Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital, China

Abstract

Background: HIV-related opportunistic infections (OIs) and malignancies continued to cause morbidity and mortality in Chinese HIV-infected individuals. The objective for this study is to elucidate the prevalence and spectrums of OIs and malignancies in HIV-infected patients in the Beijing Ditan Hospital.

Methods: The evaluation of the prevalence and spectrums of OIs and malignancies was conducted by using the clinical data of 834 HIV-infected patients admitted in the Beijing Ditan hospital from January 1, 2009, to November 30, 2012.

Results: The prevalence and spectrums of OIs and malignancies varied contingent on geographic region, transmission routes, and CD4 levels. We found that tuberculosis was most common OI and prevalence was 32.5%, followed by candidiasis(29.3%), Pneumocystis pneumonia(PCP)(22.4%), cytomegalovirus(CMV) infection(21.7%), other fungal infections(16.2%), mycobacterium avium complex(MAC)(11.3%), cryptococcosis(8.0%), progressive multifocal leukoencephalopathy(PML)(4.4%), Cerebral Toxoplasmosis(3.5%) and Penicillium marneffei infection(1.4%); while Lymphoma(2.9%), Kaposi's sarcoma(0.8%) and cervix carcinoma(0.3%) were emerged as common AIDS-defining malignancies. Pulmonary OI infections were the most prevalent morbidity and mortality in patients in the AIDS stage including pulmonary tuberculosis (26.6%) and PCP (22.4%). CMV infection(21.7%) was most common viral infection; Fungal OIs were one of most prevalent morbidity in patients in the AIDS stage, including oral candidiasis (29.3%), other fungal infection (16.2%), Cryptococcosis (8.0%) and Penicillium marneffei infection (1.4%). We found the low prevalence of AIDS-defining illnesses in central neural system in this study, including progressive multifocal leukoencephalopathy (4.4%), cerebral toxoplasmosis (3.5%), tuberculosis meningitis (3.2%), cryptococcal meningitis (2.4%) and CMV encephalitis (1.1%). In-hospital mortality rate was 4.3 per 100 person-years due to severe OIs, malignancies, and medical cost constraints.

Conclusions: The prevalence and spectrums of OIs, malignancies and co-infections were discussed in this study. It would help increase the awareness for physicians to make a diagnosis and empirical treatment sooner and plan good management strategies, especially in resource limited regions.

Figure 1. Study flow diagram.

Figure 2. Spectrum of OIs and Malignancies in HIV-infected Patients based on etiologic and empirical diagnosis in the Beijing Ditan Hospital from January 1, 2009 to November 30, 2012.

Note: PCP:pneumocystis pneumonia; CMV: cytomegalovirus; MAC: Mycobacterium avium complex; PML: progressive multifocal leukoencephalopathy.

Figure 3. Prevalence of OIs and Malignancies Related to Geographic Regions in the Study Subjects.

1.Tuberculosis; 2.Candidiasis; 3.PCP; 4.CMV infection; 5.Other fungal infection; 6.MAC; 7.Cryptococcosis; 8. PML; 9. Cerebral Toxoplasmosis; 10. Lymphoma; 11.Penicillium Marneffei infection; 12. Kaposi's Sarcoma.

Figure 4. The Prevalence of OIs and Malignancies Related to Transmission Routes in the Study Subjects.

1.Tuberculosis; 2.Candidiasis; 3.PCP; 4.CMV infection; 5.Other fungal infection; 6.MAC; 7.Cryptococcosis; 8. PML; 9. Cerebral Toxoplasmosis; 10. Lymphoma; 11.Penicillium Marneffei infection; 12. Kaposi's Sarcoma.

Figure 5. The Prevalence of OIs and Malignancies related to CD4 counts in study subjects.

1.Tuberculosis; 2.Candidiasis; 3.PCP; 4.CMV infection; 5.Other fungal infection; 6.MAC; 7.Cryptococcosis; 8. PML; 9. Cerebral Toxoplasmosis; 10. Lymphoma; 11.Penicillium Marneffei infection; 12. Kaposi's Sarcoma.

Figure 6. Distribution of CD4+T Counts and In-hospital deaths in the Study Subjects.