AIDS-Defining Opportunistic Illnesses in Qatar, 2000-2016 : A Cohort Study

Background Human immune deficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981. Globally, since introduction of antiretroviral therapy, AIDS related death felt by more than 25% between 2005 &2011. Also, HIV related opportunistic infections (OIs) are less common, especially with use of prophylaxis to prevent such infections (3). We aim in this study to assess the incidence of HIV infection and related OIs in Qatar for 17-year period, and assess the spectrum of these infections, risk factors and treatment outcome. Methods retrospective cohort study for all HIV infected patients registered in Qatar from 2000-2016. Incidence of HIV infection and related opportunistic illness was calculated per 100000 population. Demographic and Clinical characteristic were compared between two groups of patients with and without opportunistic illness. Results of 167 cases with HIV infection 54 (32.3%) of them had opportunistic illness. The average incidence rate of HIV infection over 17 years is 0.69 per 100000 population, and the incidence rate for opportunistic illness is 0.27 per 100000 population, figure1. The most common opportunistic illness is pneumocystis jirovecii pneumonia (PCP) 25% of cases, followed by CMV retinitis 7.2%, Tuberculosis 5.4%, Toxoplasmosis 4.2% and less than 2% for Kaposi sarcoma, lymphoma and cryptococcal infection.

AIDS-defining opportunistic illnesses in Qatar, 2000–2016: a cohort study

Background: Human immunodeficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981 Globally, since the introduction of antiretroviral therapy in 1996, acquired immunodeficiency syndrome (AIDS) related deaths fell by more than 25% between 2005 and 2011. HIV related opportunistic illnesses (OIs) are less common, especially with the use of prophylaxis. This study aims to assess the incidence of HIV infection and related OIs in Qatar over a 17-year period. Methods: This is a retrospective cohort study of all HIV infected patients registered in Qatar from 2000-2016. Incidence of HIV infection and related OIs were calculated per 100,000 population. Demographic and clinical characteristics were compared between two groups of patients with and without OIs. Results: In 167 cases with HIV infection, 54 (32.3%) had OIs. The average incidence rate of HIV infection over 16 years is 0.69 per 100,000 population, and the incidence rate for OIs is 0.27 per 100,000 population (Figure 1). The most common OIs is pneumocystis jirovecii pneumonia (PCP), seen in 25% of cases, followed by cytomegalovirus (CMV) retinitis with 7.2%, tuberculosis 5.4%, toxoplasmosis 4.2%, and less than 2% for Kaposi sarcoma and cryptococcal infection. The treatment outcome of cases with OIs was: cure in 59.3%, failure in 3.7%. Mortality within 3 months of OIs was 3.7%, whereas 33.4% accounted for loss to follow up after starting the treatment due to patients leaving the country. Most patients in both groups were young males. The CD4 lymphocyte count and percentage (CD4%), CD4/CD8 ratio and viral load were statistically significant risk factors in cases with OIs (p < 0.05). Presence of comorbidities was lower in patients with OIs (p = 0.032). Conclusion: Qatar has a low prevalence rate for HIV infection and related opportunistic illness. Early diagnosis and use of antiretroviral therapy are important measures to decrease the rate of opportunistic illness.

Mapping priority neighborhoods: A novel approach to cluster identification in HIV/AIDS population

BackgroundUrban disadvantaged neighborhoods have higher HIV risk behavior and higher levels of AIDS-related mortality. Studies demonstrate that interventions at the community level focusing on risk groups have increased success rates than individual patient-based based management in the context of HIV/AIDS. We tested a novel approach to identify population groups in need of greater public health efforts to achieve UNAIDS 90-90-90.MethodsWe extracted retrospective data on 2141 HIV/AIDS patients, recruited from 1997-2017 in the regional hospitals in French Guiana. Self-organizing maps were constructed and clusters were identified based on demographic and socioeconomic variables such as age, sex, CD4 counts at Nadir, type of neighborhood, unemployment rate, and presence of opportunistic illness such as Histoplasmosis and Hepatitis B in the sample population.ResultsNeighborhood unemployment rates were identified to have a large impact in the distribution of HIV/AIDS. Also, the risk of disseminated histoplasmosis, the most common AIDS-defining illness in French Guiana, was not associated to any particular neighborhood suggesting that urban socioeconomic features are not the primary drivers of exposure risk.ConclusionSocioeconomically disadvantaged neighborhoods remain hotspots for HIV/AIDS. We conclude that SOM is an effective tool in the identification of risk clusters that may guide public health efforts to optimize HIV prevention and testing in French Guiana and other developing countries.

Urban and Community Fisheries Programs: Development, Management, and Evaluation

<em>Abstract.-</em>Angling and other recreational water activities are integral activities for millions of Americans. Each year over 80 million Americans aged 16 years or older enjoy some recreational activity related to fish and wildlife. Urban waters used for such recreational activities and as sources of food supplementation and subsistence are often contaminated by pathogenic organisms such as <em>Cryptosporidium </em>species, yet few studies have specifically explored microbial risks to recreationists (swimmers, boaters, anglers, and crabbers) from recreational water contact, despite occurrences of waterborne illnesses and outbreaks. Our first study of risks from recreational water contact in Baltimore, Maryland demonstrated that (1) fishing can be a vector of exposure to <em>Cryptosporidium </em>for Baltimore anglers, and (2) there are high levels of recreational water contact, and consumption of fish and crab within this population. Based on these results, a second study was carried out to assess the prevalence of recreational water activities in Baltimore waters in a sub-population of HIV/AIDS patients, for whom cryptosporidiosis is a major opportunistic illness. Patients were surveyed at the Johns Hopkins Moore AIDS Clinic in Baltimore, Maryland. Oral interviews were conducted based on a convenience sample of 102 HIV/AIDS patients, from August-September 2006. Almost 50% of patients reported taking part in recreational water activities, of which 65% reported participating in at least one recreational activity, including fish or crab consumption. These were surprising findings, and in addition to our first study, indicate that recreationists, specifically persons with HIV/AIDS, are engaging in recreational water activities that may lead to contact with pathogen-contaminated waters in urban settings. These findings raise concerns regarding the role of urban fisheries, outdoor recreational water programs, and regulatory agencies in addressing microbial risks posed to anglers and other recreationists in urban settings.

Causes of Death in the Highly Active Antiretroviral (HAART) Era: A Retrospective Comparison between a Hybrid HIV and Hematology/Oncology Practice and the Adult & Adolescent Spectrum of HIV-Related Diseases (ASD) Project.

Background: Our practice at Virginia Mason Medical Center (VMMC) includes 600 HIV+ patients, 60 of whom died in the last decade. Our intimate doctor-to-patient care allows for increased precision when determining the underlying causes of patient mortality. Large cohort studies such as the ASD project may not allow for such detail because of dependence on medical records or death certificates to determine causes of death. Objective: To determine variances in death between a single provider VMMC patient dataset, and a larger public health cohort during the HAART era. Methods: We contrasted two datasets. The first was the Seattle/King County ASD dataset (n=4721), which recorded 351 patient deaths during 1996–2004. The second was the 1996–2006 VMMC HIV mortality cohort. Abstracted data include patient demographics, causes of death, co-morbidities, treatment adherence, CDC AIDS classification, and relevant laboratory data. We used X2 and Fisher Exact test for our statistical analysis. Results: Of the 60 VMMC patients who died, 57 (95%) were male, 16 (27%) injection drug users (IDU), 50% with significant mental illness, and 44 (73%) with a C2/C3 CDC AIDS classification. Median time between HIV diagnosis to death was 11 years (range, 0–22). There were 33 (55%) patients with poor/moderate adherence. Of the 351 ASD patients who died, 301 (86%) were male, 43 (12%) IDU, 250 (71%) with significant mental illness, and 285 (81%) with a C2/C3 CDC AIDS classification. Median time between HIV diagnosis and death was 6 years (0–18). Of 92 patients for whom adherence data was collected, 69 (75%) had poor/moderate adherence. 39 (65%) VMMC patients died from non-opportunistic illness (OI), 18 (30%) from OI, and 3 (5%) from both (see table). The most common OIs were wasting, non-Hodgkin’s lymphoma, and progressive multi-focal leukoencephalopathy (PML). The most common non-OIs were malignancy, liver failure, and pneumonia. 11 of 60 patients (18%) died despite a non-detectable HIV viral load (NDVL) and median CD4+ count of 216 cells/μL (range, 16–952). 301 of 351 ASD patients had a known cause of death. 135 (45%) died from non-OI, 105 (35%) from OI, and 61 (20%) from both non-OI and OI (see table). The most common OIs were mycobacteria, dementia, and cytomegalovirus. The most common non-OIs were liver failure, pneumonia, and sepsis. 35 of 351 patients (10%) died despite a NDVL and median CD4+ count of 223 cells/μL (5–1616). Conclusions: Males and those with substance abuse, mental illness, poor/moderate adherence, and a C2/C3 AIDS designation were heavily represented in both datasets. The VMMC patients had a longer interval between HIV diagnosis and death than those in the Seattle/King County ASD project. Liver failure and pneumonia were the dominant non-OIs in both datasets. Malignancy as a cause of death was over-represented in VMMC due to the concentration of such patients in a Hem/Onc practice. ASD had a greater proportion of patients without a known cause of death, suggesting greater difficulty designating the underlying cause of death when patients are not intimately known. Table Outcome VMMC (N=60); N (%) ASD (N=301); N (%) p-value Opportunistic Illness (OI) 18 (30) 105 (35) No Significance Non-OI 39 (65) 135 (45) .004 Both OI & non-OI 3 (5) 61 (20) .005