Recent trends in the spectrum of opportunistic infections in human immunodeficiency virus infected individuals on antiretroviral therapy in South India

Abstract

Background:Opportunistic infections (OI) are the major cause of morbidity and mortality among human immunodeficiency virus (HIV) infected individuals. The pattern of OIs differs widely, hence it is necessary to correlate spectrum of OIs and CD4 counts among HIV infected individuals in specific localities.Materials and Methods:The present study describes the clinical and laboratory profiles of different OIs among 55 HIV seropositive patients. CD4 count was estimated and antiretroviral therapy (ART) was started in 27 patients as per National Acquired Immunodeficiency Syndrome Control Organization guidelines. These 27 patients were classified into stage 1, stage 2 and stage 3 based on CD4 counts of >500 cells/μl, 200-499 cells/μl and <200 cells/μl respectively. The OIs presented by respective groups were documented.Results:Pulmonary tuberculosis was found to be the most common OI constituting 43.6% of all cases followed by candidiasis (30.9%), cryptosporidial diarrhea (21.8%), herpes zoster (16.3%), cryptococcal meningitis (3.63%), Pneumocystis jirovecii pneumonia (1.81%), and other miscellaneous infections (23.6%). Only 1 patient was found in stage I while 13 patients each were grouped in stage II or stage III. The mean CD4 count in our study population who were on ART was 230 ± 150 cells/µl.Conclusion:The pattern of OIs among our study group did not differ significantly from patients not receiving ART. The effect of ART on CD4 count differs from patient to patient based on the degree of depletion of CD4 count before the initiation of ART, drug adherence, concomitant OIs and their treatment.

Spectrum of opportunistic infections with correlation to CD4 counts in newly diagnosed HIV seropositive cases

“…Kumarasway et al in his study reported a higher prevalence of extra pulmonary tuberculosis (49%) than pulmonary which is contrary to the findings of our study. 16 Mean CD4 count observed in cases of pulmonary tuberculosis in our study was 74.5 (1-312) cells/µl, extra pulmonary tuberculosis was 67.5 (1-276) cells/µl and 65.5 (1-254) cells/µl in cases of both, these findings are on par withfindings of Shahapur PR et al 17 The HIV positive patients with extra pulmonary tuberculosis had lower mean CD4 counts than those with pulmonary tuberculosis.Some studies reported candidiasis as the most common OI in their studies. In our study, it was second most common OI with prevalence of 61.5%, with oral thrush 87.8% and esophageal candidiasis in12.2%, which is on par with findings of Singh et al (59%), and several studies have reported the incidence up to 70%.…”

Pneumocystis Jirovecii Pneumonia: Prevalence in Hospitalised Patients, a Study Conducted in a Tertiary Centre in Punjab

“…(18)(19) Our finding also corresponds with studies done earlier in India in both the northern and southern regions. (20)(21) Concomitant bacterial (44.6%) and fungal pneumonia (31.9%) is a significant finding in our study. In such cases, the dilemma for the clinician is to decide whether to treat the positive Pneumocystis finding as an infection or merely colonization.…”

Prevalence and risk factors for opportunistic infections in HIV patients who developed adverse drug reactions (ADRs) to antiretroviral therapy (ART) in a tertiary-care teaching hospital

“…Saha et al [24] showed that the common co-infections/OIs were oral candidiasis followed by chronic diarrhea, HSV-2, TB, CMV, HBV, and HCV, while Elizabeth et al [25] showed that the most common OIs were oropharyngeal candidiasis followed by TB. In the study by Shahapur et al, [26] pulmonary TB was the most common OI, followed by candidiasis, cryptosporidial diarrhea, herpes zoster, cryptococcal meningitis, and pneumocystis pneumonia.…”