Comparison of Late HIV Diagnosis as a Marker of Care for Aboriginal Versus Non-Aboriginal People Living with HIV in Ontario

BACKGROUND: Studies have found that Aboriginal people living with HIV/AIDS (APHAs) are more likely than non-APHAs to receive suboptimal HIV care, yet achieve similar clinical outcomes with proper care.OBJECTIVE: To compare the proportions of individuals diagnosed late with HIV between APHAs and non-APHAs within the Ontario HIV Treatment Network Cohort Study (OCS).METHODS: The analysis included OCS participants who completed the baseline visit by November 2009. Two definitions of the outcome of late HIV diagnosis were used: the proportion of participants with an AIDS-defining illness (ADI) before or within three months of HIV diagnosis; and the proportion of participants with a CD4+count <200 cells/mL at diagnosis. Logistic regression analysis was used to assess the association between Aboriginal ethnicity and late HIV diagnosis.RESULTS: APHAs were more likely to be female and have lower income, education and employment. No statistically significant differences were noted in the proportions receiving a late HIV diagnosis defined by ADI (Aboriginal 5.2% versus non-Aboriginal 6.3%; P=0.40). Multivariate logistic regression analysis revealed a significant association between Aboriginal ethnicity and late HIV diagnosis defined by CD4+count after adjusting for age and HIV risk factor (OR 1.55; P=0.04).DISCUSSION: APHAs were more likely to have a CD4+count <200 cells/mL at diagnosis but had similar clinical outcomes from late diagnosis when defined by ADI. However, differences may be underestimated due to recruitment limitations and selection bias.CONCLUSION: Additional work is needed to address the socioeconomic and health care needs of APHAs.

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352. Characteristics Associated with Pre-Frailty in Older People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.425 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S186-S186

Author(s):

Peter Mazonson ◽

Theoren Loo ◽

Jeff Berko ◽

Sarah-Marie Chan ◽

Ryan Westergaard ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cognitive Function ◽

Older People ◽

Logistic Regression Analysis ◽

The United States ◽

People Living With Hiv ◽

Factors Associated ◽

Increased Risk ◽

Living With Hiv

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

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Predictors of HIV/AIDS comprehensive knowledge and acceptance attitude towards people living with HIV/AIDS among unmarried young females in Uganda: a cross-sectional study

BMC Women s Health ◽

10.1186/s12905-021-01176-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tesfaldet Mekonnen Estifanos ◽

Chen Hui ◽

Afewerki Weldezgi Tesfai ◽

Mekonnen Estifanos Teklu ◽

Matiwos Araya Ghebrehiwet ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Cross Sectional Study ◽

People Living With Hiv ◽

Sectional Study ◽

Cross Sectional ◽

Young Females ◽

Comprehensive Knowledge ◽

Hiv Aids

Abstract Background Youth in general and young females, in particular, remain at the center of HIV/AIDS epidemic. To avoid and prevent HIV infection, comprehensive knowledge as well as correct understanding of transmission and prevention strategies are crucial. Thus, the aim of this study is to explore the predictors of comprehensive knowledge on HIV/AIDS and accepting attitude towards PLWHIV. Methods A cross-sectional study was conducted using data from the 2016 Uganda Demographic Health Survey. A two-stage probability sampling method was applied and data were collected using a standard questionnaire. Of the total 8674 women aged 15–49 years, 1971 eligible women aged 15–24 years were included in this analysis. Data analysis was done using SPSS version 23. A Chi-square test followed by logistic regression analysis was used to explore the relationship between specific explanatory variables and outcome variables. The results were reported using odds ratios with 95% confidence interval. P value less than 0.05 was considered as statistically significant. Results Overall, 99.3% of the unmarried women aged 15–24 years were aware of HIV/AIDS, but only 51.9% had comprehensive knowledge on HIV/AIDS. Around 70% of the respondents were aware that "using condoms every time when having sex" and "having only one faithful uninfected partner" can prevent HIV transmission. About 68% of the unmarried women rejected at least two common local misconceptions about HIV/AIDS. An alarmingly small (20.6%) proportion of the respondents had a positive acceptance attitude towards PLWHIV. All variables were significantly associated with having comprehensive knowledge on HIV/AIDS in the unadjusted logistic regression analysis. After adjustment, older age (20–24 years), being educated, wealthier, and ever been tested for HIV/AIDS became predictors of adequate comprehensive HIV/AIDS knowledge. Moreover, respondents with adequate comprehensive knowledge of HIV/AIDS were more likely (OR 1.64, 95% CI 1.30–2.08) to have a positive acceptance attitude towards PLWHIV than their counterparts. Conclusion Our study demonstrated a remarkably high level of awareness about HIV/AIDS among study participants, but the knowledge and positive acceptance attitude towards PLWHIV were not encouraging. Thus, endeavors to expand and strengthen educational campaigns on HIV/AIDS in communities, health facilities, and schools are highly recommended. Attention should particularly focus on young-aged and disadvantaged women with low educational level, poor socioeconomic status and those who have never been tested for HIV/AIDS.

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The Impact of Discrepancy between Measured versus Stated Weight on Hemorrhagic Transformation and Clinical Outcomes after Intravenous Alteplase Thrombolysis

Cerebrovascular Diseases ◽

10.1159/000479941 ◽

2017 ◽

Vol 44 (5-6) ◽

pp. 241-247 ◽

Cited By ~ 1

Author(s):

Dong Hoon Shin ◽

Min-Ju Kang ◽

Jin Wook Kim ◽

Dong-Jin Shin ◽

Hyeon-Mi Park ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Hemorrhagic Transformation ◽

Multivariable Logistic Regression Analysis ◽

Laboratory Findings ◽

Actual Weight ◽

Measured Weight ◽

Intravenous Alteplase

Background: An accurate measurement of patient weight is important in determining the dosage for intravenous alteplase thrombolysis. In most emergency rooms, however, weight is not measured. We investigated the difference between stated and measured weight and its effect on hemorrhagic transformation and clinical outcomes. Methods: We enrolled 128 consecutive patients who had hyperacute stroke and were treated by alteplase. Alteplase dose was calculated using the weight provided by patient or guardian/caregiver, and the actual weight was measured after administration. Patients were classified into 2 groups: overused group (stated weight >measured weight) and underused group (measured weight ≥stated weight). The prevalence of hemorrhagic transformation on follow-up, determined by gradient-recalled echo MRI or non-enhanced CT, was compared between the 2 groups. The predictors for hemorrhage with progression, defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) by a value of 4 or more accompanied by hemorrhage, were determined using multivariable logistic regression analysis and included the overused or underused alteplase and baseline clinical and laboratory findings. Results: Sixty-six (51.6%) of 128 patients were in the underused group and 62 patients (48.4%) in the overused group. The median difference between the stated and measured weights was 1.5 (interquartile range 0.56-3.81) kg, with the largest difference being 25.6 kg. Although there were no significant difference in baseline clinical and laboratory findings between the 2 groups, the overused group showed a significantly higher prevalence of hemorrhagic transformation (p = 0.012) and hemorrhage with progression (p = 0.025). The multivariable logistic regression analysis demonstrated that overused alteplase (OR 7.26; 95% CI 1.24-42.45; p = 0.028), baseline glucose (>144 mg/dL; OR 5.03; 95% CI 1.00-25.26; p = 0.050), and initial NIHSS (OR 1.13 per 1-point NIHSS increase; 95% CI 1.00-1.27; p = 0.047) in model 1 that use alteplase overdose as a categorical variable and overused alteplase (OR 1.67 1-mg increase; 95% CI 1.05-2.66; p = 0.027) in model 2 that use an overused alteplase dose as numerical variable were significant predictors for hemorrhage with progression. Conclusion: More alteplase usage than actual weight led to higher hemorrhagic transformation. As one of the predictors for clinical deterioration, it is important to administrate alteplase based on an accurately measured weight.

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D-Dimer as Biomarker for Early Prediction of Clinical Outcomes in Patients With Severe Invasive Infections Due to Streptococcus Pneumoniae and Neisseria Meningitidis

Frontiers in Medicine ◽

10.3389/fmed.2021.627830 ◽

2021 ◽

Vol 8 ◽

Author(s):

Simone Meini ◽

Emanuela Sozio ◽

Giacomo Bertolino ◽

Francesco Sbrana ◽

Andrea Ripoli ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Streptococcus Pneumoniae ◽

Hospital Mortality ◽

Neisseria Meningitidis ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Mortality Risk ◽

Invasive Infections ◽

D Dimer

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; no current clinical measure adequately reflects the concept of dysregulated response. Coagulation plays a pivotal role in the normal response to pathogens (immunothrombosis), thus the evolution toward sepsis-induced coagulopathy could be individuate through coagulation/fibrinolysis-related biomarkers. We focused on the role of D-dimer assessed within 24 h after admission in predicting clinical outcomes in a cohort of 270 patients hospitalized in a 79 months period for meningitis and/or bloodstream infections due to Streptococcus pneumoniae (n = 162) or Neisseria meningitidis (n = 108). Comparisons were performed with unpaired t-test, Mann-Whitney-test or chi-squared-test with continuity correction, as appropriate, and multivariable logistic regression analysis was performed with Bayesian model averaging. In-hospital mortality was 14.8% for the overall population, significantly higher in S. pneumoniae than in N. meningitidis patients: 19.1 vs. 8.3%, respectively (p = 0.014). At univariable logistic regression analysis the following variables were significantly associated with in-hospital mortality: pneumococcal etiology, female sex, age, ICU admission, SOFA score, septic shock, MODS, and D-dimer levels. At multivariable analysis D-dimer showed an effect only in N. meningitidis subgroup: as 500 ng/mL of D-dimer increased, the probability of unfavorable outcome increased on average by 4%. Median D-dimer was significantly higher in N. meningitidis than in S. pneumoniae patients (1,314 vs. 1,055 ng/mL, p = 0.009). For N. meningitidis in-hospital mortality was 0% for D-dimer <500 ng/mL, very low (3.5%) for D-dimer <7,000 ng/mL, and increased to 26.1% for D-dimer >7,000 ng/mL. Kaplan-Meier analysis of in-hospital mortality showed for N. meningitidis infections a statistically significant difference for D-dimer >7,000 ng/mL compared to values <500 ng/mL (p = 0.021) and 500–3,000 ng/mL (p = 0.002). For S. pneumoniae the mortality risk resulted always high, over 10%, irrespective by D-dimer values. In conclusion, D-dimer is rapid to be obtained, at low cost and available everywhere, and can help stratify the risk of in-hospital mortality and complications in patients with invasive infections due to N. meningitidis: D-dimer <500 ng/mL excludes any further complications, and a cut-off of 7,000 ng/mL seems able to predict a significantly increased mortality risk from much <10% to over 25%.

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P2635Prevalence of appropriate treatment in elderly heart failure patients and impact on clinical outcomes: a subgroup analysis from REPOSI registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0956 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Proietti ◽

A M Marra ◽

A Salzano ◽

G F Romiti ◽

P M Mannucci ◽

...

Keyword(s):

Heart Failure ◽

Logistic Regression ◽

Regression Analysis ◽

Elderly Patients ◽

Hospital Admission ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Appropriate Treatment ◽

Key Factor

Abstract Introduction Therapeutic appropriateness in chronic diseases is a key factor in obtaining better clinical outcomes over clinical follow-up, in particular in elderly patients. Data about therapeutic appropriateness in elderly patients with heart failure (HF) are scarce. Purpose To describe the prevalence of appropriate treatment in elderly HF patients and its impact on clinical outcomes. Methods REgistro POliterapie SIMI (REPOSI) cohort was used to assess study aims. REPOSI is an Italian Nationwide Registry of elderly (≥65 years) hospitalized patients in Internal Medicine and Geriatric wards. HF diagnosis was assessed at hospital admission according to ICD-9 code 428.XX. Therapeutic appropriateness was defined according to International Guidelines. Results Among the 7003 patients originally enrolled, a total of 1095 (15.6%) patients reported a diagnosis of HF at hospital admission. At admission, 230 (21.0%) patients were considered as treated appropriately, with 245 (22.4%) treated appropriately during hospitalization and 249 (22.7%) at discharge (p=0.0.248). Focusing on patients aged ≥80 years, prevalence of appropriate treatment was respectively: 18.9% at admission, 20.3% during hospitalization and 21.0% at discharge (p=0.266). Among the 1095 patients with HF, 815 (74.4%) had available follow-up data. Patients appropriately treated at discharge, compared to those not treated appropriately, had a lower rate of CV death (5.1% vs. 11.9%, p=0.006) and all-cause death (7.2% vs. 26.1%, p<0.001) during follow-up, with no difference in rates of rehospitalization and CV rehospitalization. A logistic regression analysis adjusted for age, sex, risk factors, comorbidities and polypharmacy, showed that appropriate therapy at discharge was inversely associated with the risk of CV death and all-cause death (Table). In patients ≥80 years, appropriate HF treatment was inversely associated with risk of all-cause death (Table). Logistic Regression Analysis All Patients ≥80 years OR (95% CI) OR (95% CI) CV Death 0.46 (0.23–0.94) 0.59 (0.26–1.36) All-Cause Death 0.26 (0.14–0.46) 0.27 (0.14–0.53) CI = Confidence Interval; CV = Cardiovascular; OR = Odds Ratio. Conclusions In elderly hospitalized HF patients, prevalence of therapeutic appropriateness was consistently low at admission, during hospitalization and at discharge, particularly in patients ≥80 years. Appropriate HF therapy was inversely associated with the risk of CV death and all-cause death in all patients and with the risk of all-cause death in patients ≥80 years. Acknowledgement/Funding None

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Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

10.21203/rs.3.rs-21428/v1 ◽

2020 ◽

Author(s):

Xiudi Han ◽

Xuedong Liu ◽

Liang Chen ◽

Yimin Wang ◽

Hui Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pleural Effusion ◽

Elderly Patients ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Community Acquired Pneumonia ◽

Multivariable Logistic Regression Analysis ◽

Clinical Failure

Abstract Background: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods: 3,011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH<7.3, PaO 2 /FiO 2 < 200 mmHg, sodium <130 mmol/L, healthcare-associated pneumonia, white blood cells >10000/mm 3 , pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration : A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

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Stereotypes of representations about HIV, contributing to the epidemic growth

HIV Infection and Immunosuppressive Disorders ◽

10.22328/2077-9828-2020-12-3-51-58 ◽

2020 ◽

Vol 12 (3) ◽

pp. 51-58

Author(s):

D. V. Antonova ◽

V. V. Bocharov ◽

N. S. Chrustaleva

Keyword(s):

Disease Transmission ◽

Public Awareness ◽

Heterosexual Transmission ◽

People Living With Hiv ◽

Life Situation ◽

Hiv Diagnosis ◽

Infection Route ◽

Late Hiv Diagnosis ◽

Study Results ◽

Living With Hiv

The aim of the study was to explore the common misconceptions about HIV as a determinant of the HIV epidemic growth and as a factor affecting disease outcomes.Materials and methods. The study involved 136 persons (50 persons with blood-borne infection route, 50 persons with heterosexual transmission, 36 persons without HIV). As research methods a special clinical map was used, as well as an author’s questionnaire, which allows to register the characteristics of risky behavior in relation to infection and the characteristics of the life situation of the disease. Statistical data processing included the deﬁnition of primary statistics, the Fisher criterion, ANOVA.Study results. A frequent occurrence of distorted representations about HIV was noted in all groups. It has been established that people living with HIV and healthy respondents do not differ in the frequency of HIV testing. The features of the life situation of the disease related to the method of the disease transmission were revealed in the study. It has been established that people living with HIV with different infection route differ in the frequency of late HIV diagnosis, the presence of AIDS, refusal of treatment. The results determine the need to increase public awareness of the disease and correct distorted representations about it.

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Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

BMC Infectious Diseases ◽

10.1186/s12879-020-05362-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Xiudi Han ◽

◽

Xuedong Liu ◽

Liang Chen ◽

Yimin Wang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Pleural Effusion ◽

Elderly Patients ◽

Clinical Outcomes ◽

Logistic Regression Analysis ◽

Community Acquired Pneumonia ◽

Multivariable Logistic Regression Analysis ◽

Clinical Failure

Abstract Background The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

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The Role of Depression, Anxiety and Illness Characteristics on Risky Sexual Behaviour among People Living with HIV in A Malaysian Tertiary Reference Hospital

Current Psychiatry Research and Reviews ◽

10.2174/2666082215666191022112412 ◽

2020 ◽

Vol 15 (4) ◽

pp. 267-276

Author(s):

Seng Choi Chong ◽

Normala Ibrahim ◽

Jin Kiat Ang ◽

Ruziana Masiran ◽

Kit-Aun Tan ◽

...

Keyword(s):

Logistic Regression ◽

Sexual Behaviour ◽

Anxiety Symptoms ◽

Risky Sexual Behaviour ◽

P Value ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Reference Hospital ◽

Living With Hiv

Background: People living with HIV (PLHIV) have a longer lifespan with treatment and continue to be sexually active. To date, the extent of risky sexual behaviour among local PLHIV and its associated factors were undetermined. Objective: To examine the role of depression, anxiety and illness characteristics on risky sexual behaviour among PLHIV attending care in a Malaysian tertiary reference hospital (N= 406). Method: It was a cross-sectional study. Subjects were recruited by systematic random sampling. Risky sexual behaviour was determined by using the modified National Youth Risk Behaviour Survey. PHQ-9 and GAD-7 were used to measure the depressive and anxiety symptoms, respectively. Chi-square test was used to examine the association between the variables. Multiple logistic regression was used to examine the predictors of the study. A p value of less than 0.05 was considered significant and odds ratio was used as the measure of risk association. Results: Our study showed that 29.3% had risky sexual behaviour. Meanwhile, 21.9% and 26.4% had depressive and anxiety symptoms, respectively. Risky sexual behaviour was significantly associated with age, religion, education level, duration of HIV diagnosis, depressive and anxiety symptoms. From multivariate logistic regression, duration of HIV diagnosis and anxiety symptoms significantly predicted risky sexual behaviour. Conclusion: This study highlights that a substantial number of PLHIV had risky sexual behaviour and psychological symptoms. It is important for psychological interventions that reduce risky sexual behaviour among PLHIV who attend treatment, especially during the early phase.

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