Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons—San Francisco, 1981–2012

Djawe, Kpandja; Buchacz, Kate; Hsu, Ling; Chen, Miao-Jung; Selik, Richard M.; Rose, Charles E.; Williams, Tiffany; Brooks, John T.; Schwarcz, Sandra

doi:10.1093/infdis/jiv235

Cited by 48 publications

(43 citation statements)

References 38 publications

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“…Despite its decreasing incidence, PCP is still a serious health concern for people living with HIV/AIDS [13]. Since there is no national surveillance for PCP in the United States and other resource-rich countries, the exact number of cases is difficult to determine.…”

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

“…Since there is no national surveillance for PCP in the United States and other resource-rich countries, the exact number of cases is difficult to determine. While fewer HIV-infected individuals develop opportunistic infections in resource-rich settings overall, PCP is still one of the most common opportunistic infections in HIV patients in the United States, Canada, and Europe [2, 13]. It mainly affects individuals who are unaware of their HIV infection or who get diagnosed late (i.e., late presenters) or are not receiving ongoing care for HIV infection [14, 15].…”

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

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Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimethoprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.

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Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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“…From the pre-ART era it was apparent that opportunistic infections including malignancies triggered by infectious agents like Kaposi’s sarcoma and EBV associated lymphomas were the hallmark of HIV [2]. Although in the current era morbidity and mortality by opportunistic diseases has decreased, albeit still significant [3,4], infections like Cytomegalovirus (CMV), tuberculosis, hepatitis C and B, Human Papillomavirus (HPV) are still at center stage of health issues in treated chronic HIV-infected persons [5] and remain important factors for the pathogenesis of serious non-AIDS events [6] as discussed in other reviews in this issue of Current.…”

Section: Introductionmentioning

confidence: 99%

HIV infection and immune activation

Boulougoura

Sereti

2016

Current Opinion in HIV and AIDS

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Purpose of review To explore new data from recent studies addressing the role of co-infections in immune activation in HIV-1 infected patients, with a focus on Immune Reconstitution Inflammatory Syndrome (IRIS), an aberrant inflammatory response occurring shortly after antiretroviral therapy (ART) initiation. Recent findings Chronic HIV infection is associated with a number of co-infections that contribute to immune activation in various settings including early after ART initiation in the most noticeable form of IRIS and also in chronic treated infection, with chronic viral infections like CMV and HCV or HBV contributing to immune activation and also morbidity and mortality. Expanding on older studies, the role of T cells in IRIS has been further elucidated with evidence of more pronounced effector activity in IRIS patients that may be leading to excessive tissue pathology. Newer studies are also continuing to shed light on the role of myeloid cells in IRIS as well as the contribution of antigen load in the syndrome. In addition, preliminary data are beginning to suggest a possible role of inflammasome formation in IRIS. In cryptococcal IRIS, the role of activated immune cells (T cell and myeloid) and biomarkers were evaluated in more detail at the site of infection (CSF). Finally, important differences of patients developing IRIS versus those who die from TB despite ART initiation were reported, a distinction that may have important implications for participant selection in studies aiming to prevent IRIS with immunosuppressive agents. Summary Better understanding of the role of opportunistic infections at ART initiation and IRIS pathogenesis will assist in improved strategies for prevention and treatment. The long-term consequences of IRIS remain unclear. Chronic viral coinfections with herpesviruses and HCV are important factors in persistent immune activation in chronic treated HIV.

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“…The findings of the present study suggest that despite the wider introduction of HAART, mortality still continues to occur due to varying study populations, time frames and analytic designs or advanced immunodeficiency soon after starting therapy. 3,13,14,15,16 CONCLUSION This study provide a systematic review of the causes of deaths in HIV infected patients of Manipur in the Eastern region of India. It also gave knowledge about the prognostic significance and concern about the need to formulate protocol based proper management of the HIV infected patients in view of these spectrum of conditions for a better life of those people living with HIV.…”

Section: Discussionmentioning

confidence: 97%

Retrospective Analysis of Causes of Death in Hiv Infected Patients in Imphal, Manipur, North Eastern Part of India

Singh¹,

Singh²,

M³

2016

jemds

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BACKGROUND AND OBJECTIVEManipur is a state located in North Eastern part of India with a huge burden of people living with HIV/AIDS. Studies of cause of death in this group of people is of utmost importance to determine the preventive strategies and to derive prognosis and to compare with trends in other parts of India and World. This study was conducted among the patients who were admitted to JNIMS Hospital.

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Mortality Risk After AIDS-Defining Opportunistic Illness Among HIV-Infected Persons—San Francisco, 1981–2012

Cited by 48 publications

References 38 publications

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with <b><i>Pneumocystis jirovecii</i></b> Pneumonia

HIV infection and immune activation

Retrospective Analysis of Causes of Death in Hiv Infected Patients in Imphal, Manipur, North Eastern Part of India

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