Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

Musubire, Abdu K; Meya, David B.; Rhein, Joshua; Meintjes, Graeme; Bohjanen, Paul R.; Nuwagira, Edwin; Muzoora, Conrad; Boulware, David R.; Hullsiek, Kathy Huppler; Coat,; teams, Astro trial

doi:10.1371/journal.pone.0209337

Cited by 25 publications

(23 citation statements)

References 60 publications

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“…The increased early mortality rate in patients with a higher neutrophil count is a counterintuitive finding but may be related to undiagnosed bacterial infections at the time of ART initiation. Moreover, a higher mortality rate was observed in HIV+ patients with concomitant cryptococcal meningitis and neutrophilia [ 36 ]. Cryptococcal meningitis could also contribute to explain our findings.…”

Section: Discussionmentioning

confidence: 99%

Hematologic alterations and early mortality in a cohort of HIV positive African patients

et al. 2020

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Introduction Infection with Human Immunodeficiency Virus (HIV) is highly prevalent worldwide, especially in Sub-Saharan Africa, where anaemia is also widespread. HIV infection is known to be associated with anaemia and various other haematologic alterations, but little data on correlation with immunological and virologic conditions in treatment-naïve patients and impact on mortality are available. Our study aims to investigate hematologic features in HIV-infected individuals in Malawi and Mozambique and assesses possible correlations with early morality. Material and methods We conducted a retrospective analysis of baseline data (general details, nutritional status, full blood count and HIV infection progress data) and 12 months follow-up status for HIV+ adult patients in 22 health facilities in Malawi (11 sites) and Mozambique (11 sites) run by DREAM program. Anagraphic details, anthropometric characteristics, full blood count, CD4+ count and Viral Load data were collected from electronical medical records (EMR) for all the HIV-positive, treatment-naïve patients starting care in the sites in the period January 2007 –December 2016. Follow-up status after one year since enrolment in care was also considered. All the data extracted from the EMR were included in a dataset and then analysed. Univariate and multivariate analysis were conducted through logistical regression to investigate associations, and survival analysis analysed in a Cox regression model. Results On the whole, 22.657 patients were included; severe and moderate anaemia were observed in 1.174 (8,2%) and 4.703 (21,9%) patients respectively. Gender, nutritional status, CD4+ count, and viral load (VL) were associated with anaemia, leukopenia, and thrombocytopenia. Among 21.166 fully evaluable patients, 8.494 (40,1%) had at least one cytopenia. Any cytopenia was present in 1/3 of patients with normal nutritional status and less advanced HIV infection, and it wouldn’t be diagnosed in a basic HIV care setting. During the first year of treatment, 1.725 subjects (7,6% of the entire sample) died. Anaemia, lower Red blood cells and platelets counts correlated with mortality in the first year of care, independently by body mass index, haemoglobin, CD4+ count and VL. Conclusions Notwithstanding anaemia is known to be associated with HIV infection at diagnosis, full blood count is not routinely performed in many African countries. Our results emphasize that including the study of a broader set of parameters in the routine HIV care services in Sub-Saharan Africa would provide significant clinical information able to predict other alterations and poor outcomes.

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Section: Discussionmentioning

confidence: 99%

Hematologic alterations and early mortality in a cohort of HIV positive African patients

et al. 2020

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“…Blood granulocyte activation status, particularly neutrophils’, has been correlated with high mortality, including that from CM-IRIS, perhaps reflecting systemic oxidative stress generated by these short-lived effector cells of the innate immune system [ 78 ]. Transcriptomic biomarkers for activated granulocytes (e.g., oxidases, arginase, integrins, etc.)…”

Section: Immunopathogenesis Of C-irismentioning

confidence: 99%

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Brienze

André

Liso

et al. 2021

Life

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Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage human immunodeficiency virus (HIV) infection who have commenced antiretroviral treatments (ART). Virtually any opportunistic pathogen can provoke this type of immune restoration disorder. In this review, we focus on recent developments in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the prediction and diagnosis of cryptococcal meningitis IRIS (CM-IRIS). We assess current therapeutic regimens and novel treatment approaches to combat CM-IRIS. We discuss the utility of biomarkers for clinical monitoring and adjusting treatment modalities in acquired immunodeficiency syndrome (AIDS) patients co-infected with Cryptococcus who have initiated ART.

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“…Interestingly, the most recent study led by Vlasova-St. Louis, which specifically focused on fatal CM- Blood granulocyte activation status, particularly neutrophils', had been correlated with high mortality, including that from CM-IRIS, perhaps reflecting systemic oxidative stress generated by these short-lived effector cells of the innate immune system [76]. Transcriptomic biomarkers for activated granulocytes (e.g.…”

Section: Blood Plasma and Serum Biomarkers In Cm-irismentioning

confidence: 99%

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Brienze¹,

André²,

Liso³

et al. 2020

Preprint

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Immune reconstitution inflammatory syndrome (IRIS) presents as an exaggerated immune reaction that occurs during dysregulated immune restoration in immunocompromised patients in late-stage HIV infection who commenced antiretroviral treatments. Virtually, any opportunistic pathogen can provoke this type of immune restoration disorders. In this review, we focus on recent development in the identification of risk factors for Cryptococcal IRIS and on advancements in our understanding of C-IRIS immunopathogenesis. We overview new findings in blood and cerebrospinal fluid which can potentially be useful in the diagnosis of cryptococcal meningitis IRIS. We assess the utility of these biomarkers to identify putative host-based targets, which may justify a clinical need for improvement in monitoring a patient’s laboratory results and adjusting treatment modalities in AIDS patients co-infected with Cryptococcus.

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Blood neutrophil counts in HIV-infected patients with cryptococcal meningitis: Association with mortality

Cited by 25 publications

References 60 publications

Hematologic alterations and early mortality in a cohort of HIV positive African patients

Hematologic alterations and early mortality in a cohort of HIV positive African patients

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

Cryptococcal Immune Reconstitution Inflammatory Syndrome: From Blood and Cerebrospinal Fluid Biomarkers to Treatment Approaches

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