Document Detail

AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study.
MedLine Citation:
PMID:  20502317     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To assess the incidence and spectrum of AIDS-defining opportunistic illnesses in the highly active antiretroviral therapy (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/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.
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/microl.
Kate Buchacz; Rose K Baker; Frank J Palella; Joan S Chmiel; Kenneth A Lichtenstein; Richard M Novak; Kathleen C Wood; John T Brooks;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  AIDS (London, England)     Volume:  24     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-11     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1549-59     Citation Subset:  IM; X    
Divisions of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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MeSH Terms
AIDS-Related Opportunistic Infections / epidemiology*,  immunology
Acquired Immunodeficiency Syndrome / drug therapy,  epidemiology*,  immunology
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Cohort Studies
Immunocompromised Host* / immunology
Neoplasms / epidemiology*,  immunology
Prospective Studies
United States / epidemiology
Grant Support
200-2001-00133//PHS HHS; 200-2006-18797//PHS HHS
John T Brooks / ; Kate Buchacz / ; Marcus Durham / ; Kathleen Wood / ; Rose K Baker / ; James T Richardson / ; Darlene Hankerson / ; Carl Armon / ; Frank J Palella / ; Joan S Chmiel / ; Carolyn Studney / ; Onyinye Enyia / ; Kenneth A Lichtenstein / ; Cheryl Stewart / ; John Hammer / ; Benjamin Young / ; Kenneth S Greenberg / ; Barbara Widick / ; Joslyn D Axinn / ; Bienvenido G Yangco / ; Kalliope Halkias / ; Douglas J Ward / ; Jay Miller / ; Jack Fuhrer / ; Linda Ording-Bauer / ; Rita Kelly / ; Jane Esteves / ; Ellen M Tedaldi / ; Ramona A Christian / ; Faye Ruley / ; Dania Beadle / ; Richard M Novak / ; Andrea Wendrow /

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