Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study

Background Human immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern Ethiopia Methods This retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection. Result One hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART). Conclusion Though the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.

Efek Samping Terapi Antiretroviral dan Kepatuhan Berobat Penderita HIV/AIDS

<p>Antiretroviral treatment side-effects and patient compliance with medical instructions continue to be a growing challenge for HIV/AIDS patients. Arv therapy has resulted in a substantial intervention that has been successful in preventing transmission and opportunistic infection. The main objective of this study was to analyze the association between side-effects of ARV therapy and medication adherence as well as another potential confounding such as opportunistic infection, family support, stress level, knowledge of ARV, marital status, and occupation. This study is a quantitative approach by using cross-sectional methods. A total of 244 respondents from 1.180 patients with confirmed HIV registered in the Care Support and Treatment (CST) service and Sriwijaya Community in the City of Palembang to respond to the survey. Non-random sampling was used to collect the samples. As the result, the majority of the respondents were male (84,43 %), ≥30 years old (57,4%), and secondary school graduates (52%). After adjusting with stress and opportunistic infection variable, a Multivariate regression analysis revealed a positive relationship between side effects and medication adherence (p-value of 0,041; 0,05), OR Adj 2,131 (1,190-4,988). PLHV who had adverse effects had a 2.131 times worse adherence rate than those who did not. In conclusion, medication adherence must be greatly improved in light of therapeutic side effects, stress levels, and opportunistic infection.</p>

Premaxillary and maxillary sinus mucormycosis post COVID: a rare case report

<p>Mucormycosis, previously termed as zygomycosis, is an opportunistic infection and is caused by fungi belonging to the order Mucorales. It is found in patients with predisposing conditions such as diabetic ketoacidosis, chronic kidney disease malignancy long-term steroid use and immunosuppressant drugs. Mucormycosis involving paranasal sinuses is a rare life-threatening opportunistic infection in a covid positive patient. The unprescribed use of corticosteroid in covid positive patient, the lymphopenia in severe covid 19 cases, preexisting diseases like uncontrolled diabetes mellitus, hematological malignancy, stem cell transplant causing weak immune system are the factors which are responsible for mucor infection in covid positive patients. We herein report the case of maxillary and premaxillary mucormycosis infection in the uncontrolled diabetic patient with post covid status in recovering phase of acute respiratory distress syndrome.</p>

336. COVID-19 and Pneumocystis jiroveci Pneumonia

Background More accounts of opportunistic infection in COVID-19 patients are emerging. At our institution, we identified 2 COVID-19 patients with Pneumocystis jiroveci pneumonia (PJP) opportunistic infection. This prompted a review of the literature to identify trends in patient characteristics, risk factors, and outcomes in this population. Methods A literature review was conducted using PubMed that identified 13 other patients with both COVID-19 and PJP infection. Age, gender, human immunodeficiency virus (HIV) status, other immunocompromised states, time between COVID-19 and PJP diagnosis, and clinical outcomes were captured for analysis. Results Eleven patients were male. The average age was 56 years. All but 2 patients were immunocompromised. At time of PJP diagnosis, seven patients had newly diagnosed HIV and one had known, well-controlled HIV. One patient had rheumatoid arthritis receiving leflunomide, 1 had ulcerative colitis receiving budesonide and sulfasalazine, 2 patients had multiple myeloma whereby both were on lenalidomide, 1 patient was a renal transplant recipient immunosuppressed on tacrolimus, mycophenolate, and methylprednisolone, and 1 patient had chronic lymphocytic leukemia getting fludarabine, cyclophosphamide, and rituximab. Nine patients had positive COVID-19 and PJP tests performed within 7 days of one another. One patient tested positive for PJP 54 days into admission for COVID-19. This patient received high dose steroids and tocilizumab for initial COVID-19 infection. Three patients were re-hospitalized with PJP after a recent admission for COVID-19 pneumonia, with a mean time to readmission of 25 days. One of these 3 patients had no treatment for COVID-19, while 2 received steroids. Five of the total 15 patients (33%) died. Conclusion COVID-19 treatments with high dose steroids and tocilizumab can make patients vulnerable for opportunistic infection with PJP. Furthermore, COVID-19 is known to cause lymphopenia which may further increase this risk. A diagnosis of concomitant PJP can be especially challenging due to nearly identical radiographical findings. Serum beta-D glucan and HIV testing can be especially helpful in this situation, and there should be a low threshold for performing bronchoalveolar lavage. Disclosures All Authors: No reported disclosures

846. Trend Analysis of Cause-Specific Mortality among HIV-Infected Veterans: A 35-Year Study

Background The aims are to estimate the rates for, and examine the trends of, all-cause and cause-specific mortality since the beginning of the epidemic, in an effort to better forecast future mortality patterns and potentially prevent premature death. Methods All patients in the HIV Atlanta VA Cohort Study (HAVACS), an ongoing, open cohort of all HIV-infected veterans who ever sought or are seeking care at the Atlanta VA Medical Center, with a documented HIV diagnosis between January 1982 and December 2016 are included. All-cause and cause-specific mortality rates are calculated annually and for the study period, and age-adjusted to the 2000 U.S. standard population. Join-point regression analyses are performed to calculate annual percent changes (APC) and 95% CIs during periods of time when significant changes in trends are observed. Results The analytic sample consisted of 4,674 patients; of whom 1,752 (36.8%) died. The age-adjusted all-cause mortality rate per 100 PY (95% CI) is 19.0 (9.9, 28.2); this rate decreased 45.2% annually from 1983 to 1987, and thereafter became relatively stable. The age-adjusted mortality rates for AIDS–opportunistic infection (aIR=19.0, 95% CI=17.0, 21.0), cardiovascular (aIR=16.2, 95% CI=9.2, 23.1; APC=-2.0), infection (aIR=20.7, 95% CI=10.3, 31.1), liver (aIR=13.8, 95% CI=9.7, 18.0; APC=-0.6), pulmonary (aIR=24.6, 95% CI=3.4, 45.8; APC=-0.3), renal (aIR=17.6, 95% CI=11.1, 24.1; APC=-1.3), and violence (aIR=14.7, 95% CI=9.2, 20.2; APC=-2.8) have all decreased since the beginning of the epidemic, most markedly for AIDS–opportunistic infection (APC=-18.0; 95% CI=-31.9, -1.4) and infection (APC=-3.4; 95% CI=-6.5, -0.3). In contrast, the age-adjusted mortality rates for AIDS–opportunistic malignancy (aIR=32.4, 95% CI=15.9, 48.9; APC=1.5), malignancy (aIR=13.2, 95% CI=6.2, 20.2; APC=1.1), and sudden death (aIR=9.6, 95% CI=6.1, 13.1; APC=32.2) have increased since the beginning of the epidemic. Figure 1. Joinpoint regression analysis of age-adjusted mortality rates in the HAVACS cohort, 1982-2016 (n=4,674). AIDS, acquired immune deficiency syndrome; APC, annual percent change; HAVACS, HIV Atlanta VA Cohort Study; HIV, human immunodeficiency virus; PY, person-years. *Statistically significant at α=0.05. 1. 2000 U.S. standard population; excludes deaths for which the date is unknown (n=46). 2. Coding Causes of Death in HIV (CoDe) protocol adapted to classify causes of death; AIDS-related illnesses refers to an appended list of AIDS-defining illnesses (1993 definition). 3. Pulmonary infections included in pulmonary, not infection. 4. Hepatocellular carcinoma included in liver, not malignancy. Conclusion HIV-infected veterans are experiencing decreasing mortality rates due to almost all causes of death, principally infections; however, increasing mortality rates due to malignancies and sudden death are observed. Identifying risk factors for those causes on the rise may help realign resources and mitigate disease burden in this population. Disclosures All Authors: No reported disclosures

Herpes simplex esophagitis in an immunocompetent host: a case report

ABSTRACT Esophagitis caused by Herpes Simplex virus is a well-recognized opportunistic infection in the immunocompromised or severely ill host. However, it is uncommon in otherwise immunocompetent host. It usually responds well to a course of acyclovir. We report a case of young female without any other immunocompromised state who presented with severe dysphagia. She was diagnosed endoscopically and later with histopathology and recovered well after a course of acyclovir.

Clinical Characteristics and Prognoses of Patients With Systemic Lupus Erythematosus Hospitalized for Pulmonary Infections

Objective: To identify factors associated with mortality in SLE patients who were hospitalized for pulmonary infections (PIs).Methods: This single-center retrospective study analyzed the characteristics and risk factors for mortality in 95 SLE patients hospitalized for PIs.Results: Ninety-five SLE patients had 97 episodes of hospitalization for PIs, and 33 of these episodes (34.02%) led to death. Death from PI was associated with a higher neutrophil count (6.30 vs. 4.201 × 109/L, p &lt; 0.01), immunoglobulin G (6.20 vs. 9.82 g/L, p = 0.01), serum creatinine (126.00 vs. 73.00 μmol/L, p = 0.01), proteinuria (2.99 vs. 0.54 g/day, p &lt; 0.01), cardiopulmonary involvement (57.58 vs. 34.38%, p &lt; 0.05), SLE disease activity index (SLEDAI; 11.00 vs. 6.00, p &lt; 0.05), and opportunistic infections (78.79 vs. 45.31%, p &lt; 0.05). Demographic characteristics, antibody/complements, bacterial infection, and primary treatment before infection (including corticosteroid and immunosuppressants) had no effect. Multivariate analysis indicated cardiopulmonary involvement (HR: 2.077; 95%CI: 1.022–4.220; p = 0.043) and opportunistic infection (HR: 2.572; 95%CI: 1.104–5.993; p = 0.029) were independent risk factors for mortality. High-dose steroid pulse therapy (HR: 0.982; 95%CI: 0.410–2.350; p = 0.982) and first-line immunosuppressant therapy (HR: 1.635; 95%CI: 0.755–3.542, p = 0.212) had no effect on mortality.Conclusion: Cardiopulmonary involvement and opportunistic infection were independent risk factors for mortality for SLE patients hospitalized for PIs. Use of high-dose pulse steroids and or immunosuppressants before hospitalization had no significant effects.