Abstract WP426: Subarachnoid Hemorrhage in patients infected with Human Immunodeficiency Virus

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Haralabos Zacharatos ◽  
Malik M Adil ◽  
Ameer E Hassan ◽  
Sarwat I Gilani ◽  
Adnan I Qureshi
Keyword(s):  
Human Immunodeficiency Virus ◽  
Subarachnoid Hemorrhage ◽  
Blood Transfusion ◽  
Hospital Mortality ◽  
Hiv Infection ◽  
The United States ◽  
Hiv Positive ◽  
Published Data ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Background: There is limited data regarding the unique attributes of ischemic stroke among patients infected with human immunodeficiency virus (HIV). There is no published data regarding the occurrence and outcomes of subarachnoid hemorrhage (SAH) among HIV infected persons. Methods: The largest all-payer Nationwide Inpatient Sample (NIS 2002-2010) data was used to identify and analyze all patients presenting with the primary diagnosis of SAH in the United States. Among this cohort, we identified the patients who were not HIV positive and those who were HIV positive. Patient demographics, medical co-morbidities, in-hospital complications, in-hospital procedures, and discharge disposition were compared between the two groups. The association between HIV infection and outcomes was evaluated in multivariate analysis after adjusting for potential confounders. Results: Of the 351,491 patients admitted with SAH, 1367 (0.39%) were infected with HIV. HIV infected patients were younger, mean age [±SD] of 45 ±14.2 years versus those who were not 58±19 years, (p<0.0001). The rate of blood transfusion [27,286 (7.8%) versus 245.6 (18%), p=0.0003], mechanical ventilation [51,199 (14.6%) versus 316.1(23.1%), p=0.008], and sepsis [14,644 (4.2%) versus 236.1 (17.3%), p<0.0001] was significantly higher among HIV infected patients. After adjusting for age, gender, hypertension, coagulopathy, atrial fibrillation, renal failure, and dyslipidemia, HIV negative patients had a significantly higher rate of discharge to home (odds ratio [OR] 1.9, 95% CI: 1.4-2.6, p<0.0001) and lower in-patient mortality (OR 0.4, 95% CI: 0.3-0.5, p<0.001). Further adjustment for blood transfusion and sepsis reduced the odds of discharge to home for the HIV negative patients, from 1.9 to 1.7 but did not affect in-hospital mortality. Conclusion: The in-hospital mortality in HIV infected patients with SAH is higher despite these patients being younger than non-HIV infected patients. We believe that this study provides a nationwide perspective which may have some important implications for early recognition and diagnosis of HIV-infection in SAH patients.

scholarly journals Levels of Macrophage Inflammatory Protein 1α (MIP-1α) and MIP-1β in Intervillous Blood Plasma Samples from Women with Placental Malaria and Human Immunodeficiency Virus Infection

2003 ◽  
Vol 10 (4) ◽  
pp. 631-636 ◽  
Author(s):  
Sujittra Chaisavaneeyakorn ◽  
Julie M. Moore ◽  
Lisa Mirel ◽  
Caroline Othoro ◽  
Juliana Otieno ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Blood Plasma ◽  
Plasma Levels ◽  
Placental Malaria ◽  
Hiv Positive ◽  
Inflammatory Protein ◽  
Immunodeficiency Virus ◽  
Macrophage Inflammatory Protein ◽  
Hiv Negative

ABSTRACT Macrophage inflammatory protein-1α (MIP-1α) and MIP-1β play an important role in modulating immune responses. To understand their importance in immunity to placental malaria (PM) and in human immunodeficiency virus (HIV)-PM coinfection, we investigated levels of these chemokines in the placental intervillous blood plasma (IVB plasma) and cord blood plasma of HIV-negative PM-negative, HIV-negative PM-positive, HIV-positive PM-negative, and HIV-positive PM-positive women. Compared to HIV-negative PM-negative women, the MIP-1β concentration in IVB plasma was significantly elevated in HIV-negative PM-positive women and HIV-positive PM-positive women, but it was unaltered in HIV-positive PM-negative women. Also, PM-infected women, irrespective of their HIV status, had significantly higher levels of MIP-1β than HIV-positive PM-negative women. The MIP-1α level was not altered in association with either infection. The IVB plasma levels of MIP-1α and MIP-1β positively correlated with the cord blood plasma levels of these chemokines. As with IVB plasma, only cord plasma from PM-infected mothers had significantly elevated levels of MIP-1β compared to PM-negative mothers, irrespective of their HIV infection status. MIP-1β and MIP-1α levels in PM-positive women were positively associated with parasite density and malaria pigment levels. Regardless of HIV serostatus, the IVB MIP-1β level was significantly lower in women with PM-associated anemia. In summary, an elevated level of MIP-1β was associated with PM. HIV infection did not significantly alter these two chemokine levels in IVB plasma.

scholarly journals Incidental Findings on Coronary Computed Tomography Angiography in Human Immunodeficiency Virus (HIV)-Positive and HIV-Negative Persons

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Sara Reinschmidt ◽  
Teja Turk ◽  
Philip E Tarr ◽  
Roger Kouyos ◽  
Christoph Hauser ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Computed Tomography Angiography ◽  
Incidental Findings ◽  
Coronary Computed Tomography Angiography ◽  
Hiv Positive ◽  
Factors Associated ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Abstract Background Incidental findings on coronary computed tomography angiography (CCTA) have a great impact on the benefits and costs of testing for cardiovascular disease. The number of incidental findings might be increased in human immunodeficiency virus (HIV)-positive individuals compared with the general population. Data are limited regarding the association between incidental findings and HIV infection. Methods We assessed the prevalence and factors associated with incidental findings among HIV-positive and HIV-negative participants ≥45 years undergoing CCTA. Logistic regression was performed to evaluate the factors associated with incidental findings in the HIV-positive and HIV-negative groups. For the analysis of the HIV effect, a propensity score-matched dataset of HIV-positive/HIV-negative participants was used. Results We included 553 participants, 341 with and 212 without HIV infection. Incidental findings were observed in 291 of 553 (53%) patients. In 42 of 553 (7.6%) participants, an incidental finding resulted in additional workup. A malignancy was diagnosed in 2 persons. In the HIV-positive group, age (1.31 per 5 years, 1.10–1.56) and smoking (2.29, 1.43–3.70) were associated with incidental findings; in the HIV-negative group, age (1.26, 1.01–1.59) and a CAC score &gt;0 (2.08, 1.09–4.02) were associated with incidental findings. Human immunodeficiency virus seropositivity did not affect the risk of incidental findings. Conclusions Incidental findings were highly prevalent among HIV-positive and HIV-negative persons. Human immunodeficiency virus infection was not associated with an increased risk of incidental findings.

scholarly journals Characteristics of Primary Thrombotic Microangiopathy in Patients with and without Human Immunodeficiency Virus: Thirteen Year Experience at the University of Maryland

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4203-4203
Author(s):  
Victoria Giffi ◽  
Mya S. Thein ◽  
Ann Zimrin
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Thrombotic Microangiopathy ◽  
Laboratory Data ◽  
Hiv Positive ◽  
Sample Collection ◽  
University Of Maryland ◽  
Immunodeficiency Virus ◽  
The University ◽  
Hiv Negative

Abstract Background: Thrombotic microangiopathy (TMA) is a syndrome characterized by thrombocytopenia and microangiopathic hemolytic anemia. TMAs can be primary or secondary to variety of clinical conditions: pregnancy, malignancy, autoimmune diseases and medications. Human immunodeficiency virus (HIV) infection is associated with thrombotic thrombocytopenic purpura (TTP), although the pathophysiology and clinical presentation has not been well-defined. Methods: In an urban center with a 3% prevalence of HIV infection, we retrospectively reviewed the charts of patients who underwent therapeutic plasma exchange (TPE) for TTP from January 2000 to December 2013 after IRB approval. The aim of our study is to describe and analyze the clinical differences seen in primary TMA with or without HIV infection. Differences of laboratory data between the 2 groups were assessed using the t -test. Results: Of 188 patients requiring TPE over 13 years at our urban tertiary medical center, 31 (17%) were HIV-positive and 154 (83%) were HIV negative. HIV-positive patients had median age of 43 years (range, 26-65), 30 (96%) black, 23 (74%) female, 23 (74%) with primary TMA. HIV-negative patients had a median age of 46 years (range, 16-82) 92 (59%) black and 104 (66%) female, 54 (35%) with primary TMA. Fifteen of 31 HIV-positive patients (48%) presented with comorbid infections caused by bacterial, viral, fungal and opportunistic organisms, whereas only 29 of the 157 (18%) HIV-negative patients presented with concomitant infection. The following comparisons were made between HIV-positive (n=23) and negative (n=54) patients with primary TMA. Laboratory data revealed that hemoglobin was lower (mean Hb: 7.0 vs 8.1 g/dL, P=0.03) and renal failure was more severe (mean creatinine 2.3 vs 1.6, P=0.04) in HIV-positive patients compared with HIV-negative. There was no statistically difference between 2 groups in LDH and platelet counts. ADAMTS13 level was available in 6/23 HIV positive and 18/54 HIV-negative primary TMA patients. The level <10% was seen in 11 HIV-negative patients. ADAMTS13 level of HIV-positive patients ranged from 14 to 74 (Sample collection was delayed in 3/6 patients). All HIV-positive cases showed immunosuppression, with a mean CD4 count of 124 cells/ µL, ranging from 2 to 444 cells/ µL. Regarding treatment, HIV-negative patients required an average of 23% more TPE sessions (18 vs. 15) than HIV-positive patients. Steroids, intravenous immune gamma-globulin and rituximab were used in both groups. Mortality and complications were similar in both groups. Discussion: The frequency of 1 in 5 patients with TMA also having HIV at the University of Maryland is one of the highest frequencies reported in the literature outside of South Africa. Our study suggests that HIV-positive patients might have a thrombotic microangiopathy triggered by an infection more commonly than patients without HIV. The absence of ADAMTS13 deficiency was notable in our HIV-positive patients. However, delayed sample collection in 3/6 patients might limit the significance of this data. The etiology of TMA in HIV infection remains unclear. Prior studies have suggested that a HIV-specific mechanism such as B cell dysregulation as a result of T cell depletion; cytokine production and HIV infection of endothelial cells play a role. The limited number of patients seen individual centers precludes controlled clinical trials to study the efficacy of treatment for this serious disease. Future prospective collaborative research studies are needed to expand our knowledge of TMA in HIV-positive populations. Disclosures No relevant conflicts of interest to declare.

scholarly journals Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population

2015 ◽  
Vol 2 (3) ◽  
Author(s):  
Barbara Hasse ◽  
Philip E. Tarr ◽  
Pedro Marques-Vidal ◽  
Gerard Waeber ◽  
Martin Preisig ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cardiovascular Risk ◽  
General Population ◽  
Hiv Infection ◽  
Poisson Regression ◽  
Hiv Positive ◽  
Strong Impact ◽  
Hiv Status ◽  
Immunodeficiency Virus ◽  
Hiv Negative

Abstract Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2–2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1–2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44–1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression ide.jpegied associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5–2.4; smoking: IRR = 2.0, 95% CI = 1.6–2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9–3.8; smoking: IRR = 2.6, 95% CI = 1.9–3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4–2.4; smoking: IRR = 1.7, 95% CI = 1.4–2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.

scholarly journals Shorter Granulocyte Telomeres Among Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection and Chronic Lung Disease in Zimbabwe

2020 ◽  
Author(s):  
Abhinav Ajaykumar ◽  
Glenn C Wong ◽  
Louis-Marie Yindom ◽  
Grace McHugh ◽  
Ethel Dauya ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Cart Initiation ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
Hiv Negative

Abstract Background Chronic lung disease (CLD) has been reported among African children with perinatally acquired human immunodeficiency virus (HIV) infection (C-PHIV), despite combination antiretroviral therapy (cART). In adults, shorter telomere length (TL) has been reported in association with both CLD and HIV. As little is known in children, our objective was to compare TL in HIV-positive (cART-naive or -treated) and HIV-negative children with and without CLD. Methods Participants included Zimbabwean C-PHIV, aged 6–16, who were either newly diagnosed and cART-naive, or on cART for &gt;6 months, and HIV-negative controls of similar age and sex. Packed blood cell (granulocyte) TLs from 621 children were compared cross-sectionally between groups. For a subset of newly diagnosed C-PHIV, changes in TL following cART initiation were evaluated. Results C-PHIV had shorter granulocyte TL compared with uninfected peers, regardless of cART. Among 255 C-PHIV without CLD, TL was shorter in cART-naive participants. In multivariable analyses adjusted for age, sex, CLD, and HIV/cART status, shorter TL was independently associated with older age, being HIV positive, and having reduced forced vital capacity (FVC). Last, cART initiation increased TL. Conclusions In this cohort, C-PHIV and those with reduced FVC have shorter granulocyte TL, possibly the result of increased immune activation and cellular turnover due to longstanding HIV infection with delayed cART initiation.

Antimalarial drug resistance markers in human immunodeficiency virus (HIV)-positive and HIV-negative adults with asymptomatic malaria infections in Port Harcourt, Nigeria

2021 ◽  
Author(s):  
Ifeyinwa Chijioke-Nwauche ◽  
Mary C Oguike ◽  
Chijioke A Nwauche ◽  
Khalid B Beshir ◽  
Colin J Sutherland
Keyword(s):  
Human Immunodeficiency Virus ◽  
Drug Resistance ◽  
Drug Susceptibility ◽  
Blood Film ◽  
University Hospital ◽  
Hiv Positive ◽  
Asymptomatic Malaria ◽  
Immunodeficiency Virus ◽  
Before And After ◽  
Hiv Negative

Abstract Background In Nigeria, indiscriminate use of antimalarial drugs may contribute to the threat of drug resistance, but this has not been evaluated among people living with human immunodeficiency virus (HIV). Methods HIV-positive adults attending a university hospital HIV clinic and HIV-negative adult volunteers from the university hospital community with a positive blood film were treated with artemether–lumefantrine. Parasite DNA from before and after treatment was polymerase chain reaction amplified to identify molecular markers of drug susceptibility. Results The pfcrt76T genotype was prevalent among both HIV-positive and HIV-negative participants (78.6% and 68.2%, respectively). Three new mutations in the pfmdr1 gene—F73S, S97L and G165R—and the uncommon pfdhps S436F variant were detected, whereas pfdhps K540E and pfdhfr I164L were absent. The A437G allele of pfdhps predominated (62/66 [94%]). The I431 V mutation was found in 19 of 66 pretreatment pfdhps sequences (28.8%). The pfmdr1 86N allele was significantly more common at day 3 post-treatment than at baseline (odds ratio 8.77 [95% confidence interval 1.21 to 380]). Conclusions We found evidence of continued chloroquine use among HIV-positive individuals. Selection for the pfmdr1 86N after artemether–lumefantrine treatment was observed, indicating a possible threat to antimalarial efficacy in the study area. The complexity of pfdhps haplotypes emphasises the need for careful monitoring of anti-folate susceptibility in Nigeria.

Trypanosoma cruziParasitemia in Chronic Chagas Disease: Comparison between Human Immunodeficiency Virus (HIV)–Positive and HIV‐Negative Patients

2002 ◽  
Vol 186 (6) ◽  
pp. 872-875 ◽  
Author(s):  
Ana Marli C. Sartori ◽  
José Eluf Neto ◽  
Elizabete Visone Nunes ◽  
Lucia Maria Almeida Braz ◽  
Hélio H. Caiaffa‐Filho ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Chagas Disease ◽  
Hiv Positive ◽  
Immunodeficiency Virus ◽  
Chronic Chagas Disease ◽  
Hiv Negative

Human Immunodeficiency Virus and Artificial Feeding

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 804-804
Author(s):  
STANLEY A. PLOTKIN
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Developing Countries ◽  
Breast Milk ◽  
Infection Control ◽  
Hiv Infection ◽  
Developed Countries ◽  
The United States ◽  
Artificial Feeding ◽  
Immunodeficiency Virus

Dr Halsey has brought to my attention that a sentence in the human immunodeficiency virus (HIV) infection control statement (AAP News, September 1988) and perinatal statement (Pediatrics 1988;82:941-944) might be misinterpreted as advocating artificial feeding for HP/-infected infants in developing countries. It was our intention to advocate the use of artificial feeding by HIV-infected mothers only in the United States and other developed countries where safe water and hygienic practices are the norm. In other countries, the advantages of breast milk outweigh the possible risk of transmission to the newborn.

Pediatric Guidelines for Infection Control of Human Immunodeficiency Virus (Acquired Immunodeficiency Virus) in Hospitals, Medical Offices, Schools, and Other Settings

PEDIATRICS ◽  
1988 ◽  
Vol 82 (5) ◽  
pp. 801-807
Author(s):  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Infection Control ◽  
Hiv Infection ◽  
The United States ◽  
Pediatric Hiv ◽  
Intravenous Drug ◽  
Clotting Factor ◽  
Maternal Infection ◽  
Immunodeficiency Virus ◽  
Acquired Immunodeficiency

Acquired immunodeficiency syndrome (AIDS), the most severe manifestation of infection with the human immunodeficiency virus (HIV), has been diagnosed in more than 900 children younger than 13 years of age throughout the United States as of May 1988, 77% of whom were infected in utero or perinatally secondary to maternal infection. Risk factors for maternal infection include intravenous drug abuse or sexual contact with partners who are intravenous drug abusers or bisexual. The remainder of children, including a high proportion of hemophiliacs, have been infected by blood or clotting factor infusion between 1979 and 1985. In addition, adolescents have acquired infection through sexual activity and intravenous drug use, as well as transfusion of contaminated blood or blood factors. The criteria for diagnosis of AIDS in children differ in some ways from those for adults, and the most recently published diagnostic criteria (Morbidity Mortality Weekly Report, Aug 14, 1987) include the expanded spectrum of disease, such as recurrent bacterial infections and encephalopathy, as well as including children with presumptive diagnosis of AIDS-associated diseases such as lymphpoid interstitial pneumonitis. There is no accurate estimate of the numbers of infected asymptomatic children or of infected children with milder symptoms that do not meet the criteria for the diagnosis of AIDS. Although most cases of pediatric HIV infection have been identified in New York City, Newark, Miami, and Los Angeles, cases are appearing in other locations. Thus, HIV infection in childhood is becoming more widespread, but in many states it is still rare. Because the cause of AIDS is a virus transmissible from human to human, pediatric health care workers must adjust infection control guidelines to meet this new threat.

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