Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000–2010

Buchacz, Kate; Lau, Bryan; Jing, Yuezhou; Bosch, Ronald J.; Abraham, Alison G.; Gill, M. John; Silverberg, Michael J.; Goedert, James J.; Sterling, Timothy R.; Althoff, Keri N.; Martin, Jeffrey N.; Burkholder, Greer A.; Gandhi, Neel R.; Samji, Hasina; Patel, Pragna; Rachlis, Anita; Thorne, Jennifer E.; Napravnik, Sonia; Henry, Keith; Mayor, Angel M.; Gebo, Kelly A.; Gange, Stephen J.; Moore, Richard D.; Brooks, John T.

doi:10.1093/infdis/jiw085

Cited by 149 publications

(122 citation statements)

References 36 publications

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“…Since then, the widespread use of PCP prophylaxis with TMP/SMX and early ART have led to a substantial decline in the PCP incidence among individuals with HIV infection. Studies in the early 2000s reported an incidence of PCP among HIV-infected individuals below 1 case per 100 person-years [2-8]. Given the trend towards earlier diagnosis of HIV infection and immediate ART independent of CD4+ T cell count, the incidence of PCP in HIV patients has likely decreased further during recent years [9-12].…”

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

“…Since there is no national surveillance for PCP in the United States and other resource-rich countries, the exact number of cases is difficult to determine. While fewer HIV-infected individuals develop opportunistic infections in resource-rich settings overall, PCP is still one of the most common opportunistic infections in HIV patients in the United States, Canada, and Europe [2, 13]. It mainly affects individuals who are unaware of their HIV infection or who get diagnosed late (i.e., late presenters) or are not receiving ongoing care for HIV infection [14, 15].…”

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

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Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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The substantial decline in the Pneumocystis jirovecii pneumonia (PCP) incidence in HIV-infected patients after the introduction of antiretroviral therapy (ART) in resource-rich settings and the growing number of non-HIV-infected immunocompromised patients at risk leads to considerable epidemiologic changes with clinical, diagnostic, and treatment consequences for physicians. HIV-infected patients usually develop a subacute course of disease, while non-HIV-infected immunocompromised patients are characterized by a rapid disease progression with higher risk of respiratory failure and higher mortality. The main symptoms usually include exertional dyspnea, dry cough, and subfebrile temperature or fever. Lactate dehydrogenase may be elevated. Typical findings on computed tomography scans of the chest are bilateral ground-glass opacities with or without cystic lesions, which are usually associated with the presence of AIDS. Empiric treatment should be initiated as soon as PCP is suspected. Bronchoalveolar lavage has a higher diagnostic yield compared to induced sputum. Immunofluorescence is superior to conventional staining. A combination of different diagnostic tests such as microscopy, polymerase chain reaction, and (1,3)-β-D-glucan is recommended. Trimethoprim/sulfamethoxazole for 21 days is the treatment of choice in adults and children. Alternative treatment regimens include dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Patients with moderate to severe disease should receive adjunctive corticosteroids. In newly diagnosed HIV-infected patients with PCP, ART should be initiated as soon as possible. In non-HIV-infected immunocompromised patients, improvement of the immune status should be discussed (e.g., temporary reduction of immunosuppressive agents). PCP prophylaxis is effective and depends on the immune status of the patient and the underlying immunocompromising disease.

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Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Section: Epidemiology and Risk Groupsmentioning

confidence: 99%

Clinical, Diagnostic, and Treatment Disparities between HIV-Infected and Non-HIV-Infected Immunocompromised Patients with Pneumocystis jirovecii Pneumonia

et al. 2018

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“…Several factors are independently associated with occurrence of OI such as African American/Black race or Hispanic/Latino ethnicity, intravenous drug users, heterosexual HIV transmission, lower TCD4+ cell count, and higher viral load [5]. Sixteen large cohorts of HIV-infected patients were recently evaluated and reported a decrease in the incidence rates of first OIs, from 2.96 events/100 person-years in 2000–2003 to 1.45 events/100 person-years in 2008–2010 [5].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome: Opening Pandora’s Box

Meireles

Moura

França

2017

Case Reports in Infectious Diseases

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One of the purposes of antiretroviral therapy (ART) is to restore the immune system. However, it can sometimes lead to an aberrant inflammatory response and paradoxical clinical worsening known as the immune reconstitution inflammatory syndrome (IRIS). We describe a 23-year-old male, HIV1 infected with a rapid progression phenotype, who started ART with TCD4+ of 53 cells/mm3 (3,3%) and HIV RNA = 890000 copies/mL (6 log). Four weeks later he was admitted to the intensive care unit with severe sepsis. The diagnostic pathway identified progressive multifocal leukoencephalopathy, digestive Kaposi sarcoma, and P. aeruginosa bacteraemia. Five weeks after starting ART, TCD4+ cell count was 259 cells/mm3 (15%) and HIV RNA = 3500 copies/mL (4 log). He developed respiratory failure and progressed to septic shock and death. Those complications might justify the outcome but its autopsy opened Pandora's box: cerebral and cardiac toxoplasmosis was identified, as well as hemophagocytic syndrome, systemic candidiasis, and Mycobacterium avium complex infection. IRIS remains a concern and eventually a barrier to ART. Male gender, young age, low TCD4 cell count, and high viral load are risk factors. The high prevalence of subclinical opportunistic diseases highlights the need for new strategies to reduce IRIS incidence.

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“…The stabilized immune system has protected HIV infected persons from common opportunistic infections which used to be the major factor for increased morbidity/mortality and has enabled them to live longer. (9,10) Despite the proven efficacy of HAART, the risk remains high because the immune system function remains impaired in the individuals once infected by HIV. Death associated with cancer among the HIV infected has therefore remained a big challenge.…”

Section: Introductionmentioning

confidence: 99%