Changes in AIDS-Defining Illnesses in a London Clinic, 1987–1998

Mocroft, Amanda; Sabin, Caroline; Youle, Mike; Madge, Sara; Tyrer, Mervyn; Devereux, Helen; Deayton, Jane R; Dykhoff, A.; Lipman, Mci; An, Peng; Ma, Jun

doi:10.1097/00126334-199908150-00007

Cited by 56 publications

(34 citation statements)

References 31 publications

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“…The decreasing trend in the incidence rate of PCP likely results from the use of chemoprophylaxis and antiretroviral therapy. Currently PCP incidence rate in our cohort is lower than that observed in both in high income and low-middle income settings in the post cART era [10], [23], [25], [33], [35].…”

Section: Discussioncontrasting

confidence: 73%

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Trends in AIDS-Defining Opportunistic Illnesses Incidence over 25 Years in Rio de Janeiro, Brazil

et al. 2014

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ObjectivesTo assess the temporal trends in incidence of AIDS-defining opportunistic illnesses in an urban cohort of a middle-income country.MethodsHIV infected patients aged ≥18 years at cohort entry were included in this analysis. We calculated incidence rates per 1000 persons-years of observation for the first opportunistic illness presented after cohort enrollment, from 1987 to 2012. Trends for overall and specific opportunistic illnesses were tested and incidence rate ratios for the most recent calendar period were calculated as the ratio between the incidence rate observed in the most recent period of the study (2009–2012) and the incidence rate observed in first period of the study (1987–1990).ResultsOverall, 3378 patients were included in this analysis; of which 1119 (33%) patients presented an opportunistic illness during follow up. Incidence rates of all opportunistic illnesses decreased over time, and the overall opportunistic illness incidence rates fell from 295.4/1000 persons-years in 1987–1990 to 34.6/1000 persons-years in 2009–2012. Tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jirovecii pneumonia were the most incident opportunistic illnesses in the cohort. Tuberculosis had the highest incidence rate in the study period. The peak in tuberculosis incidence occurred in 1991–1993 (80.8/1000 persons-years). Cerebral toxoplasmosis was the third most incident opportunistic illness in the study, with a peak of incidence of 43.6/1000 persons-year in 1987–1990.ConclusionsAll opportunistic illnesses incidence rates decreased over the years but they still occur in an unacceptable frequency. Tuberculosis co-infection among HIV-infected persists as an important challenge for health care professionals and policy makers in our setting. Impressively high rates of cerebral toxoplasmosis were found suggesting that its incidence among HIV-infected is linked to the high prevalence of Toxoplasma gondii infection in the general population.

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Section: Discussioncontrasting

confidence: 73%

“…PCP was the most incident OI in the first period of our study, with incidence rates comparable to those observed in high-income cohorts in pre cART era [25], [40]. The decreasing trend in the incidence rate of PCP likely results from the use of chemoprophylaxis and antiretroviral therapy.…”

Section: Discussionsupporting

confidence: 71%

Trends in AIDS-Defining Opportunistic Illnesses Incidence over 25 Years in Rio de Janeiro, Brazil

et al. 2014

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“…8 Longitudinal studies have recorded a dramatic decline in opportunistic infections, including PCP, attributed to effective antiretroviral therapy, increasing use of PCP prophylaxis, and increased awareness among health care professionals. 9 10 Influenza, influenza-like illnesses, and bacterial pneumonia are more commonly diagnosed in colder months, 11 12 and this cohort study of 792 HIV infected individuals with PCP shows that this diagnosis is also more common in January.…”

Section: Discussionmentioning

confidence: 99%

Prospective cohort study showing changes in the monthly incidence of Pneumocystis carinii pneumonia

Lubis

Baylis²,

Short³

et al. 2003

Postgraduate Medical Journal

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Pneumocystis carinii pneumonia (PCP) remains a serious opportunistic infection in HIV infected individuals. Seasonal changes in climate are associated with changes within individual susceptibility to infection. The possibility of monthly variability in the incidence of PCP was therefore examined by means of a cohort study of a database of 8640 HIV infected individuals attending the Chelsea and Westminster Hospital. There were 792 cases of PCP diagnosed since 1985. A marked decline was observed in the incidence of PCP in mid-1992 coincident with the introduction of PCP prophylaxis. There was a further decline in 1996 after the introduction of highly active antiretroviral therapy. Despite no significant monthly variation in the mean attendance to clinic and CD4 count, both new and all cases of PCP were higher in January than in other months (15.9% and 14.5% of all cases, respectively). A correlation with low rainfall in January and new cases of PCP was observed. These data are consistent with an influence of climatic conditions on the presentation of PCP. The diagnosis of PCP is more common in winter months suggesting that this is a transmissible infection.

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“…[2,3] The introduction of highly active antiretroviral therapy (HAART) in the mid-1990s has led to marked declines in the incidence of most AIDS-associated illnesses, but the incidence of AIDS-associated NHL (ARL) has declined less. [4][5][6][7] ARL is now the second most common AIDS-associated malignancy, and is the AIDS-defining diagnosis in approximately 3% of HIV-positive patients, although it is uncertain what percentage of patients already diagnosed with AIDS develop lymphoma.…”

Section: Introductionmentioning

confidence: 99%