2174. AIDS-defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort
Session: Poster Abstract Session: HIV: Other Opportunistic Conditions
Saturday, October 29, 2016
Room: Poster Hall
Background: Late HIV diagnosis is associated with higher morbidity and mortality, even among those who receive antiretroviral therapy (ART). Patients diagnosed late have been shown to require more resources due to hospitalizations and treatment of opportunistic infections in addition to primary treatment for their HIV infection. In Guatemala, more than 65% of patients diagnosed with HIV have progressed to AIDS. There are limited data on the epidemiology of AIDS-defining illnesses (ADIs) in Central America.

Methods: We conducted a retrospective cohort study of all patients living with HIV and receiving ART at Roosevelt Hospital in Guatemala City, Guatemala. Charts were analyzed for clinical and demographic data and the patients were interviewed. The presence of an ADI was assessed by the CDC definitions. Patients who presented with an ADI were compared to those that were diagnosed without an ADI to look for risk factors.

Results: We enrolled 3,654 patients in the study, of whom 922 (25.2%) had an ADI at the time of HIV diagnosis. Of these, 739 (80.2%) had CD4 counts less than 200 cells/mm3. Compared to patients without ADIs at diagnosis, those with ADIs were more likely to be male (67.5% compared to 54.5%, p<0.0001), of older age (35.2 years vs. 34.1 years, p=0.009), and heterosexual (89.4% vs. 85.1%, p=0.005). A higher percentage of patients with ADIs at diagnosis had sought healthcare in the 2 years prior to diagnosis (22.0% vs. 16.9%, p=0.001). The most common ADIs were Mycobacterium tuberculosis (54.8%), HIV wasting syndrome (23.8%), Pneumocystis jirovecii pneumonia (13.8%), and disseminated or extrapulmonary Histoplasmosis (11.4%).

Conclusion: In this large cohort of HIV patients in Guatemala, a significant portion presented with an ADI These data inform the most common ADIs in those diagnosed with HIV. They are different from other reports from Latin America, which showed disseminated Histoplasmosis, esophageal candidiasis, and cerebral toxoplasmosis as the three most common ADIs.

Samuel Reinhardt, MD1, Andrej Spec, MD2, Johanna Melendez, MD3, Andrea Alonzo, BS3, Ian Ross, MD4, William Powderly, MD5 and Carlos Mejia, MD6, (1)Internal Medicine, Barnes-Jewish Hospital, Saint Louis, MO, (2)Infectious Disease, Washington University, St Louis, MO, (3)Hospital Roosevelt, Guatemala City, Guatemala, (4)Internal Medicine, Barnes-Jewish Hospital, St. Louis, MO, (5)Infectious Diseases, Washington Univesity School of Medicine, St. Louis, MO, (6)Department of Internal Medicine, Hospital Roosevelt, Guatemala, Guatemala

Disclosures:

S. Reinhardt, None

A. Spec, None

J. Melendez, None

A. Alonzo, None

I. Ross, None

W. Powderly, None

C. Mejia, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.