Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010–July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.

RP care was associated with high levels of retention and adherence for clinically stable patients. Timeliness of pre-RP visits was predictive of outcomes after RP initiation.

We compared viral suppression rates between patients who continued tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) vs switched to zidovudine (ZDV)/3TC in combination with a boosted protease inhibitor after failure of first-line efavirenz/TDF/3TC. We found higher rates of viral suppression with continued TDF/3TC compared with switching to ZDV/3TC.

SETTING: The Groupe Haïtien d'étude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centres, Port-au-Prince, Haiti, facilitate “test and treat” strategies by screening all patients for tuberculosis (TB) at human immunodeficiency virus (HIV) testing.OBJECTIVE: 1) To determine the proportion of patients with chronic cough at HIV testing diagnosed with TB, stratified by HIV test results; and 2) to evaluate the additional diagnostic yield of Xpert® MTB/RIF vs. sputum microscopy.DESIGN: We conducted a retrospective cohort analysis including all adults tested for HIV at GHESKIO from August 2014 to July 2015.RESULTS: Of 29 233 adult patients tested for HIV, 2953 (10%) were diagnosed as HIV-positive. Chronic cough lasting ≥2 weeks was reported by 1116 (38%) HIV-positive patients; 984 (88%) were tested and 265 (27%) were diagnosed with TB. Chronic cough was reported by 5985 (23%) HIV-negative patients; 5654 (94%) were tested and 1179 (21%) were diagnosed with TB. Of all bacteriologically confirmed cases, 27% were smear-negative and Xpert-positive. Among all TB patients, 81% were HIV-negative.CONCLUSIONS: Screening for TB at HIV testing was high-yield, among both HIV-infected and HIV-negative individuals. Testing for both diseases should be conducted among patients who present with chronic cough at HIV testing.

BackgroundPsoriatic arthritis (PsA) is a rare disease, with an estimated prevalence of 0.02 – 0.42% in Europe and US (1). PsA is often regarded as a mild disease, but recent data suggest an increase in comorbidities and mortality, possibly related to systemic inflammation (1).ObjectivesTo study all-cause hospitalizations in patients with PsA in the United States (US) from 1993 to 2014.MethodsThe Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in NIS from 1993 to 2014 with a primary or secondary diagnosis of PsA, and compared them to total all-cause US hospitalizations during the same period. US population estimates and projections for the resident US population were obtained from the US Census Bureau.ResultsThere were 789.8 million all-cause hospitalizations in 6.4 billion person-years of observation from 1993 to 2014 (123.4 hospitalizations per 1,000 person-years). During this time-period, 332,496 hospitalizations occurred in patients with PsA (5.2 per 100,000 person-years). All-cause US hospitalizations increased from 33.7 million in 1993 to 35.4 million in 2014, an increase of 4.8% over 22 years (Figure, dotted blue line). All-cause hospitalizations in PsA patients have increased from 6,866 in 1993 (2.6 per 100,000 person-year) to 33,875 in 2014 (10.6 per 100,000 person-years, a dramatic increase of over 393% (p<0.0001, Figure solid red line). In 2014, hospitalizations in PsA patients accounted for 163,630 hospital days at a total national cost of over US$1.66 billion.ConclusionsAll-cause hospitalizations in patients with PsA in the US have significantly increased by 393% in the last 22 years, almost 80-fold of the 4.8% increase in US population all-cause hospitalization rate in the same time-period. This calls for an increase need for identification and management of serious co-morbid conditions in patients with PsA.References J Gelfand, D Gladman et al. Epidemiology of Psoriatic Arthritis in the Population of the United States. J Am Acad Dermatology, vol 53, p 573–577. Disclosure of InterestNone declared