ВИЧ-ИНФЕКЦИЯ И ВНЕБОЛЬНИЧНАЯ ПНЕВМОНИЯ. ПРИЧИНЫ СМЕРТИ

The aim was to study the characteristics of community-acquired pneumonia in patients with HIV infection, depending on the outcome of the disease and to identify significant predictors of death.Materials and methods. The study included 80 patients with community-acquired pneumonia and HIV-infection. Two groups were formed in accordance with the outcome of community-acquired pneumonia. 1 group (study group) - 40 deceased patients, 2 group (comparison group) - 40 patients discharged from the hospital with improvement. Inclusion criteria: patients over 18 years of age, diagnosis of community-acquired pneumonia, diagnosis of HIV infection, informed consent of the patient. Patients with diagnosed pulmonary tuberculosis were excluded at the stage of examination and treatment.Results. Patients with HIV-infection entered the hospital with community-acquired pneumonia of severe degree in 65% of cases, 71.25% of cases with respiratory insufficiency of II and III degrees, in 16.25% of cases with critically low oxygen saturation (less than 85%). The majority of patients had bilateral pneumonia (78.75%), in 28.75% of cases complicated by pleural effusion. Patients needed respiratory support at different levels-the chambers of the pulmonology ward in 36.25% of cases, indications for noninvasive ventilation (NIV) in the intensive care unit (ICU) were noted in 80% of cases, ventilation in the ICU in 56.25% of cases. Deceased patients were significantly more likely to be injecting drug users, reported weight loss of more than 10% in six months, CD4 + cells did not exceed 50/μl, bilateral lung damage, pleural effusion, oxygen saturation less than 90%.The conclusion. Treatment and diagnosis of comorbid patients with community-acquired pneumonia and HIV-infection is complex, in the stage of pronounced immunosuppression can lead to death. Early onset of NIV in the presence of severe respiratory failure may improve the survival prognosis.Целью работы было изучение особенностей внебольничной пневмонии у больных ВИЧ-инфекцией в зависимости от исхода заболевания и выявить значимые предикторы смерти.Материалы и методы исследования. В исследование включено 80 пациентов с внебольничной пневмонией и ВИЧ-инфекцией. Сформировано две группы в соответствии с исходом внебольничной пневмонии. 1 группа (группа изучения) - 40 умерших пациентов, 2 группа (группа сравнения) - 40 пациентов, выписанных из стационара с улучшением. Критерии включения: пациенты старше 18 лет, диагноз внебольничной пневмонии, диагноз ВИЧ-инфекции, информированное согласие пациента. Исключались пациенты с диагностированным туберкулезом легких на этапе обследования и лечения.Результаты. Больные ВИЧ-инфекцией поступали в стационар с внебольничной пневмонией тяжелой степени в 65% случаев, в 71,25% случаев – с дыхательной недостаточностью II и III степеней, в 16,25% случаев - с критически низкой сатурацией кислорода (менее 85%). Большинство пациентов имели пневмонию двусторонней локализации (78,75%), в  28,75%  случаев осложненную плевральным выпотом. Пациенты нуждались в респираторной поддержке различного уровня – ресурсами палаты пульмонологического отделения в 36,25% случаев, показания к неинвазивной вентиляции легких (НВЛ) в ОРИТ отмечены в 80% случаев, ИВЛ в ОРИТ – в 56,25% случаев. Умершие  пациенты достоверно чаще были потребителями инъекционных наркотиков, отмечали потерю веса более 10% за полгода, количество CD4+клеток у них не превышало50кл/мкл,чаще отмечались двустороннее поражение легких, наличие плеврального выпота, сатурация кислорода крови меньше 90%.Заключение. Лечение и диагностика коморбидных больных с внебольничной пневмонией и ВИЧ-инфекцией отличается сложностью, в стадии выраженной иммуносупрессии может приводить к летальному исходу. Раннее начало НВЛ при наличии выраженной дыхательной недостаточности может улучшить прогноз выживаемости.</p

Observational cohort study of rilpivirine (RPV) utilization in Europe

Altres ajuts: ViiV Healthcare LLC; Janssen Scientific Affairs; Janssen R&D; Bristol-Myers Squibb Company; Merck Sharp & Dohme Corp; Gilead Sciences; The Swiss National Science Foundation (148522); the Danish National Research Foundation and by the International Cohort Consortium of Infectious Disease (RESPOND) (DNRF126).Introduction: Data on safety and effectiveness of RPV from the real-world setting as well as comparisons with other NNRTIs such as efavirenz (EFV) remain scarce. Methods: Participants of EuroSIDA were included if they had started a RPV- or an EFV-containing regimen over November 2011-December 2017. Statistical testing was conducted using non-parametric Mann-Whitney U test and Chi-square test. A logistic regression model was used to compare participants' characteristics by treatment group. Kaplan-Meier analysis was used to estimate the cumulative risk of virological failure (VF, two consecutive values > 50 copies/mL). Results: 1,355 PLWH who started a RPV-based regimen (11% ART-naïve), as well as 333 initiating an EFV-containing regimen were included. Participants who started RPV differed from those starting EFV for demographics (age, geographical region) and immune-virological profiles (CD4 count, HIV RNA). The cumulative risk of VF for the RPV-based group was 4.5% (95% CI 3.3-5.7%) by 2 years from starting treatment (71 total VF events). Five out of 15 (33%) with resistance data available in the RPV group showed resistance-associated mutations vs. 3/13 (23%) among those in the EFV group. Discontinuations due to intolerance/toxicity were reported for 73 (15%) of RPV- vs. 45 (30%) of EFV-treated participants (p = 0.0001). The main difference was for toxicity of central nervous system (CNS, 3% vs. 22%, p 50 copies/mL and resistance in participants treated with RPV were similar to those reported by other studies. RPV safety profile was favourable with less frequent discontinuation due to toxicity than EFV (especially for CNS)