Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Int Assoc Provid AIDS Care. 2024 Jan-Dec;23:23259582241241167. doi: 10.1177/23259582241241167.
To determine the incidence of opportunistic infections (OIs) and the predictive factors for the development of OIs after antiretroviral therapy (ART) initiation among treatment-naïve patients with HIV infection.
Of 401 HIV-infected patients, 38 (9.5%) HIV-infected patients developed OIs after initiating ART, with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to OI occurrence was 26.5 (14-73) days. In multivariate Cox proportional hazard regression, body mass index ≤18.5 kg/m (adjusted hazard ratio [aHR] 2.28, 95% confidence interval [CI] 1.18-4.42, = .015), symptoms at presentation (aHR 13.59, 95% CI 3.24-56.9, < .001), serum glutamate-pyruvate transaminase >55 U/L (aHR 2.09, 95% CI 1.06-4.15, = .035), and initiation of a dolutegravir-based regimen (aHR 4.39, 95% CI 1.54-12.48, = .006) were significantly associated with OIs after ART initiation.
OIs after ART initiation are common. Malnutrition, symptomatic presentation, abnormal liver enzymes, and DTG-based regimens are predictors of OI occurrence after ART initiation. Physicians must monitor and appropriately treat OIs after ART initiation.
确定初治 HIV 感染者开始抗逆转录病毒治疗（ART）后发生机会性感染（OI）的发生率，以及发生 OI 的预测因素。
在 401 例 HIV 感染者中，有 38 例（9.5%）感染者在开始 ART 后发生 OI，发病率为 25.6/1000 人年。从开始 ART 到发生 OI 的中位时间（IQR）为 26.5（14-73）天。在多变量 Cox 比例风险回归中，体质指数≤18.5 kg/m²（调整后的危险比[aHR] 2.28，95%置信区间[CI] 1.18-4.42， = .015）、初诊时的症状（aHR 13.59，95%CI 3.24-56.9， < .001）、血清谷氨酸-丙酮酸转氨酶>55 U/L（aHR 2.09，95%CI 1.06-4.15， = .035）和开始使用多替拉韦为基础的方案（aHR 4.39，95%CI 1.54-12.48， = .006）与 ART 后发生 OI 显著相关。
ART 后发生 OI 很常见。营养不良、有症状表现、肝酶异常和以 DTG 为基础的方案是 ART 后发生 OI 的预测因素。医生必须监测和适当治疗 ART 后发生的 OI。
