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Medical Forum / Diseases and Disorders / AIDS / October 2004

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Pneumonia risk doubles

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PaulKing - 24 Oct 2004 09:59 GMT
“...HAART was associated with [greater than two times] increased risk of
developing bacterial pneumonia and [a 15-fold increase in the likelihood
of developing] NHL [Non-Hodgkins Lymphoma]...Perhaps the development of
lymphoma is somehow triggered by the therapy itself.”

Chest. 2001 Dec;120(6):1888-93
– Wolff AJ, O’Donnell AE, Aids Researchers
GMCarter - 24 Oct 2004 11:13 GMT
>“...HAART was associated with [greater than two times] increased risk of
>developing bacterial pneumonia and [a 15-fold increase in the likelihood
[quoted text clipped - 3 lines]
>Chest. 2001 Dec;120(6):1888-93
>– Wolff AJ, O’Donnell AE, Aids Researchers

Once again, context is important. You and W seem to enjoy completely
distorting the meaning of a comment by taking it so totally out of
context it can only be considered a lie. The original abstract:

STUDY OBJECTIVES: To determine whether the spectrum of HIV-related
pulmonary disease seen by a university medical center Pulmonary and
Critical Care Medicine Service has changed since the introduction of
highly active antiretroviral therapy (HAART). DESIGN: Retrospective
chart review. SETTING: A tertiary care university hospital. PATIENTS:
All HIV-infected patients referred to the Pulmonary and Critical Care
Medicine Service from January 1, 1993, through December 31, 1995 (era
1) and from July 1, 1997, through June 30, 2000 (era 2).
INTERVENTIONS: Inpatient and outpatient charts were reviewed for data
regarding patient demographics, CD4 cell counts, viral load levels,
duration of HIV seropositivity, history of opportunistic infections,
and final diagnosis. RESULTS: Pneumocystis carinii pneumonia (PCP) was
less common in the HAART era than in the pre-HAART era, whereas
bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more common
in the HAART era than in the pre-HAART era. HAART was protective
against PCP (odds ratio [OR], 0.37; confidence interval [CI], 0.16 to
0.89) in a manner dependent on the CD4 cell count. Patients receiving
HAART were at increased risk for the development of bacterial
pneumonia (OR, 2.41; CI, 1.12 to 5.17) and NHL (OR, 15.11; CI, 3.14 to
28.32). A history of PCP indicated a risk factor for bacterial
pneumonia (OR, 2.14; CI, 1.13 to 4.04). A history of cytomegalovirus
infection indicated a risk factor for NHL (OR, 6.0; CI, 1.27 to
28.32). CONCLUSIONS: There have been significant changes in the
spectrum of HIV-related pulmonary complications seen by our Pulmonary
and Critical Care Medicine Service in the HAART era.

In a more recent abstract, they also note:
Wolff AJ, O'Donnell AE. HIV-related pulmonary infections: a review of
the recent literature. Curr Opin Pulm Med. 2003 May;9(3):210-214.

Division of Pulmonary, Critical Care, and Sleep Medicine Georgetown
University Medical Center Washington, DC 20007, USA.

Antimicrobial prophylaxis and highly active antiretroviral therapy
have changed the epidemiology and impact of pulmonary infection in
patients infected with the human immunodeficiency virus (HIV).
However, pulmonary infection remains a significant contributor to the
morbidity and mortality of such patients. Bacterial pneumonia and
tuberculosis remain common lung infections in this setting, especially
where appropriate prophylaxis is unavailable or when compliance with
such therapy is poor. Pneumonia related to Pneumocystis carinii also
remains a significant problem, especially as a presenting illness in
patients not yet known to be infected with HIV. Recrudescence of
"treated" infection as a manifestation of the immune reconstitution
syndrome may become more commonly encountered as more patients are
treated with highly active therapy.

        George M. Carter
PaulKing - 26 Oct 2004 01:44 GMT
"bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more common in
the HAART era than in the pre-HAART era."

Yes, context is everything!
GMCarter - 26 Oct 2004 10:49 GMT
>"bacterial pneumonia and non-Hodgkin's lymphoma (NHL) were more common in
>the HAART era than in the pre-HAART era."
>
>Yes, context is everything!

Indeed. Because more people live longer on treatment but then some may
be at greater risk of NHL or bacterial pneumonia than having  died of
PCP or cryptococcal meningitis or CMV. Like the things that killed
David Pasquarelli, who believed your bullshit that HIV doesn't cause
AIDS.

        George M. Carter
 
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