International Journal of Epidemiology 2001;30:864-871
© International Epidemiological Association 2001
Infectious Disease |
Incidence of primary opportunistic infections in two human immunodeficiency virus-infected French clinical cohorts
a Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Centre Hospitalier Régional Universitaire de Lille, Tourcoing, France.
bGeneral Medicine Division and Partners AIDS Research Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
c INSERM Unit 330, University of Bordeaux II, Bordeaux, France.
d Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston University School of Medicine, Boston, MA, USA.
e Department of Health Policy and Management and Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
f Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.
Yazdan Yazdanpanah, Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, 135, rue du Président Coty, BP 619, F 59208 Tourcoing, France. E-mail: yyazdan{at}yahoo.com
Background Clinical guidelines for the prevention of opportunistic infections in human immunodeficiency virus (HIV)-infected individuals have been developed on the basis of natural history data collected in the USA. The objective of this study was to estimate the incidence of primary opportunistic infections in HIV-infected individuals in geographically distinct cohorts in France.
Methods We conducted our study on 2664 HIV-infected patients from the Tourcoing AIDS Reference Centre and the hospital-based information system of the Groupe d'Epidémiologie Clinique du SIDA en Aquitaine enrolled from January 1987 to September 1995 and followed through December 1995. We estimated: (1) CD4-adjusted incidence rates of seven primary opportunistic infections in the absence of prophylaxis for that specific infection or any antiretroviral drugs other than zidovudine; and (2) CD4 lymphocyte count decline.
Results The highest incidence rates for all opportunistic infections studied occurred in patients with CD4 counts <200/µl. With CD4 counts <50/µl, the most common opportunistic infections were toxoplasmic encephalitis (12.6 per 100 person-years) and Pneumocystis carinii pneumonia (11.4 per 100 person-years). Mycobacterium tuberculosis was the least common opportunistic infection (<5.0/100 person-years). Even with CD4 counts >300/µl, cases of Pneumocystis carinii pneumonia and toxoplasmic encephalitis were reported. The mean CD4 lymphocyte decline per month was 4.6 cells/µl. There was a significant association between HIV risk behaviour and the incidence of cytomegalovirus infection, between calendar year and the incidence of Pneumocystis carinii pneumonia, toxoplasmic encephalitis and Candida esophagitis, and between geographical area and the incidence of Pneumocystis carinii pneumonia and cytomegalovirus infection.
Conclusions Geographical differences exist in the incidence of HIV-related opportunistic infections. These results can be used to define local priorities for prophylaxis of opportunistic infections.
Keywords Opportunistic infections, natural history, HIV, France, incidence rate
Accepted 11 December 2000
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