Mortality In HIV Patients Research Articles

Linear Programming Model and Dietary Plan for HIV- Infected Children Ages 6 - 9 Years Using Locally Available Foods in Simiyu, Tanzania

Most HIV - infected patients lose weight, and weight loss is linked to mortality in HIV patients. An adequate diet is essential at all times to avoid weight loss, combat infection, and build and retain muscular mass. A linear programming model has been employed to model the diet for HIV - infected children aged 6-9 years to maximize energy intake using locally available foods. Fifty-eight food items obtained from a previous 24 - hours dietary recall assessment was modeled. A food exchange list was used to distribute food items into breakfast, lunch and dinner. Three different dietary plans were formulated from locally available food with recommended amount of energy intake of greater than or equal to 1815 Kcal.

Prognostic Factors in Hospitalized Patients with HIV-Associated Burkitt's Lymphoma - Real World Data Analysis

Introduction Burkitt Lymphoma (BL) is a highly aggressive and rare B-cell non-Hodgkin Lymphoma, characterized by translocation and dysregulation of the MYC gene. BL comes in three distinct forms: endemic, sporadic, and immunodeficiency related, which is most commonly secondary to HIV. Despite improvements in antiretroviral therapy (ART), the reported incidence of BL has remained stable over time. BL is a highly curable disease in patients able to tolerate aggressive therapies. However, little is known about real-world outcomes in United States patients with HIV- related BL. Our study highlights multiple factors associated with inpatient mortality and morbidity. Methods The National Inpatient Sample database was queried from October 2015 to December 2020. Adults aged >= 18 with a primary diagnosis of BL were identified and stratified into those with and without HIV. Complications included were queried using ICD codes most found in the secondary diagnosis variables. Baseline characteristics, inpatient complications, and outcomes were compared using chi-squared and Wilcoxon rank-sum tests. Logistic regression analysis was performed to assess the risk of death before and after adjusting for multiple risk factors. Results We found 3,650 admissions with a primary diagnosis of BL, 400 (11%) of whom had HIV. Patients with HIV were younger, 49% were younger than 40 years old as compared to 29% in patients with no HIV. There was a higher percentage of black patients 115 (29%), and most had Medicaid 170 (44%), there was no difference between income, hospital bed size or geographical region. Interestingly, in multivariable analysis, there were no significant differences in length of stay, race, or mortality between patients with and without HIV. The factors associated with mortality in HIV patients included acute renal failure OR 11.4 (1.22 to 107) and Sepsis OR 38.6 (1.62 to 921) Conclusion BL is an increasingly important disease in HIV-infected patients given that the incidence remains high despite advances in ART. This nationwide data analysis demonstrates the demographic characteristics of patients with HIV-associated BL in the US and the encouraging findings that outcomes are not significantly different between patients with and without HIV. Yet our study demonstrates the disproportionate distribution of HIV-BL in females and black patients. Further studies are needed to examine gender and racial disparities.

Chronic diarrhea in a pediatric patient with HIV

Despite advances in antiretroviral therapy (ART), diarrhea remains a common problem with HIV infection and contributes to reduced quality of life and survival in HIV-infected patientes. Diarrhea is estimated to occur in approximately 90 % of HIV/AIDS patients in developing countries and between 30 % and 60 % in developed countries. Opportunistic pathogens that cause diarrhea in HIV-infected persons include protozoa, fungi, viroses, and bacteria. Several species of protozoa belonging to Cryptosporidium, Microsporidia and Isospora, are among the most common causative pathogens responsible for significant morbility and mortality in HIV patients. The case of a pediatric patient with chronic diarrhea with HIV stage C3 in irregular treatment with antiretrovirals Abacavir, Lamivudine, Lopinavir/Ritonavir admitted to the Institute of Tropical Medicine in which Isospora belli was isolated in coproparasitological for which she received treatment is presented below with Trimetropim-Sulfamethoxazole in addition to Griseofulvin for tinea capitis and Ivermectin and Permethrin 5 % lotion for scabies. Diarrhea can cause significant morbility in HIV-positive patients and can be due to a multitude of etiologies, from infectious pathogens to malignancy to drugs. Diarrhea is also an independent predictor of reduced quality of life and, in the case of advanced HIV disease, increased mortality.

Snapshots of ID Week 2022

Snapshots of ID Week 2022

CD4 Association with Mortality in HIV Patients with Dyspnea in Dr Seotomo General Academic Hospital Surabaya

Introduction: HIV AIDS patients who have a CD4 count < 200 cells/uL often complain of respiratory symptoms (Wallace, 1993). The complaint was shortness of breath (62%). Opportunistic infections (IO) in HIV patients are also brought on by a decreased CD4 count of 200 cells/uL (Peters, 2007). HIV/AIDS patients with CD4 < 200 cells/uL have a risk of death of 10.399 (Kusumaadhi, 2021). This study aims to determine the association between CD4 cell count with mortality in HIV patients with shortness of breath at Cendana, Dr. Soetomo General Academic Hospital Surabaya, during the period of January–December 2020.Methods: This study used a cross-sectional retrospective design. The population in this study were patients diagnosed with HIV at Cendana, Dr. Soetomo General Academic Hospital, using a total sampling technique. The variables studied were the CD4 counts as the independent variable, and the mortality of HIV patients with dyspnea as the dependent variable. The sample in this study must meet the inclusion criteria, namely, the sample must have a history of CD4 counts in their medical record in the last 2 to 3 months while in Cendana, Dr. Soetomo General Academic Hospital. Secondary data from medical record data in Cendana, Dr. Soetomo General Academic Hospital, was used for the research from January to December 2020. Results: A total of 128 HIV patients with dyspnea and a history of CD4 counts in the previous 3 to 4 months were included in the study: 79 (61.7%) males and 49 (38.3%) females. The most common age groups were 31–40 years (33.6%), 20–30 years (32.0%), 41–50 years (23.4%), and > 60 years (2.4%), with no patients under the age of 20. The distribution of the most opportunistic infections were: pneumocystis pneumonia (n = 62), tuberculosis (n = 49), and bacterial pneumonia (n = 17). Patients lived (n = 79) and died (n = 49) in total.Conclusion: There was no significant association between CD4 count and mortality in HIV patients with dyspnea (p-value 0.084 > 0.05).

Mortality in patients with acquired human immunodeficiency virus infection hospitalized in an intensive care unit during the period 2017–2019

Identify risk factors associated with mortality in HIV patients admitted to an ICU in the city of Bogotá. Retrospective cohort study of patients treated in an ICU during the years 2017–2019. The analysis included descriptive statistics, association tests, and a logistic regression model. A predictive model of mortality at the time of admission to the ICU was developed. 110 HIV patients were identified. Association was found between a Charlson index ≥ 6 and mortality (OR = 2.3, 95% CI 1.0–5.1) and an increase in mortality in the first 21 days of ICU stay (OR = 2.2, 95% CI 1.0–4.9). In the logistic regression analysis, the absence of highly active antiretroviral therapy (HAART) upon admission to the ICU (OR = 2.5 95% CI 1.0–6.1) and the first 21 days of ICU stay (OR = 2.3 95% CI 1.0–5.4) were associated with an increase in mortality. The predictive mortality model established that mortality was higher in patients admitted to the ICU without having previously received HAART than in those who did receive therapy at the time of admission to the ICU. In patients with HIV admitted to the ICU, the absence of HAART will negatively impact mortality during their hospital stay.

The Clinic trials of Human Immunodeficiency Virus

This review paper looks for future improvement for HIV. It is obvious that HIV has become a pandemic disease and causes serious problems to human life quality, social stability and public health. However, there are still a lot people get infected by HIV and the mortality of HIV patients has decreased compared with the time that the disease was discovered. By understanding the virus structure and the mechanisms when the pathogen enters the body, humans can find ways to solve AIDS infection in these ways, from the source of the pathogen, the transmission path, and patients infected by HIV. Second, by analyzing two successful cases of HIV cured patients and the failure cases, humans find out that not everybody is suitable for the same treatments as the two successful cased did. Although, nowadays, scientists are working on HIV vaccines, the process is very slow as there are still a lot of mysteries in human immunodeficiency virus and HIV vaccines. Few types of vaccines were undergoing clinical trials. Humans still have a long way to go to overcome HIV, but as more and more attention are paid to HIV patients and the projects which are trying to overcome it, HIV patients’ life quality had improved a lot and their life cycles are prolonged.

OUTCOME OF TUBERCULOSIS IN HIV INFECTED PATIENTS WITH SPECIAL REFERENCE TO CD4 COUNT IN AN ART CENTRE, WEST BENGAL

Background: Opportunistic Infections in HIV are major determinants of mortality in HIV patients. Tuberculosis is a leading cause of mortality. Tuberculosis is a public health challenge specially in developing countries like India. The incidence of TB HIVco-infection is gradually increasing. Methods: This was institution based, retrospective study. Study was conducted at ART Centre, North Bengal Medical College & Hospital, Sushruta Nagar, Darjeeling, West Bengal from January 2015 to January 2020 including 105 HIV-TB co-infected patients. Data was collected and template was generated in MS excel sheet and analysis was done on SPSS software. Results: 105, HIV-TB co-infected patients were registered with majority being male (n=79), mean age for male and female patients were 36.78 years and 35.73 years respectively.. The number of patients diagnosed with Extra-pulmonary tuberculosis (EPTB) and Pulmonary tuberculosis (PTB) were almost equal. Majority of patients (34.3%) had CD4 counts <200 whereas (33.3%) had CD4 counts between 200-349. Favourable outcome in terms of cured patients were 82.85% with a statistically signicant pre-treatment and post-treatment improvement in body weight (p value<0.0001) and CD4 count (p value<0.002. Conclusions: There is a strong association between incidence of TB and HIV infection. Early diagnosis and treatment are essential to reduce mortality and morbidity in people living with HIV. Strict adherence to treatment and dedicated counseling for drug compliance is the need of the hour.

Effect of antiretroviral therapy on cardiac risk markers in people living with HIV/AIDS.

Introduction:Chronic HIV infection and antiretroviral therapy (ART) are the major causes of cardiovascular diseases (CVDs) and mortality in HIV patients. This study was conducted to look upon the effect of ART on CVD risk markers in patients on different ART regimens and ART-naïve patients.Methods:It was a cross-sectional, observational study done on 120 HIV-infected patients. CV risk markers were assessed and correlated with disease-specific factors within individual subgroups differentiated as Group A (ART naïve), Group B (first-line ART), and Group C (second-line ART). Carotid intimal medial thickness (CIMT) and high-sensitivity C reactive protein (hsCRP) were done to classify cases as having CVD.Results:CVD risk parameters were found to be significantly higher in cases on ART, as compared to ART-naïve cases. The mean CIMT among cases in Group C, Group B, and Group A was 0.072 ± 0.01 cm, 0.063 ± 0.01 cm, and 0.055 ± 0.01 cm, respectively (P < 0.01). 95%, 65% and 25% cases in Group C, Group B, and Group A, respectively, had high CIMT (>0.06 cm) and were seen to be directly correlated with disease-related factors, i.e., duration of disease and ART, type of ART, and low CD4 cell counts. hsCRP was significantly increased in 65 out of total 120 cases. The mean hsCRP in Group A, Group B, and Group C was 3.69 ± 3.37, 4.21 ± 3.4, and 5.72 ± 3.54 mg/L, respectively (P < 0.01), which corresponds to the high risk of CVD.Conclusion:CVD risk parameters of CIMT and hsCRP are seen to be higher in patients on ART than ART-naive subjects.

Kinetics of CD4+ T-cell recovery amongst HIV load suppressed patients on first-line antiretroviral therapy in Yaoundé, Cameroon

HIV infected patients on Antiretroviral Therapy (ART) are exposed to various immunological disorders. Immune reconstitution is one of the most challenging problem linked to morbidity and mortality in HIV patients. This study aimed at evaluating the kinetics of CD4+ T-cell recovery amongst HIV load suppressed patients on first-line ART in Yaoundé, Cameroon. This was a retrospective cohort study performed at the care and treatment units of the Yaoundé University Teaching Hospital and Essos Hospital Center, with viral suppressed patients initiated on ART between March and July 2015. Data were collected using a standard form and analyzed using R.3.6.2 software. A p&lt;0.05 was considered statistically significant for a 95%CI. Of the 499 viral suppressed participants, 32% (n=160) were male and 68% (n=339) female; 33% and 40% had severe and moderate immunodepression at baseline, respectively; 9% and 28% remain respectively on the same immunological state. CD4+ T-cell count increased by 73%, 49% and 29% for patients that started treatment, with CD4+ &lt;150 cells/ml, 150&lt;CD4+&lt;350 cells/ml and 350&lt;CD4+&lt;500 cells/ml, respectively and 14%, 34% and 40% reached a target of 500 cells/ml or more after 4 years of treatment. Elder patients and males were likely to have CD4+ T-cells less than 350 Cells/ml. Approximately 35% of patient started treatment with CD4+ T-cells &lt;350 Cells/ml. CD4+ T-cells increased significantly during 4 years of treatment but, just 29% in average achieved CD4+ ≥ 500 cells/ml. CD4 T-cells recovery represent and important challenge in the immunological monitoring of long-term HIV infected patients on ART.

Association of HIV infection with survival and cancer-specific death in cancer patients in Louisiana.

e18630 Background: Studies have reported elevated mortality in HIV patients (pts), including cancer-specific mortality, compared to non-HIV pts. However, many of these studies did not include data from Louisiana. Louisiana has among the highest HIV and AIDS case rates in the country, but there is no available large-scale data regarding cancer outcomes in HIV pts in the state. We compared our data in Louisiana to the largest known study to date over an expanded time period to evaluate for disparities. Methods: Following linkage of Louisiana Tumor Registry data from 1995-2016 and Louisiana Office of Public Health, STD/HIV Program database, we identified a total of 435,478 cancer cases, of which 2,949 were HIV-positive (0.67%). Analyses of categorical variables were performed using Pearson’s chi-squared test. Cause of death was extracted from death certificate or autopsy report. Survival analyses were performed utilizing SEER*Stat. Results: Despite the higher proportion of HIV in cancer pts in Louisiana, demographics are similar to previously published data in that cancer pts with HIV tended to be male, black, and younger than their HIV-negative counterparts (p&lt;0.001). However, although 5-year survival was substantially decreased in HIV-cancer pts in congruence with other studies, cancer-specific mortality was lower than non-HIV pts in all cohorts, including both AIDS-defining cancers (ADC) and non-AIDS-defining cancers (non-ADC). Conclusions: HIV infection in cancer pts in Louisiana is associated with lower survival but not increased cancer-specific death, independent of race, gender, age, ADC vs non-ADC, and viral vs non-viral etiology. HIV-related deaths still comprise a substantial cause of death in this population.[Table: see text]

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.

A Rapid Screening Program for Histoplasmosis, Tuberculosis, and Cryptococcosis Reduces Mortality in HIV Patients from Guatemala.

Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.

Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy.

Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.

Diabetes Mellitus and Associated Factors Among Adult HIV Patients on Highly Active Anti-Retroviral Treatment.

BackgroundHighly active anti-retroviral therapy (HAART) prolongs the life span of people living with HIV (PLWHIV) and intensely reduces HIV-related morbidity and mortality. Globally, HIV-associated non-communicable diseases are becoming major public concerns, and chronic comorbidities have appeared as a substantial reason for morbidity and mortality in HIV patients with prolonged use of HAART.PurposeA cross-sectional study design was used to assess the magnitude of diabetes mellitus and risk factors among adult HIV patients exposed to HAART at Jimma Zone Public Hospitals from May to July 30, 2018.Patients and MethodsA convenient sampling technique was used to include a total of 271 adult HIV patients on HAART visiting the selected health facilities at the time of data collection. Socio-demographic and clinical data were collected by interviewer-administered questionnaire and by reviewing patients’ record data. Bivariate and multivariate logistic regressions were used to identify variables that are independent predictors for diabetes mellitus.ResultsThe prevalence of diabetes and pre-diabetes among PLWHIV exposed to HAART was 11.4% and 16.6%, respectively. The prevalence of diabetic dyslipidemia in PLWHIV exposed on HAART was 8.9% (n=24). Government workers (AOR: 0.17, 95% C.I=0.03–0.85, P=0.031), long duration in HAART use (AOR: 11.06, 95% C.I:1.03–18.67, P=0.047), hyper-triglyceridemia (AOR: 2.62,95% C.I:0.82, 8.39, P=0.005), LDL-C <130 mg/dl (AOR: 4.04, 95% C.I=1.33–12.30, P=0.014), and obesity (AOR: 9.62, 95% C.I: 1.01–91.52, P=0.049) were independent risk factors for diabetes mellitus in PLWHIV exposed to HAART.ConclusionExposure to HAART increased the prevalence of diabetes mellitus in PLWHIV although it enhances quality of life, improves immune functions and prevents the onset of opportunistic infections. Therefore, regular screening for blood glucose level for PLWHIV on HAART is advisable.

Clinical and laboratory characteristics of mycobacteriosis in persons with HIV and case report of severe generalized mycobacteriosis

Relevance. In the context of HIV epidemic, the number of cases of mycobacteriosis has increased.The objective was to study clinical and laboratory characteristics of mycobacteriosis in HIV patients; to present a clinical case of severe generalized mycobacteriosis.Methods and materials. Retrospective analysis of 48 cases from the archives of the St. Petersburg State Budgetary Healthcare Institution «S. P. Botkin Clinical Infectious Diseases Hospital» over the period from 2016 to 2018 was performed. The inclusion criterion was newly diagnosed mycobacteriosis. The following parameters were evaluated: HIV infection duration and stage; antiretroviral therapy (ART) duration; the primary syndrome and form of mycobacteriosis; laboratory and instrumental findings; causative pathogen verification methods.Results. Median number of CD4-lymphocytes (CD4 + ) was 6.9 cell/pl. In 33.3 % of patients, HIV infection was diagnosed within 1 year before the detection of mycobacteriosis. The primary syndromes were: febrile-toxic syndrome (72.9 %), bronchopulmonary syndrome (29.2 %), diarrhea syndrome (18.8 %), abdominal pain syndrome (10.4 %). Generalized myco-bacteriosis was diagnosed in 65.3 % patients. Anemia was registered in in 96 % patients, leukopenia — in 43.8 % patients. Lymphadenopathy of various localization was the most common instrumental finding (75 %). The diagnosis was confirmed bacteriologically in 70.8 % cases. Mycobacterium avium complex group was predominant (62.5 %). There were 18.8 % deaths.Conclusion. Mycobacteriosis developed in patients with advanced immunodeficiency. Clinical and laboratory findings were nonspecific. There was a trend towards generalization of infection. The proportion of deaths indicates the high importance of mycobacteriosis in the structure of mortality in HIV patients.

Excess mortality risk from sepsis in patients with HIV - A meta-analysis.

Differences in HIV prevalence, access to antiretrovirals and ICU resources may result in wide variation in sepsis mortality in HIV patients. The aim of this study was to perform a meta-analysis to quantify the excess risk of sepsis mortality in HIV patients. A systematic review was performed using three databases. The systemic inflammatory response syndrome criteria was used for the presumptive diagnosis of sepsis. We only included studies that stratified sepsis mortality by HIV serostatus. A meta-analysis was performed using random effects models, with subgroup analyses performed using country income, sepsis severity, and time periods. 17 studies were included, containing 82,905 patients. Sepsis mortality was found to be 28% higher in the HIV positive patients (95% CI 1.13-1.46, p<.01). Relative risk of mortality was higher in patients treated in low-income countries (RR 1.43 in low-income vs. 1.29 in high-income countries). Mortality was more pronounced in HIV patients with severe sepsis (RR 1.32 in severe sepsis vs. RR 1.15 in sepsis). HIV increases the risk of sepsis mortality compared to seronegative individuals across all time periods and geographic areas. We note that this effect is more pronounced in patients with organ dysfunction.

How varying CD4 criteria for treatment initiation was associated with mortality of HIV-patients? A retrospective analysis of electronic health records from Andhra Pradesh, India.

BackgroundHIV treatment and care services were scaled up in 2007 in India with objective to increase HIV-care coverage. CD4 count based criteria was mainly used for treatment initiation with increasing threshold in later years. Therefore, this paper aimed to evaluate the survival by varying CD4 criteria for antiretroviral treatment (ART) initiation among of HIV-positive patients, and independent factors associated with the mortality.MethodsThis retrospective cohort study included 127 949 HIV-positive patients aged ≥15 years, who initiated ART between 2007 and 2013 in Andhra Pradesh state, India. The patient’s demographic and clinical characteristics were extracted from the patient’s health records from electronic Computerized Management Information System Software (CMIS). Incidence of mortality/100 person-years was calculated for CD4 and treatment initiation categories. Kaplan-Meier and multivariable Cox-regression analyses were used to explore the association.ResultsMedian CD4 count was 172 (inter-quartile range (IQR) = 102-240) at the time of treatment initiation, and 19.3% of them had ≤ 100 CD4 count. Incidence of mortality for the period 2007-08 (CD4 ≤ 200 cells/mm3) was 8.5/100 person-years compared to 6.4/100 person-years at risk for the period 2012 onwards (CD4 ≤ 350 cells/mm3). Earlier thresholds for treatment initiation showed higher risk of mortality (2007-08 (CD4 ≤ 200 cells/mm3), adjusted hazard ratio (HR): 1.86, 95% confidence interval (CI): 1.68-2.07; 2009-11 (CD4 ≤ 250 cells/mm3), HR = 1.67, 95% CI = 1.51-1.85) compared to 2012 onwards (CD4 ≤ 350 cells/mm3) criteria for treatment initiation.ConclusionsIncreasing CD4 threshold for treatment initiation over time was independently associated with lower risk of mortality. More efforts are required to detect and treat early, monitoring of follow-ups, promote health education to improve ART adherence, and provide supportive environment that encourages HIV-infected patients to disclose their HIV status in confidence.

1295. Mortality of Patients with HIV Infection Admitted to the Intensive Care Unit: A 16-Year Experience

BackgroundThe life expectancy of HIV patients has increased with antiretroviral therapy which has reduced the incidence of AIDS-associated illnesses. Longer life expectancy increases noncommunicable diseases cases and the demand for intensive care unit (ICU) care. ICU mortality is higher among HIV patients. Information about mortality and other relevant outcomes among HIV patients from developing countries is paramount for benchmarking purposes. This study aimed to evaluate the mortality of patients with HIV/AIDS admitted to the ICU during the years 1999 to 2015.MethodsAn observational retrospective study was conducted based on episodes of patients admitted to the ICU of the Fundación Valle del Lili from December 1998 to October 2015. The Cochran-Armitage test was used to evaluate the trend of HIV mortality by 4-year periods, considering sex and age groups ( <50 vs. >50 years). The Z test compared the mortality between HIV patients with non-HIV patients in the ICU; also it compared the mortality in HIV patients by sex and age group.ResultsA total of 53,798 episodes of ICU admissions were analyzed, 0.76% (414) were HIV patients, and of this 78.5% were men. Twenty-three percent were over 50 years old. Overall mortality in the ICU was 9.13%, and the mortality in HIV patients was 22.03%, which was higher when compared with a non-HIV group (9%, P < 0.001). Mortality due to HIV had a statistically significant decreasing trend (P < 0.001), going from 40% between 1999 and 2003 to 18.04% between 2012–2015, this trend was observed among men with HIV (P < 0.001) starting with 43. 5% and ending at 20%, but among women the decreasing trend was not statistically significant (P = 0.62). Mortality for HIV decreased, in the <50 years group: it went from 38. 3% to 18. 6% (P = 0.0003). Furthermore, in patients 50 years and older group mortality went from 50% to 17.9% (P = 0.025). During period 2008–2011, patients 50 years and older had more mortality compared with <50 years group (P = 0.019), but there were no differences by sex in any period.ConclusionThis study found a statistically significant trend for mortality decrease over a 16-year period among HIV patients admitted to an ICU from a developing country. Disclosures All authors: No reported disclosures.

CYTOMEGALOVIRUS PNEUMONITIS IN A CRITICALLY ILL PATIENT WITH RHEUMATOID ARTHRITIS ON IMMUNOTHERAPY

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Cytomegalovirus (CMV) pneumonitis is an uncommon diagnosis typically seen in patients with immunosuppression. It can range in pathology from minimal interstitial pneumonitis to diffuse alveolar damage. It is associated with high morbidity and mortality in HIV patients and transplant recipients but is rare in patients with autoimmune diseases on immunotherapy. CASE PRESENTATION: A 52 year old female with previous history of rheumatoid arthritis on methotrexate and infliximab for over 1 year was transferred from outside hospital to the ICU after progressive dyspnea and tachypnea with high fever for two weeks that had not been improving on antibiotics. She was intubated for pending respiratory failure and had an urgent bronchoscopy with lavage. Sample from BAL showed histoplasmosis and amphotericin B with broad antibiotics and steroid burst was started. Her course was complicated over the first week of her stay by shock requiring pressor support, AKI, transaminitis, anemia, thrombocytopenia, and difficulty weaning from the ventilator. She was diagnosed with disseminated histoplasmosis. Other labwork for infectious and autoimmune workup at this time had been negative, including histo antigen, blastomyces, toxoplasma, HIV, hepatitis panel, ANA, and ANCA panel. Extubation was attempted on day 12 of her stay but she required reintubation the following day. Ampho B was switched to itraconazole at this time but patient still did not significantly improve after several more days. A surgical lung biopsy revealed CMV with diffuse alveolar damage in addition to histoplasmosis and the patient developed a pneumothorax. Viral load PCR for CMV was 99500 IU/ml. Ganciclovir was started. Her course would be complicated further by A-Fib with RVR and neutropenia, but over the next several weeks her oxygenation and overall clinical condition would slowly improve. She was transferred to LTACH after a 2 month long ICU stay. She was eventually extubated at LTACH and is currently doing well at home following an inpatient rehab stay. DISCUSSION: This patient developed multiple organ failure during her ICU stay and only began to clinically improve following diagnosis and treatment of her CMV infection. She did not respond well to broad spectrum antibiotics or antifungal initially. BAL has poor sensitivity and specificity for CMV and more aggressive diagnostic workup is sometimes indicated. There are no current guidelines for either antiviral prophylaxis or duration of therapy for CMV in setting of autoimmune disorder on immunotherapy. CONCLUSIONS: We strongly suggest that in patients on immunosuppressive therapy with acute respiratory failure who fail to respond to treatment with a recognized pathogen, other pathologies should be considered. Reference #1: Papazian L et al. Cytomegalovirus reactivation in ICU patients. Intensive Care Med. Jan;42(1):28-37. 2016 Reference #2: Travi G et al. Cytomegalovirus pneumonia in hematopoietic stem cell recipients. J Intensive Care Med. Jul-Aug;29(4):200-12. 2014 Reference #3: Lee KY et al. Predictors of Mortality in autoimmune disease patients with concurrent cytomegalovirus infections detected by quantitative real-time PCR. PLoS One. Jul 25;12(7). 2017 DISCLOSURES: No relevant relationships by Clifford Hecht, source=Web Response