title: Predictors of opportunistic illnesses incidence in post combination antiretroviral therapy era in an urban cohort from Rio de Janeiro, Brazil.
abstract: BACKGROUND
  Opportunistic illnesses still account for a huge proportion of hospitalizations and deaths among HIV-infected patients in the post combination antiretroviral therapy (cART) era, particularly in middle- and low-income countries. The aim of this study was to assess predictors of the top four most incident opportunistic illnesses (tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jiroveci pneumonia) in an HIV clinical cohort from a middle-income country in the post cART era.
  
  
  METHODS
  A total of 2835 HIV infected participants aged ≥ 18 years at enrollment were followed from January 2000 to December 2012 until the occurrence of their first opportunistic illness, death or end of study, whichever occurred first. Extended Cox proportional hazards regression models, stratified by use of cART, were fitted to assess predictors of opportunistic illness incidence during follow-up.
  
  
  RESULTS
  The incidence rates of tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jiroveci pneumonia were 15.3, 8.6, 6.0, 4.8 per 1000 persons-year, respectively. Disease specific adjusted Cox models showed that presence of an opportunistic illness at enrollment significantly increased disease incidence while higher nadir CD4+ T lymphocyte count had a significant protective effect in patients not in use of cART. Duration of cART use also significantly reduced disease incidence.
  
  
  CONCLUSIONS
  Our findings show that, still in the post-cART era, prevention of opportunistic infections can be achieved by preventing immune deterioration by instituting early use of cART. Interventions focusing on early diagnosis and linkage to care in addition to the prompt initiation of cART are essential to reduce the incidence of opportunistic illnesses among HIV infected patients in post-cART era.
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil. lara.coelho@ini.fiocruz.br.
authors.forename: Lara E
authors.initials: LE
authors.lastname: Coelho
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Sandra W
authors.initials: SW
authors.lastname: Cardoso
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Rodrigo T
authors.initials: RT
authors.lastname: Amancio
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Sayonara R
authors.initials: SR
authors.lastname: Ribeiro
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Alessandra B
authors.initials: AB
authors.lastname: Coelho
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Dayse P
authors.initials: DP
authors.lastname: Campos
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Valdiléa G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Instituto de Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Manguinhos, CEP: 21045-900, Rio de Janeiro, Brazil.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002177:Candidiasis / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology; D016016:Proportional Hazards Models; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
keywords: AIDS-related opportunistic infections; Acquired immunodeficiency syndrome; Cohort study; Cox proportional hazards regression models; HIV; Incidence