Coelho Lara, Cardoso Sandra Wagner, Amancio Rodrigo Teixeira, Moreira Ronaldo Ismério, Campos Dayse Pereira, Veloso Valdiléa Gonçalves, Grinsztejn Beatriz, Luz Paula Mendes
Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
PLoS One. 2014 Jun 5;9(6):e98666. doi: 10.1371/journal.pone.0098666. eCollection 2014.
To assess the temporal trends in incidence of AIDS-defining opportunistic illnesses in an urban cohort of a middle-income country.
HIV 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).
Overall, 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.
All 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.
评估一个中等收入国家城市队列中艾滋病界定机会性感染的发病率随时间的变化趋势。
本分析纳入队列入组时年龄≥18岁的HIV感染患者。我们计算了1987年至2012年队列入组后首次出现的机会性感染每1000人年观察期的发病率。对总体和特定机会性感染的趋势进行了检验，并计算了最近日历期的发病率比，即研究最近期（2009 - 2012年）观察到的发病率与研究第一期（1987 - 1990年）观察到的发病率之比。
总体而言，本分析纳入了3378例患者；其中1119例（33%）患者在随访期间出现了机会性感染。所有机会性感染的发病率随时间下降，总体机会性感染发病率从1987 - 1990年的295.4/1000人年降至2009 - 2012年的34.6/1000人年。结核病、食管念珠菌病、脑弓形虫病和耶氏肺孢子菌肺炎是该队列中最常见的机会性感染。结核病在研究期间发病率最高。结核病发病率峰值出现在1991 - 1993年（80.8/1000人年）。脑弓形虫病是该研究中第三常见的机会性感染，1987 - 1990年发病率峰值为43.6/1000人年。
多年来所有机会性感染的发病率均有所下降，但仍以不可接受的频率发生。HIV感染患者中的结核合并感染仍然是我们环境中医疗保健专业人员和政策制定者面临的一项重大挑战。发现脑弓形虫病的发病率极高，表明其在HIV感染者中的发病率与普通人群中弓形虫感染的高流行率有关。
