Title
Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors
Date Issued
01 September 2022
Access level
open access
Resource Type
journal article
Author(s)
Núñez I.
Crabtree-Ramirez B.
Shepherd B.E.
Sterling T.R.
Cahn P.
Veloso V.G.
Cortes C.P.
Padgett D.
Sierra-Madero J.
McGowan C.C.
Person A.K.
Caro-Vega Y.
Publisher(s)
Elsevier B.V.
Abstract
Objectives: The aim of this study was to describe the incidence, clinical characteristics, and risk factors of late-onset opportunistic infections (LOI) in people who live with HIV (PWLHA) within the Caribbean, Central and South America network for HIV epidemiology. Methods: We performed a retrospective cohort study including treatment-naive PWLHA enrolled at seven sites (Argentina, Brazil, Chile, Peru, Mexico, and two sites in Honduras). Follow-up began at 6 months after treatment started. Outcomes were LOI, loss to follow-up, and death. We used a Cox proportional hazards model and a competing risks model to evaluate risk factors. Results: A total of 10,583 patients were included. Median follow up was at 5.4 years. LOI occurred in 895 (8.4%) patients. Median time to opportunistic infection was 2.1 years. The most common infections were tuberculosis (39%), esophageal candidiasis (10%), and Pneumocystis jirovecii (P. jirovecii) pneumonia (10%). Death occurred in 576 (5.4%) patients, and 3021 (28.5%) patients were lost to follow-up. A protease inhibitor–based regimen (hazard ratio 1.25), AIDS-defining events during the first 6 months of antiretroviral-treatment (hazard ratio 2.12), starting antiretroviral-treatment in earlier years (hazard ratio 1.52 for 2005 vs 2010), and treatment switch (hazard ratio 1.31) were associated with a higher risk of LOI. Conclusion: LOI occurred in nearly one in 10 patients. People with risk factors could benefit from closer follow-up.
Start page
469
End page
475
Volume
122
Language
English
OCDE Knowledge area
Enfermedades infecciosas
Subjects
Scopus EID
2-s2.0-85133903721
PubMed ID
Source
International Journal of Infectious Diseases
ISSN of the container
12019712
Sponsor(s)
The authors have no competing interests to declare. This work was supported by the National Institutes of Health-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet), a member of the International Epidemiologic Databases to Evaluate AIDS (U01AI069923). Institutional review board approval was obtained locally for each participating site and for the CCASAnet Data Coordinating Center at Vanderbilt University Medical Center, Nashville, TN, USA. In each of the sites contributing data to this study, ethical regulations and policies permitted retrospective analysis of de-identified clinical data without informed consent when research was approved by an institutional review board or appropriately constituted ethics committee. The authors thank the staff at each of the CCASAnet centers and especially their patients. The Caribbean, Central and South American network for HIV epidemiology (CCASAnet) includes research teams in the following sites: Fundación Huésped, Argentina: Pedro Cahn, Carina Cesar, Valeria Fink, Omar Sued, Emanuel Dell'Isola, Cleyton Yamamoto, Florencia Cahn; Instituto Nacional de Infectologia-Fiocruz, Brazil: Beatriz Grinsztejn, Valdiléa Veloso, Paula Luz, Raquel de Boni, Sandra Cardoso Wagner, Ruth Friedman, Rodrigo C. Moreira; Universidade Federal de Minas Gerais, Brazil: Jorge Pinto, Flavia Ferreira, Marcelle Maia; Universidade Federal de São Paulo, Brazil: Regina Célia de Menezes Succi, Daisy Maria Machado, Aida de Fátima Barbosa Gouvêa; Fundación Arriarán, Chile: Marcelo Wolff, Claudia Cortes, Maria Fernanda Rodriguez, Gladys Allendes; Les Centres GHESKIO, Haiti: Jean William Pape, Vanessa Rouzier, Adias Marcelin, Christian Perodin; Hospital Escuela Universitario, Honduras: Marco Tulio Luque; Instituto Hondureño de Seguridad Social, Honduras: Denis Padgett; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico: Juan Sierra Madero, Brenda Crabtree Ramirez, Pablo F. Belaunzaran, Yanink Caro Vega. Instituto de Medicina Tropical Alexander von Humboldt, Peru: Eduardo Gotuzzo, Fernando Mejia, Gabriela Carriquiry; Vanderbilt University Medical Center, USA: Catherine C. McGowan, Bryan E. Shepherd, Timothy Sterling, Karu Jayathilake, Anna K. Person, Peter F. Rebeiro, Mark J. Giganti, Jessica Castilho, Stephany N. Duda, Fernanda Maruri, Hilary Vansell. IN, BCR, BES, AKP, and YCV contributed to the study design and data analysis and drafted the manuscript. TS, DP, EG, JSM, CM, PC, BC, VGV, and CC are principal investigators of CCASAnet project; they contributed to the study design and data collection. All authors contributed to the interpretation of the study results and approved the final version of the manuscript.
This work was supported by the National Institutes of Health-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet), a member of the International Epidemiologic Databases to Evaluate AIDS (U01AI069923).
Sources of information:
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