Four-Drug-Class-Resistant HIV Linked to Higher Death Risk
Individuals with HIV who were resistant to all four antiretroviral drug classes experienced higher mortality than those who were not resistant, a difference primarily due to lower CD4 cell counts.
METHODOLOGY:
Researchers conducted a retrospective study to determine whether people living with HIV and resistance to four-drug classes (nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors) faced a higher risk for death than those without such resistance.
A total of 1097 patients with HIV were analysed, including 228 with four-drug class resistance (median age at baseline, 50 years; 72.4% men; median years of HIV diagnosis, 21.4 years) who were propensity score matched with 869 without such resistance, and followed up until a median of 8.67 years.
The primary outcome was all-cause mortality.
TAKEAWAY:
During the follow-up period, 12.3% of patients with HIV and four-drug class resistance vs 7.7% of those without such resistance died (incidence rate ratio, 1.51; P = .063).
When controlling for comorbidities, patients who were resistant to the four drug classes had a significantly higher risk for mortality than those who were not resistant (adjusted hazard ratio [AHR], 1.68; P = .024).
In the four-drug-class-resistant group, lower CD4 cell counts had a significant indirect effect on mortality (AHR, 1.62; P < .001); however, the direct effect was not statistically significant.
IN PRACTICE:
"The priority for this vulnerable population is achieving virological control to enable immune recovery," the authors wrote.
SOURCE:
This study was led by Andrea Giacomelli, MD, Università degli Studi di Milano, Milan, Italy. It was published online on August 01, 2025, in Clinical Infectious Diseases.
LIMITATIONS:
This study was limited by its retrospective design and the small sample size of four-drug-class-resistant patients. Recruiting the control group from a single centre introduced selection and information bias. Moreover, approximately 30% of four-drug-class-resistant participants lacked data on causes of death.
DISCLOSURES:
This study was conducted as a part of routine work of the PRESTIGIO Registry, which received support from ViiV Healthcare, Gilead Sciences, Merck Sharp & Dohme, and Janssen-Cilag. Some authors reported receiving consultancy fees, speaker honoraria, and honoraria for lectures and presentations and having other ties with the registry funders and various pharmaceutical companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
3 minutes ago
- Medscape
Frailty Status Predicts Outcomes After Hospital Discharge
TOPLINE: In older hospitalized adults, frailty was associated with discharge to postacute care facilities and a higher risk for readmissions and mortality. METHODOLOGY: Researchers conducted a retrospective cohort study to examine whether frailty was associated with the various facilities patients were discharged to and their health outcomes. The analysis included over 23,000 patients aged 65 years or older (53% women) who were hospitalized for at least 24 hours between 2021 and 2023 at five hospitals within a US-based academic health system. An electronic health record-based frailty index capturing 54 age-related health deficits was calculated at the most recent outpatient visit before hospitalization. Patients were classified as non-frail, pre-frail, frail, or severely frail. Overall, 22% of patients were identified as non-frail, 46% as pre-frail, 23% as frail, and 8% as severely frail. The hospital discharge destinations included home, home with home health services, and skilled nursing facilities (SNFs); health outcomes included rates of hospital readmission and post-discharge mortality. TAKEAWAY: Overall, 61% of patients were discharged home, 24% were discharged to SNF, and 15% were discharged home with home health services. Patients with higher degrees of frailty were more likely to be discharged to SNFs or home healthcare than to home alone (adjusted odds ratio [aOR], 1.20; 95% CI, 1.09-1.33 for frail and aOR, 1.17; 95% CI, 1.03-1.34 for severely frail patients). Patients with frailty had higher odds of readmission within 90 days of discharge than those without frailty (aOR, 1.91; 95% CI, 1.67-2.20), with odds increasing as the degree of frailty increased; a similar pattern was observed for the risks for mortality within 90 days after discharge. Discharge to SNFs was associated with significantly higher mortality, with hazard ratios of 5.46 (95% CI, 4.43-6.73) and 2.06 (95% CI, 1.54-2.77) for those discharged home with home health services than those discharged to home alone. IN PRACTICE: 'Automated frailty assessment at hospital discharge can identify in real time the most vulnerable individuals — severely frail patients discharged to SNF — for pragmatic trials and population health interventions,' the authors wrote. 'Discharge with home health services, particularly for frail patients, may mitigate readmission risk.' SOURCE: This study was led by Charles T. Semelka, of the Department of Internal Medicine at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. It was published online on August 6, 2025, in Journal of the American Geriatrics Society. LIMITATIONS: Confounding factors, including functional status, caregiver support, illness severity, may have been unaccounted for. The study was conducted in only one healthcare system in the southeastern US. The analyses only included individuals with a frailty score. DISCLOSURES: This study received support from the Foundation of Post-Acute and Long-Term Care Medicine and Claude D. Pepper Older Americans Independence Center, Wake Forest School of Medicine. One author reported receiving grants from the funding agencies for activities related to this work and professional effort. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
3 hours ago
- Medscape
Anesthetic Gas Emissions Show Global Regional Disparities
TOPLINE: An analysis of greenhouse gas emissions from volatile anesthetic agents across 41 countries showed that Western nations have achieved significant reductions, but Asian countries continue to increase their use of the agents. South Korea and Japan reported the highest global per capita emissions. METHODOLOGY: Researchers conducted a multicounty analysis to estimate greenhouse gas emissions from volatile anesthetics using sales data obtained from IQVIA MIDAS and national medicines agencies. They calculated kilograms of carbon dioxide (CO 2 ) equivalents per capita as an indicator of greenhouse gas emissions focusing on sales of desflurane, isoflurane, and sevoflurane in 41 countries, representing approximately 35% of the global population. ) equivalents per capita as an indicator of greenhouse gas emissions focusing on sales of desflurane, isoflurane, and sevoflurane in 41 countries, representing approximately 35% of the global population. The analysis compared emissions among 27 nations in the European Union with those among other Western countries like Australia, Canada, New Zealand, the UK, and the US. Emissions among Asian countries such as China, Hong Kong, Japan, Malaysia, South Korea, Singapore, Taiwan, and Thailand were also analyzed. Time trends and percentage changes in greenhouse gas emissions related to the procurement of volatile anesthetics from 2018 to 2023 were presented for all the groups. TAKEAWAY: Canada, New Zealand, and the UK showed a 65%-95% reduction in CO 2 equivalent emissions, achieving levels below 0.5 kg of CO 2 equivalents per inhabitant by 2023. Australia and the United States, despite reductions, still had higher levels of emissions. equivalent emissions, achieving levels below 0.5 kg of CO equivalents per inhabitant by 2023. Australia and the United States, despite reductions, still had higher levels of emissions. Asian countries saw substantial increases in emissions related to volatile anesthetics, with South Korea and Japan having approximately 2.5 kg of CO 2 equivalents per inhabitant in 2023 and China experiencing a 130% rise in emissions from 2018 to 2023. equivalents per inhabitant in 2023 and China experiencing a 130% rise in emissions from 2018 to 2023. Emissions also increased from 2018 to 2023 in some countries, including Malta, Serbia, the Czech Republic, and the Russian Federation. Trends in emissions varied across Europe; Northern countries like Finland, Norway, and the UK showed a reduction in emissions from 1-2 kg to less than 0.5 kg of CO 2 equivalents per inhabitant, whereas Denmark and Estonia maintained low levels of emissions. Italy, Portugal, and Spain saw minimal reductions. IN PRACTICE: 'The experience of nations that were receptive to awareness campaigns and phased out desflurane use show that reducing emissions below 0.5 kg of CO 2 e [equivalents] per inhabitant is attainable. This success should serve as a model for all the other countries, prompting them to implement educational initiatives for anaesthetists and adopt specific policies to mitigate emissions from inhalational anaesthetics,' the researchers reported. SOURCE: The study was led by Marta Caviglia, of the Centre for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, at the Università del Piemonte Orientale in Novara, Italy. It was published online on August 6, 2025, in Anaesthesia. LIMITATIONS: The study considered only greenhouse gas emissions from atmospheric release of volatile anesthetic agents, not accounting for emissions during production, packaging, transport, storage, and disposal phases. While data were available for 41 countries, there was clear overrepresentation of high-income nations, with incomplete or unavailable data from South America, Africa, and some Asian countries, including India. The analysis did not account for nitrous oxide emissions. DISCLOSURES: No external funding or competing interests were declared by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
3 hours ago
- Medscape
Multiple Chronic Conditions Tied to Poor Prognosis in RA
TOPLINE: In patients with rheumatoid arthritis (RA), the presence of multiple chronic conditions was associated with an increased likelihood of disease flare and reduced odds of achieving remission. METHODOLOGY: Researchers conducted a retrospective, population-based study to investigate how multiple chronic conditions and adverse social determinants of health influence disease activity in patients with RA. They analyzed the data of 659 patients with incident RA diagnosed between January 1999 and December 2014 (median age, 55.3 years; 69.7% women); each participant was required to have complete medical history of at least 1 year. A list of 55 chronic medical conditions was used to identify multimorbidity (two or more conditions) and substantial multimorbidity (five or more conditions); the burden of adverse social determinants of health was assessed using the Area Deprivation Index and Social Vulnerability Index, considering factors such as socioeconomic status, housing quality, and education, among others. Flare was identified as a worsening of disease requiring initiation, change, or escalation of treatment; remission was identified as having no more than one tender or swollen joint and normal inflammatory markers The patients were followed for a median duration of 10.3 years and had a median number of 13 RA-related visits during the follow-up period. TAKEAWAY: Among the participants, 73.3% of patients had multimorbidity and 36.1% had substantial multimorbidity. Patients with multimorbidity had 29% higher odds of an RA-related visit for disease flare and those with substantial multimorbidity had 26% higher odds (P < .05 for both); multimorbidity and substantial multimorbidity were also associated with significantly lower odds of a visit due to remission (odds ratios, 0.66 and 0.67, respectively; P < .05 for both). Each 0.1 increase in the Social Vulnerability Index above 0.3 was associated with 8% lower odds of achieving remission (P < .05). Female sex, current smoking, younger age, and shorter disease duration were associated with higher odds of a flare visit; on the contrary, male sex, never smoking, and longer disease duration were associated with higher odds of a remission visit. Seropositivity showed no significant association with either outcome. IN PRACTICE: 'Multimorbidity shows potential to act as a prognostic factor for RA disease activity and can be readily adapted to real-world clinical settings. Increased attention to multimorbidity would help identify patients at risk of poor disease control, signaling to clinicians to consider more aggressive intervention early on,' the authors of the study wrote. SOURCE: This study was led by Daniel Montes, MD, Mayo Clinic, Rochester, Minnesota. It was published online on August 5, 2025, in RMD Open. LIMITATIONS: This retrospective study relied on diagnostic codes for identifying comorbidities. The use of disease-modifying antirheumatic drugs could not be accounted for. The study population was predominantly White (88%), limiting generalizability. DISCLOSURES: This study was supported by grants from the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and National Institute on Aging. One author reported receiving intellectual property/patents from Girhilet, NLC Health Ventures, and Remission Medical and grant/research support from Pfizer. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
