The outcome predictors and therapeutic strategy of pneumocystis pneumonia in North China: a double-center retrospective study

Abstract Background: Pneumocystis pneumonia (PCP) is common in HIV/AIDS patients with advanced immunosuppression. Trimethoprim/sulfamethoxazole (TMP/SMX) is recommended as the first-line anti-pneumocystis agent as soon as PCP is suspected based on its typical feature. However, the clinical characteristic and therapeutic strategy of Chinese PCP were not well-known. Methods: We retrospectively investigated 473 HIV associated PCPs in North China from double centers, Beijing You An Hospital during 2010 to 2017 and the Infectious Disease Hospital in Harbin during 2015 to 2017. HIV associated PCP were diagnosed as the guideline recommended by CDC, NIH and HIV Medicine Association of IDSA. Demographic and clinic data were collected and statistically analysed as the parameter distribution feature. Results: Among 473 HIV associated PCPs, we found that men were over-represented in PCP due to the high incidence of HIV infection among male homosexuality, and over one-third of them were aware of their HIV infection ago but did not maintain effective antiretroviral therapy. A history of smoking and multi-organism infection or system infection were common among them. In the multivariate analysis, we found lactate dehydrogenase (LDH) (OR 1.020, 95% CI 1.006-1.033, P=0.005), alveolar-arterial O2 difference ([A-a] DO2) and neutrophils counts (OR 1.051, 95% CI 1.005-1.099, P=0.030) were unfavourable predictors and CD4 cell counts (OR 0.900, 95% CI 0.813-0.996, P=0.041) were favourable predictor of PCP outcome. Trimethoprim/sulfamethozole (TMP/SMZ) but not TMP/SMX was used to anti-pneumocystis therapy in these patients with a low side-effect incidence which mainly forcused on epispasis, fever, liver injury and myelosuppression. Caspofungin was the only alternative medicine for those presented poor efficacy or could not tolerate the side-effects of TMP-SMZ and near 30 percent of moderate/severe PCP received glucocorticoid treatment. Conclusion: The present data suggest that high levels of serum-LDH, [A-a] DO2 and neutrophils counts and low CD4 cell counts predict poor outcome of PCP. TMP/SMZ can cure most PCPs with a low side-effect incidence and caspofungin is an effective alternation. A larger prospective study is needed to obtain better estimates of PCP in China.

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Factors associated with late presentation of HIV infection in Catalonia, Spain

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.011280 ◽

2012 ◽

Vol 23 (7) ◽

pp. 475-480 ◽

Cited By ~ 19

Author(s):

N Vives ◽

D Carnicer-Pont ◽

P Garcia De Olalla ◽

N Camps ◽

A Esteve ◽

...

Keyword(s):

Hiv Infection ◽

Late Presentation ◽

Late Diagnosis ◽

Cd4 Cell Count ◽

Hiv Surveillance ◽

Factors Associated ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Populations At Risk ◽

Cd4 Cell

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend ( P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

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CD4 cell counts used as surrogate test for HIV infection

BMJ ◽

10.1136/bmj.311.7003.513b ◽

1995 ◽

Vol 311 (7003) ◽

pp. 513-513 ◽

Cited By ~ 1

Author(s):

A S Jack ◽

S Richards

Keyword(s):

Hiv Infection ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

10.21203/rs.3.rs-60503/v4 ◽

2020 ◽

Author(s):

Xiaohan You ◽

Ji Zhang ◽

Qiongxiu Zhou ◽

Jianna Zhang

Keyword(s):

Risk Factors ◽

Nephrotic Syndrome ◽

Pneumocystis Pneumonia ◽

Prednisone Dose ◽

Primary Nephrotic Syndrome ◽

Cd4 Cell Count ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Independent Risk Factors ◽

Cd4 Cell

Abstract Background: The aim of this study was to analysis the clinical features, risk factors and outcomes of patients with primary nephrotic syndrome (PNS) who developed pneumocystis pneumonia (PCP).Methods: We systematically reviewed medical records from 18 PNS patients with PCP admitted to our hospital from April 2007 to April 2019. A total of 180 cases were randomly selected as controls from PNS inpatients without infection. Results: In PCP patients, the mean age at presentation was 48.5 years, mean duration of prednisone treatment was 3.7 months and mean prednisone dose on admission was 31.3 mg/d, the most common clinical manifestation was fever (100%) and average PaO2 on admission was 59.5 mmHg. Eight patients (44.4%) had coexisting infections, most often was cytomegalovirus (4 patients), 11 patients (61.1%) had ICU admission and 9 patients (50%) had mechanical ventilation. PCP patients had more prednisone, more immunosuppressive therapy, lower CD4+ cell counts and hemoglobin, and higher serum creatinine than those without infections (p<0.05). Logistic regression analysis showed that PNS patients with prednisone usage and lower CD4+ cell counts were independent risk factors of more likely to have PCP compared to controls (OR =3.39, p=0.002; OR =0.64, p=0.021p<0.05). All patients survived after treatment. Conclusion: PCP was not unusual in PNS patients, and the most important risk factors were prednisone usage and a lower CD4+ cell count, but however, these patients had a good outcome after enough treatments.

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SP097ATTENUATED DIURNAL BLOOD PRESSURE RHYTHM IN HIV INFECTION IS ASSOCIATED WITH LOWER CD4 CELL COUNTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw159.06 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i117-i117

Author(s):

Ingjerd W Manner ◽

Bard Waldum-Grevbo ◽

Olav Oektedalen ◽

Ingrid Os

Keyword(s):

Blood Pressure ◽

Hiv Infection ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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Interleukin-2 increases CD4+ cell counts in HIV infection

Inpharma Weekly ◽

10.2165/00128413-199509770-00035 ◽

1995 ◽

Vol &NA; (977) ◽

pp. 18

Author(s):

&NA;

Keyword(s):

Hiv Infection ◽

Interleukin 2 ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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Zidovudine in Persons with Asymptomatic HIV Infection and CD4+ Cell Counts Greater than 400 per Cubic Millimeter

New England Journal of Medicine ◽

10.1056/nejm199307293290501 ◽

1993 ◽

Vol 329 (5) ◽

pp. 297-303 ◽

Cited By ~ 134

Author(s):

David A. Cooper ◽

Jose M. Gatell ◽

Susanne Kroon ◽

Nathan Clumeck ◽

Judith Millard ◽

...

Keyword(s):

Hiv Infection ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell ◽

Asymptomatic Hiv

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CD4 cell counts in adults with newly diagnosed HIV infection in Barbados

Revista Panamericana de Salud Pública ◽

10.1590/s1020-49892004001100002 ◽

2004 ◽

Vol 16 (5) ◽

Cited By ~ 9

Author(s):

Krishna R. Kilaru ◽

Alok Kumar ◽

Namrata Sippy

Keyword(s):

Hiv Infection ◽

Newly Diagnosed ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

10.21203/rs.3.rs-60503/v2 ◽

2020 ◽

Author(s):

Xiaohan You ◽

Ji Zhang ◽

Qiongxiu Zhou ◽

Jianna Zhang

Keyword(s):

Nephrotic Syndrome ◽

Pneumocystis Pneumonia ◽

Prednisone Dose ◽

Primary Nephrotic Syndrome ◽

Cd4 Cell Count ◽

Cell Counts ◽

Cd4 Cell Counts ◽

The Mean ◽

Cd4 Cell ◽

Syndrome Analysis

Abstract Background The aim of this study was to analysis the clinical features, risk factors and outcomes of patients with primary nephrotic syndrome (PNS) who developed pneumocystis pneumonia (PCP). Methods We systematically reviewed medical records from 18 PNS patients with PCP admitted to our hospital from April 2007 to April 2019. A total of 180 cases were randomly selected as controls from PNS inpatients without infection. Results In PCP patients, the mean age at presentation was 48.5 years, mean duration of prednisone treatment was 3.7 months and mean prednisone dose on admission was 31.3 mg/d, the most common clinical manifestation was fever (100%) and average PaO 2 on admission was 59.5 mmHg. Eight patients (44.4%) had coexisting infections, most often was cytomegalovirus (4 patients), 11 patients (61.1%) had ICU admission and 9 patients (50%) had mechanical ventilation. PCP patients had more prednisone, more immunosuppressive therapy, lower CD4+ cell counts and hemoglobin, and higher serum creatinine than those without infections (p<0.05). Logistic regression analysis showed that patients with prednisone usage and lower CD4+ cell counts were more likely to have PCP compared to controls (p<0.05). All patients survived after treatment. Conclusion PCP was not unusual in PNS patients, and the most important risk factor was a lower CD4+ cell count, but however, these patients had a good outcome after enough treatments.

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Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women

SAGE Open Medicine ◽

10.1177/2050312120945138 ◽

2020 ◽

Vol 8 ◽

pp. 205031212094513

Author(s):

Yan Tong ◽

Philip Tonui ◽

Aaron Ermel ◽

Omenge Orang’o ◽

Nelson Wong ◽

...

Keyword(s):

Human Papillomavirus ◽

High Risk ◽

Hiv Infection ◽

Low Risk ◽

International Agency ◽

Factors Associated ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Kenyan Women ◽

Cd4 Cell

Objectives: Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia. Methods: Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic and behavioral characteristics. Results: HIV-infected women were older and less likely to be married and to own a home and had more lifetime sexual partners than HIV-uninfected women. All HIV-infected women were receiving anti-retroviral therapy at enrollment and had satisfactory CD4 cell counts and HIV viral loads. One- and two-year persistent human papillomavirus detection was significantly associated with HIV infection for any human papillomavirus, high-risk human papillomavirus, International Agency for the Research on Cancer-classified high-risk human papillomavirus, and non-oncogenic “low-risk” human papillomavirus. Conclusion: Persistent detection of oncogenic and non-oncogenic human papillomavirus was strongly associated with HIV infection in Kenyan women with re-constituted immune systems based on satisfactory CD4 cell counts. In addition to HIV infection, factors associated with an increased risk of human papillomavirus persistence included a higher number of lifetime sex partners. Factors associated with decreased risk of human papillomavirus persistence included older age and being married. Further studies are needed to identify the immunological defects in HIV-infected women that allow human papillomavirus persistence, even in women receiving effective anti-retroviral therapy. Further studies are also needed to determine the significance of low-risk human papillomavirus persistence in HIV-infected women.

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