Low CD4 Count Is Associated With an Increased Risk of Fragility Fracture in HIV-Infected Patients

Yong, Michelle K.; Elliott, Julian; Woolley, Ian; Hoy, Jennifer

doi:10.1097/qai.0b013e31821ecf4c

Cited by 73 publications

(83 citation statements)

References 35 publications

(48 reference statements)

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“…6,20 This phenomenon is likely due to patients with more advanced disease (as evidenced by lower CD4 + counts), associated with greater fragility and often less mobility, are less able to get to clinic appointments. 31 These patient-specific differences in risk of missed visits and risk of mortality should help clinical programs target specific populations for more intensive retention in care efforts. Patients with lower CD4 + counts may need additional efforts to ensure they keep their appointments, and failure to keep appointments should be closely monitored.…”

Section: Discussionmentioning

confidence: 99%

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Horberg

Hurley

Silverberg

et al. 2013

AIDS Patient Care and STDs

102

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Linkage and retention in care soon after HIV diagnosis improves clinical outcomes. Conversely, missed visits after diagnosis are associated with increased mortality in the public care setting. We analyzed mortality among newly diagnosed HIV patients ‡ 18 years old in a large private care setting between 01/01/1997 and 12/31/ 2009, comparing patients who missed visits in their first year following diagnosis (index period) with those who did not. Patients who died during the index period were excluded. Hazard ratios (HR) for association of missed visits and mortality were obtained by Cox proportional hazards regression, adjusting for patient demographics, CD4 + counts, and AIDS-defining conditions (CDC, 1993) at diagnosis. We also evaluated risk factors of missed visits by multivariable logistic regression. 2811 patients were included, of whom 65% had ‡ 1 missed visit, and 226 patients died during follow-up. Patients with ‡ 1 missed visit had a 71% increased mortality risk (HR = 1.71, p = 0.001) with 12% increased rate per missed visit (HR = 1.12, p < 0.001). Factors associated with missed visits were younger age (OR = 1.69 compared to 60 + years), Black and Latino race/ethnicity (OR = 1.54, 1.48 respectively, compared to Caucasians), injection drug use (OR = 2.50 compared to men who have sex with men), and lower CD4 + (OR = 1.43 for CD4 + 100-199 cells/lL, OR = 1.39 for 50-99 cells/lL, and OR = 1.63 for CD4 + < 50 cells/lL, compared with CD4 + > 500 cells/lL). In an insured patient population, missed visits in the first year of HIV care are common and associated with increased mortality. Early retention in HIV care is critical to improving outcomes.

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Section: Discussionmentioning

confidence: 99%

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Horberg

Hurley

Silverberg

et al. 2013

AIDS Patient Care and STDs

102

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“…El recuento bajo de LTCD4 en el momento diagnóstico es un marcador perjudicial en la infección por VIH, asociado con mayor morbilidad y mortalidad, peor pronóstico y menor supervivencia; asimismo, aquellas personas con infección por VIH/SIDA son menos beneficiadas por la TARV, repercutiendo también de forma importante sobre la utilización y gasto sanitario, y desde la perspectiva de salud pública, aumentaría el riesgo de transmisión del VIH [8][9][10] . Investigaciones encuentran asociación entre tener un diagnóstico tardío y variables como el sexo, edad, consumo de drogas y orientación sexual 8,11,12 . En nuestro país, a pesar de ser ésta una enfermedad con altos costos en salud y consecuencias económicas 13,14 , no se encuentran muchos estudios respecto al tema.…”

Section: Introductionunclassified

Diagnóstico tardío y enfermedad avanzada de VIH en pacientes adultos en un hospital de la seguridad social de Perú

Maquera-Afaray

Cvetkovic‐Vega

Cárdenas

et al. 2016

Rev. chil. infectol.

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“…Persistent depletion of CD4 + T cells in lymphoid tissue, such as gut-associated lymphoid tissue, is even more pronounced than in blood (2). CD4 + T cell deficiency on ART is associated with a higher rate of mortality and morbidity (3,4), which includes atherosclerotic vascular disease (3,5), cardiovascular disease (4), osteoporosis and fractures (6), and non-AIDS-defining cancer (4,7,8).…”

mentioning

confidence: 99%

IFN-α Exerts Opposing Effects on Activation-Induced and IL-7–Induced Proliferation of T Cells That May Impair Homeostatic Maintenance of CD4+ T Cell Numbers in Treated HIV Infection

Cha

Jong

French

et al. 2014

The Journal of Immunology

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To determine whether IFN-α is a cause of the T cell hyperactivation and IL-7 signaling pathway defects that are observed in some HIV patients receiving antiretroviral therapy, we have investigated the effect of IFN-α on the proliferation of CD4+ and CD8+ T cells from healthy donors (n = 30) and treated HIV+ donors (n = 20). PBMC were cultured for 7 d with staphylococcal enterotoxin B or IL-7 in the absence or presence of 100 U/ml IFN-α8. Total and naive CD4+ and CD8+ T cells were assessed for proliferation (via Ki67 expression), CD127 expression, and phosphorylated STAT5 levels using flow cytometry. IFN-α significantly enhanced activation-induced proliferation (via staphylococcal enterotoxin B stimulation) but inhibited homeostatic proliferation (IL-7 induced) of CD4+ and CD8+ T cells. Both of these effects may adversely affect CD4+ T cell homeostasis in HIV patients. CD127 expression was increased in both healthy and HIV+ donors following culture with IFN-α8, and levels of IL-7–induced phosphorylated STAT5 were increased by IFN-α8 in healthy donors only. Hence, the inhibitory effects of IFN-α on IL-7–induced proliferation of CD4+ T cells are unlikely to be mediated by downregulation of CD127 expression or inhibition of STAT5 phosphorylation. These data suggest that increased IFN-α activity may promote the loss of T cells by accelerating cell turnover and activation-induced cell death while decreasing the renewal of T cells by inhibiting the proliferative effect of IL-7.

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Low CD4 Count Is Associated With an Increased Risk of Fragility Fracture in HIV-Infected Patients

Cited by 73 publications

References 35 publications

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Missed Office Visits and Risk of Mortality Among HIV-Infected Subjects in a Large Healthcare System in the United States

Diagnóstico tardío y enfermedad avanzada de VIH en pacientes adultos en un hospital de la seguridad social de Perú

IFN-α Exerts Opposing Effects on Activation-Induced and IL-7–Induced Proliferation of T Cells That May Impair Homeostatic Maintenance of CD4+ T Cell Numbers in Treated HIV Infection

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