AIDS-Defining Opportunistic Illnesses in U.S. Patients, 1994–2007: A Cohort Study

Divisions of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
AIDS (London, England) (Impact Factor: 5.55). 06/2010; 24(10):1549-59. DOI: 10.1097/QAD.0b013e32833a3967
Source: PubMed


To assess the incidence and spectrum of AIDS-defining opportunistic illnesses in the highly active antiretroviral therapy (cART) era.
A prospective cohort study of 8070 participants in the HIV Outpatient Study at 12 U.S. HIV clinics.
We calculated incidence rates per 1000 person-years of observation for the first opportunistic infection, first opportunistic malignancy, and first occurrence of each individual opportunistic illness during 1994-2007. Using stratified Poisson regression models, and adjusting for sex, race, and HIV risk category, we modeled annual percentage changes in opportunistic illness incidence rates by calendar period.
Eight thousand and seventy patients (baseline median age 38 years; median CD4 cell count 298 cells/microl) experienced 2027 incident opportunistic illnesses during a median of 2.9 years of observation. During 1994-1997, 1998-2002, and 2003-2007, respectively, rates of opportunistic infections (per 1000 person-years) were 89.0, 25.2 and 13.3 and rates of opportunistic malignancies were 23.4, 5.8 and 3.0 (P for trend <0.001 for both). Opportunistic illness rate decreases were similar for the subset of patients receiving cART. During 2003-2007, there were no significant changes in annual rates of opportunistic infections or opportunistic malignancies; the leading opportunistic illnesses (rate per 1000 person-years) were esophageal candidiasis (5.2), Pneumocystis pneumonia (3.9), cervical cancer (3.5), Mycobacterium avium complex infection (2.5), and cytomegalovirus disease (1.8); 36% opportunistic illness events occurred at CD4 cell counts at least 200 cells/microl.
Opportunistic illness rates declined precipitously after introduction of cART and stabilized at low levels during 2003-2007. In this contemporary cART era, a third of opportunistic illnesses were diagnosed at CD4 cell counts at least 200 cells/microl.

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    • "In HIV infection, oral candidiasis is estimated to occur at least once in 90% of those without ARVs, and oesophageal candidiasis in 20% of patients without ARVs and 5% of patients on ARVs [37] [38] [39]. Therefore, 55 440 cases of oral candidiasis and 16 240 of oesophageal candidiasis are expected annually (Table 1). "
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    ABSTRACT: Estimates of the incidence and prevalence of serious fungal infections, based on epidemiological data, are essential in order to inform public health priorities given the lack of resources dedicated to the diagnosis and treatment of these serious fungal diseases. However, epidemiology of these infections is largely unknown, except for candidaemia and cryptococcosis. The aim of this work is to calculate the burden of serious fungal infections in Spain. All published epidemiology papers reporting fungal infection rates from Spain were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in those populations to estimate national incidence or prevalence, depending on the condition. Around 8.1 million people suffer a fungal infection every year. Most of them are skin or mucosal infections causing no deaths. Candidaemia is more common than in other European countries and has risen by 1.88-fold in frequency in the last decade (8.1 cases × 100 000). Good estimates of invasive aspergillosis (2.75 cases × 100 000) and mucormycosis (0.04 × 100 000) are available. Fungal infections with a high mortality such as invasive aspergillosis, candidaemia, Pneumocystis pneumonia and mucormycosis are not numerous in Spain, but they affect those with severe underlying diseases and are therefore linked to poor outcomes. Additional studies are required, especially for high burden diseases such as recurrent thrush in women (∼9000 cases × 100 000 women), allergic bronchopulmonary aspergillosis (126 cases × 100 000) and severe asthma with fungal sensitisation (198 cases × 100 000). Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    Clinical Microbiology and Infection 10/2014; 21(2). DOI:10.1016/j.cmi.2014.07.013 · 5.77 Impact Factor
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    BMC Infectious Diseases 04/2014; 14(1):229. DOI:10.1186/1471-2334-14-229 · 2.61 Impact Factor
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    • "Despite evidence suggesting that PLHIV who use drugs may benefit from HAART [12] and attain high levels of adherence [13], physicians in many jurisdictions do not initiate HAART with PLHIV who use drugs, with drug use and potential non-adherence often cited as justifications for denying treatment [14, 15]. Accordingly, PLHIV who use drugs suffer disproportionately from AIDS-related opportunistic illnesses [16] and premature mortality [17]. "
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