AIDS-Defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort

Abstract

BackgroundAnecdotal evidence suggests that a high proportion of patients diagnosed with HIV in Guatemala present with AIDS. There remain limited data on the epidemiology of AIDS-defining illnesses (ADIs) in Central America.MethodsWe conducted a retrospective cohort study of all patients living with HIV at the largest HIV clinic in Guatemala. Charts were analyzed for clinical and demographic data. Presence of an ADI was assessed by US Centers for Disease Control definitions; patients who presented with an ADI were compared with those without ADI using descriptive statistics.ResultsOf 3686 patients living with HIV, 931 (25.3%) had an ADI at HIV diagnosis, 748 (80.3%) of whom had CD4 counts lower than 200 cells/mm3. Those with ADIs were more likely to be male (67.5% vs 54.6%; P < .0001) and heterosexual (89.4% vs 85.0%; P = .005). The most common ADIs were Mycobacterium tuberculosis (55.0%), Pneumocystis jirovecii pneumonia (13.7%), esophageal candidiasis (13.4%), and histoplasmosis (11.4%). Histoplasmosis and HIV wasting syndrome were both more common among rural patients.ConclusionsIn this large Guatemalan cohort of patients currently living with HIV, a significant portion presented with an ADI. These data inform the most common ADIs diagnosed among survivors, show that histoplasmosis is more commonly diagnosed in rural patients, and suggest that HIV wasting syndrome may reflect missed histoplasmosis diagnoses.

COVID-19, HIV-Associated Cryptococcal Meningitis, Disseminated Tuberculosis and Acute Ischaemic Stroke: A Fatal Foursome

“…The burden of AIDS-defining illnesses, particularly TB and CM are high in sub-Saharan African countries with an estimated rate ranging from 16% to 29%. 10 Our patient had evidence of both CM and disseminated TB, which are the two most common causes of AIDS-related deaths in sub-Saharan Africa. The most unusual presentation in this patient was the occurrence of these two life-threatening opportunistic infections in association with two other equally lethal conditions -severe COVID-19 pneumonia and acute ischemic stroke.…”

Clinical and non-clinical determinants of cervical cancer mortality: A retrospective cohort study in Lagos, Nigeria

“…As shown in our study, and in consonance with previous studies, being older than 50 years at time of diagnosis, was associated with a substantially higher risk of death from CCa ( 9 , 10 ). However, no consistent pattern was observed when 13 African countries were studied ( 57 ). Conversely, age at diagnosis was found to be protective in an Ethiopian study ( 15 ), however, the cohort used for the study had younger women with mean cohort age of 49 years which might have impacted the study finding.…”

“…A recent study in Brazil showed that HIV infection did not affect initial treatment response or early mortality in women with cervical cancer, but it did increase relapse after achieving a complete response or remission, and late mortality ( 56 ). Similarly, the immunosuppression linked with HIV/AIDS also increases the susceptibility of CCa patients to other life-threatening AIDS-defining infections and cancers ( 57 ) which adds significant morbidity and increase their mortality risk.…”