Objectives
Only a few studies have addressed liver stiffness dynamics after hepatitis C virus (HCV) treatment in patients with HIV/HCV coinfection. The aim was to evaluate the variation in liver ...stiffness and in serum liver fibrosis scores in HIV/HCV‐coinfected patients before and after treatment with direct‐acting antivirals (DAAs).
Methods
Liver stiffness measured using transient elastography as well as serum liver fibrosis scores fibrosis‐4 (FIB‐4) score and the aspartate aminotransferase to platelet ratio index (APRI) were evaluated before and at 6–12 months after DAA treatment. Variation in the outcome variables was evaluated using the Wilcoxon nonparametric test. Univariate analysis and multivariate regression models were used.
Results
A total of 78 HIV/HCV‐coinfected subjects were included in the study. Median values of hepatic stiffness significantly decreased after DAA treatment compared with baseline 16.8 (interquartile range (IQR) 10.2–27.0) kPa at baseline vs. 9.4 (IQR 6.7–15.0) kPa after DAA treatment; P < 0.01). Further, a decrease in median FIB‐4 score 2.8 (IQR 1.5–4.8) vs. 2.0 (IQR 1.3–3.2), respectively; P < 0.01 and APRI 0.9 (IQR 0.5–2.2) vs. 0.4 (IQR 0.2–0.7), respectively; P < 0.01 was found. In univariate analysis, liver stiffness decrease was associated with increasing age, ‘other’ HCV genotype (vs. G1), the presence of cirrhosis, higher pre‐DAA liver stiffness, sofosbuvir‐based regimens and longer DAA treatment (all P < 0.05). Multivariate regression confirmed the significance of the association only with higher baseline liver stiffness (P < 0.01). Greater FIB‐4 and APRI reductions were associated with higher respective baseline values, while the presence of hepatic steatosis correlated with lower score reduction after DAA.
Conclusions
A reduction in liver stiffness and an improvement in fibrosis scores were observed in HIV/HCV‐coinfected patients soon after DAA treatment. The clinical implications of these observations need to be evaluated in larger populations with longer follow‐up.
Antimicrobial stewardship programs are implemented to optimize the use of antibiotics and control the spread of antibiotic resistance. Many antimicrobial stewardship interventions have demonstrated ...significant efficacy in reducing unnecessary prescriptions of antibiotics, the duration of antimicrobial therapy, and mortality. We evaluated the benefits of a combination of rapid diagnostic tests and an active re-evaluation of antibiotic therapy 72 h after the onset of bloodstream infection (BSI). All patients with BSI from November 2015 to November 2016 in a 1100-bed university hospital in Rome, where an Infectious Disease Consultancy Unit (Unità di Consulenza Infettivologica, UDCI) is available, were re-evaluated at the bedside 72 h after starting antimicrobial therapy and compared to two pre-intervention periods: the UDCI was called by the ward physician for patients with BSI and the UDCI was called directly by the microbiologist immediately after a pathogen was isolated from blood cultures. Recommendations for antibiotic de-escalation or discontinuation significantly increased (54%) from the two pre-intervention periods (32% and 27.2%,
p
< 0.0001). Appropriate escalation also significantly increased (22.5%) from the pre-intervention periods (8.1% and 8.2%,
p
< 0.0001). The total duration of antibiotic therapy decreased with intervention (from 21.9 days standard deviation, SD 15.4 in period 1 to 19.3 days SD 13.3 in period 2 to 17.7 days in period 3 SD 11.5;
p
= 0.002) and the length of stay was significantly shorter (from 29.7 days SD 29.3 in period 1 to 26.8 days SD 24.7 in period 2 to 24.2 days in period 3 SD 20.7;
p
= 0.04) than in the two pre-intervention periods. Mortality was similar among the study periods (31 patients died in period 1 (15.7%), 39 (16.7%) in period 2, and 48 (15.3%) in period 3;
p
= 0.90). Rapid diagnostic tests and 72 h re-evaluation of empirical therapy for BSI significantly correlated with an improved rate of optimal antibiotic therapy and decreased duration of antibiotic therapy and length of stay.
Abstract Background Mortality among people with human immunodeficiency virus (HIV) declined with the introduction of combination antiretroviral therapy. We investigated trends in mortality in people ...with HIV from 1999 through 2020. Methods Data were collected from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort between January 1999 through January 2015 and the International Cohort Consortium of Infectious Disease (RESPOND) from October 2017 through December 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV, were calculated. Poisson models were used to assess mortality over time. Results Among 55 716 participants followed for median 6 years (interquartile range, 3–11), 5263 died (mortality rate MR, 13.7/1000 person-years of follow-up PYFU; 95% confidence interval CI, 13.4–14.1). Changing mortality was observed: AIDS mortality was most common between 1999–2009 (n = 952; MR, 4.2/1000 PYFU; 95% CI, 4.0–4.5) and non-AIDS–defining malignancy (NADM) between 2010–2020 (n = 444; MR, 2.8/1000 PYFU; 95% CI, 2.5–3.1). In multivariable analysis, all-cause mortality declined (adjusted mortality rate ratio aMRR, 0.97 per year; 95% CI, .96–.98), mostly 1999–2010 (aMRR, 0.96 per year; 95% CI, .95–.97) but was stable 2011–2020 (aMRR, 1.00 per year; 95% CI, .96–1.05). Mortality due to all known causes except NADM also declined. Conclusions Mortality among people with HIV in the D:A:D and/or RESPOND cohorts declined between 1999–2009 and was stable over the period 2010–2020. This decline in mortality was not fully explained by improvements in immunologic–virologic status or other risk factors.
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