AIDS-defining opportunistic illnesses in US patients, 1994-2007: A cohort study

Kate Buchacz*, Rose K. Baker, Frank Joseph Palella Jr, Joan S Chmiel, Kenneth A. Lichtenstein, Richard M. Novak, Kathleen C. Wood, John T. Brooks

*Corresponding author for this work

Research output: Contribution to journalArticle

212 Scopus citations

Abstract

Objectives: To assess the incidence and spectrum of AIDS-defining opportunistic illnesses in the highly active antiretroviral terapy (cART) era. Design: A prospective cohort study of 8070 participants in the HIV Outpatient Study at 12 U.S. HIV clinics. Methods: 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. Results: Eight thousand and seventy patients (baseline median age 38 years; median CD4 cell count 298 cells/μl) 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/μl. CONCLUSIONS: 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/μl.

Original languageEnglish (US)
Pages (from-to)1549-1559
Number of pages11
JournalAIDS
Volume24
Issue number10
DOIs
StatePublished - Jun 19 2010

Keywords

  • AIDS-related opportunistic infections
  • CD4 lymphocyte count
  • cohort studies
  • highly active antiretroviral therapy
  • incidence
  • neoplasms
  • prophylaxis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Buchacz, K., Baker, R. K., Palella Jr, F. J., Chmiel, J. S., Lichtenstein, K. A., Novak, R. M., Wood, K. C., & Brooks, J. T. (2010). AIDS-defining opportunistic illnesses in US patients, 1994-2007: A cohort study. AIDS, 24(10), 1549-1559. https://doi.org/10.1097/QAD.0b013e32833a3967