Dataset Information

Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.

ABSTRACT:

Background

Combination antiretroviral therapy (cART) has improved the survival of patients with HIV/AIDS but its impact remains uncertain on the changing prevalence and incidence of neurologic disorders with ensuing effects on mortality.

Methods

The prevalence and incidence of neurologic disorders were examined in patients receiving active care in a regional HIV care program from 1998 to 2008. The mortality hazard ratio (HR) was calculated by Cox proportional hazard models with adjustment for demographic and clinical variables.

Results

Of 1,651 HIV-infected patients assessed, 404 (24.5%) were identified as having one or more neurologic disorders, while 41% of AIDS-affected persons exhibited neurologic disease. Symptomatic distal sensory polyneuropathy (DSP, 10.0%) and HIV-associated neurocognitive disorder (HAND, 6.2%) represented the most prevalent disorders among 53 recognized neurologic disorders. Patients with at least one neurologic disorder exhibited higher mortality rates (17.6% vs 8.0%, p < 0.0001), particularly AIDS-related deaths (9.7% vs 3.2%, p < 0.0001), compared with those without neurologic disorders. The highest mortality HR was associated with opportunistic infections of CNS (HR 5.3, 95% confidence interval [CI] 2.5-11.2), followed by HAND (HR 3.1, 95% CI 1.8-5.3) and the presence of any neurologic disorder (HR 2.0, 95% CI 1.2-3.2). The risk of AIDS-related death with a neurologic disorder was increased by 13.3% per 100 cells/mm(3) decrement in blood CD4+ T-cell levels or by 39% per 10-fold increment in plasma viral load.

Conclusions

The burden and type of HIV-related neurologic disease have evolved over the past decade and despite the availability of cART, neurologic disorders occur frequently and predict an increased risk of death.

SUBMITTER: Vivithanaporn P

PROVIDER: S-EPMC3013488 | biostudies-literature | 2010 Sep

REPOSITORIES: biostudies-literature

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Publications

Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.

Vivithanaporn P P Heo G G Gamble J J Krentz H B HB Hoke A A Gill M J MJ Power C C

Neurology 20100825 13

<h4>Background</h4>Combination antiretroviral therapy (cART) has improved the survival of patients with HIV/AIDS but its impact remains uncertain on the changing prevalence and incidence of neurologic disorders with ensuing effects on mortality.<h4>Methods</h4>The prevalence and incidence of neurologic disorders were examined in patients receiving active care in a regional HIV care program from 1998 to 2008. The mortality hazard ratio (HR) was calculated by Cox proportional hazard models with ad ...[more]

PMID: 20739646

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Project description:BackgroundWe investigated the effect of delirium burden in mechanically ventilated patients, beginning in the ICU and continuing throughout hospitalization, on functional neurologic outcomes up to 2.5 years following critical illness.MethodsProspective cohort study of enrolling 178 consecutive mechanically ventilated adult medical and surgical ICU patients between October 2013 and May 2016. Altogether, patients were assessed daily for delirium 2941days using the Confusion Assessment Method for the ICU (CAM-ICU). Hospitalization delirium burden (DB) was quantified as number of hospital days with delirium divided by total days at risk. Survival status up to 2.5 years and neurologic outcomes using the Glasgow Outcome Scale were recorded at discharge 3, 6, and 12 months post-discharge.ResultsOf 178 patients, 19 (10.7%) were excluded from outcome analyses due to persistent coma. Among the remaining 159, 123 (77.4%) experienced delirium. DB was independently associated with >4-fold increased mortality at 2.5 years following ICU admission (adjusted hazard ratio [aHR], 4.77; 95% CI, 2.10-10.83; P < .001), and worse neurologic outcome at discharge (adjusted odds ratio [aOR], 0.02; 0.01-0.09; P < .001), 3 (aOR, 0.11; 0.04-0.31; P < .001), 6 (aOR, 0.10; 0.04-0.29; P < .001), and 12 months (aOR, 0.19; 0.07-0.52; P = .001). DB in the ICU alone was not associated with mortality (HR, 1.79; 0.93-3.44; P = .082) and predicted neurologic outcome less strongly than entire hospital stay DB. Similarly, the number of delirium days in the ICU and for whole hospitalization were not associated with mortality (HR, 1.00; 0.93-1.08; P = .917 and HR, 0.98; 0.94-1.03, P = .535) nor with neurological outcomes, except for the association between ICU delirium days and neurological outcome at discharge (OR, 0.90; 0.81-0.99, P = .038).ConclusionsDelirium burden throughout hospitalization independently predicts long term neurologic outcomes and death up to 2.5 years after critical illness, and is more predictive than delirium burden in the ICU alone and number of delirium days.

Project description:Socioeconomic inequality in comprehensive knowledge about HIV/AIDS can hinder progress towards ending the epidemic threat of this disease. To address the knowledge gap, it is essential to investigate inequality in HIV/AIDS services. This study aimed to investigate socioeconomic inequality, identify contributors, and analyze the trends in inequality in comprehensive knowledge about HIV/AIDS among adults in Ethiopia. A cross-sectional study was conducted using 2005, 2011, and 2016 population-based health survey data. The sample size was 18,818 in 2005, 29,264 in 2011, and 27,261 in 2016. Socioeconomic inequality in comprehensive knowledge about HIV/AIDS was quantified by using a concentration curve and index. Subsequently, the decomposition of the concentration index was conducted using generalised linear regression with a logit link function to quantify covariates' contribution to wealth-based inequality. The Erreygers' concentration index was 0.251, 0.239, and 0.201 in 2005, 2011, and 2016, respectively. Watching television (24.2%), household wealth rank (21.4%), ever having been tested for HIV (15.3%), and education status (14.3%) took the significant share of socioeconomic inequality. The percentage contribution of watching television increased from 4.3% in 2005 to 24.2% in 2016. The household wealth rank contribution increased from 14.6% in 2005 to 21.38% in 2016. Education status contribution decreased from 16.2% to 14.3%. The percentage contribution of listening to the radio decreased from 16.9% in 2005 to -2.4% in 2016. The percentage contribution of residence decreased from 7.8% in 2005 to -0.5% in 2016. This study shows comprehensive knowledge about HIV/AIDS was concentrated among individuals with a higher socioeconomic status. Socioeconomic-related inequality in comprehensive knowledge about HIV/AIDS is woven deeply in Ethiopia, though this disparity has been decreased minimally. A combination of individual and public health approaches entangled in a societal system are crucial remedies for the general population and disadvantaged groups. This requires comprehensive interventions according to the primary health care approach.

Dataset Information

Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.

Background

Methods

Results

Conclusions

Publications

Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.

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