Abstract
ObjectivesThe accurate prevalence of acquired immunodeficiency syndrome (AIDS)-defining illnesses (ADIs) in human immunodeficiency virus (HIV)-infected patients has not been well investigated. Hence, a longitudinal nationwide surveillance study analyzing the current status and national trend of opportunistic complications in HIV-infected patients in Japan is warranted.MethodsA nationwide surveillance of opportunistic complications in HIV-infected patients from 1995 to 2017 in Japan was conducted. An annual questionnaire was sent to 383 HIV/AIDS referral hospitals across Japan to collect information (CD4+ lymphocyte count, time of onset, outcome, and antiretroviral therapy [ART] status) of patients diagnosed with any of 23 ADIs between 1995 and 2017.ResultsThe response and case capture rates of the questionnaires in 2017 were 53% and 76%, respectively. The number of reported cases of opportunistic complications peaked in 2011 and subsequently declined. Pneumocystis pneumonia (38.7%), cytomegalovirus infection (13.6%), and candidiasis (12.8%) were associated with the cumulative incidence of ADIs between 1995 and 2017. The mortality rate in HIV-infected patients with opportunistic complications substantially decreased to 3.6% in 2017. The mortality rate was significantly higher in HIV patients who received ART within 14 days of diagnosis of complications than in those who received ART 15 days after diagnosis (13.0% vs. 3.2%, p < 0.01).ConclusionsWe have demonstrated a 23-year trend of a newly diagnosed AIDS status in Japan with high accuracy. The current data reveal the importance of Pneumocystis pneumonia as a first-onset illness and that early initiation of ART results in poor outcomes in HIV patients in Japan.
Highlights
As of 2018, a total of 37.9 million people were living with human immunodeficiency virus (HIV), and 770,000 people have died from HIV-related causes worldwide annually [1]
The mortality rate in HIV-infected patients with opportunistic complications substantially decreased to 3.6% in 2017
The mortality rate was significantly higher in HIV patients who received antiretroviral therapy (ART) within days of diagnosis of complications than in those who received ART days after diagnosis (13.0% vs. 3.2%, p < 0.01)
Summary
As of 2018, a total of 37.9 million people were living with human immunodeficiency virus (HIV), and 770,000 people have died from HIV-related causes worldwide annually [1]. The Ministry of Health, Labour and Welfare (MHLW) of Japan reported that approximately 30% of HIV-infected patients in Japan are unaware of their HIV infection and present with one of 23 diseases or acquired immunodeficiency syndrome (AIDS)-defining illnesses (ADIs) as the initial indicator of AIDS. These ADIs have been defined by the Japanese government for the purpose of national surveillance and reporting (S1 Table); the list of diseases may partially vary from those in other countries [3,4,5].
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