A cross sectional study of occurrence and outcome of opportunistic infections among haart experienced patients in a tertiary care hospital

Abstract

Introduction: The HIV-scenario in India is a bit different from western society as a result of the difference in socioeconomic and cultural environment, which are also important determinants in disease transmission. Opportunistic infections (OI) constitute a major cause of morbidity and mortality in PLHAs. This is even more critical where the standard of living is generally poor and access to ART (anti-retroviral therapy) is still inadequate. In developing regions such as Sub-Saharan Africa and South-East Asia, OIs in the pre-ART era were tuberculosis, candidiasis, infective diarrhoea, meningitis, dermatitis and recurrent Herpes simplex infection.Materials and Methods: 100 patients of HIV on HAART for at least 1 year were taken up for a descriptive study with respect to the prevalence of OIs and their outcome. Clinical assessment and investigations were done as per the NACO guidelines. The data was analysed using multivariate and computerised statistical methods.Results: The mean age of 100 patients in our study was 33.8 ± 1.10;71% of the patients were male. Mean CD4 count was 239.9 ± 11.25. Most common presentation was fever (64%) and weight loss (35%). Tuberculosis was the most common opportunistic infection (55%) followed by candidiasis (51%), Pneumocystis carinii 16%, cryptosporidium diarrhoea 10%, cryptococcal meningitis 6%, cerebral toxoplasmosis 2%. 74 patients were successfully treated. 12 succumbed to death, of which 3 were of tubercular meningitis and pneumocystis carinii pneumonia and 2 were of cryptococcal meningitis, cerebral toxoplasmosis and bacterial pneumonia each. Mean CD4 count of those who survived was 263.17 ±12.47 and those who succumbed was 133.25 ± 21.38. This was statistically significant showing that death occurred at a lower CD4 count.Conclusion: Our descriptive study done at a tertiary care hospital of south India showed that the main burden of opportunistic infections in HAART experienced HIV patients still lies on tuberculosis followed by candidiasis. However, Pneumocystis carinii and tubercular meningitis are among the leading causes of mortality.