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 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.

scholarly journals Reduction in Baseline CD4 Count Testing Following Human Immunodeficiency Virus “Treat All” Adoption in Uganda

2020 ◽  
Author(s):  
Esther Nasuuna ◽  
Mark W Tenforde ◽  
Alex Muganzi ◽  
Joseph N Jarvis ◽  
Yukari C Manabe ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
World Health Organization ◽  
Cd4 Count ◽  
World Health ◽  
Hiv Disease ◽  
Immunodeficiency Virus ◽  
Health Organization ◽  
Treat All ◽  
Advanced Hiv Disease ◽  
Cd4 Testing

Abstract Baseline CD4 testing rates declined from 73% to 21% between 2013 and 2018 with adoption of “Treat All” in Uganda. Advanced human immunodeficiency virus (HIV) disease (CD4 count &lt; 200 cells/µL) remained common (24% of those tested in 2018, 83% of whom had World Health Organization stage I/II disease). Despite frequent presentation with advanced HIV disease, CD4 testing has declined dramatically.

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>

Increased Risk of Death in Human Immunodeficiency Virus-infected Children With Pneumococcal Meningitis in South Africa, 2003–2005

2011 ◽  
Vol 30 (12) ◽  
pp. 1075-1080 ◽  
Author(s):  
Peter Nyasulu ◽  
Cheryl Cohen ◽  
Linda De Gouveia ◽  
Charles Feldman ◽  
Keith P. Klugman ◽  
...  
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Pneumococcal Meningitis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus

scholarly journals Endothelial Dysfunction in South African Youth Living With Perinatally Acquired Human Immunodeficiency Virus on Antiretroviral Therapy

2020 ◽  
Vol 71 (10) ◽  
pp. e672-e679 ◽  
Author(s):  
Sana Mahtab ◽  
Heather J Zar ◽  
Ntobeko A B Ntusi ◽  
Susan Joubert ◽  
Nana Akua A Asafu-Agyei ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Endothelial Dysfunction ◽  
Cd4 Count ◽  
Cvd Risk ◽  
Peripheral Arterial Tonometry ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Perinatally Acquired ◽  
Peripheral Arterial

Abstract Background Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) confer cardiovascular disease (CVD) risk in adults with HIV. Few studies have assessed endothelial dysfunction (ED), an early marker of subclinical CVD risk, in youth living with perinatally acquired HIV (YLPHIV). Methods Using peripheral arterial tonometry, we compared ED in YLPHIV and age-matched youth without HIV. A reactive hyperemic index ≤1.35 was defined as ED. Eligible participants included those aged 9–14 years and on ART ≥6 months at enrollment. Results Overall, 431 YLPHIV and 93 youth without HIV with a median age of 14.1 versus 13.9 years, respectively, were included. YLPHIV had a lower BMI z score (BMIZ; −0.2 vs 0.4; P &lt; .01) but higher rates of hypercholesterolemia (10% vs 1%; P = .01) than youth without HIV. Among YLPHIV, mean log viral load (VL) was 4.83 copies/mL with 21.7% having a CD4 count &lt;500 cell/mm3; median duration on ART was 9.8 years with 38% initiating at &lt;2 years of age. YLPHIV had higher rates of ED than youth without HIV (50% vs 34%; P = .01); this relationship persisted after adjusting for age, sex, BMIZ, elevated BP, and hypercholesterolemia (RR, 1.43; P = .02). Among YLPHIV, CD4 count &gt;500 cell/mm3 (RR, 1.04; P = .76), VL (RR, 1.01; P = .78), and current ART class (protease inhibitor based vs nonnucleoside inhibitor based: relative risk, 0.90; P = .186) were not associated with ED after adjustment. Conclusions Even after adjusting for physiologic differences, YLPHIV appear to be at increased risk of ED compared with age-matched youth without HIV. These findings have important implications for the life course of YLPHIV who may be at increased risk of premature CVD and complications.

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 Prospective International Study of Incidence and Predictors of Immune Reconstitution Inflammatory Syndrome and Death in People Living With Human Immunodeficiency Virus and Severe Lymphopenia

2019 ◽  
Vol 71 (3) ◽  
pp. 652-660 ◽  
Author(s):  
Irini Sereti ◽  
Virginia Sheikh ◽  
Douglas Shaffer ◽  
Nittaya Phanuphak ◽  
Erin Gabriel ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
The United States ◽  
Cd4 Counts ◽  
Risk Of Death ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Inflammatory Syndrome ◽  
D Dimer

Abstract Background Patients living with human immunodeficiency virus (PLWH) with low CD4 counts are at high risk for immune reconstitution inflammatory syndrome (IRIS) and death at antiretroviral therapy (ART) initiation. Methods We investigated the clinical impact of IRIS in PLWH and CD4 counts &lt;100 cells/μL starting ART in an international, prospective study in the United States, Thailand, and Kenya. An independent review committee adjudicated IRIS events. We assessed associations between baseline biomarkers, IRIS, immune recovery at week 48, and death by week 48 with Cox models. Results We enrolled 506 participants (39.3% were women). Median age was 37 years, and CD4 count was 29 cells/μL. Within 6 months of ART, 97 (19.2%) participants developed IRIS and 31 (6.5%) died. Participants with lower hemoglobin at baseline were at higher IRIS risk (hazard ratio [HR], 1.2; P = .004). IRIS was independently associated with increased risk of death after adjustment for known risk factors (HR, 3.2; P = .031). Being female (P = .004) and having a lower body mass index (BMI; P = .003), higher white blood cell count (P = .005), and higher D-dimer levels (P = .044) were also significantly associated with increased risk of death. Decision-tree analysis identified hemoglobin &lt;8.5 g/dL as predictive of IRIS and C-reactive protein (CRP) &gt;106 μg/mL and BMI &lt;15.6 kg/m2 as predictive of death. Conclusions For PLWH with severe immunosuppression initiating ART, baseline low BMI and hemoglobin and high CRP and D-dimer levels may be clinically useful predictors of IRIS and death risk.

scholarly journals Frequency of Cytomegalovirus Viral Load in Iranian Human Immunodeficiency Virus-1-Infected Patients with CD4+ Counts <100 Cells/mm3

Intervirology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Mohammad Reza Jabbari ◽  
Hoorieh Soleimanjahi ◽  
Somayeh Shatizadeh Malekshahi ◽  
Mohammad Gholami ◽  
Leila Sadeghi ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Load ◽  
Cell Count ◽  
Previous History ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Hiv 1

<b><i>Objectives:</i></b> The aim of present work was to assess cytomegalovirus (CMV) viremia in Iranian human immunodeficiency virus (HIV)-1-infected patients with a CD4+ count &#x3c;100 cells/mm<sup>3</sup> and to explore whether CMV DNA loads correlate with CD4+ cell counts or associated retinitis. <b><i>Methods:</i></b> This study was conducted at the AIDS research center in Iran on HIV-1-infected patients with CD4+ count &#x3c;100 cells/mm<sup>3</sup>, antiretroviral therapy-naive, aged ≥18 years with no previous history of CMV end-organ disease (CMV-EOD). <b><i>Results:</i></b> Thirty-nine of 82 patients (47.56%) had detectable CMV viral load ranging from 66 to 485,500 IU/mL. CMV viral load in patients with retinitis ranges from 352 to 2,720 IU/mL, and it was undetectable in 2 patients. No significant associations between CMV viremia and CD4+ cell count was found (<i>p</i> value = 0.31), whereas significant association of CMV viremia in HIV-infected patients with retinitis was found (<i>p</i> &#x3c; 0.02). <b><i>Conclusions:</i></b> We estimated the frequency of CMV viral load infection in Iranian HIV-1-infected patients with a CD4+ cell count &#x3c;100 mm<sup>3</sup>/mL in the largest national referral center for HIV-1 infection in Iran. Further research is required on the relevance of CMV viral load in diagnostic and prognostic value of CMV-EOD.

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