Morbidity and Risk of Subsequent Diagnosis of HIV: A Population Based Case Control Study Identifying Indicator Diseases for HIV Infection

Morbidity and Risk of Subsequent Diagnosis of HIV: A Population Based Case Control Study Identifying Indicator Diseases for HIV Infection

Combination antiretroviral therapy (cART) has been widely available in Ghana since 2004. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to make new copies of themselves. We demonstrated a significant decrease in missed presentations and time to diagnosis between the two time periods. Finally, the introduction of HAART has seen the emergence of several complications, termed immune reconstitution inflammatory syndrome, which includes OIs such as cytomegalovirus vitritis, Mycobacterium avium complex lymphadenitis, paradoxical responses to treatment for tuberculosis, and exacerbation of cryptococcosis. Many of the earliest manifestations of the immune suppression associated with HIV infection occur in the mouth – particularly oral candidiasis, but also viral and sometimes severe bacterial infections, including tuberculosis. To examine survival factors, we analyzed data from the Adult and Adolescent Spectrum of HIV Disease (ASD) surveillance project, a longitudinal, national multicenter surveillance project that collects information on AIDS-defining and other conditions in HIV-infected persons 1 Received 18 December 1998; revised 21 April 1999; electronically pub- lished 3 August 1999. Phenytoin is the most commonly prescribed anticonvulsant in this situation, although several patients may experience hypersensitivity reactions.

Candidosis, herpetic infections and Pneumocystis jiroveci (P. Farber may be confusing binding and neutralizing antibodies. Herpes zoster, i.e. and the special problems in women. Diagnosis at this stage is considered to be particularly important for the patient (since initiation of treatment may lower the viral set point and delay progression of disease) as well as the community (an “unaware” infected patient poses a particularly high risk for transmission due to high viral load). However, AIDS represents only the end stage of a continuous, progressive pathogenic process, beginning with primary infection with HIV, continuing with a chronic phase that is usually asymptomatic, and leading to progressively severe symptoms and, ultimately, profound immunodeficiency and opportunistic infections and cancers. Screening of all patients with Herpes zoster for HIV is also advised.

Our initial experience showed the feasibility of this treatment approach on a multi-institutional basis and in unselected HAART-responding patients,23 with encouraging clinical results. Thus, intensified HIV testing and treatment has been advocated to lower the prevalence of undiagnosed HIV infection and to control the HIV epidemic [8], [9]. Starting antiretroviral treatment for HIV infection involves commitment -drugs have to be taken every day, and for the rest of a person’s life. HIV-infected patients were identified by computed database analysis in each center. The first line ART regimen was stavudine, lamivudine, and nevirapine (or efavirenz for those taking concurrent rifampicin). CDC uses CD4 count and a clinical staging system. injecting drug users [IDU] [12]), presence of AIDS-defining illnesses, or coming from a high-HIV prevalence country is practised in most European countries [13].

Oral candidiasis has been reported to occur in 17–43% of patients with HIV infection and in more than 90% of patients with AIDS. The main aim of this analysis was to investigate the effect of the tuberculosis preventive intervention on HIV disease progression to AIDS and survival. There were 191(57.7%) patients in the study with CD4+ T-lymphocytes count of less than 200 cells per µL. 7 patients had evidence of coccidian parasitic gastroenteritis. Instead, testing is to be offered universally in selected services, to those with epidemiologic risk-factors and to children or adults presenting with one or more prescribed clinical indicator diseases. Pneumocystis jirovecii pneumonia was diagnosed clinically with chest radiography, clinical presentation, and a response to cotrimoxazole treatment. Patient inclusion was based on the treating physician’s clinical, microbiological or histological diagnosis.

were miscoded). The Danish Data Protection Agency approved the establishment of the cohort and the linkage between the four registries in this study (J.-no. Grouped vesicles on an erythematous base are a common presentation for herpes simplex, while herpes zoster often presents similarly in a dermatomal distribution. Baseline plasma HIV-RNA viral load and CD4 cell count were defined as the values closest to the start of this regimen within the preceding 180 days; patients lacking these data were excluded. We conducted a population-based nested case control study among persons with and without an incident HIV diagnosis in Denmark. Bronchoalveolar lavage was rarely performed. The Danish healthcare system provides free, tax-supported medical care for all residents, including antiretroviral treatment of HIV.
Morbidity and Risk of Subsequent Diagnosis of HIV: A Population Based Case Control Study Identifying Indicator Diseases for HIV Infection

The civil registration system (CRS) number, assigned at birth, uniquely identifies each person living in Denmark since 1968 and is used for personal identification in all Danish administrative and medical databases. We used this unique 10-digit CRS-number to link data among the following registries: The Danish HIV Cohort Study (DHCS) is a prospective, open, nationwide, population-based cohort of all HIV-infected individuals receiving care in Danish HIV clinics since 1 January 1995 [20]. The study is ongoing, with continuous enrolment of newly diagnosed patients. The Danish Civil Registration System records demographic information, vital status, and immigration and emigration dates for all Danish citizens beginning in 1967 [21]. Rapid loss of more than 10 pounds of weight that is not due to increased physical exercise or dieting. It includes diagnoses coded by the treating physician according to the International Classification of Diseases, 8th revision (ICD-8) up to the end of 1993 and according to the 10th revision (ICD-10) thereafter. Centers for Disease Control and Prevention, “Revision of the CDC Surveillance Case Definition of Acquired Immunodeficiency Syndrome for National Reporting — United States,” Morbidity and Mortality Weekly Report 34:25 (June 28, 1985), pp.

The Danish Cancer Registry (DCR) has recorded all incident cancers in Denmark since 1943, classifying cancers registered after 1977 according to ICD-10 [23]. Cases were identified from DHCS and included all individuals who (I) were diagnosed with HIV between 1 January 1995 and 1 June 2008; (II) were at least 16 years of age on the date of HIV diagnosis; and (III) were living in Denmark for at least 5 years prior to HIV diagnosis. More than 75% of women with AIDS and HIV belong to racial or ethnic minorities, African American or Hispanic, and more than 50% of new infections are in African American women. Controls not diagnosed with HIV were identified from the CRS using incidence density sampling, which involves matching each case to a sample of those who are at risk at the time of case occurrence [24]. To ensure sufficient statistical power to detect differences in the occurrence of rare events, we sampled for each case 19 random age- and gender-matched population controls that were alive on the HIV diagnosis date of their respective case. The date of HIV diagnosis/sampling constituted the index date for both cases and controls. The revised classification system for HIV infection is based on the recommended clinical standard of monitoring CD4+ T- lymphocyte counts, since this parameter consistently correlates with HIV-related immune dysfunction and disease progression and provides information needed to guide medical management of persons infected with HIV (14-18, 22-28).

Hence, all study subjects were living in Denmark during the 5-year period prior to their index date and therefore at risk of both exposure and outcome. For all study subjects we extracted hospital diagnoses from outpatient contacts and hospital stays from the DNRP and DCR, up to the day prior to the index date. ICD-10 codes were the primary source for grouping diseases. We defined 22 disease categories of interest according to the type and anatomical location of the disease (Table S1). DSP: glove and stocking dysaesthesia (burning distal acral dysaesthesia) with nocturnal exacerbations, hypoesthesia, absent ankle jerks, contact allodynia and absence of any other obvious cause of peripheral neuropathy (diabetes, alcoholism, exposure to toxins or drugs including ARV, or excessive cassava consumption) and poor response to carbamazepine and gabapentin (neurontin). Observe such a patient closely for fever and rash when trimethoprim/sulfamethoxazole is commenced. Both had AIDS and were severely anaemic with haemoglobin values of 3.0 and 3.8 g/dl (median haemoglobin of all patients was 9.6 g/dl, interquartile range 7.4–11.6 g/dl).

For cases and controls, we tabulated gender, age (16–39 years, 40–49 years, 50–59 years, and 60+ years), and hospital contact(s) in the 5-year period prior to the index date for each of the 22 disease categories (yes/no). For cases, the following variables were also included: race, most likely mode of HIV acquisition, presence of AIDS [25] at diagnosis, first CD4+ cell count, and HIV RNA measurement (within 180 days of HIV diagnosis). Frequencies and percentages were computed for all variables. For each of the 22 disease categories, conditional logistic regression analysis was used to estimate odds ratios (OR), which is an unbiased estimate of the incidence rate ratio (IRR) for subsequent HIV diagnosis [24]; unadjusted ORs as well as ORs adjusted for the remaining 21 disease categories were estimated. Observation data were subsequently stratified into three time periods prior to the index date (less than 1 year, 1–2 years, and 3–5 years,) to explore changes in ORs in the years following a given disease or disease category. We used first-time diagnoses registered within each time stratum for a given disease/disease category. Adjusted ORs were calculated for each disease category and time period (adjusted for the remaining 21 disease categories).

To identify specific HIV-indicator diseases, we explored risk estimates for the 161 specific subcategories within each of the 22 disease categories. We computed both unadjusted odds ratios for each subcategory and odds ratios adjusted for other diseases within the same disease category (Table S1). In all analyses, only first-time diagnoses for a given disease/disease category were utilized. We identified 2,363 individuals diagnosed with HIV between 1 January 1995 and 1 June 2008 and 38,684 controls. capsulatum as described by Cheesbrough (1991). There were 63 prospectively identified and adjudicated case patients who experienced AIDS-defining events (41 patients) or deaths (22 patients) during months 1–12 of HIV therapy among 1157 virologic responders. In the 5 years prior to their index date, there were a total of 138,416 hospital contacts for both cases and controls, of which 34,520 represented a first-time diagnosis for one of the 22 disease categories.

Table 1 shows characteristics of cases and controls on their index date. In the 5 years preceding the index date, 69.8% of cases (1,421 of 2,036 cases) and 53.6% of controls (19,148 of 35,718 controls) had at least one hospital contact for one of the 22 disease categories delineated below. Several disease categories were associated with an increased risk of HIV diagnosis during the following 5-year period (Figure 1). Persons diagnosed a disease in the category “sexually transmitted infections (STIs) and viral hepatitis” had the highest risk of subsequent HIV diagnosis (adjusted OR [aOR] = 12.3, 95% confidence interval [CI], 9.60–15.7). There remains only a single established case of an HIV-positive dentist having transmitted his infection to a patient – the infamous Acer case in Florida in late 1987. The presence of seizure disorder during the interval of or before the diagnosis of PML was associated with poor survival. A decreased risk of subsequent HIV diagnosis was found for persons with rheumatological diseases (aOR = 0.72, 95% CI:0.62–0.85), non-diabetes endocrine diseases (aOR = 0.60, 95% CI:0.42–0.86), and diabetes (aOR = 0.40, 95% CI:0.23–0.69).

You may also like