Prevalence of anxiety and depression in a predominantly HIV-infected population with severe cutaneous adverse drug reactions

Background: There is limited data on anxiety and depression in subjects with severe cutaneous adverse drug reactions (SCADR), in a predominantly HIV - infected population. The aim of the study was to prospectively investigate the prevalence of anxiety and depression and quality of life in patients with SCADR. Methods: In this prospective study, SJS, SJS - TEN, TEN and DRESS patients were assessed for anxiety and depression using validated scoring systems, the Hospital Anxiety and Depression Scale (HAD S), and the Dermatology Life Quality Index (DLQI). This was done at six weeks post discharge and again at six months follow - up. Results: Forty - eight patients with SCADR were enrolled at six weeks and 37/48 (77%) completed the study at six months. The populations were similar demographically at six weeks and six months. At six weeks anxiety or borderline anxiety symptoms/caseness was identified in 25/48 (52%) SCADR patients and depression or borderline depression symptoms/caseness in 24/48 (50%). Of those with symptoms, 18 were assessed as having co - morbid anxiety and depression with only 2 cases of pure anxiety and 4 of pure depression. At six months only 37 patients with SCADR returned for follow - up. Four of them had died in the interim while the other seven relocated. Of the cases of pure anxiety; one resolved and one was lost to follow - up. Of the cases of pure depression; one resolved, one persisted, one converted to comorbid anxiety and depression and one was lost to follow - up. Of those with co - morbid anxiety and depression 10 persisted, 2 converted to pure depression, 3 normalised and 2 were lost to follow - up. One previously normal patient developed anxiety symptoms and one case developed comorbid anxiety and depression. In 9/13 (69%) of the patients with SJS, SJS - TEN and TEN, co - morbid anxiety and depression persisted from week six to 6 months. In contrast in only 1/5 (20%) of the patients with DRESS, co - morbid anxiety and depression persisted from week six to 6 months. The cases of pure anxiety and depression were too small for meaningful comment. The overall SJS, SJS - TEN and TEN had median DLQI 8.4 relative to DRESS (DLQI 7.5) at six weeks. However, TEN (DLQI 14) had a greater impact on the quality of life compared to SJS (DLQI 3) and DRESS (DLQI 7.5). This pattern was maintained at six months. Conclusion: Anxiety and depression in patients with SCADR in a predominantly HIV - infected population is present. In the majority of cases, depression and anxiety coexist in patients with SCADR. These are sustained for at least 6 months post discharge. SCADR has a negative impact on quality of life. Our findings should help to improve the awareness of the impact of severe cutaneous adverse drug reactions on mental health especially as this may impact on future treatment adherence

Incidence of anxiety and depression in a predominantly HIV-infected population with severe adverse drug reactions

Little is known on the short-term or medium-term psychological and psychiatric sequelae following Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS). Based on this we did a prospective study designed to assess anxiety and depression in patients with severe cutaneous adverse drug reactions by indicating higher Hospital anxiety and depression scale (HADS)

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis

Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap (SJS/TEN), collectively referred to SJS/TEN, form a spectrum of severe life-threatening adverse drug reactions whose pathomechanism is not fully understood. The article "Photodistributed Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Proposal for a New Diagnostic Classification" by McKinley et. al., discusses a distinct distribution of epidermal necrosis in SJS/TEN, attributable to preceding exposure to ultraviolet radiation (UVR), and relative sparing of photo-protected areas. After reviewing numerous cases within the Immune-mediated Adverse drug Reactions in African HIV endemic setting Register and Biorepository (IMARI-SA) at the University of Cape Town with a similar clinical pattern as those published by McKinley et. al., we propose that the relative sparing of some areas giving an impression of photo-distribution is due to localised increase in skin pressure that reduces the blood supply in that area below a critical threshold. A dip in blood supply below this critical threshold quantitively limited T lymphocytes and cytokines that drive SJS/TEN to reach and damage the skin