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. 2016 Sep 15;214(6):862-72.
doi: 10.1093/infdis/jiw085. Epub 2016 Apr 18.

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000-2010

Kate Buchacz  1 , Bryan Lau  2 , Yuezhou Jing  2 , Ronald Bosch  3 , Alison G Abraham  2 , M John Gill  4 , Michael J Silverberg  5 , James J Goedert  6 , Timothy R Sterling  7 , Keri N Althoff  2 , Jeffrey N Martin  8 , Greer Burkholder  9 , Neel Gandhi  10 , Hasina Samji  11 , Pragna Patel  1 , Anita Rachlis  12 , Jennifer E Thorne  2 , Sonia Napravnik  13 , Keith Henry  14 , Angel Mayor  15 , Kelly Gebo  2 , Stephen J Gange  2 , Richard D Moore  2 , John T Brooks  1 ; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA
Collaborators, Affiliations

Incidence of AIDS-Defining Opportunistic Infections in a Multicohort Analysis of HIV-infected Persons in the United States and Canada, 2000-2010

Kate Buchacz et al. J Infect Dis. .

Abstract

Background: There are few recent data on the rates of AIDS-defining opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in care in the United States and Canada.

Methods: We studied HIV-infected participants in 16 cohorts in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) during 2000-2010. After excluding 16 737 (21%) with any AIDS-defining clinical events documented before NA-ACCORD enrollment, we analyzed incident OIs among the remaining 63 541 persons, most of whom received antiretroviral therapy during the observation. We calculated incidence rates per 100 person-years of observation (hereafter, "person-years") with 95% confidence intervals (CIs) for the first occurrence of any OI and select individual OIs during 2000-2003, 2004-2007, and 2008-2010.

Results: A total of 63 541 persons contributed 261 573 person-years, of whom 5836 (9%) developed at least 1 OI. The incidence rate of any first OI decreased over the 3 observation periods, with 3.0 cases, 2.4 cases, and 1.5 cases per 100 person-years of observation during 2000-2003, 2004-2007, and 2008-2010, respectively (Ptrend<.001); the rates of most individual OIs decreased as well. During 2008-2010, the leading OIs included Pneumocystis jiroveci pneumonia, esophageal candidiasis, and disseminated Mycobacterium avium complex or Mycobacterium kansasii infection.

Conclusions: For HIV-infected persons in care during 2000-2010, rates of first OI were relatively low and generally declined over this time.

Keywords: AIDS-related opportunistic infections; CD4+ T-lymphocyte count; HIV cohort studies; combination antiretroviral therapy; epidemiology; incidence; prophylaxis.

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Figures

Figure 1.
Figure 1.
The incidence of select opportunistic infections among all 63 541 patients, NA-ACCORD, 2000–2010, United States and Canada. Abbreviations: MAC, Mycobacterium avium complex; M. kansasii, Mycobacterium kansasii.
Figure 2.
Figure 2.
Time from initiation of antiretroviral therapy (ART) to the first incident opportunistic infection, NA-ACCORD, 2000–2010, United States and Canada, by period of ART initiation (A) and CD4+ T-cell count at the start of ART (B). Analyses do not consider competing risk of death.
Figure 3.
Figure 3.
CD4+ T-cell counts, viral load data, and history of antiretroviral therapy (ART) use among 5836 patients experiencing any first opportunistic infections (OIs), NA-ACCORD, 2000–2010, United States and Canada. Abbreviations: CADE, candidiasis, esophageal; CAND, candidiasis; CMV, cytomegalovirus; CMVR, CMV retinitis; COC, coccidioidomycosis; CRY, cryptosporidiosis; CRYM, cryptococcal meningitis; HIST, histoplasmosis disseminated; HIV, human immunodeficiency virus; ISO, isosporiasis, chronic intestinal; MAC, Mycobacterium avium complex or Mycobacterium kansasii infection, disseminated; PCP, Pneumocystis jiroveci pneumonia; PML, progressive multifocal leukoencephalopathy; TB, tuberculosis; TBP, tuberculosis, pulmonary; TOX, toxoplasmosis.
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