Excess mortality risk from sepsis in patients with HIV – A meta-analysis

Pyarali, Fahim; Iordanov, Roumen; Palacio, Ana; Tamariz, Leonardo

doi:10.1016/j.jcrc.2020.05.018

Cited by 7 publications

(3 citation statements)

References 37 publications

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“…HIV infection increases susceptibility to SBI by preexisting activation and exhaustion of the immune system, thereby leading to an unbalanced immune response to sepsis [ 78 ]. Incidence of and mortality from SBI is higher among PWH, with the highest relative risk of mortality among PWH in low-income settings [ 79 , 80 ]. Differences in HIV prevalence, ART access and medical resources leads to significant variation in recorded SBI mortality across settings in PWH, with mortality rates as low as 16% in high-income settings, and as high as 43% in Asia and 46% in Africa [ 81 ].…”

Section: Ahd-associated Opportunistic Infectionsmentioning

confidence: 99%

Advanced HIV disease: A review of diagnostic and prophylactic strategies

et al. 2023

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Background Despite expanded access to antiretroviral therapy (ART) and the rollout of the World Health Organization's (WHO) ‘test‐and‐treat’ strategy, the proportion of people with HIV (PWH) presenting with advanced HIV disease (AHD) remains unchanged at approximately 30%. Fifty percent of persons with AHD report prior engagement to care. ART failure and insufficient retention in HIV care are major causes of AHD. People living with AHD are at high risk for opportunistic infections and death. In 2017, the WHO published guidelines for the management of AHD that included a comprehensive package of care for screening and prophylaxis of major opportunistic infections (OIs). In the interim, ART regimens have evolved: integrase inhibitors are first‐line therapy globally, and the diagnostic landscape is evolving. The objective of this review is to highlight novel point‐of‐care (POC) diagnostics and treatment strategies that can facilitate OI screening and prophylaxis for persons with AHD. Methods We reviewed the WHO guidelines for recommendations for persons with AHD. We summarized the scientific literature on current and emerging diagnostics, along with emerging treatment strategies for persons with AHD. We also highlight the key research and implementation gaps together with potential solutions. Results While POC CD4 testing is being rolled out in order to identify persons with AHD, this alone is insufficient; implementation of the Visitect CD4 platform has been challenging given operational and test interpretation issues. Numerous non‐sputum POC TB diagnostics are being evaluated, many with limited sensitivity. Though imperfect, these tests are designed to provide rapid results (within hours) and are relatively affordable for resource‐poor settings. While novel POC diagnostics are being developed for cryptococcal infection, histoplasmosis and talaromycosis, implementation science studies are urgently needed to understand the clinical benefit of these tests in the routine care. Conclusions Despite progress with HIV treatment and prevention, a persistent 20%–30% of PWH present to care with AHD. Unfortunately, these persons with AHD continue to carry the burden of HIV‐related morbidity and mortality. Investment in the development of additional POC or near‐bedside CD4 platforms is urgently needed. Implementation of POC diagnostics theoretically could improve HIV retention in care and thereby reduce mortality by overcoming delays in laboratory testing and providing patients and healthcare workers with timely same‐day results. However, in real‐world scenarios, people with AHD have multiple comorbidities and imperfect follow‐up. Pragmatic clinical trials are needed to understand whether these POC diagnostics can facilitate timely diagnosis and treatment, thereby improving clinical outcomes such as HIV retention in care.

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Section: Ahd-associated Opportunistic Infectionsmentioning

confidence: 99%

Advanced HIV disease: A review of diagnostic and prophylactic strategies

et al. 2023

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“…In the infectious and parasitic diseases group, sepsis was the most prevalent cause, corresponding to more than half of the cases, followed by unspecified infections and infection-induced encephalopathy. Sepsis is one of the main causes of death in patients with an immune deficit since this group is vulnerable to a greater range of pathogenic agents, in addition to presenting a higher number of inflammatory markers associated with mediating the response to sepsis, leading to a 28% higher risk of disease progression compared to the general population (25,26) . When the most incident diseases with a well-defined causative agent were analyzed, pneumocystosis, tuberculosis, cryptococcosis, and toxoplasmosis stood out among the immediate causes of death.…”

Section: Discussionmentioning

confidence: 99%

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010–2019

Escobar

Cunga

Parma

et al. 2022

J Bras Doenças Sex Transm

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Introduction: Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic non-communicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. Objective: To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. Methods: In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. Results: A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval — 95%CI 6.61–8.67) — 8.99 in 2010 and 6.06 in 2019 —, showing a downward trend of 0.38% per year. Conclusion: We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.

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“…10 A metaanalysis found mortality rates were higher in patients with HIV compared with non-HIV patients, especially in lowincome countries. 58 Disease severity also influences the burden of sepsis and outcomes. A greater degree of organ dysfunction, commonly assessed by the SOFA score, was associated with a progressive increase in mortality risk.…”

Section: Comorbidities and Other Risk Factorsmentioning

confidence: 99%

Definition and Epidemiology of Sepsis

Arina,

Hofmaenner,

Singer

2024

Semin Respir Crit Care Med

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Here we review the epidemiology of sepsis, focusing on its definition, incidence, and mortality, as well as the demographic insights and risk factors that influence its occurrence and outcomes. We address how age, sex, and racial/ethnic disparities impact upon incidence and mortality rates. Sepsis is more frequent and severe among the elderly, males, and certain racial and ethnic groups. Poor socioeconomic status, geographic location, and pre-existing comorbidities also elevate the risk of developing and dying from sepsis. Seasonal variations, with an increased incidence during winter months, is also apparent. We delve into the predictive value of disease severity scores such as the Sequential Organ Failure Assessment score. We also highlight issues relating to coding and administrative data that can generate erroneous and misleading information, and the need for greater consistency. The Sepsis-3 definitions, offering more precise clinical criteria, are a step in the right direction. This overview will, we hope, facilitate understanding of the multi-faceted epidemiological characteristics of sepsis and current challenges.

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Excess mortality risk from sepsis in patients with HIV – A meta-analysis

Cited by 7 publications

References 37 publications

Advanced HIV disease: A review of diagnostic and prophylactic strategies

Advanced HIV disease: A review of diagnostic and prophylactic strategies

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010–2019

Definition and Epidemiology of Sepsis

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