Background
Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia. Older People with HIV (OPWH) are at increased risk of poor outcomes compared to younger patients. We examined the prevalence and correlates of loss to follow-up (LTFU) among newly diagnosed patients in Ukraine.
Methods
Retrospective chart review was conducted of 400 patients newly diagnosed with HIV July 1, 2017 - Dec 1, 2018. Data was collected from clinics in the city of Odessa and surrounding regions. OPWH were ≥50 years old at diagnosis and LTFU was defined as no contact with the HIV clinic for 90 days. Demographic, clinical characteristics, and follow-up outcomes were examined, and multivariate logistic regression was used to estimate the adjusted odds ratios at 95% confidence intervals.
Results
Of the 400 people living with HIV, median age was 50 (IQR35-55), 196 (49%) were women, and 177 (44%) had CD4< 200cell/mm3 at diagnosis. Overall, 65 (16.5%) were LTFU from diagnosis and 54/65 (83%) were lost after their first appointment at the HIV clinic. Among those lost to follow-up, 49 (75%) were ≥50 at the time of diagnosis. Multivariate analysis showed LTFU was associated with age >50years (aOR 3.6, CI 1.8-7.3, p=0.001), lack of ART prescription (aOR 16.4, CI 8.5-31.8, p= 0.001), and living outside the city of Odessa (aOR 2.9, CI 1.5-5.7, p=0.002). Figure 1 shows the breakdown of lost to follow-up for OPWH.
Figure 1. Retainment in HIV Care for OPWH compared to those <50 years old.
Conclusion
LTFU among OPWH is significantly greater than younger people with HIV, and associated with lack of ART and living in nonurban settings. OPWH may benefit from differentiated HIV service delivery to reduce loss to follow up and interventions tailored to improving HIV outcomes for OPWH in resource-limited settings are urgently needed.
Disclosures
All Authors: No reported disclosures
There are minimal data regarding the management of high risk endometrial cancer histologies lacking invasive disease on the final pathology specimen. This study examines a cohort of these patients and assesses outcomes including time to recurrence and risk of death after management with and without adjuvant therapies.
Endometrial cancer patients with minimal or no remaining invasive disease on final pathologic specimen from 1995 to 2010 were included. Surgical procedure was at the discretion of the operating physician. Electronic medical records were used to abstract relevant clinicopathologic data and standard statistical methods were employed.
70 patients met inclusion criteria, of which 26 were high grade histologies. Adjuvant therapies were given in 12 of 26 patients. 6/26 patients recurred, of which 50% were salvaged with therapy at time of recurrence. Overall deaths occurred in 3 of 26 patients in the high risk cohort.
Less than half of the high risk cohort received adjuvant therapies after surgical management. No histologic type was found to increase risk of recurrence, and treatment with initial adjuvant therapy did not significantly reduce recurrence risk. Large scale prospective trials are needed to aid in management of this unique endometrial cancer population.
lipopolysaccharide (LPS)-induced endotoxemia on fetal baroreceptor activity in chronically instrumented preterm fetal sheep. STUDY DESIGN: The changes in fetal baroreceptor activity due to intra-amniotic endotoxin infusion were measured in five chronically instrumented preterm fetal sheep at days 111-120. Granulocytecolony stimulating factor was injected intravenously into the fetuses on postoperative days 3 to 6, and 40 mg of LPS was infused in the amniotic cavity on postoperative days 5 and 6. Baroreceptor activity was determined by the ratio of fetal FHR decrease to mean arterial pressure increase after the injection of 30 mg phenylephrine Fetal baroreceptor activity and fetal heart rate (FHR) were measured at three points (A: control phase, B: acute phase, 3: fetal acidosis phase). Baroreceptor activity was determined by the ratio of fetal FHR decrease to mean arterial pressure increase. Histological examination for fetal membrane and umbilical cord was conducted. RESULTS: All the fetuses developed metabolic acidosis without hypoxemia after the second injection of LPS. Severe chorioamnionitis was confirmed histologically in all cases. A total number of 136 baroreceptor activity were measured in this experiment (A: n¼63, B: n¼54, and C: n¼19). There was no significant difference regarding FHR at the time of phenylephrine injection at 3 points [A:172(3.3) bpm, B:176(4.3)bpm, and C:162(4.7). p¼0.14]. However, the baroreceptor activity showed significant differences at 3 points [A:2.7(0.2), B:2.5(0.2), and C:1.6(0.1). p<0.05]. Post hoc test showed baroreceptor activity in fetal acidosis phase significantly decreased compared to the control (Figure1). CONCLUSION: Baroreceptor activity decreased without FHR change during fetal deteriorated condition induced by LPS. These data suggest that intra-uterine infection may modify variable decelerations or late decelerations.
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