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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model

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Surveillance for AIDS-defining opportunistic illnesses, 1992-1997.

J L Jones¹, D L Hanson, M S Dworkin

¹Division of HIV/AIDS Prevention-Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, USA.

MMWR. CDC Surveillance Summaries : Morbidity and Mortality Weekly Report. CDC Surveillance Summaries

|November 5, 2002

Summary

The incidence of AIDS-defining opportunistic illnesses (OIs) is decreasing due to advancements in HIV therapy. However, OIs persist, particularly in late-diagnosed patients, highlighting the need for improved prophylaxis and adherence to treatment.

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Area of Science:

Public Health
Infectious Diseases
Epidemiology

Background:

Acquired immunodeficiency syndrome (AIDS)-defining opportunistic illnesses (OIs) remain a primary cause of illness and death in individuals with human immunodeficiency virus (HIV).
While new treatments have reduced mortality, the number of people living with AIDS is increasing, necessitating ongoing surveillance of OIs.

Purpose of the Study:

To analyze trends in the incidence and occurrence of AIDS-defining opportunistic illnesses (OIs) from 1992 to 1997.
To evaluate the uptake of antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC) disease.

Main Methods:

Utilized aggregate data from the Adult/Adolescent Spectrum of HIV Disease (ASD) sentinel surveillance project (1992-1997).
Standardized prospective medical record review data to national AIDS surveillance data, analyzing frequencies, incidence, and prescription patterns.

Main Results:

Significant declines in the incidence of 15 out of 26 specific AIDS-defining OIs were observed (p<0.05).
Pneumocystis carinii pneumonia (PCP) remained the most common initial, incident, and overall OI.
Prescription rates for triple combination therapy and MAC prophylaxis increased, while PCP prophylaxis remained stable.

Conclusions:

Advances in HIV therapy are reducing OI incidence, but OIs continue to occur, especially with late diagnosis or treatment adherence issues.
While PCP prophylaxis is widely prescribed, MAC prophylaxis prescription rates remain suboptimal.
Surveillance data are crucial for guiding OI prevention guidelines and informing public health strategies.