Interventions In HIV-infected Patients Research Articles

Prevalence of syphilis in HIV-infected patients with transmission risk and influencing factors in Zhejiang Province

Objective: To investigate the prevalence of syphilis in HIV-infected patients with transmission risk and influencing factors in Zhejiang Province. Method: The information about the HIV-infected patients, who were alive, had been diagnosed with HIV for >1 year, had received no antiviral treatment or had HIV viral load ≥50 copies/ml, and were aged ≥15 years, reported in Zhejiang as of December 31, 2018 were collected from China Information System for Disease Control and Prevention. The information included general demographic characteristics, sexual behavior characteristics and antiretroviral therapy and syphilis serological test results. The prevalence of syphilis and the influencing factors were analyzed by logistic regression model. The SPSS 19.0 software was used for statistical analysis. Results: A total of 2 275 HIV-infected patients were at risk of HIV transmission, and 75.5% (1 717/2 275) of them were tested for syphilis, the prevalence rate of syphilis was 8.7% (150/1 717). Among the HIV-infected patients with syphilis, 11.3% (17/150) received no antiviral treatment, 38.7% (58/150) had viral load of 50-999 copies/ml and 50.0% (75/150) had ≥1 000 copies/ml. Multivariate logistic regression analysis showed that being men (aOR=2.04, 95%CI:1.06-3.96), homosexual transmission (aOR=1.53, 95%CI:1.04-2.27), history of sexually transmitted diseases (STDs) before HIV diagnosis (aOR=1.98, 95%CI:1.35-2.92) and HIV viral load ≥1 000 copies/ml (aOR=1.90, 95%CI:1.09-3.30) were the risk factors for syphilis. Marriage (aOR=0.47, 95%CI: 0.29-0.76) was a protective factor for syphilis. Conclusions: The prevalence of syphilis was high in HIV-infected patients with transmission risk in Zhejiang. It is urgent to carry out classified management and targeted intervention in HIV-infected patients, explore multi-disease prevention and treatment mechanism, strengthen syphilis screening and treatment in HIV-infected patients to reduce the transmission of HIV and syphilis.

Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2.

The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.

Methamphetamine and HIV-1 Tat proteins synergistically induce microglial autophagy via activation of the Nrf2/NQO1/HO-1 signal pathway

Methamphetamine (METH) is a psychostimulant that is abused throughout the world. METH is a highly addictive drug commonly used by persons living with HIV, and its use can result in cognitive impairment and memory deficits. METH and human immunodeficiency virus-1 transactivator of transcription (HIV-1Tat) have toxic and synergistic effects on the nervous system; however, the mechanism of their synergistic effects has not been clarified. We used BV2 cells, primary microglia, Nrf2-KO C57BL/6J mice, and autopsied brain tissues of METH-abusing, HIV infection, and METH-abusing individuals comorbid with HIV to explore the regulatory role of Nrf2/NQO1/HO-1 signal pathway on microglia autophagy. Our results showed that microglia were significantly activated by METH and HIV-1Tat protein. METH and HIV-1Tat protein combination significantly increase the autophagy-related proteins (LC3-II, Beclin-1, ATG5, and ATG7) expression in microglia and striatum of C57BL/6J mice. After silencing or knocking out the Nrf2 gene, the expression levels of autophagy-related proteins were significantly increased. In human brain tissue, microglia were activated, Nrf2, LC3-II, and Beclin-1 expression levels were raised, and the p62 expression level was decreased. Our results suggested that METH and HIV or HIV-1Tat synergistically affect autophagy. And the Nrf2 pathway plays a vital role in regulating the synergistic induction of microglial autophagy by METH and HIV-1Tat protein. This study may provide a theoretical basis and new ideas for effective targets for pharmacological intervention in HIV-infected patients with drug abuse.

Endovascular and Open Surgical Treatment of Peripheral Artery Disease inPatients with HIV

<h3>Objective</h3> Peripheral artery disease (PAD) is a highly prevalent disease world-wide that can ultimately result in limb loss. In the HIV infected population, the condition can present at a younger age and result in a significant level of morbidity and remains understudied. The purpose of this study is to evaluate outcomes related to endovascular and open surgical management of occlusive disease in HIV infected patients at a single- center. <h3>Methods</h3> A retrospective, single-center review of peripheral vascular interventions in HIV infected patients at a tertiary vascular referral center was performed between January 1, 2010 and December 31, 2019. Data collected included patient demographics including CD4 counts, highly active antiretroviral therapy (HAART), statin use, antiplatelet and/or anticoagulation status, pre and post intervention ankle-brachial indices, limb loss, number of re-interventions, follow up in vascular clinic, and 30-day mortality. <h3>Results</h3> During the study period, 27 patients (70.4% men) underwent peripheral vascular interventions while infected with HIV. Two patients had interventions on both lower extremities which were treated as separate occurrences resulting in an N of 29. The mean age was 55 years old (range, 33-67 years, median 57). Types of interventions employed included endovascular attempts (n=11[37.9%])), open surgery (n=16 [55.2%]) or hybrid operations including endovascular and open components (n=2 [6.9%]). One third of patients (n=10[34.5%]) required an initial reintervention within 30 days of their index operation and 13 patients (45%) required more than 1 reintervention on their lower extremity. A majority of patients (n=19[66%]) required reintervention on their lower extremity. Two patients (6.9%) required amputation within 30 days of their index case. Overall amputation rate regardless of time interval was 31% for this cohort. The 30-day mortality was 3.4%(n=1). Seventeen patients (58.6%) presented for their 1-year follow-up. While data was missing for five patients, a majority of the cohort had a CD4 count >500 prior to their index operation (n=12[50%]) while 13.8% of patients (n=4) had a CD4 count of less than 200 prior to their index case. There was a significant association, as expected, with number of reinterventions performed and an increased risk of amputation (p=0.0003). Additionally, open surgery as an index operation was significantly associated with increased risk of amputation (p=0.014). Mean hospital length of stay was 8.3 days (range, 0-40). The most common indications for surgery were claudication (n=9 [31%]) and acute limb ischemia (n=9 [31%]). Interestingly, there was no significant association between indication for surgery and resulting limb loss. The limb salvage rate for this patient cohort was 69%. <h3>Conclusions</h3> Peripheral artery disease continues to be a highly prevalent condition associated with significant morbidity for patients impacted and this impact tends to be greater in patients infected with HIV. Overall, HIV infected patients at our institution had a higher limb salvage rate than those reported in the literature with a significant association with limb loss in those whohad multiple re-interventions. More studies are needed to fully categorize recommendations regarding limb salvage as it pertains to HIV infected individuals.

Development of a risk scoring system for prognostication in HIV-related toxoplasma encephalitis

BackgroundThis study aims to evaluate specific risk factors influencing prognosis of HIV-infected patients with toxoplasma encephalitis (TE) in order to develop a prognostic risk scoring system for them.MethodsThis is a six-center retrospective study of hospitalized HIV/TE patients. Data including six-week mortality after diagnosis, baseline characteristics, clinical features, laboratory tests and radiological characteristics of eligible patients were assimilated for risk model establishing.ResultsIn this study, the six-week mortality among 94 retrospective cases was 11.7% (11/94). Seven specific risk factors, viz. time from symptom onset to presentation, fever, dizziness, CD4+ T-cell counts, memory deficits, patchy brain lesions, and disorders of consciousness were calculated to be statistically associated with mortality. A criterion value of ‘9’ was selected as the optimal cut-off value of the established model. The AUC of the ROC curve of this scoring model was 0.976 (p < 0.001). The sensitivity and specificity of the risk scoring model was 100.0 and 86.9%, respectively, which were 81.8 and 94.1% of this scoring model in the verification cohort, respectively.ConclusionsThe developed scoring system was established with simple risk factors, which also allows expeditious implementation of accurate prognostication, and appropriate therapeutic interventions in HIV-infected patients with TE.

DIAGNOSTIC SURGERY IN HIVINFECTED PATIENTS WITH DAMAGE OF CHEST ORGANS

The current epidemiological situation in the world, characterized by a constant increase in the number of HIV-infected. The steady progression of HIV infection, even in the presence of antiretroviral therapy (ART), is accompanied by the development of opportunistic diseases. Tubercolosis most often affects patients with HIV infection, as the risk of their illness is 20–37 times higher. Basically, radiation tests and immunological tests are used for the diagnostic of tuberculosis. The main diagnostic criterion for establishing the diagnosis of tuberculosis is detection of the causative agent (Mycobacterium tuberculosis by bacteriological or molecular genetic method. Other diseases with respiratory organs, pleura, and hilar lymph nodes may also occur In patients with HIV infection, which requires differential diagnostic, including surgical methods. It is often necessary to resort to a biopsy of pulmonary tissue, pleura, and hilar lymph nodes to establish a diagnosis. Among surgical methods, the use of minimally invasive operations using endoscopic techniques is most justified. Purpose of the study. Study of safety and effectiveness of the use of surgical methods in the diagnostic of chest diseases in patients with HIV infection. Materials and methods. The results of 105 diagnostic thoracic surgeries in patients with HIV infection which were performed in Moscow Research andClinicalCenterfor Tuberculosis Control of Moscow city Department in period between 2014–2017 were studied. All patients underwent diagnostic surgical interventions. Minimally invasive methods were predominantly used. The obtained diagnostic material was subjected to morphological, molecular-genetic and bacteriological analysis. Results of the research. After surgical interventions in patients with HIV infection with pathological changes in chest organs, unclear etiology, diagnosis of tuberculosis was established in 74 (70,5%) patients, nontuberculous etiology of the disease was detected in 31 (29,5%). Differential diagnosis of chest diseases in patients with HIV infection is an integral part of the work of phthisiatrician, pulmonologist and infectiologist. Surgical interventions in HIV-infected patients do not create a significant risk of changes in the immune status, respectively, their performance is independent of the level of lymphocytes and produced even with severe immunodeficiency. The use of surgical methods in diagnostic of chest diseases is safe, effective and does not lead to a significant number of complications and mortality in patients with HIV infection, regardless of the initial immune status. In addition, in number of patients, the operation is not only diagnostic, but also therapeutic, allowing significantly shortening the duration of treatment, avoiding the appointment of trial therapy. The conclusion. In case of tuberculosis, morphological verification of pathological changes in combination with bacteriological and molecular genetic research of the operation material makes it possible to assign an adequate regime of antituberculous chemotherapy in accordance with the sensitivity of the pathogen. The establishment of non-tuberculous etiology of the identified changes, changes the routing of an HIV-infected patient from an anti-tuberculosis institution to a specialized medical organization of the appropriate profile.

Randomized trial of a multidisciplinary lifestyle intervention in HIV-infected patients with moderate-high cardiovascular risk

ObjectiveTo assess the impact of a multidisciplinary lifestyle intervention on cardiovascular risk and carotid intima-media thickness (c-IMT) in HIV-infected patients with Framingham scores (FS) > 10%. DesignRandomized pilot study; follow-up 36 months. MethodsVirologically suppressed adult HIV-1-infected patients with FS >10% were randomized 1:1 to the intervention group (multidisciplinary lifestyle intervention) or control group (routine care). At baseline and months 12, 24 and 36, lipid parameters were analyzed and carotid ultrasound was performed to determine c-IMT and presence of plaques. Biomarkers were measured at baseline and month 36. The primary endpoints were lipid and FS changes at 36 months. ResultsFifty-four patients were included, 27 in each arm. Median age was 50.5 years, all patients but one were men, and FS was 16.5%. Relative to controls, total and LDL cholesterol had significantly decreased in the intervention group at 24 months (p = 0.039, p = 0.011, respectively). However, no differences between groups were found at month 36 in lipid variables, neither in FS. Tobacco use decreased in the intervention group (p = 0.031). At baseline, 74.5% of patients had subclinical atherosclerosis, and at month 36, we observed a progression in c-IMT that was greater in the intervention group (p = 0.030). D-dimer increased (p = 0.027) and soluble intercellular adhesion molecule-1 decreased (p = 0.018) at 36 months. ConclusionsIn this cohort of HIV-infected patients with FS>10% and a high percentage of subclinical atherosclerosis, a multidisciplinary lifestyle intervention resulted in a slight improvement in some cardiovascular risk factors and the FS during the first 2 years, but did not prevent c-IMT progression.

A multifaceted intervention designed to improve medical management of moderate to advanced chronic kidney disease in HIV-infected patients: a cluster randomized trial.

Chronic kidney disease (CKD) is frequent in individuals infected with human immunodeficiency virus (HIV). Progression to end-stage renal disease can be slowed by appropriate medical management. To assess whether active promotion of guidelines improves CKD management, we conducted a cluster randomized controlled trial within the French Hospital Database on HIV (FHDH-ANRS CO4). We randomized 46 centers participating in the FHDH to either simple information on guideline availability or active promotion with a multifaceted and repeated intervention comprising reminders and audit feedback and targeting of local opinion leaders carried out between April 2009 and April 2010. Outcome measure was CKD management adequacy assessed before and 2 years after the beginning of the intervention in HIV-infected patients with moderate to severe CKD. CKD management was considered adequate in case of referral to a nephrologist or if proteinuria, blood pressure, low-density lipoprotein cholesterol level, and glycemia had been measured during the previous year and medications had been prescribed when necessary. Three hundred six patients were enrolled, of whom 238 (78%) completed the 2 years of follow-up. During the study period, the percentage of patients receiving adequate CKD management improved from 64.1% to 70.4% (+6.3%) in the active arm and from 68.3% to 75.6% (+7.3%) in the control arm (adjusted mean difference, -0.7 percentage points [95% confidence interval: -9.2 to 7.9]; P = .95). The biggest impact of active promotion was on the management of proteinuria and blood pressure. Adequate compliance with CKD management guidelines improved slightly between 2009 and 2011, with no difference between the simple information and active promotion arms. CCTIRS 10.150 and CNIL DR-2010-379.

Long-term effects of an intensive intervention in HIV-infected patients with moderate-high atherosclerotic cardiovascular risk.

To evaluate the 5 year effects of an intensive intervention versus the standard-of-care intervention on cardiovascular risk factors in HIV-infected patients on antiretroviral therapy (ART). This was a longitudinal study including virologically suppressed patients with at least two cardiovascular risk factors or a Framingham risk score ≥10%. Intensive and standard-of-care interventions aimed for low-density lipoprotein cholesterol (LDL-C) <100 and <130 mg/dL, respectively, by using lipid-lowering drugs. In the intensive group, switching ART when needed to achieve the LDL-C target and low-dose aspirin were used. Achievement of LDL-C targets and changes in carotid intima-media thickness (cIMT) and cardiovascular biomarkers were compared between groups at different timepoints through a 5 year period. Twenty-two and 25 patients in the intensive and standard intervention groups, respectively, were followed up. At 5 years, pre-specified LDL-C targets were achieved in 82% (intensive) and 81% (standard of care) of patients. The median (IQR) change in LDL-C in the intensive and standard intervention groups was -78 (-96/-39.7) and -49 (-72/-3) mg/dL, respectively (P = 0.04), and in the Framingham score was -4% (-8%/-1%) and 0% (-4%/6.5%), respectively (P = 0.01). There were no significant intra- or between-group changes in cIMT measurements. A significant decrease was observed in the intensive and standard groups in interleukin 6 (P = 0.001 and P = 0.002, respectively) and in tumour necrosis factor α (P = 0.023 and P = 0.052, respectively). Asymptomatic creatine phosphokinase elevations were observed in two patients assigned to the standard intervention group. An intensive intervention on cardiovascular risk factors in HIV-infected patients on ART was feasible, safe and capable of achieving LDL-C targets in the long term. Both intensive and standard interventions were accompanied by antiatherosclerotic changes in inflammatory cytokines and lack of cIMT progression.

A Call to Action: Alcohol Interventions in HIV-Infected Patients

In a recent issue of the New England Journal of Medicine, Cho et al. (2012) provided an interesting and very comprehensive description of an alcohol-dependent patient affected by alcoholic liver disease with fibrosis, brain abscess due to toxoplasma, and advanced HIV infection. This case report is a good reminder of three important clinical issues, i.e. (a) HIV-infected alcoholic patients drink more than the general population, alcohol is their most commonly abused drug and contributes to HIV-related morbidity, mortality, and transmission (Fenton et al., 2010); (b) HIV-infected alcoholic patients often have hepatic impairment because of alcohol's effects on liver, HCV coinfection, and antiretroviral therapy (ART)-related hepatotoxicity risk (Szabo and Zakhari, 2011); indeed, alcohol alone, like in this patient (Cho et al., 2012), can be harmful enough to develop clinically significant ALD – notably, in this patient ALD delayed ART initiation (Cho et al., 2012), which may have contributed to further clinical deterioration; (c) Alcohol interventions are dramatically needed for HIV-infected patients. This patient had declined treatment, e.g., disulfiram (Cho et al., 2012), a drug that itself might cause liver failure (Edwards et al., 2011). Though preliminary research is searching for safer and more effective pharmacotherapies (e.g., Addolorato et al., 2007; Johnson et al., 2008; Leggio et al., 2011, 2012), this case (Cho et al., 2012) highlights the need to identify novel pharmacotherapies for alcoholic patients with ALD in order to provide effective interventions that both promote abstinence and help prevent progression to hepatic failure and death.

The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection

The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection

A pilot randomized trial comparing an intensive versus a standard intervention in stable HIV-infected patients with moderate-high cardiovascular risk

The influence on the progression of atherosclerosis of an intervention on cardiovascular risk factors in HIV-infected patients remains unknown. We evaluated the efficacy and safety of an intensive versus a standard intervention in HIV-infected patients with moderate-high cardiovascular risk. A pilot randomized clinical trial. Stable HIV-infected patients with viral suppression on antiretroviral therapy, and two or more cardiovascular risk factors or a Framingham risk score >or=10%. An intensive intervention targeting low-density lipoprotein (LDL)-cholesterol <100 mg/dl, using antiplatelet therapy, and switching protease inhibitor (PI) therapy, was compared with the standard intervention aiming for LDL-cholesterol <130 mg/dL. The primary endpoint was progression of atherosclerosis measured by the carotid intima-media thickness (cIMT). Secondary endpoints were efficacy in achieving the LDL-cholesterol goal, changes in inflammatory biomarkers, and feasibility and safety of the intervention. Thirty-two (47%) and 36 (53%) patients were assigned to the intensive and the standard interventions, respectively. After 12 months, the median proportion of change in the cIMT was +1.63% (-4.95 to +10.54) in the intensive intervention, and +1.79% (-6.61 to +6.1) in the standard group (P = 0.59). LDL-cholesterol (39% versus 7%, P < 0.001) and Framingham score (10% versus 0%, P = 0.03) showed larger reductions in the intensive group. No significant changes in levels of C-reactive protein, interleukin-6 and tumour necrosis factor-alpha were found. No significant adverse events were reported and no virological failures occurred during the study. An aggressive intervention targeting LDL-cholesterol in HIV-infected patients was safe and capable of attaining very stringent target levels in adherent patients. However, the intervention did not influence cIMT progression or inflammatory biomarkers after 1 year of follow-up.

Use of Diet, Nutritional Supplements and Exercise in HIV-Infected Patients Receiving Combination Antiretroviral Therapies: A Systematic Review

The use of combination antiretroviral therapy (cART) has improved the prognosis of HIV infection, but it has also been linked to a spectrum of body composition changes and metabolic alterations known as the lipodystrophy syndrome. Nutritional status could influence body composition changes. We performed a systematic search of published peer-reviewed data on the effects of diet, nutrition support and exercise on body composition and metabolic complications in patients receiving cART. Few controlled studies, most of them with small sample size, were found. Oral nutritional support increases protein and energy intake, and results in body weight and fat mass gains. Resistance exercise, with or without an aerobic component, increases lean mass and can improve insulin resistance. Low-fat diets or exercise can result in loss of fat mass, and they should be used with caution in subjects with lipoatrophy. Nutritional support and exercise result in small but significant body composition changes and can be used as complementary interventions. There is a need for further research on nutritional interventions in HIV-infected patients receiving cART.

Liver transplantation in HIV-positive patients

This article reviews the worldwide evolution of liver transplantation as a therapeutic intervention in HIV-infected patients. Since the introduction of highly active antiretroviral therapy (HAART), liver disease secondary to viral hepatitis has become a leading cause of morbidity and mortality among HIV-positive individuals. The authors contrast survival data from pilot studies in the pre-HAART era to those data emerging from more recent trials. Particular emphasis is placed on current selection criteria for HIV-positive transplant candidates. Additional consideration is given to the effect of prolonged transplant waiting time on survival outcome. The complexity of the post-transplant medication regime, including drug interactions, optimal immunosuppression and most appropriate HAART regimes, are discussed in detail. Postoperative challenges including optimal management of hepatitis B virus and recurrent hepatitis C virus post-transplant are reviewed separately. The ethical and practical arguments relating to the use of a scarce and valuable resource in this population are debated. The authors conclude with several recommendations to assist pretransplant assessment and postoperative management of such complex patients and speculate on the direction and evolution of this field in the coming years.

Productivity costs and determinants of productivity in HIV-infected patients

Background: In HIV-infected patients, reduced ability to work may be an important component of the societal costs of this disease. Few data about productivity costs in HIV-infected patients are available. Objective: The goals of this study were to estimate productivity costs in the HIV-infected population in Switzerland and to identify characteristics that may influence patient productivity. Methods: This cross-sectional study included all patients younger than retirement age (65 years for men and 62 years for women) who were enrolled in the Swiss HIV Cohort Study in 2002. Measures of productivity losses in this population were based on patients' ability to work and the median monthly wage rates adjusted for age, sex, and educational level in Switzerland. Factors associated with ability to work were analyzed in a multivariate ordinary logistic regression (proportional odds) model. As of July 1, 2002, the exchange rate for US dollars to Swiss francs (CHF) was US $1.00 ≈ CHF 1.48. Results: A total of 5319 HIV-infected patients (3665 men [68.9%] and 1655 women [31.1%]; mean [SD] age, 40.6 [8.4] years; range, 17–64 years) were included in the study. The mean annual productivity loss per patient was estimated at CHF 22,910 (95% CI, CHF 22,064-CHF 23, 756). Ability to work was independently associated with the following ( P < 0.001 for all): age (10-year increase: odds ratio [OR], 0.60 [95% CI, 0.54–0.62]), sex (female/male: OR, 0.73 [95% CI, 0.63–0.84]), history of IV drug use (OR, 0.22 [95% CI, 0.19–0.26]), time since first positive HIV test (>10 years vs ⩽10 years: OR, 0.66 [95% CI, 0.58–0.76]), CD4 cell count (201–500 vs 0–200 cells/μL: OR, 1.68 [95% CI, 1.38–2.46]; ⩾501 vs 0–200 cells/μL: OR, 2.01 [95%, CI, 1.64–2.46]), history of AIDS-indicator disease (OR, 0.47 [95% CI, 0.41–0.55]), stable partnership during the last 6 months (OR, 1.63 [95% CI, 1.43–1.86]), and educational level (higher vs basic: OR, 1.68 [95% CI, 1.45–1.95]). Conclusions: Productivity losses to society for the HIV-infected population appeared to be substantial in this analysis. Given a patient's clinical health status, a higher education level and a stable partnership were associated with greater ability to work. Socioeconomic characteristics may influence the cost-effectiveness of health care interventions in HIV-infected patients.

Quality of life in HIV infection.

HIV infection gives rise to incurable, debilitating disease in young persons and treatments capable of prolonging survival are often associated with toxicity. Quality of Life (QOL) assessment is therefore important in the evaluation of clinical interventions in HIV-infected patients. It also has a role in determining the needs of individuals and directing healthcare resources. A wide range of QOL instruments is available and choice of instrument should be guided by the information required. As would be expected, poorer QOL is correlated with the presence of disease-related symptoms and advancing WHO clinical stage of disease. Psychological dysfunction, however, is evident from the time of diagnosis and should not be overlooked.