Abstract
Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.
Highlights
Because this study analyzed data obtained during the implementation of a routine program that provided diagnostic services to newly diagnosed HIV patients, informed consent was not requested for the Opportunistic infections (OIs) screening; a written informed consent for HIV testing was obtained by the health care facilities (HCFs) of the network
This study analyzes the situation of newly diagnosed HIV patients in Guatemala
The proportion of the newly diagnosed HIV patients presenting with advanced HIV disease (AHD) was 52%, which was
Summary
In 2017, the World Health Organization (WHO) published the first guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy [3]. These guidelines recommended a package of interventions oriented to reduce AIDS-related mortality while advising rapid diagnosis and treatment of major OIs. These guidelines recommended a package of interventions oriented to reduce AIDS-related mortality while advising rapid diagnosis and treatment of major OIs These recommendations are focused on people with advanced HIV disease (AHD), there may be benefits of screening strategies that reach all patients at higher risk, such as those newly diagnosed with HIV. We developed a prospective screening study to assess the burden of AHD, the incidence of four OIs, and the mortality at 180 days in a large cohort of newly diagnosed HIV patients in Guatemala
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