Deeks, S.G. & Phillips, A.N. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 338, a3172
Positive Health Program, San Francisco General Hospital, University of California, San Francisco, CA 94131, USA.BMJ (online) (Impact Factor: 17.45). 02/2009; 338(3172):a3172. DOI: 10.1136/bmj.a3172
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- "With lives extended by antiretroviral therapy (ART), HIV patients can experience more medical comorbidities associated with ageing, and complications from HIV disease processes, treatment side effects, drug interactions and long-term sequela (Deeks & Phillips, 2009; Justice et al., 2009). Symptoms of these comorbidities are defined as subjective health-related experiences described by their intensity, duration, interference with daily activities or degree of change over time (Miaskowski , Aouizerat, Dodd, & Cooper, 2007). "
ABSTRACT: Symptom clusters are gaining importance given HIV/AIDS patients experience multiple, concurrent symptoms. This study aimed to: determine clusters of patients with similar symptom combinations; describe symptom combinations distinguishing the clusters; and evaluate the clusters regarding patient socio-demographic, disease and treatment characteristics, quality of life (QOL) and functional performance. This was a cross-sectional study of 302 adult HIV/AIDS outpatients consecutively recruited at two teaching and referral hospitals in Uganda. Socio-demographic and seven-day period symptom prevalence and distress data were self-reported using the Memorial Symptom Assessment Schedule. QOL was assessed using the Medical Outcome Scale and functional performance using the Karnofsky Performance Scale. Symptom clusters were established using hierarchical cluster analysis with squared Euclidean distances using Ward's clustering methods based on symptom occurrence. Analysis of variance compared clusters on mean QOL and functional performance scores. Patient subgroups were categorised based on symptom occurrence rates. Five symptom occurrence clusters were identified: Cluster 1 (n = 107), high-low for sensory discomfort and eating difficulties symptoms; Cluster 2 (n = 47), high-low for psycho-gastrointestinal symptoms; Cluster 3 (n = 71), high for pain and sensory disturbance symptoms; Cluster 4 (n = 35), all high for general HIV/AIDS symptoms; and Cluster 5 (n = 48), all low for mood-cognitive symptoms. The all high occurrence cluster was associated with worst functional status, poorest QOL scores and highest symptom-associated distress. Use of antiretroviral therapy was associated with all high symptom occurrence rate (Fisher's exact = 4, P < 0.001). CD4 count group below 200 was associated with the all high occurrence rate symptom cluster (Fisher's exact = 41, P < 0.001). Symptom clusters have a differential, affect HIV/AIDS patients' self-reported outcomes, with the subgroup experiencing high-symptom occurrence rates having a higher risk of poorer outcomes. Identification of symptom clusters could provide insights into commonly co-occurring symptoms that should be jointly targeted for management in patients with multiple complaints.
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- "Multimorbidity, that is associated with age, is perhaps the most common " disease pattern " found among the elderly and, for this reason, it is turning into a major medical issue for both individuals and health care providers (Marengoni et al., 2011). It is well known that HIV-infected patients experience an increased prevalence of NICMs, compared with the general population and it has been hypothesized that such increased prevalence is the result of premature aging of HIV-infected patients (Deeks and Phillips, 2009; Shiels et al., 2010; Guaraldi et al., 2011). Guaraldi et al. (2011) investigated the effect of HIV-infection on the prevalence of a set of noninfectious chronic medical conditions. "
ABSTRACT: In regression models for categorical data a linear model is typically related to the response variables via a transformation of probabilities called the link function. We introduce an approach based on two link functions for binary data named log-mean (LM) and log-mean linear (LML), respectively. The choice of the link function plays a key role for the interpretation of the model, and our approach is especially appealing in terms of interpretation of the effects of covariates on the interactions of responses. Similarly to Poisson regression, the LM and LML regression coefficients of single outcomes are log-relative risks, and we show that the relative risk interpretation is maintained also in the regressions of the interactions of responses. Furthermore, certain collections of zero LML regression coefficients imply that the relative risks for joint responses factorize with respect to the corresponding relative risks for marginal responses. This work is motivated by the analysis of a dataset obtained from a case-control study aimed to investigate the effect of HIV-infection on multimorbidity, that is simultaneous presence of two or more noninfectious commorbidities in one patient.
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- "The increased life expectancy of the HIV-1-infected population means that physicians are increasingly being faced with previously unrecognized comorbid conditions and antiretroviral-related complications. Atherosclerosis and cardiovascular events, loss of renal function, osteopenia/ osteoporosis, and non-AIDS-defining cancers are some of the emerging conditions observed in large observational cohorts, and their incidence seems to be higher than in the general population       . In addition, not only is HIV infection associated with AIDS-defining neurologic conditions with severe CD4 depletion, but also HIV-associated neurocognitive disorders seem more common in HIV-infected individuals despite achieving a successful immune recovery. "
ABSTRACT: Background: There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF) in HIV-infected patients. Methods: We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results: We identified 81 patients with a history of a coronary event (prevalence 2.15%); 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus). Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol (P = 0.025) and LDL-cholesterol (P = 0.004) was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P = 0.103). Patients using protease inhibitors associated with a favorable lipid profile increased over time (P = 0.028). Conclusions: The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.
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