The role of HIV in serious diseases other than AIDS

AIDS (London, England) (Impact Factor: 6.56). 12/2008; 22(18):2409-18. DOI: 10.1097/QAD.0b013e3283174636
Source: PubMed
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    ABSTRACT: Combination antiretroviral therapy (cART) has been widely available in Ghana since 2004. The aim of this cohort study was to assess the incidences of death, AIDS-defining events and non-AIDS defining events and associated risk factors amongst patients initiating cART in a large treatment centre. Clinical and laboratory data were extracted from clinic and hospital case notes for patients initiating cART between 2004 and 2010 and clinical events graded according to recognised definitions for AIDS, non-AIDS events (NADE) and death, with additional events not included in such definitions such as malaria also included. The cumulative incidence of events was calculated using Kaplan Meier analysis, and association of risk factors with events by Cox proportional hazards regression. Data were closed for analysis on 31st December, 2011 after a median follow-up of 30 months (range, 0-90 months). Amongst 4,039 patients starting cART at a median CD4 count of 133 cells/mm3, there were 324 (8%) confirmed deaths, with an event rate of 28.83 (95% CI 25.78-32.15) deaths per 1000-person follow-up years; the commonest established causes were pulmonary TB and gastroenteritis. There were 681 AIDS-defining events (60.60 [56.14-65.33] per 1000 person years) with pulmonary TB and chronic diarrhoea being the most frequent causes. Forty-one NADEs were recorded (3.64 [2.61-4.95] per 1000 person years), of which hepatic and cardiovascular events were most common. Other common events recorded outside these definitions included malaria (746 events) and respiratory tract infections (666 events). Overall 24% of patients were lost-to-follow-up. Alongside expected risk factors, stavudine use was associated with AIDS [adjusted HR of 1.08 (0.90-1.30)] and death (adjusted HR of 1.60 [1.21-2.11]). Whilst frequency of AIDS and deaths in this cohort were similar to those described in other sub-Saharan African cohorts, rates of NADEs were lower and far exceeded by events such as malaria and respiratory tract infections.
    PLoS ONE 10/2014; 9(10):e111400. DOI:10.1371/journal.pone.0111400 · 3.53 Impact Factor
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    ABSTRACT: Abstract The increased life expectancy among HIV-infected persons treated with combination antiretroviral therapy (ART), risk behaviors, and co-morbidities associated with ART place HIV-infected persons at risk for non-HIV-related causes of death. We used the San Francisco HIV/AIDS registry to identify deaths that occurred from January 1996 through December 2011. Temporal trends in AIDS- and non-AIDS-related mortality rates, the proportion of underlying and contributory causes of death, and the ratio of observed deaths in the study population to expected number of deaths among California men aged 20-79 (standardized mortality ratio [SMR]) of underlying causes of death were examined. A total of 5338 deaths were identified. The annual AIDS-related death rate (per 100 deaths) declined from 10.8 in 1996 to 0.9 in 2011 (p<0.0001), while the annual death rate from non-AIDS-related causes declined from 2.1 in 1996 to 0.9 in 2011 (p<0.0001). The proportion of deaths due to all types of heart disease combined, all non-AIDS cancers combined, mental disorders resulting from substance abuse, drug overdose, suicide and chronic obstructive pulmonary disease increased significantly over time. The SMRs for liver diseased decreased significantly over time but remained elevated. Our data highlight the importance of age-related causes of death as well as deaths from causes that are, at least in part, preventable.
    AIDS PATIENT CARE and STDs 10/2014; 28(10):517-523. DOI:10.1089/apc.2014.0079 · 3.58 Impact Factor
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    ABSTRACT: This study reviews recent trends of HIV inpatient admissions in two HIV centres in Europe. Chelsea and Westminster Hospital, London (UK) and four infectious diseases departments in Liguria, Italy (IT) collected data on inpatient HIV admissions from January to December 2012, including patient demographic, discharge diagnoses, CD4, viral load (VL) and combined anti-retroviral therapy (cART). Rate of patient admissions per 100 years was 6.12 for IT and 12.91 for UK (number of admissions UK=474, IT=257), 66.8% (n=488) of admissions had a VL under 400 copies/ml with 83.6% (n=611) of admissions were on cART. Median age was 47 years old. Mortality rate was 10.2% in IT and 2.8% in UK. Hepatitis C co-infection occurred in 64.6% of patients (n=166) in IT and 13.5% (n=64) in UK. Commonest diagnoses were infectious diseases (29.1%), respiratory diseases (16.6%) and neoplasms (15.0%). Majority of inpatients were taking cART and had a suppressed VL. The complications of Hepatitis C co-infection has a major impact on mortality rates and inpatient case load in Italy, and may cause similar patterns in London where rates are increasing. In the UK, a wider range of diagnoses is seen, requiring specialist input and working with other specialties. Copyright © 2015. Published by Elsevier Ltd.


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