Declining incidence of AIDS-defining opportunistic illnesses:  results from 16 years of population-based AIDS surveillance.
OBJECTIVE
To measure the incidence and risk factors of AIDS-defining opportunistic illnesses (AOIs) in the pre-highly active antiretroviral therapy (HAART) (1993-1995), early-HAART (1996-2000), and late-HAART (2001-2008) periods.


METHODS
Prospective cohort analysis of AIDS surveillance data.


METHODS
Individuals living with, or diagnosed with AIDS from 1993 through 2008 were included. Poisson regression models were used to estimate annual incidence rates of the eight most frequently occurring AOIs, and to compare these rates in the pre-HAART (1993-1995), early-HAART (1996-2000), and late-HAART (2001-2008) periods.


RESULTS
There were 18 733 individuals with AIDS included; 5788 were diagnosed prior to 1993 and 12 945 were diagnosed between 1 January 1993 and 31 December 2008. The incidence rates of Pneumocystis jiroveci pneumonia, wasting syndrome, Kaposi's sarcoma, HIV encephalopathy, cytomegalovirus retinitis, cytomegalovirus, and esophageal candidiasis decreased during the study period, with the largest declines observed between the pre-HAART and early-HAART periods. Incidence rates also decreased between the early-HAART and late-HAART periods, though not as sharply. Incidence rate reductions between the earliest and latest period ranged from 84 to 99%.


CONCLUSIONS
Steep declines in incidence of AOIs were found following the introduction of HAART and continued into the late-HAART era. These declines reflect the impact of HIV diagnosis and treatment on a population level.
School of Community Health Sciences, University of Nevada Reno, Reno, NV, USA. leilani.schwarcz@state.nm.us
Leilani
L
Schwarcz
Miao-Jung
MJ
Chen
Eric
E
Vittinghoff
Ling
L
Hsu
Sandra
S
Schwarcz
D015526:AIDS Dementia Complex / Q000453:epidemiology*; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002177:Candidiasis / Q000453:epidemiology*; D005260:Female; D019247:HIV Wasting Syndrome / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology*; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012514:Sarcoma, Kaposi / Q000453:epidemiology*