ABSTRACT
OBJECTIVES: To assess the influence of corticosteroid pulses on 60-day mortality in hospitalized patients with severe COVID-19. METHODS: We designed a multicenter retrospective cohort study in three teaching hospitals of Castilla y León, Spain (865,096 people). We selected patients with confirmed COVID-19 and lung involvement with a pO2/FiO2<300, excluding those exposed to immunosuppressors before or during hospitalization, patients terminally ill at admission, or those who died in the first 24 hours. We performed a propensity score matching (PSM) adjusting covariates that modify the probability of being treated. Then, we used a Cox regression model in the PSM group to consider factors affecting mortality. RESULTS: From 2933 patients, 257 fulfilled the inclusion and exclusion criteria. 124 patients were on corticosteroid pulses (250 mg of methylprednisolone for three days), and 133 were not. 30.3% (37/122) of patients died in the corticosteroid pulse group and 42.9% (57/133) in the nonexposed cohort. These differences (12.6%, 95% CI [8·54-16.65]) were statically significant (log-rank 4.72, p = 0, 03). We performed PSM using the exact method. Mortality differences remained in the PSM group (log-rank 5.31, p = 0.021) and were still significant after a Cox regression model (HR for corticosteroid pulses 0.561; p = 0.039). CONCLUSIONS: This study provides evidence about treatment with corticosteroid pulses in severe COVID-19 that might significantly reduce mortality. Strict inclusion and exclusion criteria with that selection process set a reliable frame to compare mortality in both the exposed and nonexposed groups.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19 Drug Treatment , COVID-19/mortality , Hospitalization , Aged , Aged, 80 and over , Female , Humans , Immunosuppressive Agents/therapeutic use , Inpatients , Male , Middle Aged , Propensity Score , Proportional Hazards Models , Retrospective Studies , Spain/epidemiology , Treatment OutcomeABSTRACT
Adherence to highly active antiretroviral therapy (HAART) has been scarcely studied in correctional settings. Our study aims to evaluate the relationship between adherence and virological outcome and to determine factors related to adherence in correctional settings. A cross-sectional retrospective study was performed in Topas prison (Salamanca, Spain). 50 inmates starting HAART were studied. Adherence was estimated through a self-report questionnaire and variables related to adherence (covering individual factors, the illness itself and the therapeutic regimen) were recorded. HIV-RNA levels and CD4 lymphocyte count were measured before starting therapy and six months after. Statistical analysis was performed using univariate and multivariate methods. 21 inmates (42%) were considered adherent and 29 (58%) were non-adherent. Adherence to treatment, as measured by our questionnaire, was the only significant and independent factor associated with an undetectable viral load at six months of therapy. Five variables were significantly associated with adherence to treatment, four of them as predictor factors for good adherence: an active occupation inside prison, the absence of HIV-related symptoms, a good or average acceptance of treatment, and a higher academic background; previous injection drug use as a risk factor for HIV transmission was associated with non-adherence. A simple self-report questionnaire may be useful for assessing adherence in prison inmates. Recognizing variables associated with adherence is essential to identify prisoners at high risk of being non-adherents in order to develop strategies for improving compliance.
Subject(s)
Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , Patient Compliance/statistics & numerical data , Adult , CD4 Lymphocyte Count , Cross-Sectional Studies , Female , HIV Infections/immunology , HIV Infections/virology , Humans , Male , Middle Aged , Prisons , RNA, Viral/blood , Retrospective Studies , Risk Factors , Spain , Surveys and Questionnaires , Treatment Outcome , Treatment Refusal , Viral LoadABSTRACT
BACKGROUND: Multiple factors have been previously described which could influence adherence to HAART. Our objective is to determine the fundamental factors which influence adherence to highly active antiretroviral therapy in our population. METHODS: A cross-sectional study was made selecting 143 outpatients attending our hospital HIV unit. 22 factors were recorded which could influence adherence to treatment (covering individual factors, the illness itself, the therapeutic regimen and the medical team). Adherence was estimated by the combination of two methods (self-report and pharmacy data); statistical analysis was performed using univariate and multivariate methods. RESULTS: 96 patients (67.13%) had good adherence and 47 (32.87%) did not. Only 3 of the 22 factors studied were significant and independent factors related with adherence: employment, housing situation and degree of treatment acceptance. CONCLUSIONS: we have found some differences regarding HAART adherence in our population compared with previous studies. Psychosocial and behavioral factors were the principal ones. We must try to detect patients at high risk of non-adherence in order to take therapeutic decisions properly, try to reinforce adherence and modify the factors associated with poor adherence.
