Incidence of AIDS-Defining Opportunistic Infections and Mortality during Antiretroviral Therapy in a Cohort of Adult HIV-Infected Individuals in Hanoi, 2007-2014

Junko Tanuma, Kyu Ha Lee, Sebastien Haneuse, Shoko Matsumoto, Dung Thi Nguyen, Dung Thi Hoai Nguyen, Cuong Duy Do, Thuy Thanh Pham, Kinh Van Nguyen, Shinichi Oka, Junko Tanuma, Kyu Ha Lee, Sebastien Haneuse, Shoko Matsumoto, Dung Thi Nguyen, Dung Thi Hoai Nguyen, Cuong Duy Do, Thuy Thanh Pham, Kinh Van Nguyen, Shinichi Oka

Abstract

Background: Although the prognosis for HIV-infected individuals has improved after antiretroviral therapy (ART) scale-up, limited data exist on the incidence of AIDS-defining opportunistic infections (ADIs) and mortality during ART in resource-limited settings.

Methods: HIV-infected adults in two large hospitals in urban Hanoi were enrolled to the prospective cohort, from October 2007 through December 2013. Those who started ART less than one year before enrollment were assigned to the survival analysis. Data on ART history and ADIs were collected retrospectively at enrollment and followed-up prospectively until April 2014.

Results: Of 2,070 cohort participants, 1,197 were eligible for analysis and provided 3,446 person-years (PYs) of being on ART. Overall, 161 ADIs episodes were noted at a median of 3.20 months after ART initiation (range 0.03-75.8) with an incidence 46.7/1,000 PYs (95% confidence interval [CI] 39.8-54.5). The most common ADI was tuberculosis with an incidence of 29.9/1,000 PYs. Mortality after ART initiation was 8.68/1,000 PYs and 45% (19/45) died of AIDS-related illnesses. Age over 50 years at ART initiation was significantly associated with shorter survival after controlling for baseline CD4 count, but neither having injection drug use (IDU) history nor previous ADIs were associated with poor survival. Semi-competing risks analysis in 951 patients without ADIs history prior to ART showed those who developed ADIs after starting ART were at higher risk of death in the first six months than after six months.

Conclusion: ADIs were not rare in spite of being on effective ART. Age over 50 years, but not IDU history, was associated with shorter survival in the cohort. This study provides in-depth data on the prognosis of patients on ART in Vietnam during the first decade of ART scale-up.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exist.

Figures

Fig 1. Survival Probabilities on ART in…
Fig 1. Survival Probabilities on ART in All Study Participants.
(a) Survival without new AIDS events on ART. (b) Overall survival on ART. Dotted lines indicate ranges of 95% CIs.
Fig 2. Survival Probabilities on ART in…
Fig 2. Survival Probabilities on ART in Subjects without AIDS History before ART.
(a) Survival without AIDS on ART in Weibull regression analysis. (b) Overall survival on ART in Weibull regression analysis. (c) Survival without AIDS on ART in semi-competing risks analysis. (d) Time to death without acquiring AIDS during ART in semi-competing risks analysis. (e) Time to death following new AIDS events during ART in semi-competing risks analysis. Dotted lines indicate ranges of 95% CIs.
Fig 3. Explanatory Hazard Ratio in Semi-Competing…
Fig 3. Explanatory Hazard Ratio in Semi-Competing Risks Analysis.
The ratio of hazards for death after and before AIDS. If the risk of death is not influenced by the risk of AIDS (i.e., time to AIDS and death are independent) the ratio is equal to one (the blue horizontal line). Dotted lines indicate ranges of 95% CIs.

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