Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naïve Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines

Abstract

To identify regional differences in the distribution of opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in Asia, the medical records of antiretroviral therapy (ART)-naïve patients who attended the following tertiary hospitals from 2003 to 2011 were reviewed: Nagoya Medical Center (NMC, Nagoya, Japan), Lampang Hospital (LPH, Lampang, northern Thailand), Bach Mai Hospital (BMH, Hanoi, northern Vietnam), and Philippine General Hospital (PGH, Manila, Philippines). Logistic regression analyses were performed to identify associations between country of origin and risk of major OIs. In total, 1,505 patients were included: NMC, = 365; LPH, = 442; BMH, = 384; and PGH, = 314. The median age was 32 years, and 73.3% of all patients were male. The median CD4 count was 200 cells/μL. Most patients at NMC and PGH were men who have sex with men. Injection drug users were most common at BMH (35.7%). (TB) was most common at PGH ( = 75) but was rare at NMC ( = 4). pneumonia (PCP) prevalence was highest at NMC ( = 74) and lowest at BMH ( = 13). Multivariable logistic regression showed increased odds of TB at PGH (adjusted odds ratio [aOR] = 42.2, 95% confidence interval [CI] = 14.6-122.1), BMH (aOR = 12.6, CI = 3.9-40.3), and LPH (aOR = 6.6, CI = 2.1-21.1) but decreased odds of PCP at BMH (aOR = 0.1, CI = 0.04-0.2) and LPH (aOR = 0.2, CI = 0.1-0.4) compared with those at NMC. The cryptococcosis risk was increased at LPH (aOR = 6.2, CI = 0.9-41.0) compared with that at NMC. Cytomegalovirus (CMV) retinitis prevalences were similar in all countries. OI prevalence remained high among ART-naïve patients in our cohort. The risks of TB, PCP, and cryptococcosis, but not CMV retinitis, differed between countries. Improved early HIV detection is warranted.

Changing Spectrum of Opportunistic Illnesses among HIV-Infected Taiwanese Patients in Response to a 10-Year National Anti-TB Programme

“…Consistent with our findings, PJP was also the most common AOI in Japan [13]. However, regional differences in the AOI spectrum have been reported [8,13,14,15,16,17].…”

“…Consistent with our findings, PJP was also the most common AOI in Japan [13]. However, regional differences in the AOI spectrum have been reported [8,13,14,15,16,17]. The observed regional differences in AOI distribution are likely attributable to a complex interaction between socioeconomic setting [50], geographical differences [8,51], genetic susceptibility [15], the implementation of highly active ART (HAART) [39], the prevalence of specific microorganisms [8,18,19,20,21,22,23,24,25], different definitions of AOIs [19,26,27,28,29], and different public health intervention methods, as also reported here.…”

“…AOIs are infections or malignancies that occur more frequently and are more severe in hosts with weakened immune systems by HIV, such as Pneumocystis jirovecii pneumonia (PJP), toxoplasmosis of brain, and Kaposi’s sarcoma [12]. AOIs vary widely depending on the studied region (such as Mycobacterium tuberculosis (MTB) as the most common aetiology in Philippines [13], India [14], and China [8]; PJP in Japan [13] and Australia [15]; esophageal candidiasis in Poland [16]; and cerebral toxoplasmosis in Lebanon [17]), the environmental prevalence of the microorganisms (such as MTB [18,19,20,21], Penicillium marneffei [8,22], Toxoplasma gondii [23], and Cryptococcus neoformans [24,25]), and the definitions of AOI [19,26,27,28,29]. The AOI spectrum may also change with improved survival due to ART.…”

Prevalence of Opportunistic Infections and Associated Factors in HIV-Infected Men Who Have Sex With Men on Antiretroviral Therapy in Bach Mai Hospital, Hanoi, Vietnam: A Case-Control Study

“…All of the participants were on the ART, and ART initiation has been reported to be associated with a reduced incidence of OIs (Ghate et al, 2009), suggesting the OI acquisition was determined by other factors in addition to CD4 T cell counts and HIV viral load. The proportion of the major OIs found in the current study was quite consistent with the study conducted by Gangcuangco et al (2017), in which the authors investigated the prevalence of major OIs among ART-naive HIV-infected patients in several countries, including Vietnam. Consistent with most of the findings regarding the OIs in HIV-infected patients, tuberculosis was identified as the most predominant OI in heterosexual participants, with a prevalence of 25.8%.…”

CRYPTOCOCCAL ANTIGENEMIA IN HIV/AIDS PATIENTS USING LATERAL FLOW IMMUNOASSAY DETECTION AT Dr. SOETOMO GENERAL HOSPITAL SURABAYA

“…The prevalence of opportunistic infections varies between regions. 15 Opportunistic infections encountered in this study include pulmonary tuberculosis, cerebral toxoplasmosis, oropharyngeal candidiasis, PCP. The most common types of opportunistic infections in this study are pulmonary tuberculosis.…”