Abstract
BackgroundOpportunistic illnesses still account for a huge proportion of hospitalizations and deaths among HIV-infected patients in the post combination antiretroviral therapy (cART) era, particularly in middle- and low-income countries. The aim of this study was to assess predictors of the top four most incident opportunistic illnesses (tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jiroveci pneumonia) in an HIV clinical cohort from a middle-income country in the post cART era.MethodsA total of 2835 HIV infected participants aged ≥ 18 years at enrollment were followed from January 2000 to December 2012 until the occurrence of their first opportunistic illness, death or end of study, whichever occurred first. Extended Cox proportional hazards regression models, stratified by use of cART, were fitted to assess predictors of opportunistic illness incidence during follow-up.ResultsThe incidence rates of tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jiroveci pneumonia were 15.3, 8.6, 6.0, 4.8 per 1000 persons-year, respectively. Disease specific adjusted Cox models showed that presence of an opportunistic illness at enrollment significantly increased disease incidence while higher nadir CD4+ T lymphocyte count had a significant protective effect in patients not in use of cART. Duration of cART use also significantly reduced disease incidence.ConclusionsOur findings show that, still in the post-cART era, prevention of opportunistic infections can be achieved by preventing immune deterioration by instituting early use of cART. Interventions focusing on early diagnosis and linkage to care in addition to the prompt initiation of cART are essential to reduce the incidence of opportunistic illnesses among HIV infected patients in post-cART era.
Highlights
Opportunistic illnesses still account for a huge proportion of hospitalizations and deaths among HIVinfected patients in the post combination antiretroviral therapy era, in middle- and low-income countries
Cases of tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jirovecci pneumonia (PCP) accounted for 71 % (402 out of 566) of the diseases
There was a significant difference in Tuberculosis Esophageal candidiasis Cerebral toxoplasmosis PCP
Summary
Opportunistic illnesses still account for a huge proportion of hospitalizations and deaths among HIVinfected patients in the post combination antiretroviral therapy (cART) era, in middle- and low-income countries. The aim of this study was to assess predictors of the top four most incident opportunistic illnesses (tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jiroveci pneumonia) in an HIV clinical cohort from a middle-income country in the post cART era. Despite the virological control and immunological recovery achieved with the use of combination antiretroviral therapy (cART), opportunistic illnesses continue to occur at an unacceptable frequency and account for a huge proportion of hospitalizations and deaths in HIV infected patients in post-cART era [1,2,3,4,5,6]. We assessed the predictors of the four most incident opportunistic illnesses in the post-cART era in an urban cohort from a middleincome country [15]
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