Incidence Rates Of Opportunistic Infections Research Articles

The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia.

Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011-2013 to 6.7 in 2017-2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011-2013 and 2017-2020. Lower hazard of OIs were found in those with age at first ART 2-14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.

P186 Long-term safety of ixekizumab in adult patients with psoriasis, psoriatic arthritis, and axial spondyloarthritis

P186 Long-term safety of ixekizumab in adult patients with psoriasis, psoriatic arthritis, and axial spondyloarthritis

Incidence and predictors of common opportunistic infection among HIV -infected children attending antiretroviral treatment clinic at Northeast Ethiopia, public hospitals 2022: A multicenter retrospective follow-up study.

Opportunistic infections (OIs) are illnesses that attack people with weakened immune systems, such as HIV patients, more frequently and severely. The majority of opportunistic infections (OIs) are the leading causes of morbidity and mortality in HIV/AIDS patients, emerging at the end of the illness. The objective of this study was to assess the incidence and risk factors of opportunistic infections (OIs) in HIV-infected children receiving antiretroviral therapy in public hospitals in Northeast Ethiopia. A multicenter retrospective follow-up study was undertaken at public hospitals in northeast Ethiopia from September 1, 2010, to January 30, 2022. A total of 341 HIV-infected children on antiretroviral therapy were included in the study. Data was entered using Epi-Data Manager version 4.6.1, and it was analyzed using STATA version 16.1. The opportunistic infection free-survival time was estimated using the Kaplan-Meier survival curve. Bivariable and multivariable Cox proportional hazard models were used to investigate the determinants of opportunistic infections. The overall incidence rate of opportunistic infections (OIs) was 6.0 (95% CI: 5.0-7.1) per 100 child-years of observation. This study's participants were observed for a minimum of 9 months and a maximum of 122 months, for a total of 21,629 months, or 1802.4 years. Children with WHO clinical stages III and IV (AHR: 1.77; 95% CI: 1.13, 2.77), non-users of Cotrimoxazole Preventive Therapy (CPT) (AHR: 2.10; 95% CI: 1.40, 3.08), and low hemoglobin levels (10mg/dl) (AHR: 1.88; 95% CI: 1.25, 2.82) were identified as significant predictors of opportunistic infection. In this study, the incidence rate of opportunistic infections among HIV-infected children was found to be high when compared to other studies. Low hemoglobin levels (10mg/dl), low CD4 counts or percentages, clinical stages III and IV, and non-users of CPT were all associated with higher rates of opportunistic infection.

Time to occurrence, predictors, and patterns of opportunistic infections incidence among HIV-positive patients attending Antiretroviral Therapy Clinic of Salale University Comprehensive Specialized Hospital: A retrospective cohort study.

Opportunistic infections (OIs) in HIV patients are infections that are more common or more severe as a result of HIV-mediated immunosuppression. The advances in the capacity of antiretroviral therapy (ART) have diminished the incidence of OIs. However, even in the ART era, HIV-related OIs continue to be major causes of hospitalization and mortality. Therefore, this study aims to identify time to occurrence, predictors, and patterns of OIs incidence among HIV-positive patients attending ART clinic of Salale University Comprehensive Specialized Hospital, Ethiopia. A retrospective cohort study was conducted between 1st September 2016 and 1st September 2021. All 419 patients diagnosed during the study period were recruited. Data were extracted from both patient medical records and ART logbooks. Stata-16 was used for data analysis. Follow-up time was calculated from the date of HIV diagnosis to the date of OIs occurrence or censoring. Cox proportional hazards regression model was used to identify the predictors of OIs incidence. The total person-time of the follow-up was 8656 person-months of observation. During the follow-up time, 199 (47.49%) of the patients had developed OIs. The incidence rate of OIs was 23 (95%CI: 20, 26) per 1000 person-months of observation. The median OIs free survival time was 36 (95%CI: 31, 40) months. Predictors such as residence, cd4 category, baseline hemoglobin level, ART side effects, isoniazid preventive therapy, and chronic disease comorbidity were significantly predicted OIs incidence. The study area’s OIs incidence remained high, requiring prompt action. To reduce the morbidity and mortality associated with OIs, HIV-positive patients with the predictors of rural residence, low CD4 category, low baseline hemoglobin level, ART side effects, not taking IPT, and baseline chronic disease comorbidity necessitate close follow-up and monitoring. Thus, we recommend focused and evidence-informed strategies to address OIs burden and improve outcomes.

PERFIL DE RESISTÊNCIA DE AGENTES DE MICOSES OPORTUNISTAS NO BRASIL

O uso indiscriminado de antifúngicos vem contribuindo com a mudança no perfil epidemiológico de fungos resistentes, elevando a taxa de mortalidade nos pacientes acometidos. No Brasil, devido à ausência de dados oficiais, não existem relatos precisos sobre a primeira detecção de resistência a antifúngicos. Entretanto, dentre os agentes causadores de micoses oportunistas a espécie mais isolada é a Candida albicans, além de outras espécies como Cryptococcus neoformans, Sporothrix schenckii e Aspergillus spp. têm sido descritas. Este estudo buscou evidenciar o progressivo aumento dos índices de resistência de fungos oportunistas aos antifúngicos comumente utilizados e ressaltar a importância do conhecimento do perfil de sensibilidade antes do início do tratamento, pois o tratamento incorreto destas infecções agrava as falhas terapêuticas e leva à remissão das micoses. Realizou-se revisão de literatura científica com base no banco de dados Bireme, Scielo, Pubmed e Google Acadêmico, utilizando como descritores: Candida albicans, Sporothrix schenckii, Cryptococcus neoformans, Aspergillus spp., micoses oportunistas, resistência, resistência em micoses oportunistas, perfil de resistência e resistência fúngica no Brasil. Os mesmos foram pesquisados em português, inglês e espanhol. Com o crescente número de pacientes imunocomprometidos os índices de infecções oportunistas aumentaram. Patógenos fúngicos oportunistas, pertencentes a estes gêneros, mostraram-se resistentes aos poliênicos (anfotericina B), imidazóis (cetoconazol, miconazol, econazol), flucitosina, triazóis (voriconazol, fluconazol, itraconazol) e multiazóis em muitos estudos. A utilização inadequada de alguns antifúngicos vem contribuindo para o aumento de taxas de incidência de infecções oportunistas, principalmente por cepas resistentes, piorando o prognóstico destes pacientes.

Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study

BackgroundOpportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital.MethodsA facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections.ResultsThis study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having “fair” or “poor” ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections.ConclusionsIn this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, “fair” or “poor” ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.

Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study

ObjectiveTo estimate and compare the burdens of opportunistic infections and herpes zoster in real-world practice among patients with various systemic rheumatic diseases.MethodsThis 13-year cohort study used national health insurance data to compare the incidence rates (IRs) of nine opportunistic infections among patients with five rheumatic diseases. The analyses were stratified according to follow-up duration using Poisson regression, and Cox models were used to compare the risk of first opportunistic infection.ResultsDuring 2000–2013, we identified 76,966 patients who had polymyositis/dermatomyositis (PM/DM, 2270 cases), systemic lupus erythematosus (SLE, 15,961 cases), systemic sclerosis (SSc, 2071 cases), rheumatoid arthritis (RA, 38,355 cases), or primary Sjögren’s syndrome (pSS, 18,309 cases). The IR of opportunistic infections was highest for PM/DM cases (61.3/1000 person-years, 95% confidence interval [CI] 56.6–66.2), followed by SLE cases (43.1/1000 person-years, 95% CI 41.7–44.5), SSc cases (31.6/1000 person-years, 95% CI 28.3–35.1), RA cases (25.0/1000 person-years, 95% CI 24.4–25.7), and pSS cases (24.1/1000 person-years, 95% CI 23.1–25.2). Multivariable Cox analysis revealed that, relative to SLE, PM/DM was associated with a significantly higher risk of opportunistic infections (hazard ratio 1.18, 95% CI 1.08–1.29). The risk of opportunistic infections was highest during the first year after the diagnosis of all five rheumatic diseases.ConclusionsThe risk of opportunistic infection was highest for PM/DM, followed by SLE, SSc, RA, and pSS. Careful observation and preventive therapy for opportunistic infections may be warranted in selected PM/DM patients, especially during the first year after the diagnosis.

Increased risk of opportunistic infection in early rheumatoid arthritis.

To estimate incidence rate (IR) and risk factors for opportunistic infections (OI) in early rheumatoid arthritis (RA) patients. Retrospective cohorts were identified in the Korean National Claims Database. Incident RA cases were recruited in 2010 (n=14 081). Follow up was ended at the time of development of new OI or at the date of last visit within 12months of diagnosis. The IR and standardized incidence ratio (SIR) of OI in early and overall RA (n=226 838) over a year were calculated. A multivariable regression model was used to identify risk factors for OI in early RA. The IR of OI in early and overall RA were 3.81/100 and 3.67/100person-years, respectively. The SIR for OI in early RA was 1.14 (95% CI, 1.05-1.23). Herpes zoster (SIR=1.12, 95% CI, 1.03-1.22) and candidiasis (SIR=2.40, 95% CI, 1.55-3.54) were common in early RA. Age (50 < age ≤ 60 [OR 1.74, 95% CI, 1.30-2.33], 60 < age ≤ 70 [OR 1.85, 95% CI, 1.36-2.52], age > 70 [OR 1.89, 95% CI, 1.34-2.68]), female sex (OR 1.40, 95% CI, 1.12-1.74), comorbidities (one comorbidity [OR 1.53, 95% CI, 1.24-1.89], ≥ two comorbidities [OR 1.84, 95% CI, 1.47-2.29]),and corticosteroid use of 5mg/d or more (OR 1.38, 95% CI, 1.13-1.69) were significantly associated with increased risk of OI in early RA. Opportunistic infections, especially for herpes zoster and candidiasis, tend to occur more often in early RA than in overall RA. Age, female sex, comorbidities and corticosteroid use are related to increased OI in early RA patients.

Incidence of Opportunistic Infections among HIV-Positive Adults on Highly Active Antiretroviral Therapy in a Teaching Hospital, India: Prospective Study.

Oral manifestations in HIV infections are numerous and some of these are acknowledged as being of great importance in the early diagnosis of the disease. Many HIV-associated oral infections occur early in HIV disease, not infrequently as the presenting sign or symptom. Thus, early detection of the associated oral opportunistic infections should, in many cases, result in earlier diagnosis of HIV infection. Cytology, a simple, painless, and inexpensive method, has become a preferred method and was used in our study for early diagnosis of certain lesions. To determine the effect of highly active antiretroviral therapy on incidence rate of opportunistic infections among HIV-positive adults in a teaching hospital in India, a prospective study was conducted and the required sample size was 40. Study participants were selected randomly from the outpatient department of an HIV clinic who were currently on for antiretroviral therapy (ART). Data on age, gender, form of contagion, antiretroviral therapy at the time of review, number of CD4 lymphocytes per milliliter, and viral load were collected. Oral cytologic investigation was carried out and then stained for histopathological examination. A total of 40 individuals were examined and the incidence of opportunistic infections was 66.7% in individuals with CD4 counts less than 200, 55.6% in individuals with CD4 counts of 200 to 499, and 40.0% in individuals with CD4 counts more than 500. The incidence of opportunistic infection was higher in individuals with low CD4 counts in spite of being on ART.

Effect of Highly Active Antiretroviral Therapy on Incidence of Opportunistic Infections among HIV Positive Adults in Public Health Facilities of Arba Minch Town, South Ethiopia: Retrospective Cohort Study

Background: Studies of Antiretroviral Therapy program in Africa have shown high incidence rate of opportunistic infections in both Antiretroviral Therapy receiving and Pre ART Human Immunodeficiency Virus infected patients. However, incidence of opportunistic infections and factors that contribute for development of it were poorly described in Ethiopia especially in the study area. Objective: To determine the effect of HAART on incidence rate of opportunistic infections among HIV-positive adults in Public Health facilities of Arba Minch town. Method: Retrospective cohort study was used and the required sample size was 464. Study participants were selected randomly from the list of adult people living with HIV attending the public health facilities for ART. Univariate analysis was used to describe patients’ baseline and follow up characteristics. Kaplan-Meier survival and log rank test were used to estimate survival and compare survival curves respectively. Cox proportional-hazard regression model was used to determine independent predictors of incidence of opportunistic infections. Result: A total of 464 patients (232 in each cohort) contribute for 898.12 person years of follow up. The incidence of opportunistic infections was 55.8 per 100 person year and 3.4 per 100 person year of follow up in pre ART and HAART cohorts respectively. Being on HAART decreased occurrence of opportunistic infections by 93%. In contrary being male, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl are independent predictors of increased risk of opportunistic infections. Conclusion: The incidence of opportunistic infection was higher in pre ART cohort. Male gender, being widowed, substance use, rural residence and having baseline CD4 count of 350-499 cells/μl were independent predictors of increased risk of opportunistic infections.

Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial.

BackgroundIt has been well established that breastfeeding is beneficial for child health, however there has been debate regarding the effect of lactation on maternal health in the presence of HIV infection and the need for nutritional supplementation in HIV positive lactating mothers.AimsTo assess the effect of nutritional supplementation to HIV infected lactating mothers on nutritional and health status of mothers and their infants.MethodsA randomized controlled clinical trial to study the impact of nutritional supplementation on breastfeeding mothers. Measurements included anthropometry; body composition indicators; CD4 count, haemoglobin and albumin; as well as incidence rates of opportunistic infections; depression and quality of life scores. Infant measurements included anthropometry, development and rates of infections.ResultsThe supplement made no significant impact on any maternal or infant outcomes. However in the small group of mothers with low BMI, the intake of supplement was significantly associated with preventing loss of lean body mass (1.32 kg vs. 3.17 kg; p = 0.026). There was no significant impact of supplementation on the infants.ConclusionsA 50 g daily nutritional supplement to breastfeeding mothers had no or limited effect on mother and child health outcomes.Clinical trial registrationISRCTN68128332 (http://www.controlled-trials.com/ISRCTN68128332)

Breastfeeding in HIV Exposed Infants Significantly Improves Child Health: A Prospective Study

Breastfeeding has been shown to benefit both maternal and child immune status. The impact of exclusive breastfeeding in the presence of HIV infection on maternal and child health is still unclear. Socio-economic factors make breast-feeding an important source of nutrition for an infant 6months and under in the developing world. A prospective study was conducted to examine the impact of feeding mode on various maternal indices including anthropometry; body composition indicators (using FTIR); haematology and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease progression. In infants we examined the impact on growth, development and morbidity. AFASS criteria (affordable, feasible, accessible, sustainable and safe) were fulfilled by 38.7% of the formula feeding mothers. No significant differences between the formula feeding and breastfeeding groups in terms of haematological, immunological and body composition changes were seen. Breastfeeding mothers had significantly lower events with high depression scores (P=0.043). Breastfeeding infants had a significantly lower risk of diarrhoea and hospitalisation at 3months (P=0.006 and 0.014 respectively). Breastfeeding was significantly associated with better development scores and growth parameters. Breastfeeding is not harmful to the mother in the presence of HIV infection. Mothers are still choosing formula feeding inappropriately despite counselling about the AFASS criteria. Breastfeeding is beneficial to the infants especially in the first 3months of life.

Estimates of opportunistic infection incidence or death within specific CD4 strata in HIV-infected patients in Abidjan, Côte d'Ivoire: impact of alternative methods of CD4 count modelling.

CD4 lymphocyte count is an important surrogate marker of HIV disease progression, but it is often unavailable at the time of clinical events. We analysed data from the Cotrame cohort (1999-2004) and the Trivacan Structured Treatment Interruption trial (2002-2005) to estimate the incidence of opportunistic infections and death within specific CD4 strata in HIV-infected patients receiving highly active antiretroviral therapy (HAART) in sub-Saharan Africa. We used three methods of CD4 modelling: the first assumed that CD4 cell count remained constant until the next measurement; the second assumed that it changed immediately to the level of the subsequent measurement; and the third assumed that it followed a linear function between two consecutive CD4 measurements. The cohort used in this analysis consisted of 981 patients. The incidence rates of opportunistic infections were highest in the lower CD4 strata and decreased in the higher CD4 count strata. The incidence rates of mild opportunistic infections and severe bacterial infections, however, remained high in the highest CD4 stratum. Although all confidence intervals overlapped among the three methods, the incidence rate estimates showed differences of up to 74% in the lowest CD4 stratum. Different methods of estimating CD4 counts at the time of clinical events led to minor differences in incidence rates, except in the CD4 stratum <50 cells/mm(3), where the follow-up time was shorter. All of the models indicate that the overall incidence of opportunistic infections under HAART in sub-Saharan Africa is high. This suggests that prophylaxis against opportunistic infections may be needed even for patients receiving HAART.

Trends in Opportunistic Infections in the Pre–and Post–Highly Active Antiretroviral Therapy Eras Among HIV-Infected Children in the Perinatal AIDS Collaborative Transmission Study, 1986–2004

We sought to determine the impact of highly active antiretroviral therapy on the incidence and prevalence of opportunistic infections in HIV-infected children. Children born from 1986 to 1998 were monitored until 2004 in the Perinatal AIDS Collaborative Transmission Study, sponsored by the Centers for Disease Control and Prevention. We determined the pre-highly active antiretroviral therapy and post-highly active antiretroviral therapy (before and after January 1, 1997, respectively) incidence rates of opportunistic infections among HIV-infected children and characterized the temporal decreases in percentages of CD4+ cells and the mortality rates among patients with and those without incident opportunistic infections. The overall opportunistic infection incidence declined from 14.4 to 1.1 cases per 100 patient-years; statistically significant reductions were seen in the incidence of the most common opportunistic infections, including Pneumocystis jiroveci pneumonia (5.8 vs 0.3 cases per 100 patient-years), recurrent bacterial infections (4.7 vs 0.2 cases per 100 patient-years), extraocular cytomegalovirus infection (1.4 vs 0.1 cases per 100 patient-years), and disseminated nontuberculous mycobacterial infection (1.3 vs 0.2 cases per 100 patient-years). Kaplan-Meier analysis of time from birth to the first opportunistic infection illustrated more-rapid acquisition of opportunistic infections by HIV-infected children born in the pre-highly active antiretroviral therapy era than by those born later. In the first 3 years of life, there was a faster decline in the percentage of CD4+ cells among children with opportunistic infections. The mortality rate was significantly higher among children with opportunistic infections. Reduction in the incidence of opportunistic infections and prolongation of the time to the first opportunistic infection were noted during the post-highly active antiretroviral therapy era. Children who experienced opportunistic infections had higher mortality rates than did those who did not. Younger children (<3 years) who experienced opportunistic infections had faster declines in percentages of CD4+ T cells.

HIV dementia: an evolving disease

Several advances have led to improvements in the care and prognosis of HIV+ individuals. The first is an understanding of the direct relationship between HIV replication and subsequent immunological and clinical progression, reinforcing the need to completely suppress HIV replication to control disease progression. The second is the wider availability of HAART which can provide effective suppression of HIV. The third major change is the ability to monitor HAART through the reliable and widespread measurement of plasma HIV RNA levels, which has become a routine part of clinical care. Since the introduction of highly active antiretroviral therapy (HAART) in the 1990s, there have been significant declines in the incidence rates of opportunistic infections in developed countries. HAART has clearly improved survival for individuals with HIV/AIDS, and has reduced the incidence of HIV-associated dementia (HIV-D) by 40–50% ( Brodt et al., 1997; Sacktor et al., 2001a,b). The prevalence of sensory neuropathies in advanced HIV/AIDS now exceeds 20% ( Schifitto et al., 2002), and may rise further with prolonged exposure to neurotoxic HAART. HIV-D and HIV-related sensory neuropathies (HIV-SN) have a combined prevalence of about 30–50% in advanced HIV disease, suggesting that HAART does not provide complete protection against neurological damage ( Bouwman et al., 1998). HIV-associated dementia (HIV-D) remains a common cause of dementia worldwide, and with HIV-related sensory neuropathies (HIV-SN) represents the commonest neurological disorders associated with AIDS. Furthermore, the temporal progression of HIV-D appears to have been altered by HAART, with most patients now showing an attenuated form of dementia, which with treatment is slowly progressive or static ( Dougherty et al., 2002). This overview will review some of the outstanding questions relating to HIV-dementia, including: (a) are there differing phenotypes or temporal patterns of progression in HIV-dementia? (b) what determines these temporal patterns? and (c), what has been the impact of therapy on HIV dementia?