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HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012-2017.

ABSTRACT: We determined the effect of HIV infection on deaths among persons >18 months of age with culture-confirmed candidemia at 29 sentinel hospitals in South Africa during 2012-2017. Of 1,040 case-patients with documented HIV status and in-hospital survival data, 426 (41%) were HIV-seropositive. The in-hospital case-fatality rate was 54% (228/426) for HIV-seropositive participants and 37% (230/614) for HIV-seronegative participants (crude odds ratio [OR] 1.92, 95% CI 1.50-2.47; p<0.001). After adjusting for relevant confounders (n = 907), mortality rates were 1.89 (95% CI 1.38-2.60) times higher among HIV-seropositive participants than HIV-seronegative participants (p<0.001). Compared with HIV-seronegative persons, the stratum-specific adjusted mortality OR was higher among HIV-seropositive persons not managed in intensive care units (OR 2.27, 95% CI 1.47-3.52; p<0.001) than among persons who were (OR 1.56, 95% CI 1.00-2.43; p = 0.05). Outcomes among HIV-seropositive persons with candidemia might be improved with intensive care.

SUBMITTER: Govender NP

PROVIDER: S-EPMC8153852 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionAge-disparate sex has long been considered a factor that increases HIV risk for young women in South Africa. However, recent studies from specific regions in South Africa have found conflicting evidence. Few studies have assessed the association between age-disparate partnerships (those involving an age gap of 5 years or more) and HIV risk at the national level. This study investigates the relationship between age-disparate sex and HIV status among young women aged 15-24 in South Africa.MethodsNationally representative weighted data from the 2002, 2005, 2008, and 2012 South African National HIV Surveys were analysed for young women aged 15-24 years using bivariate analyses and multiple logistic regressions.ResultsAfter conducting multiple logistic regression analyses and controlling for confounders, young women with age-disparate partners had greater odds of being HIV positive in every survey year: 2002 (aOR = 1.74, 95%CI: 0.81-3.76, p = 0.16); 2005 (aOR = 2.11, 95%CI: 1.22-3.66, p < 0.01); 2008 (aOR = 2.02, 95%CI: 1.24-3.29, p < 0.01); 2012 (aOR = 1.53, 95%CI: 0.92-2.54, p < 0.1). The odds of being HIV positive increased for each year increase in their male partner's age in 2002 (aOR = 1.10, 95%CI: 0.98-1.22, p = 0.11), 2005 (aOR = 1.10, 95%CI: 1.03-1.17, p < 0.01), 2008 (aOR = 1.08, 95%CI: 1.01-1.15, p < 0.05), and 2012 (aOR = 1.08, 95%CI: 1.01-1.16, p < 0.05). Findings were statistically significant (p < 0.1) for the years 2005, 2008, and 2012.ConclusionOur findings suggest that age-disparate sex continues to be a risk factor for young women aged 15-24 in South Africa at a national level. These results may reflect variation in HIV risk at the national level compared to the differing results from recent studies in a demographic surveillance system and trial contexts. In light of recent contradictory study results, further research is required on the relationship between age-disparate sex and HIV for a more nuanced understanding of young women's HIV risk.

Project description:INTRODUCTION:Cryptococcus causes 15% of AIDS-related deaths and in South Africa, with its high HIV burden, is the dominant cause of adult meningitis. Cryptococcal meningitis (CM) mortality is high, partly because patients enter care with advanced HIV disease and because of failure of integrated care following CM diagnosis. We evaluated pathways to hospital care, missed opportunities for HIV testing and initiation of care. METHODS:We performed a cross-sectional study at five public-sector urban hospitals. We enrolled adults admitted with a first or recurrent episode of cryptococcal meningitis. Study nurses conducted interviews, supplemented by a prospective review of medical charts and laboratory records. RESULTS:From May to October 2015, 102 participants were enrolled; median age was 40 years (interquartile range [IQR] 33.9-46.7) and 56 (55%) were male. In the six weeks prior to admission, 2/102 participants were asymptomatic, 72/100 participants sought care at a public-sector facility, 16/100 paid for private health care. The median time from seeking care to admission was 4 days (IQR, 0-27 days). Of 94 HIV-seropositive participants, only 62 (66%) knew their status and 41/62 (66%) had ever taken antiretroviral treatment. Among 13 participants with a known previous CM episode, none were taking fluconazole maintenance therapy. In-hospital management was mostly amphotericin B; in-hospital mortality was high (28/92, 30%). Sixty-four participants were discharged, 92% (59/64) on maintenance fluconazole, 4% (3/64) not on fluconazole and 3% (2/64) unknown. Twelve weeks post-discharge, 31/64 (48%) participants were lost to follow up. By 12 weeks post discharge 7/33 (21%) had died. Interviewed patients were asked if they were still on fluconazole, 11% (2/18) were not. CONCLUSIONS:Among hospitalised participants with CM, there were many missed opportunities for HIV care and linkage to ART prior to admission. Universal reflex CrAg screening may prompt earlier diagnosis of cryptococcal meningitis but there is a wider problem of timely linkage to care for HIV-seropositive people.

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HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012-2017.

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