Clinical features, management, and outcome of hemodialysis patients with SARS-CoV-2.

The aim of the study was to evaluate the clinical features of the patients on HD with COVID-19 and determine the prognostic factors. In this single-center prospective study, a total of 58 chronic renal failure patients on HD and diagnosed COVID-19 infection were enrolled in the study. The patients were divided into two groups according to their need for intensive care unit referral. Demographic features of the patients, clinical manifestations, laboratory data, treatments, and clinical outcome were evaluated. The mean age of 58 HD patients was 63.2 ± 13.8 (30-93) years and female-male ratio was 0.34. SARS-CoV2-PCR positivity rate was 32.8%. 85.2% of patients (n = 46) had bilateral lesions and 14.8% (n = 8) had unilateral one lesion in chest CT. The most common symptoms were fatigue (in 44 patients, 80%) and dyspnea (in 31 patients, 56.4%). The most common comorbidity was HT (in 37 patients, 67.3%). The patients who need intensive care and died were older (p = 0.015). We observed lower platelet and eosinophil counts, potassium levels, higher AST, troponin and CRP levels in the group of patients who need intensive care and died than the group who survived (p = 0.043, 0.005, 0.033, 0.007, 0.001, <0.001, respectively). 15.5% of the patients (n = 9) were transferred to intensive care unit. Among them, two were discharged with cure and seven patients died. Mortality rate was 12.1%. Older age, lower platelet and eosinophil counts and higher AST, troponin and CRP levels were prognostic risk factors in our HD patients who needed intensive care.

Trends and factors associated with modification or discontinuation of the initial antiretroviral regimen during the first year of treatment in the Turkish HIV-TR Cohort, 2011-2017.

BACKGROUND: There is limited evidence on the modification or stopping of antiretroviral therapy (ART) regimens, including novel antiretroviral drugs. The aim of this study was to evaluate the discontinuation of first ART before and after the availability of better tolerated and less complex regimens by comparing the frequency, reasons and associations with patient characteristics. METHODS: A total of 3019 ART-naive patients registered in the HIV-TR cohort who started ART between Jan 2011 and Feb 2017 were studied. Only the first modification within the first year of treatment for each patient was included in the analyses. Reasons were classified as listed in the coded form in the web-based database. Cumulative incidences were analysed using competing risk function and factors associated with discontinuation of the ART regimen were examined using Cox proportional hazards models and Fine-Gray competing risk regression models. RESULTS: The initial ART regimen was discontinued in 351 out of 3019 eligible patients (11.6%) within the first year. The main reason for discontinuation was intolerance/toxicity (45.0%), followed by treatment simplification (9.7%), patient willingness (7.4%), poor compliance (7.1%), prevention of future toxicities (6.0%), virologic failure (5.4%), and provider preference (5.4%). Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based (aHR = 4.4, [95% CI 3.0-6.4]; p < 0.0001) or protease inhibitor (PI)-based regimens (aHR = 4.3, [95% CI 3.1-6.0]; p < 0.0001) relative to integrase strand transfer inhibitor (InSTI)-based regimens were significantly associated with ART discontinuation. ART initiated at a later period (2015-Feb 2017) (aHR = 0.6, [95% CI 0.4-0.9]; p < 0.0001) was less likely to be discontinued. A lower rate of treatment discontinuation for intolerance/toxicity was observed with InSTI-based regimens (2.0%) than with NNRTI- (6.6%) and PI-based regimens (7.5%) (p < 0.001). The percentage of patients who achieved HIV RNA < 200 copies/mL within 12 months of ART initiation was 91% in the ART discontinued group vs. 94% in the continued group (p > 0.05). CONCLUSION: ART discontinuation due to intolerance/toxicity and virologic failure decreased over time. InSTI-based regimens were less likely to be discontinued than PI- and NNRTI-based ART.

Can mean platelet volume determine the severity of liver fibrosis or inflammation in patients with chronic hepatitis B?

AIMS: We aimed to determine whether mean platelet volume (MPV) is one of the variables that determine the severity of liver fibrosis and inflammation. MATERIALS AND METHODS: Patients with chronic hepatitis B virus (HBV) infection were divided into two groups: patients with fibrosis scores of 0-3 and 4-6 and patients with histologic activity index scores of 0-9 and 10-18 (according to the Ishak Scoring System). The independent variables determining the severity of liver fibrosis and inflammation were investigated. RESULTS: Two hundred and thirty-eight patients were included in this retrospective study. The fibrosis scores of 29 patients (12.2%) were higher than 3. The independent variables that determined the severity of the fibrosis score were a high level of serum γ-glutamyl transferase and a low blood platelet count (odds ratio and P values were 1.016 and 0.004 for γ-glutamyl transferase, and 0.986 and 0.002 for blood platelet count). The histologic activity indexes of 38 patients (16%) were higher than 9. The independent variables determining the severity of liver inflammation were serum HBV DNA, γ-glutamyl transferase, and globulin levels and the MPV [odds ratio and P values were, respectively, 0.1001 and 0.046 for HBV DNA (×10); 1.016 and 0.004 for γ-glutamyl transferase; 2.247 and 0.039 for globulin; and 1.488 and 0.004 for the MPV]. The sensitivity, specificity, and positive predictive value and negative predictive value of the model predicting the severity of liver inflammation were 60.5, 83, 40.3, and 91.7%, respectively (area under the receiver-operating characteristic curve=0.775, P=0.0001). CONCLUSION: MPV may provide useful information to predict the degree of liver inflammation along with other markers.