Rate and Risk Factors of Major Opportunistic Infections in HIV/AIDS Patients after Antiretroviral Therapy at Bamrasnaradura Infectious Diseases Institute
Keywords:
HIV/AIDS patients, Antiretroviral drugs, Bamrasnadarura Infectious Diseases InstituteAbstract
The objectives of this study were to determine the incidence and risk factors for new episodes ofmajor opportunistic infections (OIs) after antiretroviral therapy (ART) among HIV-infected patients. A retrospective cohort study was conducted among naïve HIV-infected patients who were initiated ART between January 2001 and December 2003 at Bamrasnaradura Infectious Diseases Institute. Patients were categorized into two groups based on baseline CD4 cell counts: group A ( 50 cells/mm3) and group B (>50 cells/mm3). All patients were followed for 15 months after ART initiation. There were 793 patients with a mean age of 35.1±7.4 years and 56% were male. Among793 patients, 531 (67.0%) were in group A and 262 (33.0%) were in group B. Median (IQR) CD4 cell count was 13 (6-26) cells/mm3 in group A and 116 (78-167) cells/mm3 in group B. Median (IQR) baseline plasma HIVRNA was 300,500 (138,500-556,000) copies/ml and 185,000 (68,000-577,500) copies/ml in groupA and group B, respectively (P<0.05). Group A had a higher proportion of male, previous OIs, body weight, transaminase enzymes (P<0.05). Incidence of major OIs (i.e., tuberculosis, cryptococcosis, pneumocystis, histoplamosis and CMV disease) at 1, 3, 6, and 12 months after ART were 2.9%, 6.8%, 8.6% and 10.2% in group A and 1.9%, 1.9%, 3.1% and 3.5% in group B respectively (log rank test, P=0.001). Cox's proportional hazard model showed that the patients with baseline CD4 cell count 50 copies/ml was associated with high incidence of OIs after initiation of ART (P=0.017, HR=4.4, 95% CI=1.307-14.493). In conclusion, HIV-infected patients who had baseline CD4 50 cells/mm3 had a higher probability of the occurrence of major OIs after initiation of ART than those who had baseline CD4>50cells/mm3. Closed monitoring of clinical conditions should be strongly recommended after ART initiation in patients with low baseline CD4 cell counts.
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