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

Kate Buchacz, Bryan Lau, Yuezhou Jing, Ronald Bosch, Alison G. Abraham, M. John Gill, Michael J. Silverberg, James J. Goedert, Timothy R. Sterling, Keri N. Althoff, Jeffrey N. Martin, Greer Burkholder, Neel Gandhi, Hasina Samji, Pragna Patel, Anita Rachlis, Jennifer E. Thorne, Sonia Napravnik, Keith Henry, Angel MayorKelly Gebo, Stephen J. Gange, Richard D. Moore, John T. Brooks, Gregory D. Kirk, Constance A. Benson, Ronald J. Bosch, Stephen Boswell, Kenneth H. Mayer, Chris Grasso, Robert S. Hogg, P. Richard Harrigan, Julio S G Montaner, Angela Cescon, Kelly A. Gebo, John T. Carey, Benigno Rodriguez, Michael A. Horberg, Lisa P. Jacobson, Gypsyamber D'Souza, Marina B. Klein, Sean B. Rourke, Ann N. Burchell, Anita R. Rachlis, Robert F. Hunter-Mellado, Angel M. Mayor, Steven G. Deeks, Michael S. Saag, Michael J. Mugavero, James Willig, North American Aids Cohort Collaboration On Research And Design (na-Accord) Of IeDEA

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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 studiedHIV-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.

Original languageEnglish (US)
Pages (from-to)862-872
Number of pages11
JournalJournal of Infectious Diseases
Volume214
Issue number6
DOIs
StatePublished - Sep 15 2016

Bibliographical note

Funding Information:
This work was supported by NIH (grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24DA000432, K24AI065298, KL2TR000421, M01RR000052, N02CP055504, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, 01AA016893, R01CA165937, R01DA004334, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794, U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214 and Z01CP010176); the CDC (contract CDC-200-2006-18797 and CDC-200-2015-63931); the Agency for Healthcare Research and Quality (contract 90047713); the Health Resources and Services Administration (contract 90051652); Canadian Institutes of Health Research (grants CBR- 86906, CBR-94036, HCP-97105 and TGF-96118); Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the Intramural Research Program of the National Cancer Institute.

Publisher Copyright:
© 2016 Published by Oxford University Press for the Infectious Diseases Society of America.

Keywords

  • AIDS-related opportunistic infections
  • CD4 T-lymphocyte count
  • HIV cohort studies
  • combination antiretroviral therapy
  • epidemiology
  • incidence
  • prophylaxis

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