scholarly journals What Determines Do-Not-Resuscitate Status in Critically Ill HIV Patients?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S435-S435
Author(s):  
Shannon L Turvey ◽  
Anne Gregory ◽  
Sean Bagshaw ◽  
Wendy I Sligl
Keyword(s):  
Viral Load ◽  
Hiv Infection ◽  
Critically Ill ◽  
Severity Of Illness ◽  
Cd4 Count ◽  
Apache Ii Score ◽  
Do Not Resuscitate ◽  
Hiv Patients ◽  
Icu Admission ◽  
First Time

Abstract Background Mortality and morbidity of people living with HIV have declined in the era of combination antiretroviral therapy (cART). However, Intensive Care Unit (ICU) admission rates remain high. In this study, we identified predictors of Do-Not-Resuscitate (DNR) status in critically ill HIV patients. Methods Retrospective cohort study of all first-time admissions of HIV-infected patients to five ICUs in Edmonton, Alberta from 2002 to 2014. Data collected included demographics, comorbidities, markers of HIV disease severity and control, admission diagnoses, severity of illness, organ failure, and DNR status. Multivariable logistic regression analysis was performed to identify factors associated with DNR status. Results During the study period, 282 patients were admitted to the ICU for the first time. Mean (SD) age was 44 (±10) years, 169 (60%) were male, 134 (48%) aboriginal, 153 (55%) co-infected with hepatitis C virus, and 184 (65%) had a history of polysubstance use. Median (IQR) CD4 count and viral load were 125 (30–300) cells/mm3and 28,000 (110–270,000) copies/mL, respectively. Only 98 (35%) patients were receiving cART at the time of admission while 45 (16%) were newly diagnosed in the ICU. Most common admission diagnosis was sepsis 189 (64%), 213 (76%) received mechanical ventilation, 133 (47%) vasopressor support and 35 (12%) renal replacement therapy. Sixty-seven (24%) patients were DNR and support was withdrawn in 42 (15%). In multivariable analysis, APACHE II score (adjusted odds ratio [aOR] 1.13; 95% CI, 1.08–1.19, P < 0.001), coronary artery disease (CAD) (aOR 5.7; 95% CI, 1.2–27.8, P = 0.03), prior opportunistic infection (OI) (aOR 2.6; 95% CI, 1.2–5.6, P = 0.015) and duration of HIV infection (aOR 1.07 per year; 95% CI, 1.01–1.14, P = 0.025) were independently associated with DNR status. Other factors such as ethnicity, HIV risk factor(s), CD4 count and viral load were not associated with DNR status. Conclusion In this relatively young cohort, one in four patients had DNR status during ICU admission. DNR designation was associated with severity of illness, along with CAD, prior OI, and duration of HIV infection. Future work should characterize the timing of patient DNR orders relative to ICU admission and describe patient and provider-specific factors that may influence decision-making towards DNR status. Disclosures All authors: No reported disclosures.

scholarly journals Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

2021 ◽  
Author(s):  
John Jospeh Diamond Princy ◽  
Kshetrimayum Birendra Singh ◽  
Ningthoujam Biplab ◽  
Ningthoukhongjam Reema ◽  
Rajesh Boini ◽  
...  
Keyword(s):  
Platelet Count ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
Total Leukocyte Count ◽  
Hiv Patients ◽  
Positive Correlation ◽  
Highly Active ◽  
The Mean

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

scholarly journals Relationship between availability of physiotherapy services and ICU costs

2018 ◽  
Vol 44 (3) ◽  
pp. 184-189 ◽  
Author(s):  
Bruna Peruzzo Rotta ◽  
Janete Maria da Silva ◽  
Carolina Fu ◽  
Juliana Barbosa Goulardins ◽  
Ruy de Camargo Pires-Neto ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Apache Ii Score ◽  
Health Evaluation ◽  
Icu Length Of Stay ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
First Time

ABSTRACT Objective: To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. Methods: This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. Results: The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. Conclusions: In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.

EFFECT OF IMMUNOMODULATORY HERBAL MEDICINAL PREPARATIONS ON CD4 + LYMPHOCYTE COUNT AND TOTAL VIRAL LOAD IN HIV-INFECTED INDIVIDUALS

INDIAN DRUGS ◽  
2012 ◽  
Vol 49 (07) ◽  
pp. 42-48
Author(s):  
S. T. Tharakan ◽  
◽  
G Kuttan ◽  
R. Kuttan ◽  
M. Kesavan ◽  
...  
Keyword(s):  
Renal Function ◽  
Body Weight ◽  
Viral Load ◽  
Hiv Infection ◽  
T Lymphocyte ◽  
Lymphocyte Count ◽  
Clinical Status ◽  
Hiv Patients ◽  
Herbal Formulation ◽  
Hematological Analysis

This study was carried out to determine the effect of herbal medication on the clinical status of HIV infected persons especially on their CD4+ T lymphocyte count and viral load. The toxicity of the medication was also studied. 25 HIV positive individuals were taken for the study. They were treated with a herbal formulation developed in our centre, for one year. Patients were evaluated for their clinical status every month and CD4+ T lymphocyte and viral load every six months. Other parameters assessed were body weight, hematological analysis and hepatic and renal function tests. Body weight was found to be increased in 20 patients out of 25 who have undergone treatment. CD4+T lymphocyte count was increased in 15 patients and viral load was decreased in 20 patients. In six patients viral load was undetectable range. Administration of these medications significantly reduced, elevated interferon-? and tumor necrosis factor in HIV patients. Medication did not produce any toxicity in HIV patients, as it did not show any significant change in hepatic function, renal function and haematology. Administration of herbal preparation was found to reduce clinical symptoms produced by HIV infection. This herbal formulation was found useful therapeutically for the management of HIV infection and did not produce any toxicity.

scholarly journals Assessment of Outcome over a 10-year Period of Patients Admitted to a Multidisciplinary Adult Intensive Care Unit with Haematological and Solid Tumours

2005 ◽  
Vol 33 (1) ◽  
pp. 26-35 ◽  
Author(s):  
J. L. Moran ◽  
P. J. Solomon ◽  
P. J. Williams
Keyword(s):  
Mechanical Ventilation ◽  
Cox Model ◽  
Severity Of Illness ◽  
Cohort Effect ◽  
Solid Tumours ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Over Time

The risk factors for time to mortality, censored at 30 days, of patients admitted to an adult teaching hospital ICU with haematological and solid malignancies were assessed in a retrospective cohort study. Patients, demographics and daily ICU patient data, from admission to day 8, were identified from a prospective computerized database and casenote review in consecutive admissions to ICU with haematological and solid tumours over a 10-year period (1989–99). The cohort, 108 ICU admissions in 89 patients was of mean age (±SD) 55±14 years; 43% were female. Patient diagnoses were leukaemia (35%), lymphoma (38%) and solid tumours (27%). Median time from hospital to ICU admission was five days (range 0–67). On ICU admission, 50% had septic shock and first day APACHE II score was 28±9. Forty-six per cent of patients were ventilated. ICU and 30-day mortality were 39% and 54% respectively. Multivariate Cox model predictors (P<0.05), using only ICU admission day data were: Charlson comorbidity index (CCI), time to ICU admission (days) and mechanical ventilation. For daily data (admission through day 8), predictors were: cohort effect (2nd vs 1st five-year period); CCI; time to ICU admission (days); APACHE II score and mechanical ventilation. Outcomes were considered appropriate for severity of illness and demonstrated improvement over time. Ventilation was an independent outcome determinant. Controlling for other factors, mortality has improved over time (1st vs 2nd five year period). Analysis restricted to admission data alone may be insensitive to particular covariate effects.

scholarly journals 4180 CD4 count is a prognostic marker in persons living with HIV and non-small cell lung cancer in the Bronx

2020 ◽  
Vol 4 (s1) ◽  
pp. 24-24
Author(s):  
Madelyn Klugman ◽  
Melissa Fazzari ◽  
Mindy Ginsberg ◽  
Thomas Rohan ◽  
David Hanna ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Viral Load ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Cd4 Count ◽  
Small Cell Lung ◽  
Hiv Patients ◽  
Persons Living With Hiv ◽  
Living With Hiv

OBJECTIVES/GOALS: There is a high burden of lung cancer in persons living with HIV (PLWH). The role that HIV status, by levels of immune function and viral load, has on survival from lung cancer is not fully understood. The study’s objectives were to assess 1) the association of HIV with survival in non-small cell lung cancer (NSCLC) and 2) prognostic factors in PLWH with NSCLC. METHODS/STUDY POPULATION: Participants were from a cohort of lung cancer patients diagnosed between 2004-2017 in the Bronx, NY, with vital status ascertainment at least annually. We compared survival from NSCLC diagnosis between HIV-negative patients (HIV-, N = 2881) and PLWH (N = 88), using Cox regression, accounting for clinical and sociodemographic factors including smoking status. In three separate comparisons to HIV-, PLWH were dichotomized by CD4 count (<200 vs. ≥200 cells/μL), CD4/CD8 ratio (median, <0.43 vs. ≥0.43) and HIV viral load (VL) suppression (<75 vs. ≥75 copies/mL). In PLWH only, we assessed the relationships of CD4 count, CD4/CD8 ratio, and VL at diagnosis with survival adjusting for age, sex, and cancer stage. CD4 count and CD4/CD8 ratio were also examined as time-varying variables using a counting process approach. RESULTS/ANTICIPATED RESULTS: PLWH were younger (median 56 years, IQR 51-52 vs. 68, IQR 60-76) and more likely to be current smokers (58% vs. 37%) at diagnosis than HIV- patients. Median survival was lower in PLWH [1.1 years, 95% confidence interval (95%CI): 0.6-1.3] than in HIV- [1.6 (1.5-1.7)]. Survival comparing PLWH with higher CD4/CD8 to HIV- was similar [hazard ratio (HR), 95%CI: 0.63 (0.37-1.07)], but those with lower CD4/CD8 experienced worse survival (HR = 1.74, 95%CI: 1.07-3.89). Among PLWH, having a CD4 count < 200 cells/μL was associated with over twice the risk of death compared to those with CD4 ≥ 200 cells/μL (HR = 2.37, 95%CI: 1.14-4.92). VL and CD4/CD8 ratio were not associated with survival. Lower time-updated CD4 count was also associated with worse survival (HR = 2.19 for CD4 <200 vs. >200 cells/μL, 95%CI: 1.16-4.13). DISCUSSION/SIGNIFICANCE OF IMPACT: Among persons with NSCLC, CD4/CD8 ratio nearest diagnosis was shown to distinguish mortality risk in PLWH compared with HIV- patients. In addition, PLWH with low CD4 had worse prognosis than PLWH who had higher CD4 counts. These results suggest HIV immune status to be an essential component influencing survival in lung cancer.

Case-control study of PD-1, PD-L1, and B7-H3 expression in human immunodeficiency virus infected (HIV+) and uninfected patients with head and neck cancers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23194-e23194
Author(s):  
Candace Barette Mainor ◽  
Katherine Ann Scilla ◽  
Jonathon Heath ◽  
Olga B. Ioffe ◽  
Ashley L Cellini ◽  
...  
Keyword(s):  
Viral Load ◽  
Head And Neck ◽  
Case Control Study ◽  
Locally Advanced ◽  
Case Control ◽  
Primary Site ◽  
Cd4 Count ◽  
Hiv Patients ◽  
Signaling Molecule ◽  
Control Study

e23194 Background: HIV+patients are typically excluded from immunotherapy trials but there are limited data on co-signaling molecule expression in these patients, including in head and neck squamous cell carcinoma (HNSCC). Methods: A case control study was conducted to evaluate tumor tissue sections for PD-L1, PD-1, and B7-H3 expression in HIV+HNSCC patients (n = 12) and HNSCC controls (n = 12). Cases and controls were matched for age at diagnosis, race, gender, TNM stage, and primary site. Smoking status, HIV RNA viral load (VL), and CD4 count were also recorded. Immunostained tumor sections were analyzed for percent of tumor cells expressing PD-L1 (PD-L1%) and B7-H3(B7-H3%) (Abcam), and percent of tumor infiltrating lymphocytes (TIL) expressing PD-1 (TIL-PD-1%) and PD-L1 (TIL-PD-L1%) (Abcam). Statistical analysis used the non-parametric Mann-Whitney test, chi-square test and Spearman’s rank correlation, Rs. Results: The 12 HIV+ HNSCC cases were predominantly male (67%), black race (67%) and cigarette smokers (100%), with a median age of 50.4 years, median viral load (VL) of 52399 copies/mL, median CD4 count (CD4) of 236cells/uL, predominantly locally advanced (75% Stage III/IVa/IVb), and oropharyngeal primary site (42%). Defining positive expression as > 5%, 42% of HIV+ HNSCC patients tumors were positive for PD-L1, 100% for B7-H3, and 92% had TILs that expressed PD-1 and PD-L1. HIV+ patients had significantly higher B7-H3% (Median 60% vs. 20%, p = 0.03) and TIL-PD-L1% (Median 15% vs. 10%, p = 0.045) compared to controls. There were no differences in PD-L1% or TIL-PD-1%. In HIV+ cases, increased VL correlated with increased TIL-PD-1% (Rs = 0.73, p = 0.011) and increased CD4 count correlated with increased tumor PD-L1% (Rs = 0.62, p = 0.04). There were no other significant correlations between CD4 count or VL and co-signaling molecule expression. Conclusions: HIV+ HNSCC patients had significantly higher tumor B7-H3 and TIL PD-L1 expression, with similar tumor PD-L1 and TIL PD-1 expression, compared to HIV negative HNSCC control patients. These findings support inclusion of HIV+ HNSCC patients in immunotherapy trials with checkpoint inhibitors.

scholarly journals Immunologic and Virologic Outcomes of Obese and Nonobese Incarcerated Adults on Antiretroviral Therapy for HIV Infection

2018 ◽  
Vol 17 ◽  
pp. 232595741775226
Author(s):  
Kristen L. Bunnell ◽  
Arwa Aldossari ◽  
Connor Perkins ◽  
Christopher Schriever ◽  
Thomas D. Chiampas ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Hiv Infection ◽  
Body Mass ◽  
Cd4 Count ◽  
Virologic Suppression ◽  
Matched Cohort ◽  
Nonobese Patients

Background: Obesity is common among patients with HIV. The objective of this study was to characterize response to antiretroviral therapy (ART) in a cohort of obese incarcerated adults compared to a nonobese cohort. Methods: A retrospective matched cohort study was conducted in an HIV telemedicine clinic. Patients with body mass index (BMI) >30 kg/m2 who received the same ART with >95% adherence for at least 6 months were matched to nonobese patients by age, gender, ART, CD4 count, and viral load at baseline. Results: Twenty pairs were included, with an average BMI of 24 kg/m2 in the nonobese cohort and 35 kg/m2 in the obese cohort. No difference was observed in the proportion of patients who achieved virologic suppression or the change in CD4 count from baseline to 6 to 12 months. Conclusion: This study revealed no differences in immunologic recovery or virologic suppression between obese and nonobese patients in an adult correctional population.

Sleeve Gastrectomy Is a Safe and Efficient Procedure in HIV Patients with Morbid Obesity: a Case Series with Results in Weight Loss, Comorbidity Evolution, CD4 Count, and Viral Load

2014 ◽  
Vol 25 (2) ◽  
pp. 229-233 ◽  
Author(s):  
Marinos Fysekidis ◽  
Régis Cohen ◽  
Mohamed Bekheit ◽  
Joseph Chebib ◽  
Abdelghani Boussairi ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Viral Load ◽  
Case Series ◽  
Cd4 Count ◽  
Hiv Patients ◽  
Efficient Procedure

scholarly journals Serum renin and major adverse kidney events in critically ill patients: a multicenter prospective study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Alexander H. Flannery ◽  
Victor Ortiz-Soriano ◽  
Xilong Li ◽  
Fabiola G. Gianella ◽  
Robert D. Toto ◽  
...  
Keyword(s):  
Critically Ill ◽  
Multicenter Study ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Renin Angiotensin System ◽  
Icu Admission ◽  
Kidney Replacement Therapy ◽  
The Individual ◽  
Major Adverse Kidney Events

Abstract Background Preliminary studies have suggested that the renin-angiotensin system is activated in critical illness and associated with mortality and kidney outcomes. We sought to assess in a larger, multicenter study the relationship between serum renin and Major Adverse Kidney Events (MAKE) in intensive care unit (ICU) patients. Methods Prospective, multicenter study at two institutions of patients with and without acute kidney injury (AKI). Blood samples were collected for renin measurement a median of 2 days into the index ICU admission and 5–7 days later. The primary outcome was MAKE at hospital discharge, a composite of mortality, kidney replacement therapy, or reduced estimated glomerular filtration rate to ≤ 75% of baseline. Results Patients in the highest renin tertile were more severely ill overall, including more AKI, vasopressor-dependence, and severity of illness. MAKE were significantly greater in the highest renin tertile compared to the first and second tertiles. In multivariable logistic regression, this initial measurement of renin remained significantly associated with both MAKE as well as the individual component of mortality. The association of renin with MAKE in survivors was not statistically significant. Renin measurements at the second time point were also higher in patients with MAKE. The trajectory of the renin measurements between time 1 and 2 was distinct when comparing death versus survival, but not when comparing MAKE versus those without. Conclusions In a broad cohort of critically ill patients, serum renin measured early in the ICU admission is associated with MAKE at discharge, particularly mortality.

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