Medina Narda, Alastruey-Izquierdo Ana, Bonilla Oscar, Mercado Danicela, Arathoon Eduardo, Rodriguez-Tudela Juan Luis
Asociación de Salud Integral, Guatemala City, Guatemala.
Global Action for Fungal Infections, Geneva, Switzerland.
HIV Med. 2025 May;26(5):701-708. doi: 10.1111/hiv.70000. Epub 2025 Feb 17.
Discontinuation of antiretroviral therapy (ART) significantly contributes to the development of advanced HIV disease (AHD) and opportunistic infections. This study analyzed data from patients who re-engaged in care after ART interruption and compared the cohort with patients with newly diagnosed HIV, focusing on the burden of tuberculosis and histoplasmosis.
A diagnostic package for opportunistic infections was implemented in Guatemala in 2017, encompassing tuberculosis and histoplasmosis. From 2017 to 2019, we enrolled 1379 adults re-engaging in care and 3412 patients with newly diagnosed HIV across 13 healthcare facilities. Data collection included demographic information, laboratory test results, and patient outcomes.
Among patients re-engaging in care, 54% (491 of 903) had AHD, which was comparable to the 50.1% (1349 of 2692) in newly diagnosed patients. Among the re-engaging cohort, 34.5% had not undergone CD4 testing, compared with 21.1% in the newly diagnosed group. This highlights a significant gap in assessing advanced HIV status through an objective, unbiased test. Among patients re-engaging in care, the incidence rates of tuberculosis and histoplasmosis were 9.7% and 8.3%, respectively, regardless of immune status. This indicated a high burden of opportunistic infections in this group, with newly diagnosed patients showing similar incidence rates of 8.5% for tuberculosis and 8.3% for histoplasmosis.
Patients re-engaging in care should follow a similar process to newly diagnosed patients. There is an urgent need for routine and immediate CD4 testing to identify AHD and implement the recommended comprehensive diagnostic and care package. Early detection and targeted interventions are crucial for reducing AIDS-related mortality.
抗逆转录病毒疗法（ART）的中断显著促进了晚期HIV疾病（AHD）的发展和机会性感染。本研究分析了ART中断后重新接受治疗的患者的数据，并将该队列与新诊断的HIV患者进行比较，重点关注结核病和组织胞浆菌病的负担。
2017年在危地马拉实施了一套机会性感染诊断方案，涵盖结核病和组织胞浆菌病。2017年至2019年，我们在13个医疗机构招募了1379名重新接受治疗的成年人和3412名新诊断的HIV患者。数据收集包括人口统计学信息、实验室检查结果和患者结局。
在重新接受治疗的患者中，54%（903例中的491例）患有AHD，这与新诊断患者中的50.1%（2692例中的1349例）相当。在重新接受治疗的队列中，34.5%的患者未进行CD4检测，而新诊断组为21.1%。这凸显了通过客观、无偏倚检测评估晚期HIV状态方面的显著差距。在重新接受治疗的患者中，无论免疫状态如何，结核病和组织胞浆菌病的发病率分别为9.7%和8.3%。这表明该组机会性感染负担较高，新诊断患者的结核病发病率为8.5%，组织胞浆菌病发病率为8.3%，两者相似。
重新接受治疗的患者应遵循与新诊断患者类似的流程。迫切需要进行常规和即时的CD4检测，以识别AHD并实施推荐的综合诊断和护理方案。早期检测和针对性干预对于降低艾滋病相关死亡率至关重要。
