ABSTRACT
This study aimed to evaluate the prevalence and associated factors of HIV-associated dementia (HAD) in people living with HIV (PLWH) aged ≥ 60 years who are currently treated with highly active antiretroviral therapy. A cross-sectional study was conducted on adult (age ≥ 60 years) PLWH at the infectious clinic, Vajira Hospital, Navamindradhiraj University, Thailand, between August 2019 and March 2021. We collected the patients' characteristics and performed Montreal Cognitive Assessment and Instrumental Activities of Daily Living test to determine whether they have HIV-associated neurocognitive disorders (HAND), which we further classified into asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND), and HAD. Finally, we evaluated the prevalence, associated factors, and characteristics of cognitive domain abnormalities in these patients. We enrolled 84 elderly PLWH patients consisting of 43 (51.2%) males. The mean patient age was 63 years (SD ± 3.9), and the median duration of HIV infection was 13 (SD ± 5.7) years. All the patients had undetectable HIV viral load. Among them, seven (8.3%) had no neurocognitive impairment, 61 (72.6%) had ANI, three (3.6%) had MND, and 13 (15.5%) had HAD. After confounder adjustment, the patient age of ≥ 65 years was found to be significantly associated with dementia (odds ratio = 5.97, 95% CI: 1.51-23.57). Significant difference in the mean score of all cognitive domains was observed between the patients with HAD and those with normal cognitive status. HAND is common in PLWH. Age older than ≥ 65 years is a risk factor of HAD.
Subject(s)
AIDS Dementia Complex , HIV Infections , Adult , Aged , Male , Humans , Female , Antiretroviral Therapy, Highly Active , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Cross-Sectional Studies , Activities of Daily Living , AIDS Dementia Complex/epidemiology , AIDS Dementia Complex/drug therapy , AIDS Dementia Complex/psychology , Cognition , Neuropsychological TestsABSTRACT
OBJECTIVE: To determine the predictive factors of neutropenia in human immunodeficiency virus (HIV)-infected patients with malignancy receiving chemotherapy (CMT) or radiotherapy (RT). MATERIALS AND METHODS: The author conducted a retrospective study on HIV-infected patients with malignancy receiving CMT or RT at Vajira Hospital, Navamindradhiraj University, Thailand, from January 1, 2013 to December 31, 2017. Baseline demographic characteristics, HIV disease data, and cancer data were collected. RESULTS: A total of 210 courses of CMT, concurrent chemoradiation therapy (CCRT), or RT treatments were administered to 39 HIV-infected patients with malignancy. Neutropenia occurred in 51 (24.3%) of the 210 treatment courses in 23 (60%) patients. Multivariable analysis revealed that HIV-infected patients with malignancy who received CMT or CCRT (hazard ratio [HR] 10.83, 95% confidence interval [CI] 1.36-86.05, p = 0.024) and those who received over five cycles of CMT (HR 5.25, 95% CI 1.10-26.01, p = 0.037) were independently associated with neutropenia. CONCLUSION: Receiving CMT or CCRT and receiving more than five cycles of CMT are risk factors for neutropenia in HIV-infected patients with malignancy.
Subject(s)
Antineoplastic Agents/adverse effects , HIV Infections/complications , Neoplasms/therapy , Neutropenia/etiology , Radiotherapy/adverse effects , Chemoradiotherapy/adverse effects , Female , HIV , Humans , Male , Middle Aged , Neoplasms/virology , Retrospective Studies , Risk Factors , ThailandABSTRACT
To compare the characteristics, presentation, investigations, and outcomes in tuberculous meningitis (TBM) patients with and without human immunodeficiency virus (HIV) coinfection. A retrospective cohort study was conducted on adult (age > 18 years) patients whose final diagnosis was TBM and who were treated at Vajira Hospital, Navamindradhiraj University, Thailand, between January 2005 and December 2016. A final total of 174 individuals were included in the study. Of these, 97 (55.75%) were HIV positive. Treatment was successful in 53 (30.5%) individuals. In HIV-infected TBM patients, there were higher proportions of patients who were younger in age (≤40 years), patients with a low body mass index, history of previous tuberculosis infection, or hepatitis C virus coinfection. A successful treatment outcome rate was lower in HIV-infected TBM patients than in HIV-uninfected TBM patients. Since HIV infection decreases the chance of successful treatment outcomes of TBM patients, future studies are needed to determine the clinical indicators for poorer survival outcomes in HIV-positive TBM patients.
