Background: pneumonia (PCP) is one of the most frequent opportunistic infections in people with HIV (PWH). However, there are limited data on long-term outcomes of PCP in the antiretroviral therapy (ART) era.
Methods: We conducted a secondary analysis of 2 prospective studies on 307 PWH, 81 with prior PCP, with a median follow-up of 96 weeks. Laboratory data were measured at protocol-defined intervals. We reviewed clinically indicated chest computerized tomography imaging in 63 patients with prior PCP at a median of 58 weeks after PCP diagnosis and pulmonary function tests (PFTs) of patients with (n = 10) and without (n = 14) prior PCP at a median of 18 weeks after ART initiation.
Results: After 96 weeks of ART, PWH with prior PCP showed no significant differences in laboratory measurements, including CD4 count, when compared with those without prior PCP. Survival rates following ART initiation were similar. However, PWH with prior PCP had increased evidence of restrictive lung pathology and diffusion impairment in PFTs. Furthermore, on chest imaging, 13% of patients had bronchiectasis and 11% had subpleural cysts. Treatment with corticosteroids was associated with an increased incidence of cytomegalovirus disease (odds ratio, 2.62; = .014).
Conclusions: PCP remains an important opportunistic infection in the ART era. While it did not negatively affect CD4 reconstitution, it could pose an increased risk for incident cytomegalovirus disease with corticosteroid treatment and may cause residual pulmonary sequelae. These findings suggest that PCP and its treatment may contribute to long-term morbidity in PWH, even in the ART era.
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http://dx.doi.org/10.1093/ofid/ofad408 | DOI Listing |
Alzheimers Dement
December 2024
Alpert Medical School of Brown University, Providence, RI, USA.
Background: Routine cognitive screening for older adults in primary care could improve AD early detection and streamline referrals for treatment or clinical trials. Digital assessments, especially when self-administered online, can overcome time barriers to cognitive screening in primary care settings and are conducive to repeat testing for disease monitoring and the evaluation of treatment outcomes. We report preliminary data on the feasibility and acceptability of three digital screening approaches for older adults completing annual follow-up visits with a primary care provider (PCP) METHODS: Cognitive screening approaches included: 1) remote online screening with the Boston Online Cognitive Assessment (BOCA) 1-4 weeks prior to the PCP appointment, 2) self-administered BOCA in the waiting room before or after the appointment, and 3) provider-administered screening during the appointment using the Digital Clock and Recall (Linus Health DCR).
View Article and Find Full Text PDFAlzheimers Dement
December 2024
Alpert Medical School of Brown University, Providence, RI, USA.
Background: New immunotherapies for early-stage Alzheimer's disease (AD) have ushered in fresh hope for AD research and clinical care, but also highlight barriers to AD screening and timely diagnosis in the US. Digital cognitive assessments could potentially streamline screening and referrals for AD treatment and/or clinical trials. We report preliminary data on the feasibility and acceptability of three digital cognitive approaches for older adults completing Annual Wellness or routine follow-up visits with a primary care provider (PCP).
View Article and Find Full Text PDFAlzheimers Dement
December 2024
Alpert Medical School of Brown University, Providence, RI, USA.
Background: New immunotherapies for early-stage Alzheimer's disease (AD) have ushered in fresh hope for AD research and clinical care, but also highlight barriers to AD screening and timely diagnosis in the US. Digital cognitive assessments could potentially streamline screening and referrals for AD treatment and/or clinical trials. We report preliminary data on the feasibility and acceptability of three digital cognitive approaches for older adults completing Annual Wellness or routine follow-up visits with a primary care provider (PCP).
View Article and Find Full Text PDFInfect Immun
December 2024
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, the Thoracic Diseases Research Unit, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
pneumonia (PJP) remains a significant cause of morbidity and mortality during AIDS. In AIDS, the absence of CD4 immunity results in exuberant and often fatal PJP. In addition, organism clearance requires a balanced macrophage response since excessive inflammation promotes lung injury and respiratory failure.
View Article and Find Full Text PDFWomens Health Rep (New Rochelle)
December 2024
Department of Family Medicine, University of Chicago, Chicago, Illinois, USA.
Purpose: Many reproductive age women, cared for routinely by primary care providers (PCPs), would benefit from interconception care, yet a minority of primary care visits include interconception care. This study assessed barriers to providing interconception care from the perspective of primary care clinicians, staff, and patients.
Materials And Methods: Clinicians ( = 11), staff ( = 14), and patients eligible for interconception care ( = 6) from three primary care clinics in Chicago, Illinois participated in focus groups or interviews.
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