Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation.

This observational study of 123 Thai participants sought to determine the rate and severity of affective symptoms during acute HIV infection (AHI) and possible associations to disease mechanisms. At diagnosis, just prior to starting combination antiretroviral therapy (cART), AHI participants completed assessments of depression and anxiety symptoms that were repeated at 4, 12, and 24 weeks. Blood markers of HIV infection and immune activation were measured at study entry, with optional cerebrospinal fluid measures. A high frequency of participants reported symptoms that exceeded published thresholds supportive of depression (55.0%) and anxiety (65.8%) at diagnosis, with significant reductions after starting cART. Meeting a threshold for clinically relevant depressive symptoms at study entry was associated with higher baseline plasma HIV RNA (5.98 vs. 5.50, t = 2.46, p = 0.015), lower CD4 counts (328 vs. 436 cells/mm3, t = 3.46, p = 0.001), and higher plasma neopterin, a marker of macrophage activation (2694 vs. 1730 pg/mL, Mann-Whitney U = 152.5, p = 0.011). Controlling for plasma HIV RNA and CD4 count, higher baseline plasma neopterin correlated with worse initial depression and anxiety scores. Depression and anxiety symptoms are frequent in acute HIV infection, associate with plasma immune activation, and can improve concurrent with cART.

Simulation of Inpatient Medical Critical Events for Physicians at a Community Hospital.

Background: Critical events are common at community hospitals, yet physicians who lead them have had varying levels of training and involvement during their residency and professional development. Little is known about the impact of simulation to improve performance during inpatient critical events among community hospitalist physicians. Objectives: To determine if hospitalist physicians reported sustained performance improvement regarding critical events as a result of simulation. Methods: Physicians at a community hospital in Northern California participated in critical event simulation over one year. Self-assessment surveys (scale 1 through 5) were collected before, after, and at 1-month post-simulation. Differences in survey scores and post-simulation trends in total composite survey scores over a 1-month period were compared among participants. Results: From February 2018 through February 2019, 25 of 32 eligible physicians (78%) participated in the simulations. Most were trained in internal medicine (76%), practiced primarily hospital medicine (72%), and had previous experience of at least 5 critical events per year (68%). Participants reported increases in mean survey scores (knowledge +0.8, familiarity +1.0, communication +1.2, technical skills +1.0) which were sustained at one month post-simulation (knowledge +0.8, familiarity +1.0, communication +1.3, technical skills +0.9) (all p < 0.0001). At one month post-simulation, participants who were clinic-based and had <5 years of post-residency experience had higher composite survey score differences compared to those who were hospital-based and had ≥5 years of experience, respectively (p < 0.05). Conclusion: Simulation may lead to sustained performance improvement at critical events as reported by community hospitalist physicians. Further investigation is needed.