Point-of Care Ultrasound for Patients With HIV

NCT ID: NCT04246983

Last Updated: 2022-12-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-01

Study Completion Date

2022-12-01

Brief Summary

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Rationale: Point-of-care ultrasound (POCUS) is increasingly used by various specialists in the Netherlands, but its role in managing patients with HIV is unclear. In settings endemic for tuberculosis, Fast Assessment with Sonography for HIV/Tuberculosis (FASH) has proven its value to detect extrapulmonary tuberculosis in patients with HIV. However, there is no data to support POCUS for patients with HIV in resource affluent settings.

Objective: The investigators aim to determine the feasibility and diagnostic value of POCUS in detecting opportunistic disease in HIV patients with advanced disease stages in the Netherlands.

Study design: The investigators will perform a prospective observational pilot study.

Study population: The investigators will include new adult patients with HIV presenting with a cluster of differentiation 4 (CD4) T-cell count below 350 cells/mm3, and all adult HIV patients requiring admission to hospital. Intervention (if applicable): The investigators will perform a focused ultrasound examination including FASH, and ultrasound of the lung, liver and kidneys. In case of positive findings additional examinations will be undertaken to determine the underlying pathology and/or treatment started as indicated. In case of negative findings, patients will be followed for 12 months to observe for (possibly missed) opportunistic infections.

Main study parameters/endpoints: Our primary outcomes include acceptability of POCUS by patients, interobserver variation in interpretation of POCUS images, and number of diagnosed AIDS and non-AIDS related problems. Secondary outcomes include sensitivity and specificity, negative predictive value and positive predictive value of our POCUS protocol. In addition, incidence rates of opportunistic infections will be compared to a historical matched control group.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The ultrasound examination is painless and without risk to the participants. It will take approximately 30 minutes and will be combined with routine visits to the hospital. Benefits include potential earlier detection of opportunistic disease, while adverse effects may arise from false positive findings requiring further examinations which may cause stress or anxiety. The rate of false positive findings in POCUS has not been formally investigated, but appears low. The effect of POCUS in advanced HIV/AIDS can only be studied in HIV patients.

Detailed Description

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Conditions

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HIV/AIDS Opportunistic Infections, HIV Related

Keywords

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HIV Opportunistic disease Ultrasound

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Patients with HIV undergoing point of care ultrasound

Group Type EXPERIMENTAL

Opportunistic infection Ultrasound (OpUS) screening

Intervention Type DIAGNOSTIC_TEST

this point-of-care ultrasound protocol will include lung ultrasound, assessment of pericardial and pleural effusions, ascites, abdominal lymphadenopathy and splenic micro abscesses, as well as a focused ultrasound of liver and kidneys.

Interventions

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Opportunistic infection Ultrasound (OpUS) screening

this point-of-care ultrasound protocol will include lung ultrasound, assessment of pericardial and pleural effusions, ascites, abdominal lymphadenopathy and splenic micro abscesses, as well as a focused ultrasound of liver and kidneys.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* new patients with HIV presenting with a CD4 T-cell count below 350 cells/mm3
* patients with HIV who are admitted to hospital

Exclusion Criteria

\- absence of informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Erasmus Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Mischa Huson

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mischa Huson, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Erasmus Medical Centre

Locations

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Erasmus MC

Rotterdam, , Netherlands

Site Status

Countries

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Netherlands

References

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Heller T, Wallrauch C, Goblirsch S, Brunetti E. Focused assessment with sonography for HIV-associated tuberculosis (FASH): a short protocol and a pictorial review. Crit Ultrasound J. 2012 Nov 21;4(1):21. doi: 10.1186/2036-7902-4-21.

Reference Type BACKGROUND
PMID: 23171481 (View on PubMed)

Heller T, Mtemang'ombe EA, Huson MA, Heuvelings CC, Belard S, Janssen S, Phiri S, Grobusch MP. Ultrasound for patients in a high HIV/tuberculosis prevalence setting: a needs assessment and review of focused applications for Sub-Saharan Africa. Int J Infect Dis. 2017 Mar;56:229-236. doi: 10.1016/j.ijid.2016.11.001. Epub 2016 Nov 9.

Reference Type BACKGROUND
PMID: 27836795 (View on PubMed)

Giordani MT, Tamarozzi F, Kaminstein D, Brunetti E, Heller T. Point-of-care lung ultrasound for diagnosis of Pneumocystis jirovecii pneumonia: notes from the field. Crit Ultrasound J. 2018 Apr 17;10(1):8. doi: 10.1186/s13089-018-0089-0.

Reference Type BACKGROUND
PMID: 29666966 (View on PubMed)

Hunter L, Belard S, Janssen S, van Hoving DJ, Heller T. Miliary tuberculosis: sonographic pattern in chest ultrasound. Infection. 2016 Apr;44(2):243-6. doi: 10.1007/s15010-015-0865-8. Epub 2015 Dec 11.

Reference Type BACKGROUND
PMID: 26661658 (View on PubMed)

Agostinis P, Copetti R, Lapini L, Badona Monteiro G, N'Deque A, Baritussio A. Chest ultrasound findings in pulmonary tuberculosis. Trop Doct. 2017 Oct;47(4):320-328. doi: 10.1177/0049475517709633. Epub 2017 May 25.

Reference Type BACKGROUND
PMID: 28541140 (View on PubMed)

Giordani MT, Brunetti E, Binazzi R, Benedetti P, Stecca C, Goblirsch S, Heller T. Extrapulmonary mycobacterial infections in a cohort of HIV-positive patients: ultrasound experience from Vicenza, Italy. Infection. 2013 Apr;41(2):409-14. doi: 10.1007/s15010-012-0336-4. Epub 2012 Sep 24.

Reference Type BACKGROUND
PMID: 23001543 (View on PubMed)

Schouten M, van Velde AJ, Snijdewind IJ, Verbon A, Rijnders BJ, van der Ende ME. [Late diagnosis of HIV positive patients in Rotterdam, the Netherlands: risk factors and missed opportunities]. Ned Tijdschr Geneeskd. 2013;157(15):A5731. Dutch.

Reference Type BACKGROUND
PMID: 23575291 (View on PubMed)

French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS. 2004 Aug 20;18(12):1615-27. doi: 10.1097/01.aids.0000131375.21070.06.

Reference Type BACKGROUND
PMID: 15280772 (View on PubMed)

Huson M, Rokx C. Exploring the role of point-of-care ultrasound for people with HIV in a resource affluent setting: A prospective observational study. Int J STD AIDS. 2023 Nov;34(13):984-989. doi: 10.1177/09564624231188744. Epub 2023 Jul 27.

Reference Type DERIVED
PMID: 37500120 (View on PubMed)

Other Identifiers

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NL72666.078.20

Identifier Type: -

Identifier Source: org_study_id