients Receiving Antiretroviral Therapy - 7 PLADs, China, 2010-2019.

What is already known about this topic?With increasing coverage of antiretroviral therapy (ART) for HIV-infected patients, more and more attention has been paid to the impact of HIV drug resistance on death in those patients in China.What is added by this report?Among HIV-infected patients receiving ART, the risk of death is higher in patients with HIV drug resistance [adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.10–8.62], with viral load ≥1,000 copies/mL but drug resistance untested (AOR=4.65, 95% CI: 1.74–12.39), and with neither viral load nor drug resistance being tested (AOR=17.52, 95% CI: 8.73–35.19) when compared with drug-sensitive patients.What are the implications for public health practice?It is important to strengthen drug resistance monitoring and prevention in HIV-infected patients. While performing ART for HIV-infected patients, viral load testing and drug resistance testing should be carried out routinely and promptly.

Multicentre derivation and validation of a prognostic scoring system for mortality assessment in HIV-infected patients with talaromycosis.

BackgroundAlthough the widespread use of modern antiretroviral therapy (ART) has reduced the incidence of talaromycosis in people living with HIV, mortality remains as high as 20% in this population, even after appropriate antifungal treatment.ObjectivesThe objective of our study was to develop a risk assessment system for HIV‐infected patients with comorbid talaromycosis, in order to provide these patients with appropriate, effective and potentially life‐saving interventions at an early stage of their illness.Patients/MethodsThis was a multicentre, retrospective cohort study conducted in China. We built a predictive model based on data from 11 hospitals, and a validated model using the data of 1 hospital located in an endemic area.ResultsForward stepwise multivariate statistical calculations indicated that age, aspartate aminotransferase/alanine transaminase ratio and albumin levels, and BUN levels were valid, independent predictors of the risk of death in HIV‐infected patients with talaromycosis. Our developed and validated risk scoring system is effective for the identification of HIV‐infected patients with talaromycosis at high risk of death at hospital admission (p < .001; AUC = 0.860). In our study, our risk prediction model provided functional and robust discrimination in the validation cohort (p < .001; AUC = 0.793).ConclusionThe prognostic scoring system for mortality assessment developed in the present study is an easy‐to‐use clinical tool designed to accurately assist clinicians in identifying high‐risk patients with talaromycosis.

The clinical outcome of HIV infection at a tertiary care center in Riyadh, Saudi Arabia.

Objectives:To investigate clinical characteristics and the outcome of people living with HIV (PLWHIV) at tertiary care center in Riyadh, Saudi Arabia.Methods:The present retrospective, observational study was carried between 2000-2019 at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. The demographic and clinical characteristics of 137 PLWHIV patients were collected by reviewing the medical data record.Results:Of the total 137 PLWHIV, 78.8% were male and 21.2% were female. At care entry, the most opportunistic infections found were the cytomegalovirus infections. cytomegalovirus (CMV) infections in 13.8% of patients, tuberculosis (8%), AIDS associated malignancy (10.9%), hepatitis B (5.8%), NTM (3.6%), hepatitis C (2.2%). In the present study, more than half of the patients received integrase based combination therapy. The highest number (n=20) of patients were diagnosed in 2018.Conclusions:Our findings describe the clinical characteristics and outcomes of PLWHIV at a major tertiary referral hospital in Saudi Arabia. The non AIDS related disease is the major cause of death in HIV infected patients. Early diagnosis and initiation of antiretroviral therapy resulted in a significant decrease in morbidity and mortality.

Echocardiographic Findings and Follow-Up in Two HIVAssociated Pulmonary Arterial Hypertension Cases

Pulmonary arterial hypertension associated with HIV infection is a separate entity. The prevalence is up to one thousand times higher than in general population. The mechanisms are multifactorial and incompletely elucidated. Echocardiography can suggest the diagnosis, but the gold standard method of diagnosing pulmonary arterial hypertension is right heart catheterization. We present clinical and paraclinical findings (NYHA, 6MWD, sPAP, RVGLS) and follow-up in two patients living with HIV, who are included in the Romanian National Program of Pulmonary Arterial Hypertension. In patients, the possible thromboembolism or left heart dysfunction were excluded. Each case has its own particularities, but both of them responded to treatment with sildenafil and improved clinical and paraclinical parameters. Mortality is high, usually due to right heart failure and pulmonary arterial hypertension is considered an independent predictor of death in HIV-infected patients. Co-management with both a Pulmonary Hypertension (PH) expert and a HIV expert is recommended.

Model-Based Assessment of Variability in Isoniazid Pharmacokinetics and Metabolism in Patients Co-Infected With Tuberculosis and HIV: Implications for a Novel Dosing Strategy.

Tuberculosis is the most common cause of death in HIV-infected patients. Isoniazid is used as a first-line drug to treat tuberculosis infection. However, variability in isoniazid pharmacokinetics can result in hepatotoxicity or treatment failure. Determination of clinical factors affecting isoniazid pharmacokinetics and metabolic pathways in HIV co-infected patients is therefore critical. Plasma levels of isoniazid, acetyl-isoniazid, and isonicotinic acid from 63 patients co-infected with tuberculosis and HIV were analyzed by liquid chromatography with tandem mass spectrometry followed by nonlinear mixed-effects modeling. Patients were genotyped to determine acetylator status. Patients were either on concomitant efavirenz-based antiretroviral therapy or HIV treatment naïve. Clearances of isoniazid were 1.3-fold and 2.3-fold higher in intermediate and rapid acetylators, respectively, compared with slow acetylators. Patients on concomitant efavirenz-based antiretroviral therapy had 64% and 80% higher population predicted clearances of acetyl-isoniazid and isonicotinic acid, respectively, compared with patients who were HIV treatment naïve. Both sex and CD4 cell count affected the bioavailability of isoniazid. Variability in isoniazid exposure could be reduced by dose adaptions based on acetylator type and sex in addition to the currently used weight bands. A novel dosing strategy that has the potential to reduce isoniazid-related toxicity and treatment failure is presented.

A randomized open label trial of tamoxifen combined with amphotericin B and fluconazole for cryptococcal meningitis.

Background: Cryptococcal meningitis is a leading cause of death in HIV-infected patients. International treatment guidelines recommend induction therapy with amphotericin B and flucytosine. This antifungal combination is most effective, but unfortunately flucytosine is expensive and unavailable where the burden of disease is greatest. Where unavailable, guidelines recommend treatment with amphotericin and fluconazole, but this is less effective, with mortality rates of 40-50%. Faster rates of clearance of yeast from cerebrospinal fluid (CSF) are associated with better outcomes - improving the potency of antifungal therapy is likely to be an effective strategy to improve survival. Tamoxifen, a selective estrogen receptor modulator used to treat breast cancer, has anti-cryptococcal activity, appearing synergistic when combined in vitro with amphotericin, and fungicidal when combined with fluconazole. It is concentrated in the brain and macrophages, off-patent, cheap and widely available. We designed a randomized trial to deliver initial efficacy and safety data for tamoxifen combined with amphotericin and fluconazole. Method: A phase II, open-label, randomized (1:1) controlled trial of tamoxifen (300mg/day) combined with amphotericin (1mg/kg/day) and fluconazole (800mg/day) for the first 2 weeks therapy for HIV infected or uninfected adults with cryptococcal meningitis. The study recruits at Cho Ray Hospital and the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. The primary end point is Early Fungicidal Activity (EFA-the rate of yeast clearance from CSF), over the first two weeks of treatment. 50 patients will be recruited providing ≈80% and 90% power to detect a difference in the EFA of -0.11 or -0.13 log10CFU/ml/day, respectively. Discussion: The results of the study will inform the decision to proceed to a larger trial powered to mortality. The size of effect detectable has previously been associated with reduced mortality from this devastating disease. Particular side effects of interest include QT prolongation. Trial registration: Clinicaltrials.gov NCT03112031 (11/04/2017)

A randomized open label trial of tamoxifen combined with amphotericin B and fluconazole for cryptococcal meningitis.

Background: Cryptococcal meningitis is a leading cause of death in HIV-infected patients. International treatment guidelines recommend induction therapy with amphotericin B and flucytosine. This antifungal combination is most effective, but unfortunately flucytosine is expensive and unavailable where the burden of disease is greatest. Where unavailable, guidelines recommend treatment with amphotericin and fluconazole, but this is less effective, with mortality rates of 40-50%. Faster rates of clearance of yeast from cerebrospinal fluid (CSF) are associated with better outcomes - improving the potency of antifungal therapy is likely to be an effective strategy to improve survival. Tamoxifen, a selective estrogen receptor modulator used to treat breast cancer, has anti-cryptococcal activity, appearing synergistic when combined in vitro with amphotericin, and fungicidal when combined with fluconazole. It is concentrated in the brain and macrophages, off-patent, cheap and widely available. We designed a randomized trial to deliver initial efficacy and safety data for tamoxifen combined with amphotericin and fluconazole. Method: A phase II, open-label, randomized (1:1) controlled trial of tamoxifen (300mg/day) combined with amphotericin (1mg/kg/day) and fluconazole (800mg/day) for the first 2 weeks therapy for HIV infected or uninfected adults with cryptococcal meningitis. The study recruits at Cho Ray Hospital and the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. The primary end point is Early Fungicidal Activity (EFA-the rate of yeast clearance from CSF), over the first two weeks of treatment. 50 patients will be recruited providing ≈80% and 90% power to detect a difference in the EFA of -0.11 or -0.13 log10CFU/ml/day, respectively. Discussion: The results of the study will inform the decision to proceed to a larger trial powered to mortality. The size of effect detectable has previously been associated with reduced mortality from this devastating disease. Particular side effects of interest include QT prolongation. Trial registration: Clinicaltrials.gov NCT03112031 (11/04/2017).

Epidemiology of Opportunistic Infections in HIV Infected Patients on Treatment in Accredited HIV Treatment Centers in Cameroon.

Background:The African continent accounts for over 70% of people infected with Human Immunodeficiency Virus (HIV). The HIV sero-prevalence rate in Africa is estimated at 4.3%. In developed countries, such as France, pneumocystis is indicative of AIDS in 30% of patients; however, in Africa, pulmonary tuberculosis (TB) is the most-documented opportunistic infection (OI) and the leading cause of death in HIV-infected patients. In 2016, Cameroon had 32,000 new cases of OI and 29,000 deaths as a result of these infections. However, there is little existing data on the epidemiological profile of OIs in Cameroon, which is why we conducted this study in accredited HIV treatment centers and care/treatment units in the two cities of Douala and Yaounde, Cameroon.Methods:This was a retrospective descriptive and analytical study carried out in 12 accredited HIV treatment centers in the cities of Yaoundé and Douala, Cameroon, over a period of seven months from October 2017 to April 2018. A stratified sampling method was used with three sampling levels: the city, type of health facility and size of active files. Ethical clearance and administrative authorization were obtained from the appropriate authorities and data were collected using a pre-tested survey form. The data collected was entered and analyzed using Epi Info version 3.5.4.Results:Out of a total of 1,617 HIV-infected patients sampled, 419 (25.9%) had at least one OI. Of these patients with an OI, 246 or 65% had a baseline CD4 count of <200/mm3. There was a significant relationship between the male gender and the onset of OI (OR = 1.47; p = 0.01). Age ≥ 50 years was associated with the occurrence of OI (OR = 2.57; p = 0.01). A CD4 count of <200/mm3 was also associated with the risk of developing an OI (OR = 3.12; p = <0.01).Conclusion and Global Health Implications:The prevalence of OI is high among people living with HIV (25.9%). Shingles was the most common OI found followed by pulmonary tuberculosis. Male gender, age ≥ 50 years, and CD4 <200/mm3 were the most common factors associated with the occurrence of these OI. These findings suggest that public health interventions for reducing HIV related co-morbidities (and implicitly mortality) should especially target the male gender for greater impact in addition to other measures.

АНАЛИЗ ПРИЧИН СМЕРТИ, СТРУКТУРЫ ВТОРИЧНОЙ И СОПУТСТВУЮЩЕЙ ПАТОЛОГИИ ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ ГОМЕЛЬСКОЙ ОБЛАСТИ

Background. The analysis of the spectrum of causes of death associated with HIV infection presents some difficulties, since a significant number of deaths of HIV-infected patients are not directly related to the manifestation of immunodeficiency. The goal is to determine the spectrum of secondary diseases, the immediate and main causes of death, as well as target organs for opportunistic infections and diseases of HIV-infected patients in Gomel region. Material and methods. The case histories, data of of infectious diseases and the protocols of pathological autopsies of HIV-infected patients in the Svetlogorsk district of Gomel region for 2012-2018 were studied. Results. Among HIV-infected deceased patients, men predominate (more than 60%), aged 35 to 44 years (about 50%). The number of deceased patients with the experience of infection from 1 to 12 years is decreasing and increasing from 13 to 21 years (28.4%). Life expectancy after HIV infection is 10.5 ± 4.9 years. Among HIV-infected deceased patients who had indicators of immune status, the content of CD4 + lymphocytes were less than 200 cells in 63.8% of patients, in 23.3% the number of CD4 + cells at the time of death was less than 50. Viral load in 22.4% of deaths at the time of death exceeded 500,000 copies/μl, the majority (89.2%) of the dead had the 4th clinical stage of HIV infection. Conclusions. In 74.6% of patients, HIV infection was the main disease and the main cause of death. Among the spectrum of secondary diseases that caused death pneumocystis pneumonia, progressive multifocal leukoencephalopathy, cryptococcal infection, toxoplasmosis of the brain, tuberculosis, lymphomas, CMV-infection, generalized candidiasis, atypical mycobacteriosis, pulmonary aspergillosis and others were identified. In 25.4% of cases, HIV infection was regarded as concomitant rather than the main pathology, among which liver cirrhosis and other pathologies predominated: acute cerebrovascular accident, coronary heart disease, chronic rheumatic heart disease, dilated cardiomyopathy, chronic alcoholic disease and others. The increase in the number of autopsies and constant monitoring of the causes of death of HIV-infected deaths and associated opportunistic infections and diseases will improve the quality and speed up the time-to-life diagnosis of various pathologies in HIV-infected patients.

HIV-related Malignancies and Mimics: Imaging Findings and Management.

The risk of developing malignancy is higher in patients with human immunodeficiency virus (HIV) infection than in non-HIV-infected patients. Several factors including immunosuppression, viral coinfection, and high-risk lifestyle choices lead to higher rates of cancer in the HIV-infected population. A subset of HIV-related malignancies are considered to be acquired immunodeficiency syndrome (AIDS)-defining malignancies, as their presence confirms the diagnosis of AIDS in an HIV-infected patient. The introduction of highly active antiretroviral therapy (HAART) has led to a significant drop in the rate of AIDS-defining malignancies, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical carcinoma. However, non-AIDS-defining malignancies (eg, Hodgkin lymphoma, lung cancer, hepatocellular carcinoma, and head and neck cancers) now account for an increasing number of cancer cases diagnosed in HIV-infected patients. Although the number has decreased, AIDS-defining malignancies account for 15%-19% of all deaths in HIV-infected patients in the post-HAART era. Most HIV-related malignancies in HIV-infected patients manifest at an earlier age with a more aggressive course than that of non-HIV-related malignancies. Understanding common HIV-related malignancies and their specific imaging features is crucial for making an accurate and early diagnosis, which impacts management. Owing to the weakened immune system of HIV-infected patients, other entities such as various infections, particularly opportunistic infections, are prevalent in these patients. These processes can have confounding clinical and imaging manifestations that mimic malignancy. This article reviews the most common AIDS-defining and non-AIDS-defining malignancies, the role of imaging in their diagnosis, and the imaging mimics of malignancies in HIV-infected patients. ©RSNA, 2018.

Cardiovascular disease burden among human immunodeficiency virus-infected individuals

Human Immunodeficiency Virus (HIV) infection affects 36.7 million people worldwide, it accounted for 1.1 million deaths in 2015. The advent of combined antiretroviral therapy (cART) has been associated with a decrease in HIV-related morbidity and mortality. However, there are increasing concerns about long-lasting effects of chronic inflammation and immune activation, leading to premature aging and HIV-related mortality. Cardiovascular diseases, especially coronary artery disease, are among the leading causes of death in HIV-infected patients, accounting for up to 15% of total deaths in high income countries. Furthermore, as cART availability expands to low-income countries, the burden of cardiovascular related mortality is likely to rise. Hence, over the next decade HIV-associated cardiovascular disease burden is expected to increase globally. In this review, we summarize our understanding of the pathogenesis and risk factors associated with HIV infection and cardiovascular disease, in particular coronary artery disease.