Work

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

Year: 2016

Type: article

Abstract: Background. Late HIV diagnosis is associated with higher morbidity and mortality, even among those who receive antiretroviral therapy (ART). Patients diagnosed late have been shown to require more resources due to hospitalizations and treatment of opportunistic infections in addition to primary treatment for their HIV infection. In Guatemala, more than 65% of patients diagnosed with HIV have progressed to AIDS. There are 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 and receiving ART at Roosevelt Hospital in Guatemala City, Guatemala. Charts were analyzed for clinical and demographic data and the patients were interviewed. The presence of an ADI was assessed by the CDC definitions. Patients who presented with an ADI were compared with those that were diagnosed without an ADI to look for risk factors. Results. We enrolled 3654 patients in the study, of whom 922 (25.2%) had an ADI at the time of HIV diagnosis. Of these, 739 (80.2%) had CD4 counts less than 200 cells/mm3. Compared to patients without ADIs at diagnosis, those with ADIs were more likely to be male (67.5% compared with 54.5%, P < 0.0001), of older age (35.2 years versus 34.1 years, P = 0.009), and heterosexual (89.4% versus 85.1%, P = 0.005). A higher percentage of patients with ADIs at diagnosis had sought healthcare in the 2 years prior to diagnosis (22.0% versus 16.9%, P = 0.001). The most common ADIs were Mycobacterium tuberculosis (54.8%), HIV wasting syndrome (23.8%), Pneumocystis jirovecii pneumonia (13.8%), and disseminated or extrapulmonary histoplasmosis (11.4%). Conclusion. In this large cohort of HIV patients in Guatemala, a significant portion presented with an ADI These data inform the most common ADIs in those diagnosed with HIV. They are different from other reports from Latin America, which showed disseminated histoplasmosis, esophageal candidiasis, and cerebral toxoplasmosis as the 3 most common ADIs. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1722