WCIM 2014 SEOUL KOREA 159
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0433 Infectious Disease
Anal and Dry Sex in Commercial Sex Work, and Rela- tion to Risk for Sexually Transmitted Infections and HIV
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI4 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2, Kenyatta National Hospital, Kenya3, Nairobi University, Kenya4
Background: To examine the practices of anal intercourse and dry sex within a cohort of female sex workers (FSWs) in Kenya, focusing on the prevalence and perceived risk of the practices, demographic and behavioural correlates, and association with sexual- ly transmitted infections (STI).
Methods: A survey was conducted among FSWs with 147 participants randomly sampled from an existing cohort of self identifi ed FSWs.Results: 40.8% of participants reported ever practising anal intercourse and 36.1% reported ever practising dry sex.
Although the majority of women surveyed believed anal intercourse and dry sex to be high risk practices for HIV infection compared with vaginal sex, about one third of women reported never or rarely using condoms during anal intercourse, and about 20% never or rarely using condoms during dry sex. Reported consistent condom use was lower with both of these practices than with penile-vaginal intercourse. Anal intercourse was associated with experience of recent forced sexual intercourse, while dry sex was not. Anal intercourse was almost always initiated by clients, whereas dry sex was likely to be initiated by the women themselves. Sex workers reported charging higher fees for both practices than for vaginal intercourse. Both practices were associ- ated with reported symptoms and diagnoses of STI.
Conclusions: Both anal intercourse and dry sex were common in this sample, and although perceived as high risk practices, were not adequately protected with condom use. Education and other interventions regarding these high risk sexual behaviours need to be translated into safer practices, particularly consistent condom use, even in the face of fi nancial vulnerability.
PS 0435 Infectious Disease
Adverse Outcomes after Major Surgery in HIV-Infected Patients: A Nationwide Matched Cohort Study
Chien-Chang LIAO1, Ta-Liang CHEN1 Taipei Medical University, Taiwan R.O.C1
Background: Patients with infection of human immunodeficiency virus (HIV) were known to have a higher risk of complications during hospitalization. However, the association between HIV-infection and postoperative adverse events were not com- pletely understood.
Methods: We conducted a population-based study in 2566 HIV-infected patients and 10,264 non-HIV controls receiving major surgery from the Taiwan National Health Insurance Research Database in 2004 and 2010. Propensity-score methods were used to construct a matched-pairs cohort that reduced important baseline differences between patients who with and without HIV infection. Adjusted rate ratios (RRs) and 95% confi dence intervals (CIs) of major postoperative complications and 30-day mortality were evaluated among HIV-infected patients with different severity in the multivariable logistic regressions.
Results: After the adjustment, HIV-infected patients had higher risks of postoperative pneumonia (RR 1.66; 95% CI 1.25-2.20), septicemia (RR 1.32; 95% CI 1.08-1.62), acute renal failure (RR 2.15; 95% CI 1.27-3.66), surgical site infection (RR 1.59; 95%
CI 1.38-1.82) and overall complications (RR 1.46; 95% CI 1.31-1.61). Compared with surgical patients without HIV infection, HIV-infected patients had increased 30-day postoperative mortality (RR 2.71; 95% CI 1.82-4.05), particularly in those with viral hepatitis (RR 4.14; 95% CI 2.23-7.70), pulmonary tuberculosis (RR 11.1; 95% CI 3.39- 36.4), diabetes (RR 6.20; 95% CI 2.11-18.2), preoperative HIV-related hospitalization (RR 3.70; 95% CI 2.38-5.74), opportunistic infection (RR 6.31; 95% CI 3.50-11.4) and highly active antiretroviral therapy (RR 4.14; 95% CI 2.34-7.33).
Conclusions: HIV-infected patients showed signifi cantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly fi vefold when compared with pa- tients without HIV infection. Our fi ndings suggest the urgency revising the protocol of postoperative care for this specifi c population.
PS 0436 Infectious Disease
Candidemia: A Poor Prognosis. Experience of 104 Cases
Marta PEREZ DE LIS NOVO1, Emma FILGUEIRA DAVILA2, Julian FERNANDEZ MARTIN1, Jorge PEREIRA TAMAYO2, Candido DIAZ LAGARES3, Alexandre PEREZ GONZALEZ1, Begoña MACHADO1, Roberto PEREZ ALVAREZ1
Internal Medicine, Meixoeiro Hospital, Spain1, Anaesthesia, Meixoeiro Hospital, Spain2, Vall d’ Hebron, Spain3
Background: To analyze the clinical features, epidemiology, diagnosis and treatment of candidemia treated in a tertiary care hospital.
Methods: From 2007 to 2013, patients with candidemia were identifi ed at a hospital in Spain.The medical records of all patients with bloodstream infections due to Can- dida species were retrospectively reviewed.
Results: During the six-year period, a total of 104 episodes of candidemia were iden- tifi ed, 70 men (67%) and 46 women (33%), with a mean age of 65 years (range 16- 83). risk factors for candidemia were: neoplasms (41%), diabetes (25%) and renal failure (16%). Candidemia was associated with the presence of invasive devices such as central venous catheter (52%), urinary catheter (48%) and the presence of previous antibiotic treatment (80%) and abdominal surgery (42%). The most frequent form of clinical presentation was sepsis in 67 patients (65.7%) and seven patients were diag- nosed with endocarditis. C. albicans (46%) was the most common pathogen, followed by C. parapsilosis (24%) and C. glabrata (17%). (8%). Ninety-three patients (89%) received empirical antifungal therapy and in 72 (78%) was appropriate. Antifungal ad- ministered in order of frequency were: fl uconazole 68 patients (65%), caspofungin at 9 (9.5%), amphotericin B, 8 (7%) and voriconazole (2%). Mortality in the fi rst 30 days following the candidemia was 46% (n = 48). Risk factors that were associated with mortality were age> 60 years (p = 0.002), insuffi cient renal (p = 0.03), candidemia unknown focus, or abdominal focus (p = 0.008) and empirical treatment Inappropriate (p = 0.001).
Conclusions: The mortality of candidemia in our country is high, and inappropriate treatment is the only factor improved prognosis. A high index of suspicion is essential for diagnosis. The existence of protocols and practice guidelines are necessary to im- prove the management of infection and prognosis.
PS 0437 Infectious Disease
Predictors of Mortality in HIV-1 Infected Children on Antiretroviral Therapy in Kenya
Njeri Rahab MBUGUA1, Asunta Wagura WAGURA2, Elizabeth Ann BUKUSI4 Kenya Medical Research Institute, Kenya1, Kenya Network of Women Living with HIV/AIDS, Kenya2, Kenyatta National Hospital, Kenya3, Nairobi University, Kenya4
Background: Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to defi ne correlates of mortality in order to improve outcome.
Methods: HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.
Results: Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log10 copies/ml. Twenty children (13.4%) died at a median of 35 days post- HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in fi rst 4 months and 1.0 deaths/100 child- years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight- for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).
Conclusions: High early mortality was observed in this cohort of Kenyan children re- ceiving HAART, and low baseline hemoglobin was an independent risk factor for death.
