Treating neuroendocrine neoplasms in the setting of HIV infection

2021 ◽  
pp. 1-17
Author(s):  
Aimee R. Hayes ◽  
Kate Smith ◽  
Man Liu ◽  
Simon Jenkinson ◽  
Ashley B. Grossman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Treatment Outcomes ◽  
Hiv Positive ◽  
Neuroendocrine Neoplasms ◽  
Hiv Diagnosis ◽  
Data Registry ◽  
Kaplan Meier ◽  
Younger Age ◽  
Neuroendocrine Carcinomas

BACKGROUND: There is a paucity of knowledge regarding neuroendocrine neoplasms (NEN) in patients with HIV infection. OBJECTIVE: To explore the incidence, characteristics and treatment outcomes of NEN in HIV-positive individuals. METHODS: This is a single-center, descriptive cohort study. Patients with HIV and biopsy-confirmed NEN were identified from our data registry. Data were collected retrospectively from medical records. Progression-free and overall survival (OS) were estimated using the Kaplan-Meier method. RESULTS: Nineteen HIV-positive patients with neuroendocrine tumors (NET) (n = 14), neuroendocrine carcinomas (NEC) (n = 2) or Merkel cell carcinoma (MCC) (n = 3) were included (median age at NEN diagnosis, 53 years). In 15 (79%) patients, HIV diagnosis preceded NEN diagnosis by a median of 11 years and 14 were receiving antiretroviral therapy (ART). Of those with data available, 75% had a viral load <  50 copies/ml and mean CD4 771 cells/mm3. The median OS in the NEC/MCC cohort was 8 months (range 5–29). The median OS in the NET cohort was not reached but based on the 25th centile, 75% of patients are expected to survive for at least 57 months. Treatment outcomes will be described. CONCLUSIONS: Within the limits of a small descriptive cohort study, our study shows no evidence in the era of ART that patients with HIV and NEN are diagnosed at a younger age, nor have a poorer prognosis compared with the wider NEN population. Thus, they should receive maximal NEN therapies to support best outcomes.

scholarly journals Presentation, Clinical Characteristics, and Treatment Outcomes among Tuberculous Meningitis Patients with and Without HIV Infection at Vajira Hospital, Thailand: A Retrospective Cohort Study

2021 ◽  
Vol 20 ◽  
pp. 232595822110455
Author(s):  
Lakkana Boonyagars ◽  
Chunlanee Sangketchon ◽  
Kittisak Pholtawornkulchai
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Tuberculous Meningitis ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Final Diagnosis ◽  
Hiv Positive ◽  
Adult Age

To compare the characteristics, presentation, investigations, and outcomes in tuberculous meningitis (TBM) patients with and without human immunodeficiency virus (HIV) coinfection. A retrospective cohort study was conducted on adult (age > 18 years) patients whose final diagnosis was TBM and who were treated at Vajira Hospital, Navamindradhiraj University, Thailand, between January 2005 and December 2016. A final total of 174 individuals were included in the study. Of these, 97 (55.75%) were HIV positive. Treatment was successful in 53 (30.5%) individuals. In HIV-infected TBM patients, there were higher proportions of patients who were younger in age (≤40 years), patients with a low body mass index, history of previous tuberculosis infection, or hepatitis C virus coinfection. A successful treatment outcome rate was lower in HIV-infected TBM patients than in HIV-uninfected TBM patients. Since HIV infection decreases the chance of successful treatment outcomes of TBM patients, future studies are needed to determine the clinical indicators for poorer survival outcomes in HIV-positive TBM patients.

scholarly journals Factors Associated with Unfavourable Treatment Outcomes in Patients with Tuberculosis: A 16-Year Cohort Study (2005–2020), Republic of Karakalpakstan, Uzbekistan

2021 ◽  
Vol 18 (23) ◽  
pp. 12827
Author(s):  
Jamshid Gadoev ◽  
Damin Asadov ◽  
Anthony D. Harries ◽  
Ajay M. V. Kumar ◽  
Martin Johan Boeree ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Outcomes ◽  
Rural Areas ◽  
Hiv Positive ◽  
Loss To Follow Up ◽  
Pulmonary Tb ◽  
Public Health Burden ◽  
Factors Associated ◽  
Disability Pensioner ◽  
The Republic

Tuberculosis (TB) remains a public health burden in the Republic of Karakalpakstan, Uzbekistan. This region-wide retrospective cohort study reports the treatment outcomes of patients registered in the TB electronic register and treated with first-line drugs in the TB Programme of the Republic of Karakalpakstan from 2005–2020 and factors associated with unfavourable outcomes. Among 35,122 registered patients, 24,394 (69%) patients were adults, 2339 (7%) were children, 18,032 (51%) were male and 19,774 (68%) lived in rural areas. Of these patients, 29,130 (83%) had pulmonary TB and 7497 (>22%) had been previously treated. There were 7440 (21%) patients who had unfavourable treatment outcomes. Factors associated with unfavourable treatment outcomes included: increasing age, living in certain parts of the republic, disability, pensioner status, unemployment, being HIV-positive, having pulmonary TB, and receiving category II treatment. Factors associated with death included: being adult and elderly, living in certain parts of the republic, having a disability, pensioner status, being HIV-positive, and receiving category II treatment. Factors associated with failure included: being adolescent, female, having pulmonary TB. Factors associated with loss to follow-up included: being male, disability, pensioner status, unemployment, receiving category II treatment. In summary, there are sub-groups of patients who need special attention in order to decrease unfavourable treatment outcomes.

A new surveillance system for monitoring HIV infection in Victoria, Australia

Sexual Health ◽  
2007 ◽  
Vol 4 (3) ◽  
pp. 195 ◽  
Author(s):  
Rebecca Guy ◽  
Megan S. C. Lim ◽  
Yung-Hsuan J. Wang ◽  
Nicholas Medland ◽  
Jonathan Anderson ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hiv Testing ◽  
Surveillance System ◽  
Risk Behaviour ◽  
Anal Intercourse ◽  
Unprotected Anal Intercourse ◽  
Hiv Positive ◽  
Sexual Risk Behaviour ◽  
Hiv Diagnosis ◽  
Hiv Test

Objectives: To establish a new mechanism for monitoring patterns of HIV infection, in the context of a sustained increase in HIV diagnosis among men who have sex with men (MSM) in Victoria. Methods: Between April 2004 and August 2005, a linked voluntary HIV sentinel surveillance system was implemented at five medical clinics with a high case load of MSM. Using a questionnaire, doctors collected HIV testing history, demographic and sexual risk behaviour information from all clients undergoing voluntary HIV testing. Questionnaires were linked with HIV test results. Logistic regression analysis was conducted to determine factors associated with HIV infection. Results: Of 3435 MSM tested for HIV at participating sites, 1.7%, (95% CI = 1.2–2.2) were newly diagnosed with HIV; between 2004 and 2005 the proportion increased from 1.3% (95% CI = 1.2–1.5) to 2.0% (95% CI = 1.8–2.2), P = 0.107. There was no significant change in the number of HIV tests conducted per month or in demographic characteristics, testing history and sexual behaviour characteristics between time periods. In multivariate analysis, reporting unprotected anal intercourse (UAI) with any partner, UAI with a HIV-positive partner/s and being aged 30–39 years or 40 years or greater were significantly associated with HIV infection. Conclusion: This new surveillance mechanism, based on linked testing at participating clinics, indicates that the increase in HIV notifications in 2005 was unrelated to changes in testing and data from a Melbourne sexual behavioural survey suggests the increase was more likely to be attributed to increases in transmission within the past few years. The sentinel system highlighted UAI, especially with HIV positive partner/s are important transmission factors.

scholarly journals Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: an Observational Cohort Study

2021 ◽  
Author(s):  
Xiaoliang Zeng ◽  
huanhuan chen ◽  
qiuying zhu ◽  
zhiyong shen ◽  
guanghua lan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Treatment Outcomes ◽  
Antiviral Treatment ◽  
Time Lag ◽  
Cd4 Count ◽  
Attrition Rate ◽  
Hiv Diagnosis ◽  
Cd4 Cell Count ◽  
Art Initiation

Abstract Background: The number of HIV infected children receiving antiviral treatment in Guangxi is increasing. Understanding factors and trends of mortality and attrition in HIV-infected children under antiretroviral therapy (ART) was an urgently need to improve treatment outcomes. This study aimed to describe and assess mortality and attrition after ART initiation between 2004 and 2018 among children with HIV in Guangxi, China.Methods: Cohort study data were extracted from the National Free Antiretroviral Treatment Program (NFATP) database, which has standard guidelines for core treatment indicators and other data at all HIV/AIDS treatment facilities of Guangxi. A total of 901 HIV-infected children who have started ART were included in the study. The study collected the following data: age, gender, WHO clinic stages before ART, CD4 cell count before ART, Cotrimoxazole prophylaxison (CTX) use before ART, initial ART regimen, malnutrition before ART, abnormal liver function before ART, abnormal kidney function before ART, severe anemia before ART, and time lag between a HIV diagnosis and ART initiation.Results: HIV-infected children under ART had a mortality rate of 0.87 per 100 person-years, and an attrition rate of 3.02 per 100 person-years. Mortality was lower among children with CD4 count between 200-500 copies/ml (Adjusted Hazard Ratio (AHR) 0.22, 95% Confidence Interval (CI) 0.09-0.54), and CD4 count ≥500 copies/ml (AHR 0.09, 95% CI 0.03-0.27); but higher among children with late ART initiation at 1-3 months (AHR 2.37, 95% CI 1.10-5.08), and at ≥ 3 months (AHR 2.22, 95% CI 1.05-4.72). Attrition was lower among children with a CD4 count ≥500 copies/ml (AHR 0.61, 95% CI 0.40-0.93), but higher among children with late ART initiation at 1-3 months (AHR 1.63, 95% CI 1.10-2.42), and at ≥ 3 months (AHR 1.26, 95% CI 0.85-1.86).Conclusion: Supportive programs are needed to educate children’s families and parents on early ART, link HIV-infected children to care, and retain them in care among other programs that treat and manage physical conditions of HIV-infected children before ART initiation.

scholarly journals Recent infections among individuals with a new HIV diagnosis in Rwanda, 2018–2020

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259708
Author(s):  
Gallican N. Rwibasira ◽  
Samuel S. Malamba ◽  
Gentille Musengimana ◽  
Richard C. M. Nkunda ◽  
Jared Omolo ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Infection ◽  
National Level ◽  
Age Groups ◽  
Monitoring And Evaluation ◽  
Hiv Positive ◽  
Newly Diagnosed ◽  
Epidemic Control ◽  
Hiv Diagnosis ◽  
Recent Infection

Background Despite Rwanda’s progress toward HIV epidemic control, 16.2% of HIV-positive individuals are unaware of their HIV positive status. Tailoring the public health strategy could help reach these individuals with new HIV infection and achieve epidemic control. Recency testing is primarily for surveillance, monitoring, and evaluation but it’s not for diagnostic purposes. However, it’s important to know what proportion of the newly diagnosed are recent infections so that HIV prevention can be tailored to the profile of people who are recently infected. We therefore used available national data to characterize individuals with recent HIV infection in Rwanda to inform the epidemic response. Methods We included all national-level data for recency testing reported from October 2018 to June 2020. Eligible participants were adults (aged ≥15 years) who had a new HIV diagnosis, who self-reported being antiretroviral therapy (ART) naïve, and who had consented to recency testing. Numbers and proportions of recent HIV infections were estimated, and precision around these estimates was calculated with 95% confidence intervals (CI). Logistic regression was used to assess factors associated with being recently (within 12 months) infected with HIV. Results Of 7,785 eligible individuals with a new HIV-positive diagnosis, 475 (6.1%) met the criteria for RITA recent infection. The proportion of RITA recent infections among individuals with newly identified HIV was high among those aged 15–24 years (9.6%) and in men aged ≥65 years (10.3%) compared to other age groups; and were higher among women (6.7%) than men (5.1%). Of all recent cases, 68.8% were women, and 72.2% were aged 15–34 years. The Northern province had the fewest individuals with newly diagnosed HIV but had the highest proportion of recent infections (10.0%) compared to other provinces. Recent infections decreased by 19.6% per unit change in time (measured in months). Patients aged ≥25 years were less likely to have recent infection than those aged 15–24 years with those aged 35–49 years being the least likely to have recent infection compared to those aged 15–24 years (adjusted odds ratio [aOR], 0.415 [95% CI: 0.316–0.544]). Conclusion Public health surveillance targeting the areas and the identified groups with high risk of recent infection could help improve outcomes.

scholarly journals Impact of the test and treat policy on delays in antiretroviral therapy initiation among adult HIV positive patients from six clinics in Johannesburg, South Africa: results from a prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e030228 ◽  
Author(s):  
Dorina Onoya ◽  
Tembeka Sineke ◽  
Cheryl Hendrickson ◽  
Idah Mokhele ◽  
Mhairi Maskew ◽  
...  
Keyword(s):  
South Africa ◽  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hiv Positive ◽  
Adjusted Relative Risk ◽  
Hiv Diagnosis ◽  
Test And Treat ◽  
Art Initiation

ObjectivesTo assess delays to antiretroviral therapy (ART) initiation before and after the Universal Test and Treat (UTT) and the same-day initiation (SDI) of ART policy periods in Johannesburg, South Africa.DesignProspective cohort study.SettingPatients were recruited from six primary health clinics in Johannesburg.ParticipantsOverall, 1029 newly diagnosed HIV positive adults (≥18 years) were consecutively enrolled by referral from the testing counsellor between April and December 2015 (pre-UTT n=146), July and August 2017 (UTT, n=141) and October 2017 and August 2018 (SDI, n=742).Main outcome measuresCox proportional hazards regression was used to assess predictors of 30 days ART initiation. Additionally, predictors of immediate ART initiation were evaluated using Poisson regression.ResultsOverall, 30 days ART proportions were 71.9% overall, 36.9% pre-UTT (44.3% of those eligible), 65.9% under UTT and 79.9% under the SDI policy. The median days to ART initiation declined from 21 pre-UTT (IQR: 15–30) to 8 (IQR: 6–16) under UTT and 5 days (IQR: 0–8) under the SDI policy. However, only 150 (20.2%) of the SDI cohort-initiated ART immediately after HIV diagnosis. Living in a two-adult home (adjusted HR (aHR) 1.2 vs living alone, 95% CI 1.0 to 1.5) increased the likelihood of 30-day ART. Missing baseline cluster of differentiation four (CD4) data decreased the likelihood of 30 days ART by 40% (aHR 0.6 vs CD4 <350 cells/µL, 95% CI 0.5 to 0.7). More women took up immediate ART (adjusted relative risk (aRR) 1.3, 95% CI 1.0 to 1.9). Participants ≥40 years (aRR 0.6 vs 18–24 years, 95% CI 0.4 to 0.9) were less likely to start ART immediately after HIV diagnosis. However, immediate ART rates increased with longer policy implementation time (aRR 0.2 for <3 months vs >10 months, 95% CI 0.1 to 0.4).ConclusionsThe study results highlight a positive move towards earlier ART initiation during the UTT and SDI periods and emphasise a need to increase same-day ART implementation further.

scholarly journals Epidemiological factors associated with the absence of previous HIV testing among HIV-positive persons in Singapore, 2012–2017

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e050133
Author(s):  
Li Wei Ang ◽  
Matthias Paul Han Sim Toh ◽  
Irving Charles Boudville ◽  
Chen Seong Wong ◽  
Sophia Archuleta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Heterosexual Transmission ◽  
Hiv Positive ◽  
Multivariable Logistic Regression Analysis ◽  
Targeted Prevention ◽  
Hiv Diagnosis ◽  
Factors Associated ◽  
Epidemiological Factors

ObjectiveTo assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore.Study designCross-sectional.Setting and participantsWe analysed data of HIV-positive persons infected via sexual transmission, who were notified to the National HIV Registry in 2012–2017.OutcomesEpidemiological factors associated with the absence of HIV testing prior to diagnosis were determined separately for two groups of HIV-positive persons: early and late stages of HIV infection at diagnosis.Results2188 HIV-positive persons with information on HIV testing history and CD4 cell count were included in the study. The median age at HIV diagnosis was 40 years (IQR 30–51). Nearly half (45.1%) had never been tested for HIV prior to their diagnosis. The most common reason cited for no previous HIV testing was ‘not necessary to test’ (73.7%). The proportion diagnosed at late-stage HIV infection was significantly higher among HIV-positive persons who had never been tested for HIV (63.9%) compared with those who had undergone previous HIV tests (29.0%). Common risk factors associated with no previous HIV testing in multivariable logistic regression analysis stratified by stage of HIV infection were: older age at HIV diagnosis, lower educational level, detection via medical care and HIV infection via heterosexual transmission. In the stratified analysis for persons diagnosed at early-stage of HIV infection, in addition to the four risk factors, women and those of Malay ethnicity were also less likely to have previous HIV testing prior to their diagnosis.ConclusionTargeted prevention efforts and strategies are needed to raise the level of awareness of HIV/AIDS and to encourage early and regular screening among the at-risk groups by making HIV testing more accessible.

scholarly journals Experiences, Emotions, and Adjustments of HIV-Infected Men in HIV-Concordant Marital Relationship in Cambodia

2018 ◽  
Vol 12 (5) ◽  
pp. 1215-1225
Author(s):  
Roshna Thapa ◽  
Youngran Yang
Keyword(s):  
Hiv Infection ◽  
Medical Personnel ◽  
Physical Symptoms ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Dyadic Relationship ◽  
Content Analysis Method ◽  
Heterosexual Relationship ◽  
Study Results ◽  
Living With Hiv

Although it has been well documented that the HIV infection experience can be problematic for those affected, the experiences and perceptions of living with HIV among married males in Cambodia have not yet been examined until now. This study’s purpose was to describe the revelations, emotions, reactions, and adjustments to HIV diagnosis among infected Cambodian males in seroconcordant heterosexual relationship. Fifteen qualitative in-depth interviews were conducted with 15 HIV-positive males using unstructured, open-ended questions and in the local Khmer language. Conventional content analysis method was employed for analyzing data. After analysis, four main categories were developed: knowledge of HIV-positive status; realization of self-deeds; discouraging news for both partners; and comparative improvement of life. Participants reported the appearance of physical symptoms as the only reason for pursuing HIV testing. Feelings ranged from sadness and guilt to acceptance of HIV infection in their lives. The participants’ wives expressed anger and worry about being infected by their husbands. However, sufficient inspiration from medical personnel and peer groups, as well as a shared concern for their children, helped couples adjust to their dyadic relationship. The study results highlight the link between individual and couple experiences and emotions post-infection, with implications for designing and implementing coping interventions for this population. The findings of this study have public health implications in the design of couple-based intervention and counseling programs for HIV prevention and treatment with the input of the HIV-positive individuals’ voices.

scholarly journals Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Surbhi Grover ◽  
Yehoda M. Martei ◽  
Priya Puri ◽  
Pooja Prabhakar ◽  
Miriam Mutebi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hiv Infection ◽  
Treatment Outcomes ◽  
Scale Up ◽  
The United States ◽  
Sub Saharan Africa ◽  
Younger Age ◽  
Sub Saharan ◽  
Specific Association ◽  
Living With Hiv

Introduction The number and lifespan of individuals living with HIV have increased significantly with the scale-up of antiretroviral therapy. Furthermore, the incidence of breast cancer in women with HIV is growing, especially in sub-Saharan Africa (SSA). However, the association between HIV infection and breast cancer is not well understood. Methods A literature search was performed to identify articles published in journals pertaining to breast cancer and HIV, with an emphasis on SSA. Selected US-based studies were also identified for comparison. Results Among the 56 studies reviewed, the largest study examined 314 patients with breast cancer and HIV in the United States. There is no consensus on whether HIV infection acts as a pro-oncogenic or antioncogenic factor in breast cancer, and it may have no relation to breast cancer. A higher incidence of breast cancer is reported in high-income countries than in SSA, although breast cancer in SSA presents at a younger age and at a more advanced stage. Some studies show that patients with breast cancer and HIV experience worse chemotherapy toxicity than do patients without HIV. Data on treatment outcomes are limited. The largest study showed worse treatment outcomes in patients with HIV, compared with their counterparts without HIV. Conclusion HIV infection has not been associated with different clinical presentation of breast cancer. However, some evidence suggests that concurrent diagnosis of HIV with breast cancer is associated with increased therapy-related toxicity and worse outcomes. Systematic prospective studies are needed to establish whether there is a specific association between breast cancer and HIV.

Sign in / Sign up

Export Citation Format

Share Document