Independent Risk Factors for Deaths due to AIDS in Chongqing, China: Does Age Matter?

Zhou, Yihong; Yang, Zhongping; Liu, Min; Lu, Yanqiu; Qin, Yuanyuan; He, Xiaoqing; Zeng, Yanming; Harypursat, Vijay; Chen, Yaokai

doi:10.3389/fmed.2020.586390

Cited by 8 publications

(7 citation statements)

References 38 publications

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“…Unlike earlier studies [ 9 , 26 , 27 ], interval between ATT to ART was not associated with the later development of paradoxical TB-IRIS in the current study, this may be due to the relatively uniform schedule for 2 week in the time from ATT to ART. Late diagnosis is extremely severe among hospitalized PLHIV in Chongqing, it’s reported that the prevalence of advanced HIV was as high as 77.4% [ 19 ], and those usually combined with multiple pathogenic bacteria infection and multiple organ system damages, especially CNS infections, so the complicated circumstances led to a delay in the initiation of ART to approximately 2 weeks or more, however, the overall prognosis was not affected.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

Yang,

Liu,

et al. 2024

BMC Infect Dis

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Background China is a country burdened with a high incidence of both tuberculosis (TB) and HIV, Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an important early complication in TB and HIV co-infected patients, but data from China are limited. Additionally, as an integrase strand transfer inhibitor (INSTI)-based antiretroviral therapy (ART) regimen becomes the first-line treatment, concerns have arisen regarding the potential increase in the incidence of paradoxical TB-IRIS. Nevertheless, the existing data are inconclusive and contradictory. Methods We conducted a retrospective study at Chongqing Public Health Clinical Center from January 2018 to December 2021. We collected demographic and clinical data of HIV/TB co-infected patients who initiated ART. We described the patient characteristics, identified predictors for TB-IRIS, and determined clinical outcomes. The Statistical Package for Social Science (SPSS 25) was used to analyse the data. Continuous variables were compared using Student’s t-test or rank sum test. Counting data were compared using the chi-square test or Fisher’s exact test. The variables with statistical significance in the univariate analysis were added to the binary logistic regression. A p-value less than 0.05 was considered statistically significant. Results A total of 384 patients co-infected with naive HIV and pulmonary TB (PTB) who were given ATT and ART combination were included. 72 patients (18.8%) developed paradoxical TB-IRIS with a median of 15 (12, 21) days after initiating ART. Baseline age ≤ 40years, CD4 + T-cell counts ≤ 50cells/µL, HIV viral load ≥ 500,000 copies/mL were found to be significantly associated with development of paradoxical TB-IRIS. Mortality rates were similar in the TB-IRIS (n = 5, 6.9%) group and non-TB-IRIS (n = 13, 4.2%) group. Interestingly, CD4+ T-cell counts recovery post-ART was significant higher in the TB-IRIS group when compared to the non-TB-IRIS group at the end of 24 weeks (P = 0.004), as well as at 48 weeks (P = 0.015). In addition, we consider that INSTI- based ART regimen do not increased the risk of Paradoxical TB-IRIS. Conclusion Paradoxical TB-IRIS, while often leading to clinical deterioration and hospitalization, is generally manageable. It appears to have a positive impact on the recovery of CD4 + T-cell counts over time. Importantly, our data suggest that INSTI-based ART regimens do not elevate the risk of TB-IRIS. Thus, paradoxical TB-IRIS should not be considered an impediment to initiating ART in adults with advanced immunodeficiency, except in the case of tuberculous meningitis (TBM).

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Section: Discussionmentioning

confidence: 99%

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

Yang,

Liu,

et al. 2024

BMC Infect Dis

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“…[1] However, previous studies on the effectiveness of B/F/TAF have not specifically analyzed patients with baseline HIV RNA >500,000 copies/mL. In Chongqing, China, where the prevalence of advanced HIV among hospitalized patients living with HIV exceeds 70%, [2] up to 25% of patients have baseline HIV-1 RNA >500,000 copies/mL in our study, and many patients have opportunistic infections. In such a complex medical setting, the virological suppression rates of patients using B/F/TAF remain uncertain.…”

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confidence: 84%

Consistent efficacy of B/F/TAF in treatment-naïve HIV patients across different baseline HIV-1 RNA levels at week 48

He,

Zhou,

Yang

et al. 2023

Chinese Medical Journal

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To the Editor: Previous studies have demonstrated the efficacy of bictegravir (B), emtricitabine (F), and tenofovir alafenamide (TAF) in achieving virological suppression in human immunodeficiency virus (HIV)-infected patients. Virological suppression can be influenced by various factors, with baseline HIV-1 RNA being a critical consideration. Guidelines often use a baseline HIV RNA level of >500,000 copies/mL as the primary reference indicator for drug selection. [1] However, previous studies on the effectiveness of B/F/TAF have not specifically analyzed patients with baseline HIV RNA >500,000 copies/mL. In Chongqing, China, where the prevalence of advanced HIV among hospitalized patients living with HIV exceeds 70%, [2] up to 25% of patients have baseline HIV-1 RNA >500,000 copies/mL in our study, and many patients have opportunistic infections. In such a complex medical setting, the virological suppression rates of patients using B/F/TAF remain uncertain.

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“…Talaromycosis is an independent predictor of death in PLWHA in hospital, especially in older patients [4].…”

Section: Introductionmentioning

confidence: 98%

Hematological toxicity of amphotericin B deoxycholate-based induction therapy in patients with HIV-associated talaromycosis.

Zhou

et al. 2022

Preprint

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Objectives: This study's objective was to investigate the predictors for severe anemia, severe leukopenia, and severe thrombocytopenia when amphotericin B deoxycholate-based induction therapy is used in HIV patients with talaromycosis.Patients and methods: A total of 170 HIV patients with talaromycosis were enrolled from January 1st, 2019 to September 30th, 2020.Results: Approximately 42.9%, 20.6%, and 10.6% of the enrolled patients developed severe anemia, severe leukopenia and severe thrombocytopenia, respectively. Baseline lower hemoglobin levels, higher serum creatinine levels, higher AST/ALT ratios, lower sodium levels, and higher administered doses of amphotericin B were observed to be independent risk factors associated with the development of severe anemia. Co-infection with tuberculosis and lower platelet levels at baseline were shown to be independent risk factors associated with the development of severe leukopenia. A lower platelet level at baseline was the independent risk factor found to be associated with the development of severe thrombocytopenia. Conclusion: The preceding findings reveal risk factors for severe anemia, severe leukopenia, and severe thrombocytopenia, which will favor prevention and timely treatment of hematological toxicity, improvement of patient’s outcomes, shorter hospital stays, and a reduction of the requirement for blood transfusion.

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Independent Risk Factors for Deaths due to AIDS in Chongqing, China: Does Age Matter?

Cited by 8 publications

References 38 publications

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome in initiating ART among HIV-Infected patients in China-risk factors and management

Consistent efficacy of B/F/TAF in treatment-naïve HIV patients across different baseline HIV-1 RNA levels at week 48

Hematological toxicity of amphotericin B deoxycholate-based induction therapy in patients with HIV-associated talaromycosis.

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