Incidence of opportunistic diseases after the “treat all” strategy: 10 years cohort for HIV

Abstract

High active anti-retroviral therapy (HAART) has improved the life expectancy of people living with HIV/AIDS (PLWHA) and reduced the development of opportunistic diseases, supporting a strategy introduced in 2014, which sought to enhance prevention with early treatment and for all. This was a retrospective and comparative cohort study before and after the implementation of “treat all” strategy, based on primary and secondary data, extracted from the medical records followed at the Specialized Care Service between 2009 and 2018 and from public databases. Of the 892 patients selected, 790 were active, 28 abandoned treatment and 40 died, 92%, 3.3% and 4.7%, respectively. About 440 (51.2%) started follow-up between 2009 and 2013, before the “treat all” strategy, and 417 (48.9%) started follow-up after 2014, when the national recommendation was already the “treat all” strategy. A total of 508 (58.2%) male patients were counted, the mean age was 33.5 years on the date of entry, most of them had a total of 8 to 11 years of study (21.1%) and about 6.5% of the patients were illiterate. The main routes of HIV transmission were heterosexual intercourse (67.95%) and MSM (men who have sex with men) (31%). The mean CD4 cell count at presentation was 392 cells/mm3 and 23% of participants had a CD4 count less than 200 cells/mm3. Elevated levels of viral load were found at entry, with 30% having at least 100,000 copies/mL. During the ten years of observation, there were 245 episodes of opportunistic diseases. The five most common opportunistic diseases during the study period were tuberculosis (28.6%), herpes zoster (23.3%), oral candidiasis (15.5%), neurotoxoplasmosis (11.4%) and pneumocystosis (6.1%). Forty patients died during the study period, 4.7% of the total. There was a reduction in opportunistic infections in the second group of the study, especially for oral candidiasis (p = 0.03), as well as a better response to LogCV treatment (1.28±1.97). It is concluded that the diagnosis and treatment strategy has shown over the years an effective reduction in opportunistic infections.