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. 2017 Dec 30;4(4):ofx249.
doi: 10.1093/ofid/ofx249. eCollection 2017 Fall.

AIDS-Defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort

Samuel W Reinhardt  1 , Andrej Spec  2 , Johanna Meléndez  3 , Andrea Alonzo Cordon  3 , Ian Ross  1 , William G Powderly  2 , Carlos Mejia Villatoro  3
Affiliations

AIDS-Defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort

Samuel W Reinhardt et al. Open Forum Infect Dis. .

Abstract

Background: Anecdotal evidence suggests that a high proportion of patients diagnosed with HIV in Guatemala present with AIDS. There remain limited data on the epidemiology of AIDS-defining illnesses (ADIs) in Central America.

Methods: We conducted a retrospective cohort study of all patients living with HIV at the largest HIV clinic in Guatemala. Charts were analyzed for clinical and demographic data. Presence of an ADI was assessed by US Centers for Disease Control definitions; patients who presented with an ADI were compared with those without ADI using descriptive statistics.

Results: Of 3686 patients living with HIV, 931 (25.3%) had an ADI at HIV diagnosis, 748 (80.3%) of whom had CD4 counts lower than 200 cells/mm3. Those with ADIs were more likely to be male (67.5% vs 54.6%; P < .0001) and heterosexual (89.4% vs 85.0%; P = .005). The most common ADIs were Mycobacterium tuberculosis (55.0%), Pneumocystis jirovecii pneumonia (13.7%), esophageal candidiasis (13.4%), and histoplasmosis (11.4%). Histoplasmosis and HIV wasting syndrome were both more common among rural patients.

Conclusions: In this large Guatemalan cohort of patients currently living with HIV, a significant portion presented with an ADI. These data inform the most common ADIs diagnosed among survivors, show that histoplasmosis is more commonly diagnosed in rural patients, and suggest that HIV wasting syndrome may reflect missed histoplasmosis diagnoses.

Keywords: AIDS; AIDS-defining illnesses; Guatemala; HIV; global health.

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Figures

Figure 1.
Figure 1.
Distribution of number of ADIs diagnosed in individual patients. This figure shows the frequency of the number of ADIs among patients diagnosed with at least 1 ADI at the time of HIV diagnosis (total = 931). Abbreviation: ADI, AIDS-defining illness.
See this image and copyright information in PMC

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