scholarly journals 377. Diagnostic Yield of Bone Marrow Aspiration and Biopsy in Human Immunodeficiency Virus Patients with Fever and/or Cytopenia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S197-S197
Author(s):  
Stephanie Egge ◽  
Mathew Malus ◽  
Ariel Osorio ◽  
Richard Mansour ◽  
Samip Master ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Human Immunodeficiency Virus ◽  
Early Diagnosis ◽  
Bone Marrow Aspiration ◽  
The United States ◽  
Cd4 Count ◽  
Hiv Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Wbc Count

Abstract Background Human Immunodeficiency Virus (HIV) patients are at increased risk of opportunistic infections and malignancies. Evaluation for the etiology of fever and/or cytopenia with conventional means such as cultures and serology can remain negative. Bone marrow aspiration or biopsy (BMAB) has the advantage of diagnosing disseminated infections, hematological abnormalities and oncological malignancies in HIV patients. Methods We performed a retrospective descriptive study of HIV patients with fever and/ or cytopenia who underwent Bone marrow aspiration or biopsy (BMAB). Patients with a diagnosis of HIV, 18 years and older who underwent BMAB in University Health (UH) Hospital or in UH clinics from January 2012 to February 2018 were included. Results There were a total of 42 patients who underwent Bone Marrow Aspiration or Biopsy. The median age was 41.5 years. Twenty-eight patients were Male and 14 were female. Preexisting Hematological malignancy was present in 10 patients at the time of BMAB. Average CD4 count at the time of BMAB was 92. 8 patients were compliant with ART and 12 patients were compliant with clinic appointments. White Blood Cell (WBC) count below 4.4 cells / L was present in 30 patients at the time of BMAB. Disseminated Mycobacterium Avium Complex infection (2 patients),Disseminated Histoplasmosis (2 patients), Disseminated Cryptococcus (1 patient) and Parvovirus B19 (based on Immunohistochemistry, 1 patient) were diagnosed from BMAB. CD4 count of these 6 patients range from 0 to 12 at the time of BMAB. All 6 patients presented to the hospital with fever for evaluation. Average WBC count, Hemoglobin and platelet count in these patients are 4.1 cells / liter, 8.7 g/dL and 74.8 k/micro liter, respectively. All 6 patients were non compliant to HIV medications and clinic appointments. Conclusion Since the advent of Anti Retroviral drugs with excellent efficacy and early diagnosis of HIV patients, incidence of disseminated fungal and mycobacterial infections have decreased in the United States. But patients with low CD4 count and cytopenias warrant a Bone Marrow aspiration or Biopsy to make a clear and early diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals Use of Intrauterine Devices and Risk of Human Immunodeficiency Virus Acquisition Among Insured Women in the United States

2019 ◽  
Vol 70 (10) ◽  
pp. 2221-2223
Author(s):  
Julia L Marcus ◽  
Jonathan M Snowden ◽  
Mara E Murray Horwitz ◽  
Sengwee Toh ◽  
Casie Horgan ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Intrauterine Device ◽  
The United States ◽  
Hiv Diagnosis ◽  
Health Insurance Data ◽  
Virus Acquisition ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hiv Acquisition

Abstract Concerns have been raised about progestin-containing contraceptives and the risk of human immunodeficiency virus (HIV) acquisition. Based on health insurance data from women in the United States with intrauterine device (IUD) insertions during 2011–2018, there was no increased risk of incident HIV diagnosis for levonorgestrel-releasing IUDs versus copper IUDs.

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.

scholarly journals PrEP for women: An update for healthcare providers

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Danielle P. Clement ◽  
Kara McGee ◽  
Kathryn Trotter
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Risk ◽  
Healthcare Providers ◽  
The United States ◽  
Cultural Factors ◽  
Clinical Encounters ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Social And Cultural Factors ◽  
Exposure Prophylaxis

Women account for almost 20% of all new diagnoses of human immunodeficiency virus (HIV) in the United States, yet their utilization of pre-exposure prophylaxis (PrEP) to prevent HIV infection is highly underutilized. Significant racial, social, and cultural factors further marginalize those who are at increased risk. Women’s healthcare providers should screen for HIV risk and offer PrEP during routine clinical encounters.

scholarly journals Haematological profile of human immunodeficiency virus infected patients

2019 ◽  
Vol 5 (1) ◽  
pp. 164
Author(s):  
C. L. Chitra ◽  
R. Manipriya ◽  
K. Deepa
Keyword(s):  
Human Immunodeficiency Virus ◽  
Complete Blood Count ◽  
Stage Iv ◽  
Cd4 Count ◽  
Stage I ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Increased Risk ◽  
Haematological Profile ◽  
Immunodeficiency Virus

<p class="abstract"><strong>Background:</strong> In India, approximately 6 million populations are affected by human immunodeficiency virus (HIV). Anemia and leukopenia, especially thrombocytopenia is seen commonly in HIV infections. Low CD4+ count and increased viral load are some of the factors associated with increased risk of thrombocytopenia. The aim of the study was to study the hematological changes that occur in HIV infected patients who attend the Institute of Venereology, before starting HAART.</p><p class="abstract"><strong>Methods:</strong> This cross-sectional study was conducted in the Institute of Venereology, Madras Medical College/Rajiv Gandhi Government General Hospital, Chennai in 100 treatment-naive HIV infected patients. Detailed history and clinical examination was done. Blood samples were collected. Complete blood count, CD4 count, prothrombin time, activated plasma thromboplastin time, peripheral smear etc., were done. Results were collected and analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 100 patients, 56% were males and 43% females and one transgender. Anaemia was detected in 72%patients. 73.5% males and 76.2% females with CD4 count &lt;350/μl were anemic. The commonest anaemia was normochromic normocytic, seen in 65% patients. 7 male and 7 female patients had leukopenia. 81.25%patients with lymphocytopenia had CD4 count &lt;350/μl. 12% males and 4% females had neutropenia. 17% had neutrophilia. Patients in WHO stage I did not have neutropenia. 23% patients had thrombocytopenia. 47% patients with thrombocytopenia were in stage IV. Maximum number of patients with normal platelet count was in stage I.</p><p class="abstract"><strong>Conclusions:</strong> Haematological abnormalities are a common occurrence during the course of HIV infection. Identifying and treating the haematological changes have great impact on both the morbidity and mortality of HIV infected patients.</p>

scholarly journals Clinical Profile of Adverse Cutaenous Drug Reactions in Patients with Human Immunodeficiency Virus

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Puteri Nabilah Maharani ◽  
Oki Suwarsa ◽  
Susantina Prodjosoewojo
Keyword(s):  
Human Immunodeficiency Virus ◽  
Clinical Features ◽  
Secondary Data ◽  
Stevens Johnson Syndrome ◽  
Clinical Feature ◽  
Drug Reactions ◽  
Hiv Patients ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Cutaneous Drug Reactions

Background: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs. Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage. Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%). Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs.

scholarly journals Hepatotoxicity Chemotherapy-Induced in HIV Patients

Cells ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 2871
Author(s):  
Silvia Bressan ◽  
Alessandra Pierantoni ◽  
Saman Sharifi ◽  
Sergio Facchini ◽  
Vincenzo Quagliarello ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Chemotherapeutic Drugs ◽  
Hiv Patients ◽  
Simultaneous Treatment ◽  
Risks And Benefits ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hiv And Cancer ◽  
Chronic Disease State ◽  
Selection Of

Human immunodeficiency virus (HIV) affects more than 37 million people globally, and in 2020, more than 680,000 people died from HIV-related causes. Recently, these numbers have decrease substantially and continue to reduce thanks to the use of antiretroviral therapy (ART), thus making HIV a chronic disease state for those dependent on lifelong use of ART. However, patients with HIV have an increased risk of developing some type of cancer compared to patients without HIV. Therefore, treatment of patients who are diagnosed with both HIV and cancer represents a complicated scenario because of the risk associated with drug–drug interaction (DDIs) and related toxicity. Selection of an alternative chemotherapy or ART or temporarily discontinuation of ART constitute a strategy to manage the risk of DDIs. Temporarily withholding ART is the less desirable clinical plan but risks and benefits must be considered in each scenario. In this review we focus on the hepatotoxicity associated with a simultaneous treatment with ART and chemotherapeutic drugs and mechanisms behind. Moreover, we also discuss the effect on the liver caused by the association of immunotherapeutic drugs, which have recently been used in clinical trials and also in HIV patients.

ACQUIRED IMMUNODEFICIENCY SYNDROME, HUMAN IMMUNODEFICIENCY VIRUS AND HEMOPHILIA

1987 ◽  
Author(s):  
P H Levine
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Specific Activity ◽  
Subsequent Development ◽  
Immune Dysfunction ◽  
The United States ◽  
Clotting Factor ◽  
Increased Risk ◽  
Immunodeficiency Virus

Less than 15 years ago the National Heart, Lung and Blood Institute surveyed physicians in the United States in order to characterize the demographics of hemophilia. The average age of persons with hemophilia in the United States was found to be 11.5 years old. By 10 years later, the life expectancy was predicted to be normal, and indeed the average age of persons with hemophilia in the U.S. is now in the early twenties. Early, intensive and predictably efficacious control of hemorrhage has made this result possible, and the therapeutic product which has allowed such control is commercial clotting factor concentrate.We now know that starting in 1978, and with great frquency during 1982 and 1983, the majority of U.S. hemophiliacs were infected with human immunodeficiency virus (HIV). It is estimated that as of January, 1987, approximately two thirds of the 20,000' persons with hemophilia in the United States have been infected with HIV. Among those with severe factor VIII deficiency, more than 9056 are seropositive. As of 1/5/87, there were 288 cases of AIDS among U.S. hemophiliacs, for an AIDS rate of approximately 2.256 of those with HIV infection. This number included 185 with severe, 32 with moderate and 28 with mild hemophilia A; 12 with severe, 6 with moderate and 1 with mild hemophilia B; 9 with vWD, and 4 others. A disproportionate number were older patients: 55 were ages 1-19; 62 ages 20-29; 85 ages 30-39, and 86 age 40 or older. Although the AIDS attack rate is no longer climbing logarhythmically, new cases are certainly still occurring.A variety of other HIV-related syndromes have emerged. Of great concern is immune thrombocytopenia, which is now relatively common; among a group of 209 carefully followed HIV-positive patients at our center, 31 (1556) are or have been thrombocytopenic. Progressive failure to normally gain height and weight in children with hemophilia has recently been shown by our group to correlate with HIV antibody positivity, and also with decreased T4/T8 ratio, decreased T4 cell count, decreased skin test reactivity, and subsequent development of ARC or AIDS in some such children. Finally, a picture of progressive fall in T4 count associated with recurrent non-specific infections and increased likelihood of positive viral culture, may predict an increased risk of developing AIDS.We know that the immune dysfunction in hemophilia is complex, and not wholly explained by HIV infection. One important factor may be the many foreign proteins contained in commercial clotting factor concentrates, and their ability to stimulate T cells. It is known that latent HIV infection in cultured T4 lymphocytes can be induced to enter the proliferative, viral secretory phase by the addition of soluble foreign antigens to the cell culture. Recent data of Brettler and colleagues, to be presented at this meeting, suggest that the use of highly purified VI!I:C (specific activity >3000 u/mg) in place of the present extremely impure products, may improve the immune dysfunction in hemophilia. This observation offers a new hypothetical approach to the prevention of progressive T4 cell depletion in HIV infected hemophiliacs, and requires immediate and extensive further study.The psychosocial burden of HIV infection is immense. The need for extensive, formal education and support programs is largely unmet in most parts of the world. Such programs are best run out of hemophilia treatment centers in most cases, and must include an active program on prevention of sexual transmission, provision of HIV testing before and during pregnancies, provision for maintenance of confidentiality, etc. Education concerning HIV is like all other forms of education. It requires formal organization, a curriculum, active rather than passive learning in which there is interaction between the teacher and the pupil, time for planned repetition, reinforcement with written materials, and assessment of goals achieved. For all of these reasons it is inappropriate to assume that the physician at the hemophilia center will be able to provide an adequate education program. Adquate paramedical personnel will need to undertake this effort, under the directjon of the physician.

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.

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