Sogaard O.S.,Aarhus University Hospital |
Reekie J.,University College London |
Ristola M.,University of Helsinki |
Jevtovic D.,Institute for Infectious and Tropical Diseases |
And 8 more authors.
Journal of Infection | Year: 2013
Objectives: This study aimed to determine incidence rates (IR) and identify risk factors for severe bacterial non-AIDS infections (SBnAI) requiring hospital admission. Methods: Data from the prospective EuroSIDA cohort were utilized to determine IRs of first diagnosis of the following SBnAI requiring hospital admission: bacteremia, endocarditis, meningitis, peritonitis, pneumonia, osteitis, and pyolonephritis. Incidence rate-ratios (IRRs) and risk factors were assessed by Poisson regression. Results: During 35,839 person-years of follow-up (PYFU), 275 patients were diagnosed with SBnAI (IR = 7.67 per 1000 PYFU, 95% confidence interval: 6.79-8.64). The most frequent infections were pneumonia (IR = 5.36, 4.63-6.17), bacteremia (IR = 1.14, 0.82-1.55), and pyelonephritis (IR = 0.67, 0.43-1.00). A strong risk factor for SBnAI was reduced estimated glomerular filtration rate [eGFR] (adjusted IRR = 5.07, 2.12-12.1 and IRR = 2.73, 1.63-4.56 for eGFR ≤ 60 and 60.1-90 compared to eGFR > 90, respectively). No current combined antiretroviral therapy (cART) compared with current cART use increased the risk of SBnAI (adjusted IRR = 2.96, 2.03-4.32). Other risk factors for SBnAI included current CD4+ count <350 cells/μL, female gender, age, infection with HIV through IDU, prior AIDS diagnosis, and anaemia. Conclusions: Enhanced attention directed towards people with comorbidity is warranted to limit the burden of these infections. © 2013 The British Infection Association.
PubMed | Wrocław University, University of Bonn, Copenhagen University, University of Zürich and 5 more.
Type: Journal Article | Journal: HIV medicine | Year: 2016
HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence.People enrolled in EuroSIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRMs and IURMs, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence.A total of 15 648 people contributed 95 033 person-years of follow-up, of whom 610 developed 643 malignancies [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/L: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with 500 cells/L], independent of age, while a CD4 count < 200 cells/L was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs would decrease by 29% over a 5-year period from 3.1 (95% CI 1.5-5.9) per 1000 person-years in 2011, whereas the IURM incidence would increase by 44% from 4.1 (95% CI 2.2-7.2) per 1000 person-years over the same period.Demographic and HIV-related risk factors for IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs will continue to increase as a result of aging of the HIV-infected population, high smoking and lung cancer prevalence and a low prevalence of untreated HIV infection. These findings suggest the need for targeted preventive measures and evaluation of the cost-benefit of screening for IURMs in HIV-infected populations.
Mocroft A.,University College London |
Ryom L.,Copenhagen University |
Begovac J.,University of Zagreb |
D'Arminio Monforte A.,Institute of Infectious Diseases |
And 6 more authors.
AIDS | Year: 2014
Objectives: To determine the relationship between measures of renal function [current estimated glomerular filtration rate (eGFR) and proportion of follow-up with a low eGFR (%FU ≤60 ml/min)] and fatal/nonfatal AIDS, non-AIDS events and all-cause mortality. Design: An observational, longitudinal cohort study of 12 155 persons from EuroSIDA. Methods: Persons with at least one eGFR measurement after 1 January 2004, using the CKD-EPI formula, were included. Poisson regression analyses were used to determine whether current eGFR or %FU of 60 ml/min or less were independent prognostic markers for clinical events. Results: During 61 425 person-years of follow-up (PYFU), the crude incidence of deaths was 11.1/1000 PYFU [95% confidence interval (CI) 10.0-12.1] at current eGFR more than 90 ml/min and 199.6 (95% CI 1144.3-254.3/1000 PYFU) when current eGFR was 30 ml/min or less. Corresponding figures for AIDS were 12.2 (11.1-13.3) and 63.9 (36.5-103.7) and for non-AIDS were 16.0 (14.8-17.3) and 203.6 (147.7-259.5). After adjustment, current eGFR of 30 ml/min or less was a strong predictor of death [adjusted incidence rate ratios (aIRR) 4.35; 95% CI 3.20-5.91] and non-AIDS events (3.63; 95% CI 2.57-5.13), although the relationship with AIDS was less strong (1.45; 95% CI 1.01-2.08). After adjustment, %FU of 60 ml/min or less was associated with a 22% increased incidence of death (aIRR 1.22 per 10% longer; 95% CI 1.18-1.27), a 13% increased incidence of non-AIDS events (95% CI 1.08-1.18) and a 15% increased incidence of AIDS events (95% CI 1.06-1.24). Conclusion: Both current eGFR and %FU of 60 ml/min or less were associated with death and non-AIDS events in HIV-positive persons. Our findings highlight the association between underlying renal dysfunction and morbidity and mortality in HIV infection, although reverse causality cannot be excluded. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Reekie J.,University College London |
Kowalska J.D.,Copenhagen University |
Karpov I.,Belarus State Medical University |
Rockstroh J.,University of Bonn |
And 8 more authors.
PLoS ONE | Year: 2012
Background: Differences in access to care and treatment have been reported in Eastern Europe, a region with one of the fastest growing HIV epidemics, compared to the rest of Europe. This analysis aimed to establish whether there are regional differences in the mortality rate of HIV-positive individuals across Europe, and Argentina. Methods: 13,310 individuals under follow-up were included in the analysis. Poisson regression investigated factors associated with the risk of death. Findings: During 82,212 person years of follow-up (PYFU) 1,147 individuals died (mortality rate 14.0 per 1,000 PYFU (95% confidence interval [CI] 13.1-14.8). Significant differences between regions were seen in the rate of all-cause, AIDS and non-AIDS related mortality (global p<0.0001 for all three endpoints). Compared to South Europe, after adjusting for baseline demographics, laboratory measurements and treatment, a higher rate of AIDS related mortality was observed in East Europe (IRR 2.90, 95%CI 1.97-4.28, p<.0001), and a higher rate of non-AIDS related mortality in North Europe (IRR 1.51, 95%CI 1.24-1.82, p<.0001). The differences observed in North Europe decreased over calendar-time, in 2009-2011, the higher rate of non-AIDS related mortality was no longer significantly different to South Europe (IRR 1.07, 95%CI 0.66-1.75, p = 0.77). However, in 2009-2011, there remained a higher rate of AIDS-related mortality (IRR 2.41, 95%CI 1.11-5.25, p = 0.02) in East Europe compared to South Europe in adjusted analysis. Interpretations: There are significant differences in the rate of all-cause mortality among HIV-positive individuals across different regions of Europe and Argentina. Individuals in Eastern Europe had an increased risk of mortality from AIDS related causes and individuals in North Europe had the highest rate of non-AIDS related mortality. These findings are important for understanding and reviewing HIV treatment strategies and policies across the European region. © 2012 Reekie et al.
PubMed | Belarus State Medical University, Research Center for Paediatric Oncology, Harvard University and Republican Research and Practical Center for Pulmonology and TB
Type: | Journal: International journal of mycobacteriology | Year: 2017
We urgently need novel treatments for multidrug-resistant tuberculosis (MDR-TB). Autologous mesenchymal stromal cell (MSC) infusion is one such possibility due to its potential to repair damaged lung tissue and boost immune responses. We aimed to assess the safety and effectiveness of MSC to improve treatment outcomes among MDR-TB patients.We analyzed treatment outcomes for 108 Belarusian MDR-TB patients receiving chemotherapy. Thirty-six patients (cases) also had MSCs collected, extracted, cultured, and reinfused (average time from chemotherapy start to infusion was 49days) in optimal dose; another 36 patients (without MSC treatment) were study controls. We identified another control group: 36 patients from the Belarusian national surveillance database (surveillance controls) 1:1 matched to cases.Successful outcomes were observed in 81% of cases, 42% of surveillance controls, and 39% of study controls. After adjusting for age, odds of a successful outcome were 6.5 (95% confidence interval, 1.2-36.2, p=0.032) times greater for cases than surveillance controls. Adjusting for other potential confounders increased the effect estimate while maintaining statistical significance. Cases were less likely (p=0.01) to be culture negative at 2months than surveillance controls, indicating a poorer initial prognosis in cases before (or shortly after) infusion. Radiological improvement was more likely in cases than in study controls.MSC treatment could vastly improve treatment outcomes for MDR-TB patients. Our findings could revolutionize therapy options and have strong implications for future directions of MDR-TB therapy research.
PubMed | Belarussian Research Center for Paediatric Oncology, Belarus State Medical University, Center for Monitoring Research, Harvard University and Republican Research and Practical Center for Pulmonology and TB
Type: | Journal: Journal of clinical tuberculosis and other mycobacterial diseases | Year: 2016
We urgently need novel treatments for multidrug-resistant tuberculosis (MDR-TB). Autologous mesenchymal stromal cell (MSC) infusion is one such possibility due to its potential to repair damaged lung tissue and boost immune responses. We aimed to assess the effectiveness of MSC to improve outcomes among MDR-TB patients.We analyzed outcomes for 108 Belarussian MDR-TB patients receiving chemotherapy. Thirty-six patients (cases) also had MSCs extracted, cultured and re-infused (average time from chemotherapy start to infusion was 49 days); another 36 patients were study controls. We identified another control group: 36 patients from the Belarussian surveillance database (surveillance controls) 1:1 matched to cases.Of the cases, 81% had successful outcomes versus 42% of surveillance controls and 39% of study controls. Successful outcome odds were 6.5 (95% Confidence Interval: 1.2-36.2, p=0.032) times greater for cases than surveillance controls (age-adjusted). Radiological improvement was more likely in cases than study controls. Culture analysis prior to infusion demonstrated a poorer initial prognosis in cases, yet despite this they had better outcomes than the control groups.MSC treatment could vastly improve outcomes for MDR-TB patients. Our findings could revolutionize therapy options and have strong implications for future directions of MDR-TB therapy research.
Voitikova M.V.,National Academy of Sciences of Belarus |
Khursa R.V.,Belarus State Medical University
Nonlinear Phenomena in Complex Systems | Year: 2014
This paper presents an effective hemodynamic classification algorithm for blood pressure (BP) monitoring data. The proposed approach takes into account two aspects of the hemodynamic states detection, namely the linear regression modeling of BP parameters and the classification block on the base of Data Mining algorithm called Support Vector Machine (SVM). At first, 4 features are extracted from the BP signals and then these features are reduced to only 2, finally, the SVM-classifier is used to classify the hemodynamic states. The proposed classification method is applied to clinical database. Thus 9 types of the hemodynamic states, including latent hypertension and high-risk hypertension, can be discriminated by SVM-classifier with the accuracy of 96%.
Kovganko V.N.,Belarusian National Technical University |
Kovganko N.N.,Belarus State Medical University
Russian Journal of General Chemistry | Year: 2013
Ethyl 3-(4-hydroxyphenyl)-3-ketopropionate was synthesized by acylation of acetoacetic ester with 4-acetoxybenzoyl chloride, followed by cleavage of aroylacetoacetic ester and hydrolysis of the protecting acetate group. Further esterification of the phenol hydroxy group with 4-alkoxybenzoic acids resulted in the synthesis of mesogenic 3-aryl-3-keto ester used to produce copper(II) metallomesogenic complexes. © 2013 Pleiades Publishing, Ltd.
Kazyra I.,Belarus State Medical University |
Pilkington C.,Great Ormond Street Hospital for Children |
Marks S.D.,Great Ormond Street Hospital for Children |
Tullus K.,Great Ormond Street Hospital for Children
Archives of Disease in Childhood | Year: 2010
Safety and efficacy data are presented on the use of mycophenolate mofetil (MMF) in 26 children and adolescents with lupus. Data include therapy before and 12 months after starting MMF. 18 of 26 patients had biopsy-proved lupus nephritis. Group 1 were commenced on MMF induction and/or maintenance therapy (n=14), group 2 converted from azathioprine because of inadequate disease control (n=12). 73% of all (10 (71%) group 1 and 10 (83%) group 2) patients experienced a significant improvement in British Isles Lupus Assessment Group score (from median 9.0 to 3.0). Children with hypocomplementaemia increased their C3 significantly in both groups (0.53-1.15 for group 1 and 0.63-1.2 g/l for group 2, p=0.001), and C4 level only in group 1 (0.08-0.17, p=0.01). Renal function and albuminuria improved in those with active nephritis (p≤0.01). Significant improvements were seen in both groups in haemoglobin, erythrocyte sedimentation rate and lymphocyte counts. Prednisolone dose was weaned in both groups, p<0.05. Side-effects were seen in four patients, but none was judged to be severe enough to discontinue treatment. MMF treatment in this cohort of children with lupus seemed to be safe, well tolerated and effective.
Kubarko A.I.,Belarus State Medical University |
Kubarko N.P.,Belarus State Medical University |
Kubarko Y.A.,Belarus State Medical University
Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova | Year: 2014
Based on the data analysis of contrast-color sensitivity, contrast - frequency sensitivity and dynamic visual acuity, the quantitative estimation of light sensitivity of ill and healthy eyes of patients with demyelinating optic neuropathy in acute retrobulbar neuritis has been carried out. The differences between these functional parameters of light sensitivity of the visual system are used for discussion of the pathogenesis of demyelinating optic neuropathy and possibility of its early diagnosis.