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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

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  • 1 Institute of Tropical Medicine (NEKKEN), Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan
  • | 2 Bridgeport Hospital-Yale New Haven Health, Bridgeport, Connecticut
  • | 3 Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
  • | 4 Bach Mai Hospital, Hanoi, Vietnam
  • | 5 Ministry of Public Health, Nonthaburi, Thailand
  • | 6 Philippine General Hospital, University of the Philippines, Manila, Philippines
  • | 7 National Hospital Organization Nagoya Medical Center, Nagoya, Japan
  • | 8 Lampang Hospital, Lampang, Thailand

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.

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Author Notes

Address correspondence to Koya Ariyoshi, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, P.O. Box 852-8523, Nagasaki, Japan. E-mail: kari@nagasaki-u.ac.jpThese authors contributed equally to this work.

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.

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