Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis.

Background: There has been a rising prevalence of polypharmacy among people living with HIV (PLWH). Uncertainty however remains regarding the exact estimates of polypharmacy among these cohorts of patients. Methods: We conducted a systematic search of PubMed; EMBASE, CROI, Cochrane Database of Systematic Reviews; Science Citation Index and Database of Abstracts of Reviews of Effects for studies between 1 January 2000 and 30 June 2021 that reported on the prevalence of polypharmacy (ingestion of > 5 non-ART medications) among PLWH on antiretroviral therapy regimen (ART). Prevalence of polypharmacy among HIV-positive patients on ART with Clopper-Pearson 95% confidence intervals were presented. The heterogeneity between studies was evaluated using I 2 and τ 2 statistics. Results: One hundred ninety-seven studies were initially identified, 23 met the inclusion criteria enrolling 55,988 PLWH, of which 76.7% [95% confidence interval (CI): 76.4-77.1] were male. The overall pooled prevalence of polypharmacy among PLWH was 33% (95% CI: 25-42%) (I 2 = 100%, τ2 = 0.9170, p < 0.0001). Prevalence of polypharmacy is higher in the Americas (44%, 95% CI: 27-63%) (I 2 = 100%, τ2 = 1.0886, p < 0.01) than Europe (29%, 95% CI: 20-40%) (I 2 = 100%, τ2 = 0.7944, p < 0.01). Conclusion: The pooled prevalence estimates from this synthesis established that polypharmacy is a significant and rising problem among PLWH. The exact interventions that are likely to significantly mitigate its effect remain uncertain and will need exploration by future prospective and systematic studies. Registration: PROSPERO: CRD42020170071. Plain Language Summary: Background: In people living with HIV (PLWH), what is the prevalence of polypharmacy and is this influenced by sociodemographic factors?Methods and Results: In this systematic review and meta-analysis of 23 studies comprising 55,988 participants, we have for the first time found an estimated polypharmacy pooled prevalence of 33% among PLWH. There was a relatively higher pooled prevalence of polypharmacy among the America's compared with European cohorts of PLWH.Conclusion: Polypharmacy among PLWH is a rising morbidity that needs urgent intervention both at policy and patient levels of care.

HIV and AIDS-defining opportunistic illnesses in the state of Qatar: A cohort population-based retrospective study covering 17 years (2000-2016).

Background and introduction: Human immune deficiency virus (HIV) infection remains a major health problem since discovery of the virus in 1981. Globally, since introduction of antiretroviral therapy, AIDS-related mortality was reduced by 47% since 2010. Also, HIV-related opportunistic infections (OIs) became less common, especially with use of prophylaxis to prevent such infections. In this study, we aim to assess the incidence of HIV infection and related OIs in Qatar for 17-year period, and to assess the spectrum of these infections, risk factors and treatment outcomes. Methods: This is a retrospective cohort study for all HIV infected patients registered in the state of Qatar from 2000 to 2016. Incidence of HIV infection and related opportunistic illness was calculated per 100,000 population. Demographic and Clinical characteristic were compared between two groups of patients with and without opportunistic illness. Results: of 167 cases with HIV infection 54 (32.3%) had opportunistic illness. The average incidence rate of HIV infection over 17 years is 0.69 per 100,000 population, and the incidence rate for opportunistic illness is 0.27 per 100,000 population. The most common opportunistic illness is pneumocystis jirovecii pneumonia (PCP) which constituted 25% of cases, followed by cytomegalovirus (CMV) retinitis 7.2%, Tuberculosis 5.4%, Toxoplasmosis 4.2% and, less than 2% for each of Kaposi sarcoma, lymphoma and cryptococcal infection.The outcome of treatment of cases with opportunistic illness showed cure rates of 59.3%, one year relapse rates of 8.76% and overall, 90-day mortality of 3.7% however, 33.4% of patients left the country before completion of therapy.Most of our patients in both groups were of young age, majority males, and almost half of them were Qatari. The CD4 count, CD4%, CD4/CD8 ratio and viral load were statistically significant risk factors in cases with opportunistic illness with a p value < 0.05, however presence of comorbidities was lower in patients with opportunistic illness P value of 0.032. Conclusion: Qatar has a low prevalence rate for HIV infection and related opportunistic illness. Early diagnosis and use of antiretroviral therapy are important measures to decrease the rate of opportunistic illness.

Accuracy of clinical scoring systems for the diagnosis of tuberculosis meningitis in a case mix of meningitides a retrospective cohort study.

BACKGROUND: Tuberculosis meningitis (TBM) is elusive to diagnosis. Two widely used clinical scores are the Thwaites diagnostic score (TDS) and The Lancet Consensus score (LCS). We aim to evaluate the accuracy of these scores in a retrospective cohort of meningitis patients. METHODS: A retrospective review of all meningitis cases admitted to a tertiary center in a 7-year period. The primary outcome was the sensitivity and the specificity of a preset cutoff on the TDS and the LCS and finding the best cutoff value with optimum sensitivity and specificity using Receiver operating characteristic (ROC) curve analysis. RESULTS: We included 156 cases of meningitis; 80 TBM and 76 controls (other meningitides). Seventy-eight (97.5%) of TB cases were suggestive of TBM compared to 45(59.2%) of controls (p < .001) using the TDS. Sensitivity was 97.5% and specificity was 40.8%. The PPV was 63.4% and the NPV was 93.9%. The area under the ROC curve (AUC) was 0.80 (0.73-0.87 at 95% CI). When calculated for bacterial meningitis vs TBM a cutoff of 4 showed excellent sensitivity (93%) and specificity (96%). AUC =0.96 (0.89-1.00 at 95% CI). While for the LCS, 67 (83.3%) were suggestive of TBM vs. 11 controls (14.5%) (p < .001). Sensitivity was 83.8%, specificity was 85.5%, and PPV and NPV were 85.9% and 83.3% respectfully. The AUC was 0.93 (95% CI 0.89-0.97). CONCLUSION: The TDS performs best in differentiating bacterial meningitis from TBM and has a good negative predictive value. The LCS has good sensitivity and specificity in differentiating TBM from others forms of meningitides.

Hepatitis E in Qatar imported by expatriate workers from Nepal: epidemiological characteristics and clinical manifestations.

Prompted by cases of acute hepatitis in expatriate workers presenting at Alkhor Hospital, Qatar, a limited prospective observational study was conducted from July 2005 to June 2006 to determine the epidemiological and clinical features of patients (predominantly Nepalese) presenting with acute hepatitis. Countrywide during that period samples from 86 Nepalese presenting at different centers were found to be anti-HEV IgG positive and 50 of these were also positive for anti-HEV IgM. Fifty-eight of those Nepalese were seen and treated at Alkhor Hospital and of them 43 were confirmed as cases of acute HEV, being positive for both anti-HEV IgM and IgG. The remaining 15 were diagnosed as probable cases of acute HEV on the basis of clinical and epidemiological similarity. It seems likely that transit in Kathmandu in reportedly unsanitary conditions was the focus of infection. In some of those examined at Alkhor, ultrasound detected a thickened gallbladder wall in 30 of 39 (76.9%) with two cases having clinical acalcular cholecystitis. Higher levels of alanine aminotransferase and aspartate aminotransferase were associated with severe disease and derangement in coagulation. On the available evidence hepatitis E was imported by expatriate workers and it is clear that medical screening of these workers pre- and post-arrival must be improved to prevent further outbreaks. It is also essential that health care workers in Qatar are made aware of this ongoing problem of imported HEV and understand the variable presentation of the condition.

Rupture of spleen in a mechanically ventilated patient with falciparum malaria admitted with pulmonary edema.

Rupture of the spleen in malaria may constitute a diagnostic challenge to many clinicians particularly in non-endemic areas where experience with malaria is limited. Our aim is to increase the awareness among clinicians from non-endemic areas of serious malarial complications. We present a young American military man who was admitted to Hamad General Hospital and had 2 serious malarial complications, namely, acute pulmonary edema and rupture of the spleen. He was unusual compared with what was published previously in 4 main points: 1. The rupture of spleen occurred while the patient on mechanical ventilation and under the effect of sedation, which constituted a diagnostic challenge. 2. The 2 complications occurred in a patient with a low parasitemia. 3. The causative species for splenic rupture is Plasmodium falciparum, and 4. The first sample of peripheral blood smear for malarial parasite was negative. We treated him successfully and discharged home in a good condition.