Clinical outcomes of people living with human immunodeficiency virus(HIV)with diffuse large B-cell lymphoma(DLBCL)in Shanghai,China

Background:Numerous studies have focused on lymphoma among patients infected with human immunodeficiency virus(HIV).However,little is known about the treatment options and survival rate of lymphoma in the Chinese people living with HIV(PLHIV).Our study aimed to investigate the prognosis and compare outcome of dose-adjusted etoposide,prednisone,vincristine,cyclophosphamide,doxorubicin,and rituximab(DA-EPOCH-R)with standard cyclophosphamide,doxorubicin,vincristine,prednisone and rituximab(R-CHOP)as front line therapy for PLHIV with diffuse large B-cell lymphoma(DLBCL)receiving modern combined antiretroviral therapy(cART).Methods:A retrospective analysis evaluating PLHIV with DLBCL was performed in Shanghai Public Health Clinical Center from July 2012 to September 2019.The demographic and clinical data were collected,and overall survival(OS)and progression-free survival(PFS)analyses of patients receiving R-CHOP or DA-EPOCH-R therapy were performed by Kaplan-Meier analysis.Additionally,a Cox multiple regression model was constructed to identify related factors for OS.Results:A total of 54 eligible patients were included in the final analysis with a median follow-up of 14 months(interquartile range[IQR]:8-29 months).The proportion of high international prognostic index(IPI)patients was much larger in the DA-EPOCH-R group(n=29)than that in the R-CHOP group(n=25).The CD4 cell counts and HIV RNA levels were not significantly different between the two groups.The 2-year OS for all patients was 73%.However,OS was not significantly different between the two groups,with a 2-year OS rate of 78%for the DA-EPOCH-R group and 66%for the R-CHOP group.Only an IPI greater than 3 was associated with a decrease in OS,with a hazard ratio of 5.0.The occurrence of grade 3 and 4 adverse events of chemotherapy was not significantly different between the two groups.Conclusions:Outcomes of R-CHOP therapy do not differ from those of DA-EPOCH-R therapy.No HIV-related factors were found to be associated with the OS of PLHIV in the modern cART era.

Risk factors affecting the mortality of HIVinfected patients with pulmonary tuberculosis in the cART era:a retrospective cohort study in China

Background:Tuberculosis infection still places a great burden on HIV-infected individuals in China and other developing countries.Knowledge of the survival of HIV-infected patients with pulmonary tuberculosis(PTB)would provide important insights for the clinical management of this population,which remains to be well described in current China.Methods:HIV-infected patients with PTB admitted to Shanghai Public Health Clinical Center from January 2011 to December 2015 were retrospectively enrolled.In this cohort,the survival prognosis was estimated by the Kaplan-Meier method,while univariate and multivariate Cox proportional hazards models were used to determine the risk factors affecting mortality.Results:After reviewing 4914 admitted patients with HIV infection,359 PTB cases were identified.At the time of PTB diagnosis,the patients’median CD4+T cell count was 51/mm3(IQR:23-116),and 27.30%of patients(98/359)were on combination antiretroviral therapy(cART).For the 333 cases included in the survival analysis,the overall mortality was 15.92%(53/333)during a median 27-month follow-up.The risk factors,including age older than 60 years(HR:3.18;95%CI:1.66-6.10),complication with bacterial pneumonia(HR:2.64;95%CI:1.30-5.35),diagnosis delay(HR:2.60;95%CI:1.42-4.78),CD4+T cell count less than 50/mm3(HR:2.38;95%CI:1.27-4.43)and pulmonary atelectasis(HR:2.20;95%CI:1.05-4.60),might independently contribute to poor survival.Among patients without cART before anti-TB treatment,the later initiation of cART(more than 8 weeks after starting anti-TB treatment)was found to increase the mortality rate(OR:4.33;95%CI:1.22-15.36),while the initiation of cART within 4-8 weeks after starting anti-TB treatment was associated with the fewest deaths(0/14).Conclusions:The subjects in this study conducted in the cART era were still characterized by depressed immunological competence and low rates of cART administration,revealing possible intervention targets for preventing TB reactivation in HIV-infected individuals under current circumstances.Furthermore,our study indicated that the timely diagnosis of PTB,prevention of secondary bacterial pneumonia by prophylactic management and optimization of the timing of cART initiation could have significant impacts on decreasing mortality among HIV/PTB co-infected populations.These findings deserve further prospective investigations to optimize the management of HIV/PTB-co-infected patients.Trial registration:NCT01344148,Registered September 14,2010.

Clinical features and treatment outcomes of human immunodeficiency virus-associated cryptococcal meningitis:a 2-year retrospective analysis

Background:Cryptococcal meningitis(CM)is one of the most common opportunistic infections caused by Cryptococcus neoformans in human immunodeficiency virus(HIV)-infected patients,and is complicated with significant morbidity and mortality.This study retrospectively analyzed the clinical features,characteristics,treatment,and outcomes of first-diagnosed HIV-associated CM after 2-years of follow-up.Methods:Data from all patients(n=101)of HIV-associated CM hospitalized in Shanghai Public Health Clinical Center from September 2013 to December 2016 were collected and analyzed using logistic regression to identify clinical and microbiological factors associated with mortality.Results:Of the 101 patients,86/99(86.9%)of patients had CD4 count<50 cells/mm^3,57/101(56.4%)were diagnosed at≥14 days from the onset to diagnosis,42/99(42.4%)had normal cerebrospinal fluid(CSF)cell counts and biochemical examination,30/101(29.7%)had concomitant Pneumocystis(carinii)jiroveci pneumonia(PCP)on admission and 37/92(40.2%)were complicated with cryptococcal pneumonia,50/74(67.6%)had abnormalities shown on intracranial imaging,amongst whom 24/50(48.0%)had more than one lesion.The median time to negative CSF Indian ink staining was 8.50 months(interquartile range,3.25-12.00 months).Patients who initiated antiretroviral therapy(ART)before admission had a shorter time to negative CSF Indian ink compared with ART-naïve patients(7 vs.12 months,χ^2=15.53,P<0.001).All-cause mortality at 2 weeks,8 weeks,and 2 years was 10.1%(10/99),18.9%(18/95),and 20.7%(19/92),respectively.Coinfection with PCP on admission(adjusted odds ratio[AOR],3.933;95%confidence interval[CI],1.166-13.269,P=0.027)and altered mental status(AOR,9.574;95%CI,2.548-35.974,P=0.001)were associated with higher mortality at 8 weeks.Conclusion:This study described the clinical features and outcomes of first diagnosed HIV-associated CM with 2-year follow-up data.Altered mental status and coinfection with PCP predicted mortality in HIV-associated CM.