Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries

Llibre, Josep M; Revollo, Boris; Vanegas, Samuel; López-Núñez, Juan J.; Ornelas, Arelly; Marin, Joan M; Santos, José Ramón; Marte, P López; Morera, Marta; Zuluaga, Paola; Tor, Jordi; Clotet, Bonaventura

doi:10.3109/00365548.2013.777778

Cited by 22 publications

(32 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar reduction in hospitalizations due to AIDS-defining illnesses in the late HAART era was observed in Brazil, France, and the United States. [2,4–6,18,24,25] The rate of hospitalizations for PCP in 2000 in our study (1.7/100 patient years) was lower than the rate reported in the United States (3.9/100 person years) [24] but higher than the EUROSIDA report (0.3/100 person years). [25] This reflects differences in HIV care, HAART availability and adherence to treatment as well as the immunological status (CD4 cell counts) of the patients at the time of HIV diagnosis and during the follow-up period in different parts of the world.…”

Section: Discussioncontrasting

confidence: 61%

Hospitalizations of HIV patients in a major Israeli HIV/AIDS center during the years 2000 to 2012

et al. 2017

View full text Add to dashboard Cite

To evaluate hospitalization rates and causes among human immunodeficiency virus (HIV) patients in the late highly active antiretroviral therapy (HAART) era. Data during the years 2000 to 2012 were obtained from hospital/clinical charts. Hospitalizations were defined as a ≥24 hours hospital admission. Obstetric admissions were excluded. Causes of hospitalizations were defined as acquired immune deficiency syndrome (AIDS)-defining illnesses, AIDS-related diseases (HAART adverse events, metabolic complications and non-AIDS-defining tumors/infections), and non-HIV-related diseases. Hospitalization rates are presented as admissions per 100 patient years. The number of HIV patients (58% males) in our center increased from 521 in 2000 to 1169 in 2012. 1676 hospital admissions (in 557 patients) were observed during the years of the study. The mean number of admissions per hospitalized patient was 3 ± 3.39. Hospitalization rates of HIV patients declined significantly (18.4/100 in 2000, 9/100 patient years in 2012; P = .0001), but it was higher than the rates reported in the Israeli general population (X8.76 in 2000, X6.04 in 2012). Furthermore, hospitalizations for AIDS-defining illness declined (from 46.9% to 16.1%) whereas non-HIV-related hospitalizations increased (from 31.3% to 60.1%). Lower cluster of differentiation 4 (CD4) cell counts and older age, at the time of HIV diagnosis, were associated with higher rates of admissions (especially for AIDS-defining illnesses) and mortality. Hospitalization rates of HIV patients, especially for AIDS-defining illness, continue to decline in the late HAART era despite the increasing age of the patients, though it is still higher than that of the general population. Low CD4 cell counts and older age, at the time of HIV diagnosis, are associated with readmissions and mortality.

show abstract

Section: Discussioncontrasting

confidence: 61%

Hospitalizations of HIV patients in a major Israeli HIV/AIDS center during the years 2000 to 2012

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In addition to TB, PCP was another important pre-ART cause of death. The epidemiology and 12-month mortality rate of HIV-1-infected patients with PCP have decreased significantly in the late-ART era, but in-hospital mortality rates have remained unchanged (17). Although no differences have been found between the incidences of PCP of patients who survived and of those who expired, patients who did not receive prophylaxis with TMP-SMZ were still at high risk for respiratory failure within the first six months of admission.…”

Section: Discussionmentioning

confidence: 99%

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

et al. 2014

View full text Add to dashboard Cite

Objective Short-term mortality rates remain high among critically ill human immunodeficiency virus-1 (HIV-1) patients though long-term mortality rates have dropped. Baseline risk factors for short-term mortality have not yet been determined in China. In this paper, we herein describe clinical characteristics, laboratory findings, causes of clinical deterioration, and risk factors associated with mortality among HIV-1 patients within six months after hospital admission. Methods We carried out a prospective study of hospitalized patients in advanced stages of HIV infection. These patients started antiretroviral therapy three or four weeks after admission. Follow-up was conducted for a period of six months. We used a multivariate logistic-regression analysis to identify risk factors associated with mortality. Results A total of 141 patients met our inclusion criteria. The mean age was 41 years. Fever and weight loss were the most common clinical manifestations of advanced HIV disease. Oral candidiasis, tuberculosis, cytomegaloviremia, and pneumocystis pneumonia were the most common opportunistic infections. Significantly decreased CD4+ T-cell counts, hypoalbuminemia, anemia, hyponatremia, as well as elevated C-reactive protein (CRP) and glutamic alanine transaminase levels were common laboratory test abnormalities. The mortality rate was 21.3%. The patients who died were more likely than the survivors to have low CD4+ Tcell counts as well as low creatinine, hemoglobin, albumin, and serum sodium levels while also having longer intervals of fever and higher CRP levels. A multivariate analysis demonstrated that the independent risk factors for mortality were active tuberculosis [odds ratio (OR): 2.681; 95% confidence interval (CI), p=0.049], hyponatremia (OR: 3.027; 95% CI, p=0.015), and being at clinical stage 4 (as defined by the World Health Organization) (OR: 9.492; 95% CI, 1.200-75.065; p=0.033) within the first six months of admission. Conclusion Special consideration should be given to patients who have active tuberculosis, are at clinical stage 4, and present with hyponatremia upon admission as these were found to be important factors associated with mortality within six months of hospital admission in HIV-1 patients.

show abstract

“…The depletion of CD4 + lymphocytes and high levels of HIV RNA in HIV-infected persons occur in parallel to the risk of developing pulmonary infections [4]. It is well known that CD4 + levels ,200 cells per mm 3 are a risk factor for Pneumocystis jirovecii pneumonia (PCP) [5][6][7]. However, there is no information regarding HIV RNA levels.…”

Section: Introductionmentioning

confidence: 99%

Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome

Cillóniz

Polverino

Gabarrús

et al. 2014

European Respiratory Journal

View full text Add to dashboard Cite

We describe the aetiology of community-acquired pneumonia (CAP) in HIV-infected patients, risk factors for bacterial or Pneumocystis jirovecii CAP and prognostic factors of 30-day mortality.This was a prospective observational study of 331 consecutive adult CAP cases in HIV-infected patients (January 2007 to July 2012).128 (39%) patients had CD4 + cell counts ,200 per mm 3 and 99 (43%) ha HIV RNA levels ,200 copies per mL on antiretroviral therapy. Streptococcus pneumoniae was the most frequent microorganism in the group with CD4+ cell counts o200 per mm 3 ; P. jirovecii was the most frequent microorganism in the group with CD4+ cell counts ,200 per mm 3 and in patients with HIV RNA o200 copies per mL. Predictors of bacterial CAP were: time with symptoms f5 days (OR 2.6, 95% CI 1.5-4.4), C-reactive protein level o22 mg?dL -1 (OR 4.3, 95% CI 2.3-8.2) and hepatitis C virus co-infection (OR 2.3, 95% CI 1.4-3.9). White blood cell count f4610 12 per L (OR 3.7, 95% CI 1.2-11.5), lactate dehydrogenase (LDH) level o598 U?L -1 (OR 12.9, 95% CI 4.2-39.7) and multilobar infiltration (OR 5.8, 95% CI 1.9-19.5) were predictors of P. jirovecii. Overall 30-day mortality was 7%. Appropriate antibiotic treatment (OR 0.1, 95% CI 0.03-0.4), LDH o598 U?L -1 (OR 6.2, 95% CI 1.8-21.8) and mechanical ventilation (OR 22.0, were the variables independently associated with 30-day mortality.The described predictors may help clinicians to distinguish between bacterial and P. jirovecii pneumonia in patients with suspected or confirmed HIV infection. @ERSpublications Clinical risk factors in HIV patients to distinguish between bacterial and Pneumocystis jirovecii pneumonia

show abstract

Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries

Cited by 22 publications

References 22 publications

Hospitalizations of HIV patients in a major Israeli HIV/AIDS center during the years 2000 to 2012

Hospitalizations of HIV patients in a major Israeli HIV/AIDS center during the years 2000 to 2012

Baseline Factors Associated with Mortality within Six Months after Admission among Hospitalized HIV-1 Patients in Shenyang, China

Community-acquired lung respiratory infections in HIV-infected patients: microbial aetiology and outcome

Contact Info

Product

Resources

About