Predictors of opportunistic illnesses incidence in post combination antiretroviral therapy era in an urban cohort from Rio de Janeiro, Brazil

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.

Ten years of antiretroviral therapy: Incidences, patterns and risk factors of opportunistic infections in an urban Ugandan cohort

“…Uganda is among the 20 countries with the highest estimated burden of HIV-tuberculosis co-infections worldwide, and tuberculosis is the leading cause of death in PLHIV in low-income countries [ 41 , 42 ]. This was also reflected in our cohort where tuberculosis was the most frequent AIDS-defining disease with an incidence of 15.3 per 1000 PYFU similarly to other HIV-cohorts from high tuberculosis burden countries [ 26 , 43 – 45 ]. Although tuberculosis can also occur in PLHIV who are not severely immunocompromised [ 46 ], its incidence in our study decreased with both increased CD4 cell count and the time spent on ART.…”

Mortality in HIV-infected women, heterosexual men, and men who have sex with men in Rio de Janeiro, Brazil: an observational cohort study

“…The AIDS laboratory at INI provides primary, specialty, and tertiary care for a cohort of HIV infected individuals in Rio de Janeiro State. A longitudinal observational clinical database has been maintained on patients receiving HIV care which has provided data for several studies (9, 12). Data are updated regularly using outpatient and inpatient clinical documentation and laboratory testing results.…”

Perfil clínico-socioeconômico e demográfico de pacientes soropositivos para HIV/Aids em região de tríplice fronteira

“…A Síndrome da Imunodeficiência Adquirida (Aids) é uma doença emergente, grave, causada pelo retrovírus, vírus da imunodeficiência humana (HIV), que constitui um dos maiores problemas de saúde pública no Brasil e no mundo (Pinto et al, 2018). A síndrome é caracterizada pela diminuição quantitativa e qualitativa dos linfócitos T (principalmente CD4 + ), fragilizando a atuação do sistema imunológico e, consequentemente, debilitando o portador (Coelho et al, 2016). Cerca de 37,9 milhões de pessoas em todo o mundo vivem com HIV, e somente 23,3 milhões de pessoas possuem acesso à terapia antirretroviral (TARV), isso faz com que esse índice de infecção cresça mais de 5,0% ao ano, acarretando 1,7 milhões de novas infecções por HIV anualmente (Unaids, 2019).…”