Effect of Opportunistic Illness on Risk of Death in HIV Disease

JAMA ◽  
1998 ◽  
Vol 279 (18) ◽  
pp. 1500 ◽  
Author(s):  
William G. Powderly
Keyword(s):  
Hiv Disease ◽  
Risk Of Death ◽  
Opportunistic Illness

scholarly journals Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project

Blood ◽  
1998 ◽  
Vol 91 (1) ◽  
pp. 301-308 ◽  
Author(s):  
Patrick S. Sullivan ◽  
Debra L. Hanson ◽  
Susan Y. Chu ◽  
Jeffrey L. Jones ◽  
John W. Ward ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Disease Surveillance ◽  
Cd4 Count ◽  
Hiv Disease ◽  
Black Race ◽  
Risk Of Death ◽  
Female Sex ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Cd4 Percentage

Abstract To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/μm or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of ≥200 cells/μL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/μL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

Bronchopulmonary Kaposi s sarcoma in 106 HIV 1 infected patients

1998 ◽  
Vol 9 (9) ◽  
pp. 518-525 ◽  
Author(s):  
Frances B Hannon ◽  
Philippa J Easterbrook ◽  
Simon Padley ◽  
Fiona Boag ◽  
Ruth Goodall ◽  
...  
Keyword(s):  
Radiological Finding ◽  
Older Age ◽  
Prior History ◽  
Hiv Disease ◽  
Cd4 Cell Count ◽  
Risk Of Death ◽  
History Of ◽  
Advanced Hiv Disease ◽  
Cd4 Cell ◽  
Hiv 1

The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV related bronchopulmonary Kaposi s sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV infected homosexual men with bronchopulmonary Kaposi s sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis median CD4 cell count was 15 106 l, range 0-288 , and 93 had had a diagnosis of cutaneous Kaposi s sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough 92 , dyspnoea 69 , pleuritic pain 20 , haemoptysis 13 and wheezing 10 . The most common radiological finding in 73 of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months range 0-37 months from diagnosis and 9 months range 1-25 from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death hazards ratio HR =0.48, 95 CI=0.26-0.87 . Factors associated with a poor survival, after adjustment for treatment effect were older age HR=1.79, 95 CI=1.22-2.84 for each 10 year increase in age; a history of pleuritic pain HR=2.97, 95 CI=1.39-6.32 ; presence of pleural effusion on X ray HR=2.01, 95 CI=1.13- 3.59 and a prior diagnosis of cutaneous Kaposi s sarcoma HR=1.8, 95 CI=1.00, 3.24 . Bronchopulmonary Kaposi s sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.

scholarly journals Epidemiology of Anemia in Human Immunodeficiency Virus (HIV)-Infected Persons: Results From the Multistate Adult and Adolescent Spectrum of HIV Disease Surveillance Project

Blood ◽  
1998 ◽  
Vol 91 (1) ◽  
pp. 301-308 ◽  
Author(s):  
Patrick S. Sullivan ◽  
Debra L. Hanson ◽  
Susan Y. Chu ◽  
Jeffrey L. Jones ◽  
John W. Ward ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Disease Surveillance ◽  
Cd4 Count ◽  
Hiv Disease ◽  
Black Race ◽  
Risk Of Death ◽  
Female Sex ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Cd4 Percentage

To study the incidence of, the factors associated with, and the effect on survival of anemia in human immunodeficiency virus (HIV)-infected persons, we analyzed data from the longitudinal medical record reviews of 32,867 HIV-infected persons who received medical care from January 1990 through August 1996 in clinics, hospitals, and private medical practices in nine United States cities. We calculated the 1-year incidence of anemia (a hemoglobin level of <10 g/dL or a physician diagnosis of anemia); the adjusted odds ratios showing excess risk of anemia associated with demographic factors, prescribed therapies, and concurrent diseases; the risk of death for patients who developed anemia compared with risk for patients who did not develop anemia; and, of patients who did develop anemia, the risk of death for those who did not recover from anemia compared with the risk for those who did recover. The 1-year incidence of anemia was 36.9% for persons with one or more acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (clinical AIDS), 12.1% for patients with a CD4 count of less than 200 cells/μm or CD4 percentage of <14 but not clinical AIDS (immunologic AIDS), and 3.2% for persons without clinical or immunologic AIDS. Of anemia diagnoses, 22% were identified by physicians as drug related. Incidence of anemia was associated with clinical AIDS, immunologic AIDS, neutropenia, thrombocytopenia, bacterial septicemia, black race, female sex, prescription of zidovudine, fluconazole, and ganciclovir, and lack of prescription of trimethoprim-sulfamethoxazole. The increased risk of death associated with anemia differed by first CD4 count: for patients with a CD4 count of ≥200 cells/μL at the beginning of the survival analysis, the risk of death was 148% (99% confidence interval [CI], 114 to 188) greater for those who developed anemia; for patients whose first CD4 count was <200 cells/μL, the risk of death was 56% (99% CI, 43 to 71) greater for those in whom anemia developed. For persons in whom anemia developed, the risk of death was 170% (99% CI, 132 to 203) greater for persons who did not recover from anemia compared with those who did recover. Anemia is a frequent complication of HIV infection, and its incidence is associated with progression of HIV disease, prescription of certain chemotherapeutics, black race, and female sex. Anemia, particularly anemia that does not resolve, is associated with shorter survival of HIV-infected patients.

scholarly journals Tuberculosis in HIV-Associated Cryptococcal Meningitis is Associated with an Increased Risk of Death

2020 ◽  
Vol 9 (3) ◽  
pp. 781
Author(s):  
Morris K. Rutakingirwa ◽  
Fiona V. Cresswell ◽  
Richard Kwizera ◽  
Kenneth Ssebambulidde ◽  
Enock Kagimu ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Regression Models ◽  
Proportional Hazards ◽  
Health Concern ◽  
Hiv Disease ◽  
Public Health Concern ◽  
Risk Of Death ◽  
Proportional Hazards Regression ◽  
Increased Risk ◽  
Advanced Hiv Disease

Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were compared between three groups: ‘prevalent TB’ if TB treated >14 days prior to cryptococcal meningitis diagnosis, ‘concurrent TB’ if TB treated ± 14 days from diagnosis, or ‘No TB at baseline’. We used time-updated proportional-hazards regression models to assess TB diagnosis as a risk for death. Of 870 participants with cryptococcal meningitis, 50 (6%) had prevalent TB, 67 (8%) had concurrent TB, and 753 (86%) had no baseline TB. Among participants without baseline TB, 67 (9%) were diagnosed with incident TB (after >14 days), with a median time to TB incidence of 41 days (IQR, 22–69). The 18-week mortality was 50% (25/50) in prevalent TB, 46% (31/67) in concurrent TB, and 45% (341/753) in the no TB group (p = 0.81). However, TB co-infection was associated with an increased hazard of death (HR = 1.75; 95% CI, 1.33–2.32; p < 0.001) in a time-updated model. TB is commonly diagnosed in cryptococcal meningitis, and the increased mortality associated with co-infection is a public health concern.

scholarly journals Depresi dan Progresi Penyakit HIV

2021 ◽  
Vol 3 (9) ◽  
pp. 683-700
Author(s):  
Nadia Putri Kinanti ◽  
Rara Warih Gayatri ◽  
Tika Dwi Tama
Keyword(s):  
Public Health ◽  
Viral Load ◽  
Literature Search ◽  
Risk Of Bias ◽  
Hiv Disease ◽  
Hiv Patients ◽  
Risk Of Death ◽  
Hiv Progression ◽  
Cell Decline ◽  
Cd4 Cell

Abstract: Depression is a common problem that occurs in people with HIV. Depression in HIV patients is associated with adherence to antiretroviral therapy (ARV), the possibility of HIV transmission, virologic failure and progression of disease to AIDS. However, there is contradictory evidence that overlaps based on previous studies. This study aims to investigate the relationship between depression and HIV disease progression. This study uses PICOS in the literature search. The literature search used 3 databases, SpringerLink, BMC Public Health and PubMed. Literature study search used 5 keywords “Depression”, “HIV Progression” “low CD4”, “Viral load counts” and “HIV-related death”. A total of 1,763 articles were found and identified. Transparency of the identification process to find articles analyzed using PRISMA diagrams. Assessment of study quality using STROBE and Tool To Assess Risk of bias in Cohort Studies. This study reviewed 4 articles that fit the criteria of inclusion and exclusion. This study shows depression plays a role in HIV disease progression. 75 percent of the articles showed significant association between depression and CD4 cell decline, increased viral load and risk of death. Both depressive symptoms and depressive disorder (MDD) play a role in CD4 cell decline and viral load increase over a 4-6 year period. Depressive symptoms in newly diagnosed HIV represent an 8-12 percent higher risk of death within 2 years. For this reason, it’s necessary to screen for depression before conducting a VCT test to provide initial data on the mental health of HIV patients and to determine depression management programs in HIV patients. Abstrak: Depresi merupakan masalah umum yang terjadi pada penderita HIV. Depresi pada penderita HIV dikaitkan dengan kepatuhan terapi antiretroviral (ARV), kemungkinan penularan HIV, kegagalan virologi dan perkembangan penyakit menjadi AIDS. Namun, terdapat bukti kontradiktif yang saling tumpang tindih berdasarkan penelitian terdahulu. Studi ini bertujuan mencari hubungan depresi dan progresi penyakit HIV.  Studi ini menggunakan PICOS dalam pencarian literatur. Pencarian literatur menggunakan 3 database, Springerlink, BMC Public Health dan PubMed dengan menggunakan 5 kata kunci “Depression”, “HIV Progression” “low CD4”, “Viral load counts” dan “HIV-related death”. Sebanyak 1.763 artikel ditemukan dan diidentifikasi. Transparansi proses identifikasi menggunakan diagram PRISMA. Penilaian kualitas studi menggunakan STROBE dan Tool To Assess Risk of bias in Cohort Studies. Studi ini meninjau 4 artikel yang sesuai kriteria inklusi dan eksklusi. Studi ini menunjukan depresi berperan terhadap progresi penyakit HIV. 75 persen artikel menunjukan hubungan yang signifikan antara depresi dengan penurunan sel CD4, peningkatan viral load maupun risiko kematian. Gejala depresi maupun gangguan depresi (MDD) memiliki peran dalam penurunan sel CD4 dan peningkatan viral load dalam periode 4-6 tahun. Gejala depresi pada penderita baru menunjukan 8-12 persen risiko kematian yang lebih tinggi dalam kurun waktu 2 tahun. Untuk itu, diperlukan adanya skrining depresi sebelum melakukan tes VCT sebagai baseline data kesehatan mental pasien HIV dan penentuan program penanganan depresi pada penderita HIV.

Allergy Shots at Home Don't Raise Risk of Death

2006 ◽  
Vol 39 (8) ◽  
pp. 18
Author(s):  
MICHELE G. SULLIVAN
Keyword(s):  
Risk Of Death ◽  
At Home

“Music First”

GeroPsych ◽  
2018 ◽  
Vol 31 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Dane L. Shiltz ◽  
Tara T. Lineweaver ◽  
Tim Brimmer ◽  
Alex C. Cairns ◽  
Danielle S. Halcomb ◽  
...  
Keyword(s):  
Usual Care ◽  
Psychological Symptoms ◽  
Care Facility ◽  
Care Group ◽  
Music Listening ◽  
Term Care ◽  
Antipsychotic Medications ◽  
Risk Of Death ◽  
Extended Care ◽  
Individualized Music

Abstract. Existing research has primarily evaluated music therapy (MT) as a means of reducing the negative affect, behavioral, and/or cognitive symptoms of dementia. Music listening (ML), on the other hand, offers a less-explored, potentially equivalent alternative to MT and may further reduce exposure to potentially harmful psychotropic medications traditionally used to manage negative behavioral and psychological symptoms of dementia (BPSD). This 5-month prospective, naturalistic, interprofessional, single-center extended care facility study compared usual care (45 residents) and usual care combined with at least thrice weekly personalized ML sessions (47 residents) to determine the influence of ML. Agitation decreased for all participants (p < .001), and the ML residents receiving antipsychotic medications at baseline experienced agitation levels similar to both the usual care group and the ML patients who were not prescribed antipsychotics (p < .05 for medication × ML interaction). No significant changes in psychotropic medication exposure occurred. This experimental study supports ML as an adjunct to pharmacological approaches to treating agitation in older adults with dementia living in long-term care facilities. It also highlights the need for additional research focused on how individualized music programs affect doses and frequencies of antipsychotic medications and their associated risk of death and cerebrovascular events in this population.

Understanding Terminal Decline in Cognition and Risk of Death

2006 ◽  
Vol 11 (3) ◽  
pp. 164-171 ◽  
Author(s):  
Patrick Rabbitt ◽  
Mary Lunn ◽  
Danny Wong
Keyword(s):  
Risk Factors ◽  
Longitudinal Study ◽  
Test Scores ◽  
Intelligence Test ◽  
Practice Effects ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Impending Death ◽  
Intelligence Test Scores ◽  
Reduced Risk

There is new empirical evidence that the effects of impending death on cognition have been miscalculated because of neglect of the incidence of dropout and of practice gains during longitudinal studies. When these are taken into consideration, amounts and rates of cognitive declines preceding death and dropout are seen to be almost identical, and participants aged 49 to 93 years who neither dropout nor die show little or no decline during a 20-year longitudinal study. Practice effects are theoretically informative. Positive gains are greater for young and more intelligent participants and at all levels of intelligence and durations of practice; declines in scores of 10% or more between successive quadrennial test sessions are risk factors for mortality. Higher baseline intelligence test scores are also associated with reduced risk of mortality, even when demographics and socioeconomic advantage have been taken into consideration.

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