SEVERE AND COMORBID CONDITIONS IN HIV PATIENTS: AN ANALYSIS OF ADVERSE OUTCOMES
https://doi.org/10.22328/2077-9828-2017-9-1-55-64
Abstract
Increasing HIV-related mortality makes a significant negative impact on socioeconomic and demographic situation in the Russian Federation. The objective of the present study was to define the causes of death in severe and comorbid HIV cases. To this end, a retrospective analysis of 265 case histories of deceased HIV patients admitted in 2010–2014 to the in-patient hospital of Saint-Petersburg Center for Prevention and Control of AIDS and Infectious Diseases was carried out. Concomitant conditions were diagnosed based on the results of clinical, laboratory, and instrumental investigations and on anamnesis data. The analysis suggests that HIV was found for the first time upon admission in 16% of the cases. The severity of patients’ conditions was associated with the delayed admission to the hospital and with the presence of mixed infections and concomitant conditions. ART was prescribed to 193 patients who then received the therapy for one month to three years. Patients’ conditions were becoming progressively worse in the cases of discontinued ART or non-adherence to ART and of failur to provide preventive treatments for opportunistic infections and concomitant somatic conditions. The main causes of lethal outcomes at the advanced stages of HIV infection were comorbidities, including HIV + chronic viral hepatitis and/or tuberculosis, malignancy, neurological conditions, and drug abuse.
About the Authors
O. N. Leonova
Saint-Petersburg Center for Prevention and Control of AIDS and Infectious Diseases; I.P.Pavlov SPbMU MON
Russian Federation
Russian Federation
Ye. V. Stepanova
Saint-Petersburg Center for Prevention and Control of AIDS and Infectious Diseases; I.P.Pavlov SPbMU MON
Russian Federation
Russian Federation
N. A. Belyakov
Первый Санкт-Петербургский государственный медицинский университет имени академика И.П.Павлова
Russian Federation
Saint-Petersburg
Russian Federation
Saint-Petersburg
References
1. Рассохин В.В., Бузунова С.А., Врацких Т.В., Пантелеева О.В., Торопов С.Э., Тотрова З.М., Голубкин А.А., Орлов Г.М., Беляков Н.А. Проблема старения и инвалидизации ВИЧ-инфицированных пациентов // ВИЧ-инфекция и иммуносупрессии. 2015. Т. 7, № 1. С. 7–15. [Rassokhin V.V., Buzunova S.А., Vrackikh T.V., Panteleeva O.V., Toropov S.E., Totrova Z.M., Golubkin A.A., Orlov G.M., Belyakov N.A. The problem of senescence and debilitation of HIV patients. HIV Infection and Immunosuppressive Disorders, 2015, Vol. 7, No. 1, pp. 7–15 (In Russ.)].
2. Леонова О.Н., Виноградова Т.Н., Сизова Н.В., Степанова Е.В. Проблемы лечения больных с тяжелыми формами ВИЧ-инфекции // ВИЧ-инфекция и иммуносупрессии. 2013. Т. 5, № 2. С. 58–65. [Leonova O.N., Vinogradova T.N., Sizova N.V., Stepanova E.V. Problems in the therapeutic treatment of patients having severe forms of HIV infection. HIV Infection and Immunosuppressive Disorders, 2013, Vol. 5, No. 2, pp. 58–65 (In Russ.)].
3. Centers for Disease Control and Prevention. Advancing HIV prevention: new strategies for a changing epidemic– United States, 2003. MMWR 2003, Vol. 52 (15), pp. 329–332. URL: http://www.cdc.gov/ mmwr/PDF/wk/mm5215.pdf (дата обращения 12.03.2016 г.).
4. A Large International HIV/AIDS Study Comparing Two Strategies for Management of Anti-Retroviral Therapy (The SMART Study), 2006. URL: http://www.niaid.nih.gov/news/newsreleases/Archive/2006/Pages/smartqa06.aspx (дата обращения 12.03.2015 г.).
5. Вирус иммунодефицита человека — медицина / Под ред. Н.А.Белякова и А.Г.Рахмановой. СПб.: Балтийский медицинский образовательный центр, 2010. 752 с. [Human immunodeficiency virus: Medicine. Еd. N.A.Belyakov and A.G.Rakhmanova. Saint-Petersburg: Baltic Medical Educational Center, 2010, 752 p. (In Russ.)].
6. Рахманова А.Г., Яковлев А.А., Дмитриева М.И., Виноградова Т.Н., Козлов А.А. Анализ причин смерти ВИЧ-инфицированных в 2008–2010 гг. по материалам клинической инфекционной больницы им. С.П.Боткина, г. Санкт-Петербург // Казанский медицинский журнал. 2012. Т. 93, № 2. С. 522–526. [Rakhmanovа A.G., Yakovlev A.A., Dmitrieva M.I., Vinogradova T.N., Kozlov A.A. Analysis of the causes of death of HIV-infected in 2008–2010. Materials of Clinical Infectious Diseases Hospital im. S.P.Botkina. Saint-Petersburg. Kazan Medical Journal, 2012, Vol. 93, No. 2, pp. 522–526 (In Russ.)].
7. ВИЧ-инфекция, вторичные и сопутствующие заболевания: Медицинский тематический архив / Под ред. Н.А.Белякова, В.В.Рассохина, Е.В.Степановой. СПб.: Балтийский медицинский образовательный центр, 2014. № 8. 368 с. [HIV infection, secondary and concomitant diseases: Medical theme archive. Ed. N.A.Belyakov, V.V.Rassohin, E.V.Stepanova, Saint-Petersburg: Baltic Medical Educational Center, 2014, No. 8, 368 p. (In Russ.)].
8. Рассохин В.В., Беляков Н.А., Розенталь В.В., Леонова О.Н., Пантелеева О.В. Вторичные и соматические заболевания при ВИЧ-инфекции // ВИЧ-инфекция и иммуносупрессии. 2014. Т. 6, № 1. С. 7–18. [Rassokhin V.V., Belyakov N.A., Rosenthal V.V., Leonova O.N., Panteleyeva O.V. Secondary somatic diseases and HIV infection. HIV Infection and Immunosuppressive Disorders, 2014, Vol. 6, No. 1, pp. 7–18 (In Russ.)].
9. Сафонова П.В., Рассохин В.В., ДиКлементе Р.Дж., Браун Дж.Л., Сейлс Д.М., Роуз И.С., Рыбников В.Ю., Виноградова Т.Н., Беляков Н.А. Опыт употребления психоактивных веществ в прошлом и рискованное поведение в настоящем у ВИЧ-инфицированных женщин // ВИЧ-инфекция и иммуносупрессии. 2014. Т. 6, № 4. С. 24–34. [Safonova P.V., Rassokhin V.V., DiClemente R.J., Brown J.L., Sales J.M., Rose E.S., Rybnikov V.Yu., Vinogradova T.N., Belyakov N.A. Experience of substance use in the past and risky behavior in the present in HIV-infected women. HIV Infection and Immunosuppressive Disorders, 2014, Vol. 6, No. 4, pp. 24–34 (In Russ.)].
10. Kaplan R.C., Kingsley L.A., Sharrett A.R., Lazar J., Tien P.C., Mack W.J., Cohen M.H., Jacobson L., Gange S.J. TeTen-year predicted coronary heart disease risk in HIV-infected men and women. Clin. Infect. Dis., 2007, Vol. 45, pp. 1074–1081.
11. Яковлев А.А., Мусатов В.Б., Савченко М.А. Причины летальных исходов у ВИЧ-инфицированных пациентов, получающих антиретровирусную терапию // ВИЧ-инфекция и иммуносупрессии. 2015. Т. 7, № 1. С. 84–90. [Yakovlev A.A., Musatov V.B., Savchenko M.A. Causes of death in HIV-infected patients receiving antiretroviral therapy. HIV Infection and Immunosuppressive Disorders, 2015, Vol. 7, No. 1, pp. 84–90 (In Russ.)].
12. Кольцова О.В., Сафонова П.В., Рыбников В.Ю., Штерн М.А. Личностные особенности и поддержание непрерывности лечения у ВИЧ-инфицированных пациентов // Вестник С.-Петербургского ун-та. Серия 16. 2013. Вып. 4. С. 49–59. [Koltsovа O.V., Safonovа P.V., Rybnikov V.Yu., Stern M.A. Personality characteristics and maintaining continuity of treatment in HIV-infected patients. Vestnik St.-Petersburg Univ. Series 16, 2013, Issue 4, pp. 49–59 (In Russ.)].
13. Cohen M.S., Chen Y.Q., McCauley M., Gamble T., Hosseinipour M.C., Kumarasamy N., Hakim J., Kumwenda J., Grinsztejn B., Pilotto J.H., Godbole S.V., Mehendale S., Chariyalertsak S., Santos B.R., Mayer K.H., Hoffman I.F., Eshleman S.H., Piwowar-Manning E., Wang L., Makhema J. Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine, 2011, No. 365, pp. 493–505.
14. Panel on Clinical Practices for Treatment of HIV Infection convened by the Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. November 10, 2003.
15. Bell J.E., Bussuttil A., Ironside J.W., Rebus S., Donaldson Y.K., Simmonds P., Peutherer J.F. Human immuno-defciency virus and the brain: investigation of virus load and neuro-pathologic changes in pre-AIDS subjects. J. Infectious Diseases, 1993, Vol. 168, pp. 818–824.
16. Ostrow D., Grant I., Atkinson H. Assessment and management of AIDS patients with neuropsy-chiatric disturbances. J. Clin. Psychiatry, 1988, Vol. 49, Suppl., рр. 14–22.
17. Беляков Н.А. Головной мозг как мишень для ВИЧ. СПб.: Балтийский медицинский образовательный центр, 2011. 48 с. [Belyakov N.A. The brain as a target for VICH. Saint-Petersburg: Baltic Medical Educational Center, 2011, 48 p. (In Russ.)].
18. Некрасова А.В., Леонова О.Н., Степанова Е.В., Рассохин В.В. Особенности развития злокачественных опухолей у пациентов с ВИЧ-инфекцией в Санкт-Петербурге // ВИЧ-инфекция и иммуносупрессии. 2016. Т. 8, № 1. С. 31–41. [Nekrasova A.V., Leonova O.N., Stepanova E.V., Rassokhin V.V. Features of development of malignant tumors in patients with HIV infection in St.-Petersburg. HIV Infection and Immunosuppressive Disorders, 2016, Vol. 8, No. 1, pp. 31–41 (In Russ.)].
19. Ledergerber B., Talenti A., Egger M. Risk of HIV related Kaposi’s sarcoma and non-Hodgkin’s lymphoma with potent antiretroviral therapy: prospective cohort study. BMJ, 1999, No. 319, pp. 23–24.
20. Пантелеев А.М. Туберкулез органов дыхания у больных ВИЧ-инфекцией // ВИЧ-инфекция и иммуносупрессии. 2010. Т. 2, № 1. С. 16–22. [Panteleyev A.M. Tuberculosis of respiratory organs in HIV patients. HIV Infection and Immunosuppressive Disorders, 2010, Vol. 2, No. 1, pp. 16–22 (In Russ.)].
21. Pence B.W., Miller W.C., Whetten K., Eron J.J., Gaynes B.N. Mental disorders common among HIV-infected patients. J. Acquired Immune Defcit. Syndrome, 2006, Vol. 42, рр. 298–306.
22. Sourial N., Wolfson C., Zhu B., Quail J., Fletcher J., Karunananthan S., Bandeen-Roche K., Béland F., Bergman H. Correspondence analysis is a useful tool to uncover the relationships among categorical variables. J. Clin. Epidemiol., 2010, Vol. 63 (6), pp. 638–646.
23. Patrick D., Tyndall M., Cornelisse P. Incidence of hepatitis C virus among drug users duringan outbreak of HIV infection. Canadian Medical Association Journal, 2001, Vol. 165, pp. 889–895.
24. Thomas C.Q. HIV epidemiology and the effects of antiviral therapy on long-term consequences. AIDS, 2008, No. 22 (3), рр. 7–12.
25. ВИЧ-инфекция и центральная нервная система: Медицинский тематический архив / Под ред. Н.А.Белякова, Т.Н.Трофимовой, В.В.Рассохина. СПб.: Балтийский медицинский образовательный центр, 2013. № 4. 122 с. [HIV infection and central nervous system: Medical theme archive. Ed. N.A.Belyakov, T.N.Trofimova, V.V.Rassohin. Saint-Petersburg: The Baltic Medical Education Center, 2013, No. 4, pp. 122 (In Russ.)].
26. Трофимова Т.Н., Беляков Н.А. Общие особенности лучевой диагностики ВИЧ-ассоциированных поражений головного мозга // Лучевая диагностика и терапия. 2012. Т. 1, № 3. С. 3–10. [Trofimova T.N., Belyakov N.A. Common features of radiation diagnosis of HIV associated brain lesions. Beam Diagnostics and Terapiya, 2012, Vol. 1, No. 3, pp. 3–10 (In Russ.)].
27. Steven A.S., Ellen S.H., Laura S. Quality of Life Among Individuals with HIV Starting Antiretroviral Therapy in Diverse Resource-Limited Areas of the World. AIDS and Behavior, 2012, No. 16 (2), рр. 266–277.
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For citations:
Leonova O.N., Stepanova Ye.V., Belyakov N.A. SEVERE AND COMORBID CONDITIONS IN HIV PATIENTS: AN ANALYSIS OF ADVERSE OUTCOMES. HIV Infection and Immunosuppressive Disorders. 2017;9(1):55-64. (In Russ.) https://doi.org/10.22328/2077-9828-2017-9-1-55-64
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