scholarly journals Incidence and Risk Factors for Invasive Pneumococcal Disease and Community-acquired Pneumonia in Human Immunodeficiency Virus–Infected Individuals in a High-income Setting

2019 ◽  
Vol 71 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Hannah M Garcia Garrido ◽  
Anne M R Mak ◽  
Ferdinand W N M Wit ◽  
Gino W M Wong ◽  
Mirjam J Knol ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
General Population ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Pneumococcal Disease ◽  
Incidence Rates ◽  
Community Acquired Pneumonia ◽  
Cd4 Counts ◽  
Immunodeficiency Virus

Abstract Background Although people living with human immunodeficiency virus (PLWH) are at increased risk of invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP), it is unclear whether this remains the case in the setting of early initiation of combination antiretroviral therapy (cART), at high CD4 cell counts. This is important, as pneumococcal vaccination coverage in PLWH is low in Europe and the United States, despite longstanding international recommendations. Methods We identified all CAP and IPD cases between 2008 and 2017 in a cohort of PLWH in a Dutch HIV referral center. We calculated incidence rates stratified by CD4 count and cART status and conducted a case-control study to identify risk factors for CAP in PLWH receiving cART. Results Incidence rates of IPD and CAP in PLWH were 111 and 1529 per 100 000 patient-years of follow-up (PYFU). Although IPD and CAP occurred more frequently in patients with CD4 counts <500 cells/μL (incidence rate ratio [IRR], 6.1 [95% confidence interval, 2.2–17] and IRR, 2.4 [95% confidence interval, 1.9–3.0]), the incidence rate in patients with CD4 counts >500 cells/μL remained higher compared with the general population (946 vs 188 per 100 000 PYFU). All IPD isolates were vaccine serotypes. Risk factors for CAP were older age, CD4 counts <500 cells/μL, smoking, drug use, and chronic obstructive pulmonary disease. Conclusions The incidence of IPD and CAP among PLWH remains higher compared with the general population, even in those who are virally suppressed and have high CD4 counts. With all serotyped IPD isolates covered by pneumococcal vaccines, our study provides additional argumentation against the poor current adherence to international recommendations to vaccinate PLWH.

scholarly journals LONG-TERM INCIDENCE OF CERVICAL CANCER IN WOMEN WITH HUMAN IMMUNODEFICIENCY VIRUS

2018 ◽  
Vol 8 (5-s) ◽  
pp. 394-399
Author(s):  
Subhash Kumar Mishra Golden ◽  
Nidhi Vishnoi
Keyword(s):  
Cervical Cancer ◽  
Human Immunodeficiency Virus ◽  
Cancer Prevention ◽  
Incidence Rate ◽  
Invasive Cervical Cancer ◽  
Incidence Rates ◽  
Self Report ◽  
Prevention Measures ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Background: The objective of this study was to estimate the incidence of invasive cervical cancer (ICC) in women with human immunodeficiency virus (HIV) and compare it with the incidence in HIV-uninfected women. Methods: In a cohort study of HIV-infected and uninfected women who had Papanicolaou tests obtained every 6 months, pathology reports were retrieved for women who had biopsy results or a self report of ICC. Histology was reviewed when reports confirmed ICC. Incidence rates were calculated and compared with those in HIV-negative women. Results: After a median follow-up of 10.3 years, 3 ICCs were confirmed in HIV-seropositive women, and none were confirmed in HIV-seronegative women. The ICC incidence rate was not found to be associated significantly with HIV status (HIV-negative women [0 of 100,000 person-years] vs HIV-positive women [21.4 of 100,000 person-years]; P = .59). A calculated incidence rate ratio standardized to expected results from the Surveillance Epidemiology and End Results database that was restricted to HIV-infected Women’s Interagency HIV Study participants was 1.32 (95% confidence interval, 0.27-3.85; P = 0.80). Conclusions: Among women with HIV in a prospective study that incorporated cervical cancer prevention measures, the incidence of ICC was not significantly higher than that in a comparison group of HIV-negative women. Keywords: Cervical Cancer, Human Immunodeficiency Virus, Women, Cancer Prevention.

scholarly journals Increased risk of hyperlipidemia in patients with anxiety disorders: A population-based study

2020 ◽  
Author(s):  
I-Chia Chien ◽  
Ching-Heng Lin
Keyword(s):  
General Population ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Incidence Rate ◽  
Prevalence Rate ◽  
Female Gender ◽  
Incidence Rates ◽  
Secondary Diagnosis ◽  
Increased Risk ◽  
Incident Cases

Abstract Objective This study examined the prevalence and incidence of hyperlipidemia among patients with anxiety disorders in Taiwan. Methods We used a large dataset containing random samples, and more than 766,000 subjects who were aged 18 years or older in 2005 were identified. Subjects who had more than one primary or secondary diagnosis of anxiety disorders were identified. Individuals who had a primary or secondary diagnosis of hyperlipidemia or medication treatment for hyperlipidemia were also identified. The prevalence rate of hyperlipidemia in patients with anxiety disorders with that of the general population in 2005 was compared. We then followed this cohort to monitor incident cases of hyperlipidemia in anxiety patients, and assessed whether a difference existed from the general population during the period 2006–2010. Results A higher prevalence rate of hyperlipidemia in patients with anxiety disorders was observed as compared with the general population (21.3% vs. 7.6%, odds ratio 2.14; 95% confidence interval, 2.07–2.22) in 2005. Additionally, a higher average annual incidence rate of hyperlipidemia in patients with anxiety disorders was also found as compared with the general population (5.49% vs. 2.50%, risk ratio 1.64; 95% confidence interval, 1.58–1.70) from 2006 to 2010. Conclusions Patients with anxiety disorders had higher prevalence and incidence rates of hyperlipidemia than the general population. Risk factors that were found to be associated with the higher incidence rate of hyperlipidemia among anxiety patients included a greater age, the female gender, and the presence of diabetes and hypertension.

scholarly journals Prognostic Nomogram for Death from Pneumocystis Pneumonia in Non-HIV- and HIV-Infected Patients

2021 ◽  
Author(s):  
Qiuyue Feng ◽  
Jingjing Hao ◽  
Ang Li ◽  
Zhaohui Tong
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Area Under The Curve ◽  
Pneumocystis Pneumonia ◽  
Prediction Of Mortality ◽  
Immunodeficiency Virus ◽  
Precise Prediction ◽  
Independent Risk Factors

Abstract Background: Pneumocystis pneumonia is a major cause of death in immunocompromised patients. Many risk factors for poor prognosis have been reported, but few studies have created predictive models with these variables to calculate the death rate accurately. This study created nomogram models for the precise prediction of mortality risk in non-human immunodeficiency virus (NHIV)- and human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).Methods: A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to screen out mortality risk factors to create the nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristic (ROC) curves.Results: A total of 167 NHIV-PJP patients and 193 HIV-PJP patients were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells ≤100/µl and sulfa combined with caspofungin (CAS) treatment were identified as independent risk factors for death that could be combined to accurately predict mortality risk in NHIV-PJP patients. We created a nomogram for mortality by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. The independent risk factors for death in HIV-PJP patients included in the nomogram were pneumothorax, platelet (PLT) ≤80×109/L, haemoglobin (HGB) ≤90 g/L, albumin (ALB), cytomegalovirus (CMV) coinfection and sulfa combined with CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and excellent calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970).Conclusions: Our nomograms were useful tools for the precise prediction of mortality in NHIV-PJP and HIV-PJP patients.

scholarly journals Prognostic Nomogram for Death from Pneumocystis Pneumonia in Non-HIV- and HIV- Infected Patients

2021 ◽  
Author(s):  
Qiuyue Feng ◽  
Jingjing Hao ◽  
Ang Li ◽  
Zhaohui Tong
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Area Under The Curve ◽  
Pneumocystis Pneumonia ◽  
Prediction Of Mortality ◽  
Immunodeficiency Virus ◽  
Precise Prediction ◽  
Independent Risk Factors

Abstract Background: Pneumocystis pneumonia is a major cause of death in immunocompromised patients. Many risk factors for poor prognosis have been reported, but few studies have created predictive models with these variables to calculate the death rate accurately. This study created nomogram models for the precise prediction of mortality risk in non-human immunodeficiency virus (NHIV)- and human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).Methods: A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to screen out mortality risk factors to create the nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristic (ROC) curves.Results: A total of 167 NHIV-PJP patients and 193 HIV-PJP patients were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells ≤100/µl and sulfa combined with caspofungin (CAS) treatment were identified as independent risk factors for death that could be combined to accurately predict mortality risk in NHIV-PJP patients. We created a nomogram for mortality by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. The independent risk factors for death in HIV-PJP patients included in the nomogram were pneumothorax, platelet (PLT) ≤80×109/L, haemoglobin (HGB) ≤90 g/L, albumin (ALB), cytomegalovirus (CMV) coinfection and sulfa combined with CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and excellent calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970).Conclusions: Our nomograms were useful tools for the precise prediction of mortality in NHIV-PJP and HIV-PJP patients.

Secondary Malignancies in CML Patients – Data From the German CML Study IV

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3746-3746 ◽  
Author(s):  
Manuel Barreto Miranda ◽  
Michael Lauseker ◽  
Ulrike Proetel ◽  
Annette Schreiber ◽  
Benjamin Hanfstein ◽  
...  
Keyword(s):  
General Population ◽  
Confidence Interval ◽  
Incidence Rate ◽  
Interferon Alpha ◽  
Research Funding ◽  
Incidence Rates ◽  
Primary Cancer ◽  
Secondary Malignancies

Abstract Abstract 3746 Introduction: The increase of overall survival in chronic myeloid leukemia (CML) requires closer long-term observation in the face of a potential carcinogenicity of tyrosine kinase inhibitors (TKIs). Preclinical studies with imatinib in rats showed neoplastic changes in kidneys, urinary bladder, urethra, preputial and clitoral glands, small intestine, parathyroid glands, adrenal glands, and nonglandular stomach. Two epidemiologic studies on patients with chronic myeloproliferative neoplasms (CMPN) and CML (Frederiksen H et al., Blood 2011; Rebora P et al., Am J Epidemiol 2010) found an increased risk of secondary malignancies compared with the general population independent of treatment. In contrast, in a recent analysis of patients with CML and CMPN treated with TKI (Verma D et al., Blood 2011) a decreased risk of secondary malignancies was reported. Aims: To further elucidate the risk of TKI treated CML patients for the development of secondary malignancies we analysed data of the CML study IV, a randomized 5-arm trial (imatinib 400 mg vs. imatinib 800 mg vs. imatinib 400 mg in combination with interferon alpha vs. imatinib 400 mg in combination with AraC vs. imatinib 400 mg after interferon failure). Patients and methods: From February 2002 to April 2012, 1551 CML patients in chronic phase were randomized, 1525 were evaluable. Inclusion criteria allowed the history of primary cancer if the disease was in stable remission. Forty-nine malignancies were reported in 43 patients before the diagnosis of CML. If relapses occurred within 5 years after diagnosis of primary cancer they were not considered for further analysis. Median follow-up was 67.5 months. Age-standardized incidence rates were calculated from the age-specific rates using the European standard population (1976). Results: In total, 67 secondary malignancies in 64 patients were found in CML patients treated with TKI (n=61) and interferon alpha only (n=3). Twelve of these patients developed neoplasms after diagnosis of a primary cancer before diagnosis of CML, 5 patients with metastases or recurrence of the first malignancy (range of diagnosis 5–19 years after primary cancer). Median time to secondary malignancy was 2.5 years (range 0.1–8.3 years). The types of neoplasms were: prostate (n=9), colorectal (n=6), lung (n=6), non Hodgkin's lymphoma (NHL; n=7), malignant melanoma (n=5), skin tumors (basalioma n=4 and squamous cell carcinoma n=1), breast (n=5), pancreas (n=4), kidney (n=4), chronic lymphocytic leukemia (n=3), head and neck (n=2), biliary (n=2), sarcoma (n=2), and esophagus, stomach, liver, vulva, uterus, brain, cancer of unknown origin (each n=1). With these numbers the age-standardized incidence rates of secondary malignancies in CML patients were calculated: 534 cases per 100,000 for men (confidence interval [350;718]), and 582 for women (confidence interval [349;817]). The incidence rates of the general population in Germany were 450 and 350 cases, respectively (“Krebs in Deutschland 2007/2008”, 8th ed., Robert Koch Institute, 2012). The incidence rate of NHLs was higher for CML patients than for the general population but this is not significant. Conclusions: In our cohort, the incidence rate of secondary neoplasms in CML patients was slightly increased compared to the general population. The most common secondary malignancies in CML patients under treatment were cancers of the skin, prostate, colon, lung and NHL. Since the occurrence of secondary neoplasia increases over time, long-term follow-up of CML patients is warranted. Disclosures: Müller: Novartis, BMS: Consultancy, Honoraria, Research Funding. Hochhaus:Novartis, BMS, MSD, Ariad, Pfizer: Consultancy Other, Honoraria, Research Funding. Hehlmann:Novartis: Research Funding.

scholarly journals Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria

2015 ◽  
Vol 2 (4) ◽  
Author(s):  
Charlotte A. Chang ◽  
Seema Thakore Meloni ◽  
Geoffrey Eisen ◽  
Beth Chaplin ◽  
Patrick Akande ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Incidence Rate ◽  
Clinical Stage ◽  
Cox Proportional Hazards ◽  
World Health ◽  
Clinical Markers ◽  
Art Initiation ◽  
Immunodeficiency Virus

Abstract Background.  Despite the benefits of antiretroviral therapy (ART), tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV)-infected persons in Africa. Nigeria bears the highest TB burden in Africa and second highest HIV burden globally. This long-term multicenter study aimed to determine the incidence rate and predictors of TB in adults in the Harvard/AIDS Prevention Initiative in Nigeria (APIN) and President's Emergency Plan for AIDS Relief (PEPFAR) Nigeria ART program. Methods.  This retrospective evaluation used data collected from 2004 to 2012 through the Harvard/APIN PEPFAR program. Risk factors for incident TB were determined using multivariate Cox proportional hazards regression with time-dependent covariates. Results.  Of 50 320 adults enrolled from 2005 to 2010, 11 092 (22%) had laboratory-confirmed active TB disease at ART initiation, and 2021 (4%) developed active TB after commencing ART. During 78 228 total person-years (PY) of follow-up, the TB incidence rate was 25.8 cases per 1000 PY (95% confidence interval [CI], 24.7–27.0) overall, and it decreased significantly both with duration on ART and calendar year. Risk factors at ART initiation for incident TB included the following: earlier ART enrollment year, tenofovir-containing initial ART regimen, and World Health Organization clinical stage above 1. Time-updated risk factors included the following: low body mass index, low CD4+ cell count, unsuppressed viral load, anemia, and ART adherence below 80%. Conclusions.  The rate of incident TB decreased with longer duration on ART and over the program years. The strongest TB risk factors were time-updated clinical markers, reinforcing the importance of consistent clinical and laboratory monitoring of ART patients in prompt diagnosis and treatment of TB and other coinfections.

scholarly journals Risk Factors for Community‐Acquired Pneumonia among Persons Infected with Human Immunodeficiency Virus

2000 ◽  
Vol 181 (1) ◽  
pp. 158-164 ◽  
Author(s):  
Thomas R. Navin ◽  
David Rimland ◽  
Jeffrey L. Lennox ◽  
John Jernigan ◽  
Marty Cetron ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Community Acquired Pneumonia ◽  
Immunodeficiency Virus

scholarly journals Antiretroviral Therapy as Prevention of … Pneumococcal Infections?

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Anaïs Lesourd ◽  
Jérémie Leporrier ◽  
Valérie Delbos ◽  
Guillemette Unal ◽  
Patricia Honoré ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
General Population ◽  
Significant Risk ◽  
Pneumococcal Vaccination ◽  
Vaccination Strategy ◽  
Pneumococcal Infections ◽  
Hiv Patients ◽  
Immunodeficiency Virus

Abstract Background Despite antiretroviral therapy, it is generally believed that the risk for pneumococcal infections (PnIs) is high among patients infected with human immunodeficiency virus (HIV). However, most studies in this field have been conducted before 2010, and the proportion of virologically suppressed patients has drastically increased in these latter years thanks to larger indications and more effective antiretroviral regimens. This study aimed to re-evaluate the current risk of PnI among adult patients infected with HIV. Methods The incidence of PnI was evaluated between 1996 and 2014 in 2 French regional hospitals. The 80 most recent cases of PnI (2000–2014) were retrospectively compared with 160 controls (HIV patients without PnI) to analyze the residual risk factors of PnI. Results Among a mean annual follow-up cohort of 1616 patients, 116 PnIs were observed over 18 years. The risk factors of PnI among patients infected with HIV were an uncontrolled HIV infection or “classic” risk factors of PnI shared by the general population such as addiction, renal or respiratory insufficiency, or hepatitis B or C coinfection. Pneumococcal vaccination coverage was low and poorly targeted, because only 5% of the cases had been previously vaccinated. The incidence of invasive PnIs among HIV patients with a nonvirologically suppressed infection or comorbidities was 12 times higher than that reported in the general population at the country level (107 vs 9/100000 patients), whereas the incidence among virologically suppressed HIV patients without comorbidities was lower (7.6/100000 patients). Conclusions Human immunodeficiency virus infection no longer per se seems to be a significant risk factor for PnI, suggesting a step-down from a systematic to an “at-risk patient” targeted pneumococcal vaccination strategy.

scholarly journals Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States

2018 ◽  
Vol 74 (9) ◽  
pp. 1468-1474 ◽  
Author(s):  
Matthew C Lohman ◽  
Amanda J Sonnega ◽  
Emily J Nicklett ◽  
Lillian Estenson ◽  
Amanda N Leggett
Keyword(s):  
United States ◽  
Risk Factors ◽  
Older Adults ◽  
Confidence Interval ◽  
Incidence Rate ◽  
The United States ◽  
Incidence Rates ◽  
Mortality Incidence ◽  
Representative Cohort ◽  
Related Mortality

AbstractBackgroundFalls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality.MethodsCause-of-death data from the National Death Index (NDI; 1999–2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths.ResultsThe overall incidence rate of fall-related mortality was greater in HRS–NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality.ConclusionIncidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.

Sign in / Sign up

Export Citation Format

Share Document