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Regional Differences in the Prevalence of Major Opportunistic Infections among Antiretroviral-Naïve Human Immunodeficiency Virus Patients in Japan, Northern Thailand, Northern Vietnam, and the Philippines
Louie Mar A. Gangcuangco
Louie Mar A. Gangcuangco
Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
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Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
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Ikumi Sawada
Ikumi Sawada
Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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Naho Tsuchiya
Naho Tsuchiya
Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
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Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
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Cuong D. Do
Cuong D. Do
Bach Mai Hospital, Hanoi, Vietnam
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Thanh Thuy T. Pham
Thanh Thuy T. Pham
Bach Mai Hospital, Hanoi, Vietnam
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Archawin Rojanawiwat
Archawin Rojanawiwat
Ministry of Public Health, Nonthaburi, Thailand
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Marissa Alejandria
Marissa Alejandria
Philippine General Hospital, University of the Philippines, Manila, Philippines
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Katerina Leyritana
Katerina Leyritana
Philippine General Hospital, University of the Philippines, Manila, Philippines
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Yoshiyuki Yokomaku
Yoshiyuki Yokomaku
National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Panita Pathipvanich
Panita Pathipvanich
Lampang Hospital, Lampang, Thailand
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Koya Ariyoshi
Koya Ariyoshi
Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
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To identify regional differences in the distribution of opportunistic infections (OIs) among human immunodeficiency virus (HIV)-infected patients in Asia, the medical records of antiretroviral therapy (ART)-naïve patients who attended the following tertiary hospitals from 2003 to 2011 were reviewed: Nagoya Medical Center (NMC, Nagoya, Japan), Lampang Hospital (LPH, Lampang, northern Thailand), Bach Mai Hospital (BMH, Hanoi, northern Vietnam), and Philippine General Hospital (PGH, Manila, Philippines). Logistic regression analyses were performed to identify associations between country of origin and risk of major OIs. In total, 1,505 patients were included: NMC, N = 365; LPH, N = 442; BMH, N = 384; and PGH, N = 314. The median age was 32 years, and 73.3% of all patients were male. The median CD4 count was 200 cells/μL. Most patients at NMC and PGH were men who have sex with men. Injection drug users were most common at BMH (35.7%). Mycobacterium tuberculosis (TB) was most common at PGH (N = 75) but was rare at NMC (N = 4). Pneumocystis pneumonia (PCP) prevalence was highest at NMC (N = 74) and lowest at BMH (N = 13). Multivariable logistic regression showed increased odds of TB at PGH (adjusted odds ratio [aOR] = 42.2, 95% confidence interval [CI] = 14.6–122.1), BMH (aOR = 12.6, CI = 3.9–40.3), and LPH (aOR = 6.6, CI = 2.1–21.1) but decreased odds of PCP at BMH (aOR = 0.1, CI = 0.04–0.2) and LPH (aOR = 0.2, CI = 0.1–0.4) compared with those at NMC. The cryptococcosis risk was increased at LPH (aOR = 6.2, CI = 0.9–41.0) compared with that at NMC. Cytomegalovirus (CMV) retinitis prevalences were similar in all countries. OI prevalence remained high among ART-naïve patients in our cohort. The risks of TB, PCP, and cryptococcosis, but not CMV retinitis, differed between countries. Improved early HIV detection is warranted.
- Supplemental Materials (PDF 45 KB)
Author Notes
Note: Supplemental tables appear at www.ajtmh.org.
Authors' addresses: Louie Mar A. Gangcuangco, Department of Clinical Tropical Medicine, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan, and Department of Internal Medicine, Bridgeport Hospital-Yale New Haven Health, Bridgeport, CT, E-mail: louiemarmd@gmail.com. Ikumi Sawada and Koya Ariyoshi, Department of Clinical Tropical Medicine, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan, E-mails: sawada.ikumi@gmail.com and kari@nagasaki-u.ac.jp. Naho Tsuchiya, Department of Clinical Tropical Medicine, Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan, and Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan, E-mail: nahot@megabank.tohoku.ac.jp. Cuong D. Do and Thanh Thuy T. Pham, Department of Infectious Diseases, Bach Mai Hospital, Hanoi, Vietnam, E-mails: doduy.cuong@gmail.com and phamthanhthuy714@gmail.com. Archawin Rojanawiwat, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand, E-mail: archawin191@yahoo.com. Marissa Alejandria and Katerina Leyritana, Section of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines, E-mails: mmalejandria@gmail.com and kateleyritana@yahoo.com. Yoshiyuki Yokomaku, Department of Infectious Diseases and Immunology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan, E-mail: yokomaku@nnh.hosp.go.jp. Panita Pathipvanich, Day Care Center, Lampang Hospital, Lampang, Thailand, E-mail: panitapa@yahoo.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Blaxhult A, Kirk O, Pedersen C, Dietrich M, Barton SE, Gatell JM, Mulcahy F, Hirschel B, Mocroft A, Lundgren JD, 2000. Regional differences in presentation of AIDS in Europe. Epidemiol Infect 125: 143–151.
-
2.
Nucci M, Queiroz-Telles F, Tobon AM, Restrepo A, Colombo AL, 2010. Epidemiology of opportunistic fungal infections in Latin America. Clin Infect Dis 51: 561–570.
-
3.
Handford CD, Rackal JM, Tynan AM, Rzeznikiewiz D, Glazier RH, 2012. The association of hospital, clinic and provider volume with HIV/AIDS care and mortality: systematic review and meta-analysis. AIDS Care 24: 267–282.
-
4.
Kaslow RA, Carrington M, Apple R, Park L, Munoz A, Saah AJ, Goedert JJ, Winkler C, O'Brien SJ, Rinaldo C, Detels R, Blattner W, Phair J, Erlich H, Mann DL, 1996. Influence of combinations of human major histocompatibility complex genes on the course of HIV-1 infection. Nat Med 2: 405–411.
-
5.
Pant Pai N, Shivkumar S, Cajas JM, 2012. Does genetic diversity of HIV-1 non-B subtypes differentially impact disease progression in treatment-naive HIV-1-infected individuals? A systematic review of evidence: 1996–2010. J Acquir Immune Defic Syndr 59: 382–388.
-
6.
Ruxrungtham K, Brown T, Phanuphak P, 2004. HIV/AIDS in Asia. Lancet 364: 69–82.
-
7.
Yang CH, Huang YF, Hsiao CF, Yeh YL, Liou HR, Hung CC, Yang SY, 2008. Trends of mortality and causes of death among HIV-infected patients in Taiwan, 1984–2005. HIV Med 9: 535–543.
-
8.
AIDS Surveillance Committee, Ministry of Health Labour and Welfare, 2014. HIV/AIDS Surveillance in 2014. Available at: http://api-net.jfap.or.jp/status/2014/14nenpo/14nenpo_menu.html. Accessed April 27, 2016.
-
9.
Dickson N, McAllister S, Sharples K, Paul C, 2012. Late presentation of HIV infection among adults in New Zealand: 2005–2010. HIV Med 13: 182–189.
-
10.
Kiertiburanakul S, Boonyarattaphun K, Atamasirikul K, Sungkanuparph S, 2008. Clinical presentations of newly diagnosed HIV-infected patients at a university hospital in Bangkok, Thailand. J Int Assoc Physicians AIDS Care (Chic) 7: 82–87.
-
11.
Kong BN, Harwell JI, Suos P, Lynen L, Mohiuddin S, Reinert S, Pugatch D, 2007. Opportunistic infections and HIV clinical disease stage among patients presenting for care in Phnom Penh, Cambodia. Southeast Asian J Trop Med Public Health 38: 62–68.
-
12.
Zhou J, Kumarasamy N, Ditangco R, Kamarulzaman A, Lee CK, Li PC, Paton NI, Phanuphak P, Pujari S, Vibhagool A, Wong WW, Zhang F, Chuah J, Frost KR, Cooper DA, Law MG, 2005. The TREAT Asia HIV Observational Database: baseline and retrospective data. J Acquir Immune Defic Syndr 38: 174–179.
-
13.
Chariyalertsak S, Sirisanthana T, Saengwonloey O, Nelson KE, 2001. Clinical presentation and risk behaviors of patients with acquired immunodeficiency syndrome in Thailand, 1994–1998: regional variation and temporal trends. Clin Infect Dis 32: 955–962.
-
14.
Yasuoka A, Tsukamoto M, Kurihara S, Takami Y, Shiki N, 2012. A National Survey of HIV-Related Opportunistic Infections in 2010. AIDS Research Project. Tokyo, Japan: Ministry of Health, Labour and Welfare, 16–34.
-
15.
Louie JK, Chi NH, Thao LTT, Quang VM, Campbell J, Chau NV, Rutherford GW, Farrar JJ, Parry CM, 2004. Opportunistic infections in hospitalized HIV-infected adults in Ho Chi Minh City, Vietnam: a cross-sectional study. Int J STD AIDS 15: 758–761.
-
16.
Klotz SA, Nguyen HC, Van Pham T, Nguyen LT, Ngo DT, Vu SN, 2007. Clinical features of HIV/AIDS patients presenting to an inner city clinic in Ho Chi Minh City, Vietnam. Int J STD AIDS 18: 482–485.
-
17.
Section Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, 2008. Epidemiological Information. Bangkok, Thailand: Ministry of Public Health.
-
18.
World Health Organization, 2007. WHO Case Definitions of HIV for Surveillance and Revised Clinial Staging and Immunological Classification of HIV-Related Diseases in Adults and Children. Available at: http://www.who.int/hiv/pub/guidelines/hivstaging/en/. Accessed May 4, 2015.
-
19.
Ministry of Health Labour and Welfare, 2011. Anti HIV Treatment Guideline. Available at: http://www.haart-support.jp/guideline.htm. Accessed April 1, 2015.
-
20.
Ministry of Public Health, 2000. National Guidelines for the Clinical Management of HIV Infection in Children and Adults, 6th Edition. Bangkok, Thailand: Ministry of Public Health.
-
21.
Vietnam Ministry of Health, 2009. Guidelines for HIV/AIDS Diagnosis and Treatment. Available at: http://www.who.int/hiv/pub/guidelines/vietnam_art.pdf. Accessed June 4, 2015.
-
22.
Philippine Society for Microbiology and Infectious Diseases, 2006. Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 Update. Available at: http://www.psmid.org.ph/pdf/Introduction_Edited_4.pdf. Accessed June 4, 2015.
-
23.
Vanittanakom N, Cooper CR Jr, Fisher MC, Sirisanthana T, 2006. Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 19: 95–110.
-
24.
Vietnam Authority of HIV/AIDS Control, 2014. An Annual Update on the HIV Epidemic in Vietnam. Available at: http://www.aidsdatahub.org/annual-update-hiv-epidemic-viet-nam-viet nam-authority-hivaids-control-vaac-2014. Accessed February 2, 2016.
-
25.
Farr AC, Wilson DP, 2010. An HIV epidemic is ready to emerge in the Philippines. J Int AIDS Soc 13: 16.
-
26.
HIV and AIDS Data Hub for Asia-Pacific, 2015. Country Profiles. Available at: http://www.aidsdatahub.org. Accessed May 11, 2015.
-
27.
Trinh QM, Nguyen HL, Nguyen VN, Nguyen TV, Sintchenko V, Marais BJ, 2015. Tuberculosis and HIV co-infection-focus on the Asia-Pacific region. Int J Infect Dis 32: 170–178.
-
28.
World Health Organization, 2012. Global Tuberculosis Control: WHO Report 2011. Available at: http://apps.who.int/iris/bitstream/10665/44728/1/9789241564380_eng.pdf. Accessed February 2, 2016.
-
29.
Janssens JP, Rieder HL, 2008. An ecological analysis of incidence of tuberculosis and per capita gross domestic product. Eur Respir J 32: 1415–1416.
-
30.
Kufa T, Mabuto T, Muchiri E, Charalambous S, Rosillon D, Churchyard G, Harris RC, 2014. Incidence of HIV-associated tuberculosis among individuals taking combination antiretroviral therapy: a systematic review and meta-analysis. PLoS One 9: e111209.
-
31.
Narasimhan P, Wood J, Macintyre CR, Mathai D, 2013. Risk factors for tuberculosis. Pulm Med 2013 :828939.
-
32.
Deiss RG, Rodwell TC, Garfein RS, 2009. Tuberculosis and illicit drug use: review and update. Clin Infect Dis 48: 72–82.
-
33.
Friedman H, Newton C, Klein TW, 2003. Microbial infections, immunomodulation, and drugs of abuse. Clin Microbiol Rev 16: 209–219.
-
34.
Lowe DM, Rangaka MX, Gordon F, James CD, Miller RF, 2013. Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression. PLoS One 8: e69969.
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