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1.
Ir Med J ; 113(3): 42, 2020 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-32815702

RESUMO

Presentation A 40-year-old Irish female presented with a new diagnosis of HIV, advanced immunosuppression and severe respiratory failure. Diagnosis Patient was subsequently diagnosed with Pneumocystis jiroveci Pneumonia (PJP). Treatment The patient was treated for HIV and PJP and required mechanical ventilation. She continued to deteriorate and veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) was deployed in her management after 18 days of mechanical ventilation. Conclusion HIV presenting with extensive pneumonia secondary to PJP and advanced immunosuppression is still a treatable condition. All available respiratory support including ECMO should be considered for patients even if they have been on mechanical ventilation for more than 7 days.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Infecções por HIV/complicações , Infecções por HIV/terapia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/terapia , Insuficiência Respiratória/terapia , Adulto , Feminino , Infecções por HIV/imunologia , Humanos , Tolerância Imunológica , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/imunologia , Respiração Artificial , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Epidemiol Infect ; 147: e136, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30869051

RESUMO

Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count <200 cells/mm3; viral load <400 copies/ml; the presence of AIDS-defining illness; prior antiretroviral therapy use) indicated a potential false-recent result. Of 508 diagnoses in 2016, we linked 448 (88.1%) to an avidity test result. RITA classified 12.5% of diagnoses as recent, with the highest proportion (26.3%) amongst people who inject drugs. On multivariable logistic regression recent infection was more likely with a concurrent sexually transmitted infection (aOR 2.59; 95% CI 1.04-6.45). Data were incomplete for at least one RITA criterion in 48% of cases. The study demonstrated the feasibility of integrating RITA into routine surveillance and showed some ongoing HIV transmission. To improve the interpretation of RITA, further efforts are required to improve completeness of the required epidemiological data.


Assuntos
Algoritmos , Monitoramento Epidemiológico , Infecções por HIV/diagnóstico , Testes Sorológicos/métodos , Afinidade de Anticorpos , Contagem de Linfócito CD4 , Anticorpos Anti-HIV/sangue , Humanos , Técnicas Imunoenzimáticas/métodos , Irlanda , Carga Viral
3.
Ir Med J ; 112(8): 987, 2019 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31650816

RESUMO

Aims To explore doctors' perceptions of the motivators and barriers to complying with intravenous to oral switch antibiotic guidelines in a Model 4 Irish hospital. Methods A cross-sectional study was carried out amongst doctors attending hospital-wide educational sessions in November 2018 via a validated paper-based survey post ethical approval. Data were independently analysed using SPSS. Results One hundred and seventy four doctors of all grades and a variety of specialties participated. Respondents felt they were aware of the local intravenous to oral switch criteria but expressed they required prompts to consider switching to oral agents when appropriate, inclusive of alert stickers in the Kardex and medical notes as well as reminders from nursing and pharmacy staff. Other interventions to assist with improved decision-making included further education to junior doctors on the benefits of an intravenous to oral switch, electronic prescribing, and better accessibility to laboratory results. Conclusion Results will assist in implementing quality improvement initiatives to increase the rate of guideline compliance.


Assuntos
Antibacterianos/administração & dosagem , Atitude do Pessoal de Saúde , Médicos , Administração Intravenosa , Administração Oral , Estudos Transversais , Fidelidade a Diretrizes , Humanos , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
4.
Ir Med J ; 108(7): 199-202, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26349347

RESUMO

This study describes the demographics and treatment status of HIV-infected adults accessing ambulatory care in the Republic of Ireland and estimates diagnosed HIV prevalence rates. 3254 HIV-infected adults attended 1 of the 6 specialist HIV centres in the 12- month period 1st July 2009 to 30th June 2010. 2023/3254 (62%) were male, 1761/3133 (56%) Irish and 1048/3133 (34%) African. 1924/3098 (62%) resided in the Dublin area. The mean age was 39.8 years (SD 9.3); probable route of acquisition was available for 2898/3254 (89%); heterosexual acquisition accounted for 1442 (50%), MSM 777 (27%) and IDU 598 (21%). 2574/3202 (80%) were on highly active antiretroviral therapy (HAART). Of these 87% had HIV-RNA levels < 50cpm and 94% < 500cpm. The HIV diagnosed prevalence rate is estimated at 1.09/1000 nationally and at 2.25/1000 in the Dublin area for 15-59 year olds.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
6.
J Viral Hepat ; 15(7): 482-9, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18221297

RESUMO

The objective of the study was to evaluate the role of rapid virological response (RVR) in predicting sustained virological response (SVR) rates to hepatitis C virus (HCV) therapy. 65 HIV / HCV co-infected patients commenced HCV treatment per protocol. HIV / HCV patients with a mean CD4 count of 502 were treated for 24-48 weeks depending on genotype. Virological response was assessed at weeks 4 (RVR), 12 [early virological response (EVR)], 24, at end of treatment (EOTR) and 24 weeks post-completion of treatment (SVR). Primary end-point was defined as undetectable HCV RNA at 24 weeks post-treatment completion. Fifty-five per cent of co-infected patients were on highly active anti-retroviral therapy. A majority of patient group were male. 60% of HIV / HCV patients achieved SVR (35% genotype 1 / 4; 77% genotype 2 / 3). 24 HIV / HCV patients achieved undetectable HCV levels compared with baseline by week 4. The positive predictive value (PPV) of RVR at week 4 for subsequent SVR in HIV-HCV co-infected patients was 100%; the negative predictive value (NPV) was 57%. Significant variables associated with SVR were: (i) lower median pre-treatment HCV viral load, (ii) genotype 2 / 3 disease and (iii) achievement of RVR. Independent variables associated with RVR were low pre-treatment HCV viral load and genotype 2 / 3 disease. Achievement of RVR, a negative HCV-PCR, at week 4 of treatment is predictive of SVR in this cohort of patients. This may be used to guide optimal treatment duration in patient groups. More significantly, the data serve to highlight the subgroup of patients who, on achieving RVR, should be actively supported to complete HCV treatment with full dose therapy, especially patients co-infected with G2 / 3 disease for whom 6 months' full dose therapy may be sufficient to obtain a SVR.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/complicações , Hepacivirus/genética , Hepatite C/complicações , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Viremia , Adulto , Feminino , Genótipo , Hepacivirus/efeitos dos fármacos , Humanos , Interferon alfa-2 , Masculino , Polietilenoglicóis/uso terapêutico , RNA Viral/sangue , Proteínas Recombinantes , Estudos Retrospectivos , Resultado do Tratamento
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