ABSTRACT
Background@#Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder caused by uncontrolled terminal complement activation, which leads to intravascular hemolysis (IVH), thromboembolism (TE), renal failure, and premature mortality. @*Methods@#We performed a secondary analysis of data collected from patients enrolled in the Korean National PNH Registry to assess the relative importance of risk factors, specifically lactate dehydrogenase (LDH) and hemoglobin (Hb), in predicting the incidence of TE, impaired renal function, and death in complement inhibitor-naïve patients with PNH. @*Results@#Multivariate regression modeling indicated that LDH ≥ 1.5 × upper limit of normal (ULN), male sex, and pain were associated with increased risk of TE (P = 0.016, 0.045, and 0.033, respectively), hemoglobinuria and pain were associated with an increased risk of impaired renal function (P = 0.034 and 0.022, respectively), and TE was associated with an increased incidence of death (P < 0.001). Hb < 8 g/dL was not a predictor of TE, impaired renal function, or death in multivariate regression analyses. Standardized mortality ratio analysis indicated that LDH ≥ 1.5 × ULN (P < 0.001), Hb < 8 g/dL (P < 0.001), and Hb ≥ 8 g/dL (P = 0.004) were all risk factors for death; in contrast, patients with LDH < 1.5 × ULN had similar mortality to the general population. @*Conclusion@#In complement inhibitor-naïve patients with PNH, LDH ≥ 1.5 × ULN was a significant predictor of TE, and TE was a significant predictor of death. Hb was not a significant predictor of TE, impaired renal function, or death. Therefore, controlling IVH will improve clinical outcomes for patients with PNH.
ABSTRACT
For certain subgroups within people living with the human immunodeficiency virus [HIV] [active tuberculosis [TB], pregnant women, children <5 years old, and serodiscordant couples], the World Health Organization recommends antiretroviral therapy [ART] irrespective of CD4 count. Another subgroup which has received increased attention is ''HIV-infected presumptive TB patients without TB". In this study, we assess the proportion of HIV-infected presumptive TB patients eligible for ART in Karnataka State [population 60 million], India. This was a crosssectional analysis of data of HIV-infected presumptive TB patients diagnosed in May 2015 abstracted from national TB and HIV program records. Of 42,585 presumptive TB patients, 28,964 [68%] were tested for HIV and 2262 [8%] were HIV positive. Of the latter, 377 [17%] had active TB. Of 1885 ''presumptive TB patients without active TB", 1100 [58%] were already receiving ART. Of the remaining 785 who were not receiving ART, 617 [79%] were assessed for ART eligibility and of those, 548 [89%] were eligible for ART. About 90% of ''HIV-infected presumptive TB patients without TB" were eligible for ART. This evidence supports a public health approach of starting all ''HIV-infected presumptive TB patients without TB" on ART irrespective of CD4 count in line with global thinking about 'test and treat'