Late-onset opportunistic infections while receiving anti-retroviral therapy in Latin America: burden and risk factors
Isaac Núñez, Brenda Crabtree‐Ramírez, Bryan E. Shepherd, Timothy R. Sterling, Pedro Cahn, Valdiléa G. Veloso, Claudia P. Cortés, Denis Padgett, Eduardo Gotuzzo, Juan Sierra‐Madero, Catherine C. McGowan, Anna K. Person, Yanink Caro‐Vega
Abstract
OBJECTIVES: The aim of this study was to describe the incidence, clinical characteristics, and risk factors of late-onset opportunistic infections (LOI) in people who live with HIV (PWLHA) within the Caribbean, Central and South America network for HIV epidemiology. METHODS: We performed a retrospective cohort study including treatment-naive PWLHA enrolled at seven sites (Argentina, Brazil, Chile, Peru, Mexico, and two sites in Honduras). Follow-up began at 6 months after treatment started. Outcomes were LOI, loss to follow-up, and death. We used a Cox proportional hazards model and a competing risks model to evaluate risk factors. RESULTS: A total of 10,583 patients were included. Median follow up was at 5.4 years. LOI occurred in 895 (8.4%) patients. Median time to opportunistic infection was 2.1 years. The most common infections were tuberculosis (39%), esophageal candidiasis (10%), and Pneumocystis jirovecii (P. jirovecii) pneumonia (10%). Death occurred in 576 (5.4%) patients, and 3021 (28.5%) patients were lost to follow-up. A protease inhibitor-based regimen (hazard ratio 1.25), AIDS-defining events during the first 6 months of antiretroviral-treatment (hazard ratio 2.12), starting antiretroviral-treatment in earlier years (hazard ratio 1.52 for 2005 vs 2010), and treatment switch (hazard ratio 1.31) were associated with a higher risk of LOI. CONCLUSION: LOI occurred in nearly one in 10 patients. People with risk factors could benefit from closer follow-up.