Human immunodeficiency virus in chronic limb-threatening ischaemia: Risk factors, management, and outcomes: A South African retrospective cohort study.
Craig Corbett, Helene Louwrens, Tonya M Esterhuizen, Daniel C Germishuys, Reinhard Hayes
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引用次数: 0
Abstract
Background: People living with human immunodeficiency virus (PLHIV) have an increased risk of chronic limb-threatening ischaemia (CLTI), yet data from sub-Saharan Africa in the modern antiretroviral era remain limited. We estimated the human immunodeficiency virus (HIV) prevalence in patients admitted with index CLTI and compared risk factors and outcomes with those of their seronegative counterparts.
Methods: Retrospective study of adults admitted with CLTI to Tygerberg Hospital (2016-2022). Patients identified via discharge summaries were corroborated with medical records. Clinical and HIV status data were extracted from medical and laboratory records.
Results: Among 1205 patients admitted with index CLTI, the estimated prevalence of HIV was 3.5% (95% CI: 2.5% - 4.7%), with 588 confirmed HIV-negative (48.8%) and 575 with unknown HIV status (47.7%). The PLHIV cohort was 69% male compared to 64% in the HIV-negative group (p = 0.511). The mean age of PLHIV with CLTI was 51 years (± 9 years) compared to 62 years (± 11 years) (p < 0.001). People living with human immunodeficiency virus were less than half as likely to undergo endovascular therapy as their definitive management although not statistically significant (7.1% vs 17.8%; odds ratios: 0.49, 95% CI: 0.13-1.93, p = 0.305). A similar proportion of PLHIV and HIV-negative patients underwent open revascularisation (23.8% vs 22.8%, p = 0.652). Surgical management had similar rates of successful outcomes (defined as below ankle amputation or better, 90% vs 95.5%, p = 0.433). We found no difference in in-hospital mortality rates.
Conclusion: People living with HIV were younger and had fewer risk factors for CLTI than their HIV-negative counterparts. In-hospital revascularisation outcomes, complication rates and mortality were similar.
Contribution: Further study is needed regarding the district hospital HIV burden and long-term outcomes in these patients.
背景：人类免疫缺陷病毒（PLHIV）感染者患慢性肢体威胁性缺血（CLTI）的风险增加，然而在现代抗逆转录病毒时代来自撒哈拉以南非洲的数据仍然有限。我们估计了患有CLTI指数的患者的人类免疫缺陷病毒（HIV）患病率，并将危险因素和结果与血清阴性的患者进行了比较。方法：对2016-2022年泰格伯格医院收治的CLTI成人患者进行回顾性研究。通过出院总结确定的患者与医疗记录相吻合。从医疗和实验室记录中提取临床和艾滋病毒状况数据。结果：在1205例CLTI指数患者中，估计HIV患病率为3.5% (95% CI: 2.5% - 4.7%)，其中588例确诊HIV阴性（48.8%），575例未知HIV状态（47.7%）。PLHIV队列中男性占69%，而hiv阴性组中男性占64% （p = 0.511）。PLHIV合并CLTI患者的平均年龄为51岁（±9岁），而CLTI患者的平均年龄为62岁（±11岁）（p < 0.001）。人类免疫缺陷病毒感染者接受血管内治疗的可能性不到其最终治疗方法的一半，尽管没有统计学意义（7.1% vs 17.8%；优势比：0.49,95% CI: 0.13-1.93, p = 0.305）。PLHIV和hiv阴性患者接受开放性血运重建术的比例相似（23.8% vs 22.8%, p = 0.652）。手术治疗的成功率相似（定义为踝关节以下截肢或更好，90% vs 95.5%, p = 0.433）。我们发现住院死亡率没有差异。结论：与HIV阴性人群相比，HIV感染者更年轻，CLTI的危险因素更少。住院血运重建结果、并发症发生率和死亡率相似。贡献：需要进一步研究地区医院艾滋病毒负担和这些患者的长期预后。
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