Opportunistic diseases among HIV-infected patients: a multicenter-nationwide Korean HIV/AIDS cohort study, 2006 to 2013

Youn Jeong Kim, Jun Hee Woo, Min Ja Kim, Dae Won Park, Joon-Young Song, Shin Woo Kim, Jun Yong Choi, June Myung Kim, Sang Hoon Han, Jin-Soo Lee, Bo Youl Choi, Joo Shil Lee, Sung-Soon Kim, Mee-Kyung Kee, Moon Won Kang, Sang Il Kim, Youn Jeong Kim, Jun Hee Woo, Min Ja Kim, Dae Won Park, Joon-Young Song, Shin Woo Kim, Jun Yong Choi, June Myung Kim, Sang Hoon Han, Jin-Soo Lee, Bo Youl Choi, Joo Shil Lee, Sung-Soon Kim, Mee-Kyung Kee, Moon Won Kang, Sang Il Kim

Abstract

Background/aims: The frequencies of opportunistic diseases (ODs) vary across countries based on genetic, environmental, and social differences. The Korean HIV/AIDS cohort study was initiated in 2006 to promote research on human immunodeficiency virus (HIV) infection in Korea, and to provide a logistical network to support multicenter projects on epidemiological, clinical, and laboratory aspects of HIV infection. This study evaluated the prevalence of ODs among HIV-infected patients in the era of highly active antiretroviral therapy, and the risk factors associated with ODs.

Methods: The study enrolled 1,086 HIV-infected patients from 19 hospitals. This study examined the baseline data of the HIV/AIDS Korean cohort study at the time of enrollment from December 2006 to July 2013.

Results: Candidiasis was the most prevalent opportunistic infection (n = 176, 16.2%), followed by Mycobacterium tuberculosis infection (n = 120, 10.9%), Pneumocystis jirovecii pneumonia (n = 121, 11.0%), cytomegalovirus infection (n = 52, 4.7%), and herpes zoster (n = 44, 4.0%). The prevalence rates of Kaposi's sarcoma (n = 8, 0.7%) and toxoplasmosis (n = 4, 0.4%) were very low compared with other countries. The risk factors for ODs were a low CD4 T cell count at the time of HIV diagnosis (odds ratio [OR], 1.01; p < 0.01), current smoking (OR, 2.27; p = 0.01), current alcohol use (OR, 2.57; p = 0.04), and a history of tuberculosis (OR, 5.23; p < 0.01).

Conclusions: Using recent Korean nationwide data, this study demonstrated that an important predictor of ODs was a low CD4 T cell count at the time of HIV diagnosis. Tuberculosis remains one of the most important ODs in HIV-infected patients in Korea.

Keywords: AIDS-related opportunistic infections; HIV; Korea; Tuberculosis.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Distribution of CD4 cell count in study patients with opportunistic disease. PCP, Pneumocystis carinii pneumonia; CMV, cytomegalovirus.

References

    1. World Health Organization . Geneva: World Health Organization; c2015. Global health observatory data repository [Internet] [cited 2015 Sep 22]. Available from: .
    1. Buchacz K, Baker RK, Palella FJ, Jr, et al. AIDS-defining opportunistic illnesses in US patients, 1994-2007: a cohort study. AIDS. 2010;24:1549–1559.
    1. Schwarcz L, Chen MJ, Vittinghoff E, Hsu L, Schwarcz S. Declining incidence of AIDS-defining opportunistic illnesses: results from 16 years of population-based AIDS surveillance. AIDS. 2013;27:597–605.
    1. Kim JM, Cho GJ, Hong SK, et al. Epidemiology and clinical features of HIV infection/AIDS in Korea. Yonsei Med J. 2003;44:363–370.
    1. Oh MD, Park SW, Kim HB, et al. Spectrum of opportunistic infections and malignancies in patients with human immunodeficiency virus infection in South Korea. Clin Infect Dis. 1999;29:1524–1528.
    1. The Korean Society for AIDS Clinical guidelines for the treatment and prevention of opportunistic infections in HIV infected Koreans. Infect Chemother. 2012;44:93–139.
    1. Joint Committee for the Development of Korean Guideline for Tuberculosis . Korean guidelines for tuberculosis. 1st ed. Cheongju: Korea Centers for Disease Control and Prevention; 2011.
    1. Seage GR, 3rd, Losina E, Goldie SJ, Paltiel AD, Kimmel AD, Freedberg KA. The relationship of preventable opportunistic infections, HIV-1 RNA, and CD4 cell counts to chronic mortality. J Acquir Immune Defic Syndr. 2002;30:421–428.
    1. Egger M, Hirschel B, Francioli P, et al. Impact of new antiretroviral combination therapies in HIV infected patients in Switzerland: prospective multicentre study. Swiss HIV Cohort Study. BMJ. 1997;315:1194–1199.
    1. Damtie D, Yismaw G, Woldeyohannes D, Anagaw B. Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar University Hospital, Northwest Ethiopia. BMC Res Notes. 2013;6:534.
    1. Xiao J, Gao G, Li Y, et al. Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital, China. PLoS One. 2013;8:
    1. Hanna DB, Gupta LS, Jones LE, Thompson DM, Kellerman SE, Sackoff JE. AIDS-defining opportunistic illnesses in the HAART era in New York City. AIDS Care. 2007;19:264–272.
    1. Narain JP, Lo YR. Epidemiology of HIV-TB in Asia. Indian J Med Res. 2004;120:277–289.
    1. Ledergerber B, Egger M, Opravil M, et al. Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study. Lancet. 1999;353:863–868.
    1. Nagai H. Factors for the onset of and the exacerbation of tuberculosis. 5. The infection and prognosis of tuberculosis among patients with immunodeficiency, especially HIV-infected patients. Kekkaku. 1999;74:753–758.
    1. Moreno S, Jarrin I, Iribarren JA, et al. Incidence and risk factors for tuberculosis in HIV-positive subjects by HAART status. Int J Tuberc Lung Dis. 2008;12:1393–1400.
    1. Sterling TR, Lau B, Zhang J, et al. Risk factors for tuberculosis after highly active antiretroviral therapy initiation in the United States and Canada: implications for tuberculosis screening. J Infect Dis. 2011;204:893–901.
    1. Seyler C, Toure S, Messou E, Bonard D, Gabillard D, Anglaret X. Risk factors for active tuberculosis after antiretroviral treatment initiation in Abidjan. Am J Respir Crit Care Med. 2005;172:123–127.
    1. de Sanjose S, Mbisa G, Perez-Alvarez S, et al. Geographic variation in the prevalence of Kaposi sarcoma-associated herpesvirus and risk factors for transmission. J Infect Dis. 2009;199:1449–1456.
    1. Manosuthi W, Chaovavanich A, Tansuphaswadikul S, et al. Incidence and risk factors of major opportunistic infections after initiation of antiretroviral therapy among advanced HIV-infected patients in a resource-limited setting. J Infect. 2007;55:464–469.
    1. Cha HH, Lee SH, Lee DH, et al. Degree of disease progression in homeless HIV/AIDS patients during the first medical visit. Infect Chemother. 2011;43:198–202.
    1. Chattopadhyay A, Patton LL. Smoking as a risk factor for oral candidiasis in HIV-infected adults. J Oral Pathol Med. 2013;42:302–308.
    1. Chattopadhyay A, Patton LL. Risk indicators for HIV-associated jointly occurring oral candidiasis and oral hairy leukoplakia. AIDS Patient Care STDS. 2007;21:825–832.

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