Mortality In HIV-infected Patients Research Articles

Predictors of short-term mortality in HIV-infected patients admitted to Intensive Care Unit

Introduction: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. Objective: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. Methods: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. Results: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% between 2003 and 2012. Among the risk factors for mortality were low albumin, high APACHE, low CD4+ T lymphocyte count, and not using antiretroviral therapy. Conclusion: Despite the availability of diagnosis and treatment for HIV-infected individuals, the number of new cases of advanced Aids diagnosed in high-complexity services such as ICU is high, as well as the non-use of combination antiretroviral therapy. It is necessary to strengthen anti-HIV screening to detect and treat more cases in the early stages.

Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients.

Antiretroviral therapy (ART) prolongs lifespan and decreases mortality of HIV infected patients. However, many patients do not achieve optimal immune reconstitution. The influence of non-optimal immune recovery on non-AIDS related diseases is not well defined in aged HIV-infected patients receiving ART. A retrospective study was conducted at Tianjin Second People's Hospital, China to evaluate the association of an inadequate immunological response and non-AIDS diseases in HIV infected patients ≥60 years of age and virally suppressed for at least 2 years by ART. The study included patients (n = 666) who initiated ART between August 2009 and December 2020. The prevalence of patients with an inadequate immunological response was 29.6%. The percentage of non-AIDS diseases such as hypertension, cardiovascular disease (CVD), diabetes, tumor, and chronic kidney disease (CKD) was 32.9, 9.9, 31, 4.1, and 13%, respectively. In addition to baseline CD4+ T cell counts, CVD and tumor were associated with poor immune reconstitution in aged Chinese HIV-1 infected patients. The adjusted odds ratios (95% confidence interval) were AOR 2.45 (95% CI: 1.22-4.93) and 3.06 (95% CI: 1.09-8.56, p = 0.03). Inadequate immunological response was associated with greater mortality (AOR: 2.83, 95% CI: 1.42-5.67, p = 0.003) in this cohort. These results tend to demonstrate appropriate drug selection at ART initiation and prevention of non-AIDS complications during ART decreased mortality of and an inadequate immunological response in aged HIV infected patients.

HIV and liver disease.

Liver-related diseases are associated with the high levels of morbidity and mortality in people living with HIV. Between 13% and 18% of all-cause mortality in HIV-infected patients involves a liver-related damage, this being one of the main causes of death not related to acquired immunodeficiency syndrome (AIDS). People living with HIV, even when the disease is under control, are more likely to develop pathologies and complications of a liver-related origin than the general population, both due to common causes such as alcoholism, non-alcoholic fatty liver disease, hepatic viral infections and ageing, in addition to specific HIV-related processes such as antiretroviral treatment toxicity and liver damage inherent to HIV infection. On the other hand, some antiretroviral drugs may have a beneficial effect in reversing liver fibrosis in patients with HIV and chronic liver disease. This paper reviews the main risk factors associated with liver disease in people living with HIV and the role of antiretroviral therapy (ART) in this disease.

Dynamics of hospital admissions and all-cause mortality of HIV infected patients in Kazakhstan: data from unified nationwide electronic healthcare system 2014-2019.

Although global HIV pandemic has stabilized, it continues to rise in Eastern Europe and Central Asia due to exponential growth of newly acquired cases. Based on UNAIDS, there are currently 35,000 people living with HIV (PLWH) in Kazakhstan. This alarming HIV epidemiologic situation mandates urgent investigation of causes, routes of transmission and other characteristics in order to halt the epidemic. We aimed to analyze the data of all hospitalized patients for the period of 2014-2019 who tested positive for HIV from the Unified National Electronic Health System (UNEHS) of Kazakhstan. This cohort study extracted data for all HIV positive patients during 2014-2019 from UNEHS of Kazakhstan to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Crosscheck of the target population data was conducted with tuberculosis, viral hepatitis, alcohol abuse and intravenous drug user (IDU) cohorts in order to create a comprehensive database. All survival functions and factors associated with mortality were tested for significance. The cohort population (n = 2,213) mean age was 33.3 ± 13.3 years with 1,375 males (62.1%) and 838 females (37.9%). Incidence rate decreased from 2.05 in 2014 to 1.88 in 2019, however, prevalence and mortality continues to escalate every year, the mortality raised significantly from 0.39 in 2014 to 0.97 in 2019. People aged >50 years, males, retired people, patients from tuberculosis hospital profile had much lower survival probabilities than the corresponding groups. Adjusted Cox regression model death hazard showed strong association of HIV patients with tuberculosis coinfection (HR 1.4, 95% CI 1.1; 1.7, p < 0.001). The results of this study demonstrate high rates of HIV mortality, strong association of HIV with TB coinfection, regional, age specific, gender, hospital profile and social status differences that significantly affect HIV prevalence. Since the prevalence of HIV is continuing to increase, more information is necessary for evaluation and implementation of prevention procedures.

The impact of HIV co-infection on presentation and outcome in adults with tuberculous pericarditis: Findings from the IMPI trial

Background. Little is known about the impact of HIV infection on clinical presentation, complications, and morbid pericarditis-relatedoutcomes of tuberculous pericarditis and its predictors.Objective. To assess the impact of HIV infection on presentation and outcomes in the multicountry Investigation of the Management of Pericarditis (IMPI) randomised controlled trial of immunotherapy in tuberculous pericarditis conducted in sub-Saharan Africa.Methods. We compared clinical features and outcomes of 1 370 adult patients treated for tuberculous pericarditis (939 and 431 HIVinfected and uninfected, respectively) enrolled in the IMPI trial. Cox proportional hazards models were used to determine independent predictors of outcomes of HIV-associated tuberculous pericarditis.Results. At presentation, HIV-infected (v. uninfected) patients were younger (median age 34.0 years v. 47.7 years), had lower body mass (mean weight 56 kg v. 60 kg), higher prevalence of tachycardia (58.5% v. 51.9%), hypotension (9.4% v. 3.9%), anaemia (65.9% v. 26.8%), and radiographic pulmonary infiltrates compatible with tuberculosis (35.4% v. 27.4%), but had lower rates of peripheral oedema (37.1% v. 48.3%). HIV-infected (v. uninfected) patients were less likely to develop constrictive pericarditis (4.1% v. 10.0% at 1 year, p&lt;0.0001 (hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.27 - 0.63, p&lt;0.0001)). However, there was no difference in case fatality rate at 1 year (14.9% v. 12.2%, respectively, p=0.09; (HR 1.20, 95%CI 0.90 - 1.59, p=0.22)). Among HIV-infected patients, heart failure New York Heart Association (NYHA) class III - IV, low body mass, hypotension, and peripheral oedema were independently associated with death.Conclusion. HIV infection alters the cardiovascular presentation and reduces the incidence of constrictive pericarditis, but does notincrease case fatality. Mortality in HIV-infected patients is independently predicted by markers of pericardial and tuberculosis diseaseseverity.

HIV- RELATED PULMONARY ARTERIAL HYPERTENSION: A CASE REPORT

The use of highly active antiretroviral therapy (HAART) has increased the life expectancy of HIV-infected patients. With prolonged survival and improved control of infectious susceptibility, vascular complications have emerged as a signicant source of morbidity and mortality in HIV-infected patients [1]. HIV-associated pulmonary arterial hypertension (HIV-PAH) is an important lung disease in HIV-infected persons who live longer with antiretrovirals. HIV-PAH may be detected via chest radiographs, CT scans, or electrocardiograms, but Doppler echocardiography is the most useful screening test to identify candidates for right heart catheterization. Because the survival for HIV-infected individuals with PAH with advanced symptoms (New York Heart Association, NYHA class III-IV) is worse compared with less symptomatic individuals (NYHA class I-II) (2), identication of asymptomatic individuals is of critical importance. Histologically, THE lesions in HIV-infected patients with PAH include concentric laminar intimal brosis, medial hypertrophy, recanalized thrombi, and plexiform lesions (3). According to a more recent study by Sitbon et al [4] in 2008, the prevalence has remained at 0.5% even in the modern era of HIV therapy, suggesting that HAART has not made a dramatic impact on the prevention of HIV-PAH. We present a case of HIVPAH to highlight the importance of the non-infectious pulmonary complications associated with HIV disease.

1176: EFFECT OF HIV INFECTION ON SHORT-TERM MORTALITY IN SEPSIS: A POPULATION-BASED COHORT STUDY

Introduction: The reported short-term mortality among septic patients infected with the human immunodeficiency virus (HIV) is markedly higher compared to the general population. However, the evidence base on the prognostic impact of HIV in sepsis is generally dated, based mostly on small cohorts, and the temporal trajectories of sepsis-related short-term mortality in HIV-infected patients are unknown. Methods: We used a statewide dataset identify hospitalizations aged ≥18 years with sepsis in Texas during 2014-2017. Sepsis was defined by “explicit” ICD-9 and ICD-10 codes for severe sepsis (995.92, R65.20) and septic shock (785.52, R65.21). HIV was identified using ICD-9 and ICD-10 codes 042 and B20. Hierarchical logistic models were used to estimate the association of HIV with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations and for sensitivity analyses restricted to ICU admissions and those with septic shock. Results: Among 283,025 sepsis hospitalizations, 2,079 (0.7%) had HIV. Compared to those without HIV, sepsis hospitalizations with HIV were younger (aged ≥65 years, 7.6% vs 57.0%), more commonly racial minority (76.0 % vs 47.8%), uninsured (20.9% vs 8.5%), and had higher mean [SD] Deyo comorbidity index (6.0 [2.1] vs 2.6 [2.4]); [p < 0.0001 for all comparisons]. The rates of septic shock were similar among sepsis hospitalizations with and without HIV (61.5% vs 59.6%; p = 0.0786). Short-term mortality among sepsis hospitalizations with and without HIV was 29.1% vs 31.2%, respectively. On adjusted analyses, HIV was not associated with short-term mortality (adjusted odds ratio [aOR] 1.04 [95% CI 0.93-1.16]), with similar findings on sensitivity analyses. Short-term mortality among sepsis hospitalizations did not change statistically over time among those with HIV (aOR 1.01/year [95% CI 0.85-1.20]), but decreased among those without HIV (aOR 0.98/year [95% CI 0.97-0.99]). Conclusions: HIV infection was not associated with adverse impact on short-term mortality in sepsis. However, short-term mortality remained statistically unchanged over time among sepsis hospitalizations with HIV, contrasting the downtrend among those without HIV. Further studies are needed to determine the factors underlying the diverging mortality trends.

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.

Commentary: Chinese Herbal Medicine Usage Reduces Overall Mortality in HIV-Infected Patients With Osteoporosis or Fractures.

Commentary: Chinese Herbal Medicine Usage Reduces Overall Mortality in HIV-Infected Patients With Osteoporosis or Fractures.

Fluoroquinolone antibiotics: in vitro antibacterial and time-kill bactericidal evaluation against etiology of bacteremia in human immunodeficiency virus (HIV)-infected patients

BackgroundBacteremia constitutes a significant public health challenge and represents a vital cause of morbidity and mortality in HIV-infected patients, and fluoroquinolones are commonly prescribed antibiotics due to their range of activities and pharmacokinetic profiles. This study the evaluated antibacterial activities and time-kill kinetics of fluoroquinolone antibiotics: Ofloxacin (OFL), Ciprofloxacin (CIP) and Levofloxacin (LEV) against the etiology of bacteremia of genera Staphylococcus, Streptococcus, Acinetobacter, Pseudomonas, Klebsiella, Haemophilus, Enterobacter, and Salmonella using disc diffusion, micro-broth dilution and plate count techniques.ResultsThe lowest mean growth inhibition zones (mm ± SD) of OFL, LEV, and CIP against the isolates were 10.5 ± 0.0, 10.1 ± 0.1 and 9.6 ± 0.3, respectively. The MIC values of OFL, LEV and CIP on isolates ranged from 6.25 to > 50 µg/mL, MBC ranged from 12.5 to > 50 µg/mL, while MBC/MIC ratios were ≤ 2. The time-kill assay revealed that logarithmic reductions in viable cell counts (Log10 CFU/mL) of bacteria exposed to OFL, LEV and CIP ranged from 0.17 to 2.14 for P. aeruginosa; 0.13 to 1.31 for H. influenzae; 0.04 to 2.23 for Acinetobacter spp; and 0.08 to 2.08 for K. pneumoniae. LEV and OFL (1 × MIC concentration) achieved bactericidal effects on S. typhi ST07 and E. aerogenes EA01 at 30 h post-inoculation, respectively, while ≥ 99.9% reduction in the number of viable K. pneumoniae cells exposed to CIP was achieved at 24 h post-inoculation.ConclusionThe fluoroquinolones demonstrated higher inhibitory activities at higher concentrations against the etiology of bacteremia in HIV-infected patients, signifying a concentration-dependent inhibition of bacterial growth. The MIC-based time-kill curve analyses showed that LEV achieved 3 Log10-fold reduction (≥ 99.9% reduction) in CFU/mL of most etiology of bacteremia faster compared with the other two fluoroquinolones.

Classification of Absolute Cd4+ T Lymphocytes Count in Immunological, Virological and Erythropoietic Growth Factor among HIV Infected Patients

Background: HIV-infection resulted in CD4+ T-cell depletion which is accompanied by an increase in CD8+ T-cells resulting in an inverted CD4/CD8 ratio. Low CD4/CD8 ratio has been identified as a hallmark of inmmunosenescence and a surrogate of mortality in HIV infected patients especially in ART-naïve patients Aim: Classification of absolute CD4+ T-lymphocytes count in immunological, virological and erythropoietic growth factor among HIV infected patients Methodology: One hundred samples each was collected from HIV positive subjects on ART and HIV positive subjects ART naïve. Six milliliters of whole blood was collected from each consented subject, 3ml was dispensed into 5ml K2EDTA bottle for immediate analysis of absolute CD4 count, CD8 count, total white cell count and HIV screening. The remaining 3ml of blood was dispensed into plain bottle; serum was extracted for the analysis of erythropoietin and viral load Results: Mean values of CD8, CD4/CD8, EPO and TWBC in CD4 &lt;200 were significantly (p&lt;0.05) lower compared to CD4 &gt;500 and CD4 200-499. Mean values of VL in CD4 &lt;200 were significantly (p&lt;0.05) higher compared to CD4 &gt;500 and CD4 200-499 among HIV subjects on ART and ART-naïve Conclusion: Immunological and erythropoetic growth factor assessed in this study were decline while viral load was increasing as HIV infection progresses with depletion in absolute CD4 count, this study shows the efficacy of ART on the treated subjects. However, based on this study, absolute CD8 T cells count, CD4/CD8 ratio and erythropoietin can be used as surrogate makers to ascertain pathogenesis in HIV-infected subjects.

Influencing Factors of Mortality Among Adult HIV Patients Under Antiretroviral Therapy: The Case of Hossana Queen Elleni Mohammad Memorial Hospital, Ethiopia

Even though the use of ART has brought a significant reduction in the mortality and morbidity of patients living with HIV/AIDS globally, still a number of patients die after the start of Antiretroviral Therapy. This study aimed at identifying influencing factors of mortality among adult HIV infected patients who are on ART in Hossana Queen Elleni Mohammad Memorial Hospital. The data for the study were obtained from Hossana Queen Elleni Mohammad Memorial Hospital Antiretroviral Therapy clinic. The HIV infected patients ≥ 15 years of age. Binary logistic regression model was applied to analyze the data so as to identify the influencing factors associated with mortality of HIV infected patients. A total of 400 adult HIV infected patients who were under ART were included in the study. Of 400 patients, 18.75% of them died. Age of the patients 40 or above (OR=1.73, 95% CI: 1.13–1.92), primary education (OR=0.29, 95% CI: 0.030–0.71), secondary or above education (OR=0.13, 95% CI: 0.03–0.16), alcohol (OR=3.35, 95% CI: 1.79– 6.27), baseline weight 50 kg or above (OR=0.42, 95% CI: 0.23–0.77), TB positive (OR=3.76, 95% CI: 2.06–6.83), and baseline CD4 200 or above (OR=0.24, 95% CI: 0.19–0.50) were significantly associated with mortality among HIV patients under Antiretroviral Therapy. Health workers need to support those patients with no or little education by continuous awareness creation of taking care of themselves and knowing what factors facilitate death. Furthermore, patients who drink alcohol need to reduce excessive drinking.

Cytological Spectrum of Pulmonary Histoplasmosis Diagnosed by Bronchoalveolar Lavage: 12 Years of Experience in French Guiana

Disseminated histoplasmosis is a major cause of mortality in HIV-infected patients. Rapid and efficient diagnosis of Histoplasma capsulatum is crucial. Cytopathology is available in most hospitals and represents a rapid diagnostic alternative. In this study, we reviewed 12 years of experience to describe the cytology of histoplasmosis diagnosed by bronchoalveolar lavage (BAL) in relation to patient characteristics. BAL-diagnosed pulmonary histoplasmosis concerned 17 patients (14 HIV+). BAL cellularity ranged from 76,000 to 125,000 cells/mL in HIV patients, and 117,000 to 160,000 cells/mL in non-HIV patients. Macrophages predominated in all HIV patients (from 60% to 88%), lymphocytic infiltrates ranged from 5% to 15%, and neutrophils were very heterogeneous (from 2% to 32%). The number of H. capsulatum at hot spots seemed greater in HIV-infected than in immunocompetent patients (9 to 375 vs. 4 to 10) and were inversely proportional to the CD4 counts. Yeasts were both intracellular and extracellular in 85.7% of the HIV patients. This is the most comprehensive series detailing the cytological aspects of BAL in the diagnosis of H. capsulatum, focusing on the number of yeasts and their clustering pattern. The cytological examination of the Gomori-Grocott-stained BAL allows a reliable diagnosis of histoplasmosis.

Effect of HIV infection on pre- and post-liver transplant mortality in patients with organ failure.

Organ failure (OF), a leading cause of death in HIV-positive individuals, is common in patients undergoing liver transplantation (LT). We examined the impact of HIV infection on pre- and post-LT mortalities in cirrhotic patients stratified by the number and type of OFs. We performed a cross-sectional study and a retrospective cohort study using the US National Inpatient Sample (NIS) and the United Network for Organ Sharing (UNOS) registry data, respectively. Patients who had not yet undergone LT from the NIS database (2010-2014) and patients undergoing LT from the UNOS database (2003-2016) were included in the study. Analysis of patients (201348) from the NIS database showed that one [adjusted odds ratio (aOR) 1.531; 95% confidence interval (CI) 1.160-2.023], two (aOR 1.624; 95% CI 1.266-2.083) or three or more OFs (aOR 1.349; 95% CI 1.165-1.562) were associated with higher pre-LT mortality in HIV-infected patients compared with HIV-negative patients with the corresponding number of OFs. In patients without OF, HIV infection was not associated with increased pre-LT mortality. UNOS data for patients undergoing LT (38942) showed that the presence of two or more OFs was associated with increased post-LT 1-year mortality in HIV-infected patients compared with non-HIV-infected patients with the corresponding number of OFs (aOR 2.342; 95% CI 1.576-3.480). However, in patients with no OF or only one OF, HIV infection was not associated with increased post-LT 1-year mortality (aOR 1.372; 95% CI 0.911-2.068). The results of this study emphasize the importance of preventing OF development, and justify LT for HIV-infected patients with no or only one OF.

Chinese Herbal Medicine Usage Reduces Overall Mortality in HIV-Infected Patients With Osteoporosis or Fractures.

The survival of patients with HIV has greatly improved, due to Anti-Retroviral Therapy (ART). However, long-term HIV survivors often develop serious bone abnormalities, possibly due to the interplay of osteoblasts, osteoclasts, HIV ad ART. We evaluated in a nation-wide study in Taiwan the effect of Chinese herbal medicine (CHM) on overall mortality in HIV patients with osteoporosis or fractures. Enrollment period was between 1998 and 2011. Patients with osteoporosis or fractures before the HIV infection, and those with less than 14 days CHM use, were excluded. This left 498 patients, 160 CHM users, 338 without CHM. Univariate Kaplan-Meier and multivariate Cox regression analysis were used to compare the overall mortality in these 2 groups. Due to the nature of Chinese medicine, CHMs inevitably varied. We therefore also used rule mining and network analysis to determine which major CHM clusters were prescribed to the patients. CHM users had a much Lower mortality (hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.24–0.77, p < 0.005) and higher survival (p = 0.004, log-rank test). Although the CHMs greatly varied, network analysis identified one main cluster of strongly related CHM combinations (Chuan-Xiong-Cha-Tiao-San (CXCTS), Gan-Cao (GC; Glycyrrhiza uralensis Fisch.), Liu-He-Tang (LHT), Huang-Qin-Tang (HQT), Jia-Wei-Ping-Wei-San (JWPWS), and Dang-Gui-Long-Hui-Wan (DGLHuiW)). CHM as an additional treatment strongly improves overall survival in HIV-infected patients with osteoporosis and fractures.

NEUROLOGICAL COMPLICATIONS OF HIV INFECTION, EPILEPTIC SEIZURES AND RISK OF DEATH

Objectives: The study highlights the importance of epileptic seizures in HIV-positive patients with neurological complications, as well as the main neurological disorders that the seizures occurred in. The risk of death associated with seizure onset and the risk of death of the neurological conditions that the seizures arose from was calculated. Methods: 166 HIV-positive patients with neurological disorders admitted to the Clinical Infectious Diseases Hospital of Constanta between June 2012 and June 2020, were enrolled in an analytical, observational, and retrospective study. The data were extracted from the observation and follow-up sheets of these patients, which presented with neurological manifestations such as epileptic seizures. The data were processed using the IBM SPSS statistics 23 software. Results: Epileptic seizures were described in 47 patients (28,3%) and have been associated more with Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT) and less with HIV associated dementia (HAD) (p &lt; 0,05). Extrapolating, the association of seizures with opportunistic infections versus other neurological complications was statistically significant (p &lt; 0.05). The risk of death was 6 times higher for the patients diagnosed with opportunistic infections than for those suffering from other neurological conditions. In general, the risk of death associated with epileptic seizures in HIV positive patients was 3 times higher, compared to the risk of death in patients without epileptic seizures. Conclusions: The presence of epileptic seizures should accelerate the rhythm of the investigations being conducted; in order to establish the etiological diagnosis and decrease the morbidity and mortality of HIV-infected patients with neurological complications.

Hemoglobin and CD4 count in HIV patients initiating antiretroviral therapy at a tertiary care hospital in Goa

Background: Hematological abnormalities are known to be independent predictors of morbidity and mortality in HIV-infected patients. The current study was conducted to evaluate the hemoglobin levels and CD4 count at the time of initiation of highly active antiretroviral therapy (HAART) of newly diagnosed HIV/AIDS patients attending ART centre at Goa Medical College.Methods: A hospital based observational retrospective study was carried out in Department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from patient’s treatment record card at the ART centre using preformed questionnaire.Results: The prevalence of anaemia in study participants was 66.35%. The prevalence of severe anaemia and mild-moderate anaemia was 9% and 57.3% respectively, while 33.65% of participants were not anaemic. Significant difference was observed in the prevalence of anaemia among immune deficient male participants (CD4 count &lt;500 cells/mm3) and participants with no significant immune deficiency (CD4 count ≥500 cells /mm3) (77.5% versus 50%). Significant difference was also seen in the prevalence of anaemia among immune deficient female participants (CD4 count &lt;500 cells/mm3) and participants with no significant immune deficiency (CD4 count ≥500 cells /mm3) (93.5% versus 56%).Conclusions: The current study revealed high prevalence of anemia in HIV patients prior to the initiation of ART in both males as well as females. Mild to moderate anemia was predominant in the study participants than severe anemia. There was significant difference observed in the prevalence of anemia among immune deficient population and participants with normal CD4 count. Prompt diagnosis of anaemia, identification of the underlying cause of anaemia in HIV patients as well as the implementation of appropriate treatment is essential.

Clinical features and Outcomes of Cryptococcemia patients with and without HIV infection.

The effects of cryptococcemia on patient outcomes in those with or without HIV remain unclear. One hundred and seventy-nine cryptococcemia patients were enrolled in this retrospective study. Demographic characteristics, blood test results and outcome were compared between the two groups. The diagnosis time of Cryptococcus infection was 2.0(0-6.0) days for HIV-infected patients, 5.0 (1.5-8.0) days for HIV-uninfected patients (p=.008), 2.0 (1.0-6.0) days for cryptococcal meningitis (CM) patients and 6.0 (5.0-8.0) days for non-CM patients (p<.001). HIV infection [adjusted odds ratio (AOR) (95% confidence interval): 6.0(2.3-15.9)], CRP<15mg/L [AOR:3.7(1.7-8.1)) and haemoglobin>110g/L [AOR:2.5(1.2-5.4)] were risk factors for CM development. Forty-six (25.7%) patients died within 90days. ICU stay [AOR:2.8(1.1-7.1)], hypoalbuminemia [AOR:2.7(1.4-5.3)], no anti-cryptococcal treatment [AOR:4.7(1.9-11.7)] and altered consciousness [AOR:2.4(1.0-5.5)] were independent risk factors for 90-day mortality in all patients. HIV infection did not increase the 90-day mortality of cryptococcemia patients when anti-Cryptococcus treatment was available. Non-Amphotericin B treatment [AOR:3.4(1.0-11.2)] was associated with 90-day mortality in HIV-infected patients, but age≥50.0years old [AOR:2.7(1.0-2.9)], predisposing disease [AOR:4.1(1.2-14.2)] and altered consciousness [AOR:3.7(1.1-12.9)] were associated with 90-day mortality in HIV-uninfected patients who accepted anti-Cryptococcus treatment. HIV infection increased the incidence of CM rather than mortality in cryptococcemia patients. The predictive model was completely divergent in HIV-infected and HIV-uninfected patients, suggesting that novel strategies for diagnosis and treatment algorithms are urgently needed.

Age and gender aspects of HIV-infected patients mortality

Aim of study: to present the causes of mortality in HIV-infected patients, taking into account age and gender aspects.Materials and methods. The frequency, causes of mortality in the group of 284 HIV-infected patients are analyzed. Among them were 190 (66,9%) men, 94 (33,1%) women. The average age of patients was 45,3±4,2 years. The medical documentation of patients were retrospectively analyzed.Results. In the analyzed group of deceased HIV-infected patients, the overwhelming majority were young people under 40 years old (61.6%) compared with people who died between the ages of 41–50 years old — 73 (25,7%) and 51 years old and older 36 (12,7%) (p&lt;0,05). In all age groups, the proportion of deceased men significantly (more than 2 times) exceeded the proportion of women. Among young males, co-infection with viruses of parenteral hepatitis, tuberculosis and alcohol abuse is more common. Over 70% of deceased patients did not receive ART or were on short courses of therapy (less than 1 year). The average life expectancy after HIV-infection diagnosis was 5,8±4,4 years and did not differ depending on the gender and age of the patients. AIDS-related causes of death accounted for 141 (49,6%) cases, nonAIDS-associated — 143 (50,4%). Among AIDSrelated causes, tuberculosis was the most frequent (59/20,8%). Among non AIDS-associated causes, death was associated with the decompensation of liver cirrhosis. A significant influence on the formation of AIDS-associated mortality of a complex of factors — co-infection with viruses of parenteral hepatitis, the presence of «advanced» stages of HIV infection, alcoholism and life expectancy with HIV infection, must be taken into account when monitoring HIV-infected patients.

Relationships among Self-Efficacy, Quality of Life, Perceived Vulnerability, and Readiness to Quit Smoking in People Living with HIV.

Smoking-related diseases (e.g., lung cancer) are the leading cause of mortality in HIV-infected patients. While many PLWH who smoke report a desire to quit, a majority of them have low readiness to quit. This study used logistic and linear regression to examine the relations among two (continuous vs. binary) measures of readiness to quit, smoking cessation self-efficacy (SE), quality of life (QoL), and perceived vulnerability (PV) using baseline data from 100 PLWH who smoke who participated in a clinical trial. Results showed no significant main effects (SE, QoL, and PV) or interaction effects (SE × QoL and SE × PV) on a continuous measure of readiness to quit. However, a follow-up analysis revealed that SE had a curvilinear effect on readiness to quit such that self-efficacy was positively associated with readiness to quit except at the highest levels of self-efficacy where readiness to quit declined. Greater SE significantly increased the likelihood of reporting readiness to quit (yes/no) among those with low QoL or high PV. For PLWH who smoke, improving self-efficacy may increase readiness to quit especially among those with lower quality of life. Psychoeducation tailored to PLWH designed to reduce unrealistic invulnerability to smoking-related diseases along with interventions that target self-efficacy may improve readiness to quit.