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The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan.

Katano H, Hishima T, Mochizuki M, Kodama Y, Oyaizu N, Ota Y, Mine S, Igari T, Ajisawa A, Teruya K, Tanuma J, Kikuchi Y, Uehira T, Shirasaka T, Koibuchi T, Iwamoto A, Oka S, Hasegawa H, Okada S, Yasuoka A - BMC Infect. Dis. (2014)

Bottom Line: Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection.However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased.Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (-) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. katano@nih.go.jp.

ABSTRACT

Background: Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection. However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased. In the present study, autopsy cases of HIV infection in Japan were retrospectively investigated to reveal the prevalence of opportunistic infections and malignancies.

Methods: A total of 225 autopsy cases of HIV infection identified at 4 Japanese hospitals from 1985-2012 were retrospectively reviewed. Clinical data were collected from patient medical records.

Results: Mean CD4 counts of patients were 77.0 cells/μL in patients who received any antiretroviral therapy during their lives (ART (+) patients) and 39.6 cells/μL in naïve patients (ART (-) patients). Cytomegalovirus infection (142 cases, 63.1%) and pneumocystis pneumonia (66 cases, 29.3%) were the most frequent opportunistic infections, and their prevalence was significantly lower in ART (+) patients than ART (-) patients. Non-Hodgkin lymphoma and Kaposi sarcoma were observed in 30.1% and 16.2% of ART (-) patients, and 37.9% and 15.2% of ART (+) patients, respectively. Malignant lymphoma was the most frequent cause of death, followed by cytomegalovirus infection regardless of ART. Non-acquired immunodeficiency syndrome (AIDS)-defining cancers such as liver and lung cancer caused death more frequently in ART (+) patients (9.1%) than in ART (-) patients (1.5%; P = 0.026).

Conclusions: The prevalence of infectious diseases and malignancies were revealed in autopsy cases of HIV infection in Japan. The prevalence of cytomegalovirus infection and pneumocystis pneumonia at autopsy were lower in ART (+) patients than ART (-) patients. Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (-) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.

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Distribution of cytomegalovirus and Candida albicans. (A) CMV positive rate in each organ. Black bar indicates the CMV positive rate in each organ from 142 CMV-positive patients. Because CMV was detected in more than one organ per patient, the sum of the black bars is over 100%. (B) The positive rate of Candida albicans in each organ. Black bar indicates the positive rate of Candida albicans per organ from 25 Candida albicans-positive patients.
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Figure 2: Distribution of cytomegalovirus and Candida albicans. (A) CMV positive rate in each organ. Black bar indicates the CMV positive rate in each organ from 142 CMV-positive patients. Because CMV was detected in more than one organ per patient, the sum of the black bars is over 100%. (B) The positive rate of Candida albicans in each organ. Black bar indicates the positive rate of Candida albicans per organ from 25 Candida albicans-positive patients.

Mentions: CMV was the most commonly identified pathogen among the autopsy cases (Table 2) and was detected in various organs, the most frequent being the adrenal gland (Figure 2A). PCP and NTM were also common pathogens found in the lungs of autopsied patients. Candida albicans was frequently detected in the gastrointestinal tract and oral cavity (Figure 2B). The prevalence of CMV and PCP was significantly lower in ART (+) patients than in ART (−) patients (Table 2). There was no significant difference in the prevalence of other opportunistic infections such as NTM and Candida or prevalence of HIV encephalopathy between ART (+) and (−) patients (Table 2).


The prevalence of opportunistic infections and malignancies in autopsied patients with human immunodeficiency virus infection in Japan.

Katano H, Hishima T, Mochizuki M, Kodama Y, Oyaizu N, Ota Y, Mine S, Igari T, Ajisawa A, Teruya K, Tanuma J, Kikuchi Y, Uehira T, Shirasaka T, Koibuchi T, Iwamoto A, Oka S, Hasegawa H, Okada S, Yasuoka A - BMC Infect. Dis. (2014)

Distribution of cytomegalovirus and Candida albicans. (A) CMV positive rate in each organ. Black bar indicates the CMV positive rate in each organ from 142 CMV-positive patients. Because CMV was detected in more than one organ per patient, the sum of the black bars is over 100%. (B) The positive rate of Candida albicans in each organ. Black bar indicates the positive rate of Candida albicans per organ from 25 Candida albicans-positive patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016795&req=5

Figure 2: Distribution of cytomegalovirus and Candida albicans. (A) CMV positive rate in each organ. Black bar indicates the CMV positive rate in each organ from 142 CMV-positive patients. Because CMV was detected in more than one organ per patient, the sum of the black bars is over 100%. (B) The positive rate of Candida albicans in each organ. Black bar indicates the positive rate of Candida albicans per organ from 25 Candida albicans-positive patients.
Mentions: CMV was the most commonly identified pathogen among the autopsy cases (Table 2) and was detected in various organs, the most frequent being the adrenal gland (Figure 2A). PCP and NTM were also common pathogens found in the lungs of autopsied patients. Candida albicans was frequently detected in the gastrointestinal tract and oral cavity (Figure 2B). The prevalence of CMV and PCP was significantly lower in ART (+) patients than in ART (−) patients (Table 2). There was no significant difference in the prevalence of other opportunistic infections such as NTM and Candida or prevalence of HIV encephalopathy between ART (+) and (−) patients (Table 2).

Bottom Line: Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection.However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased.Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (-) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. katano@nih.go.jp.

ABSTRACT

Background: Opportunistic infections and malignancies such as malignant lymphoma and Kaposi sarcoma are significant complications of human immunodeficiency virus (HIV) infection. However, following the introduction of antiretroviral therapy in Japan in 1997, the incidence of clinical complications has decreased. In the present study, autopsy cases of HIV infection in Japan were retrospectively investigated to reveal the prevalence of opportunistic infections and malignancies.

Methods: A total of 225 autopsy cases of HIV infection identified at 4 Japanese hospitals from 1985-2012 were retrospectively reviewed. Clinical data were collected from patient medical records.

Results: Mean CD4 counts of patients were 77.0 cells/μL in patients who received any antiretroviral therapy during their lives (ART (+) patients) and 39.6 cells/μL in naïve patients (ART (-) patients). Cytomegalovirus infection (142 cases, 63.1%) and pneumocystis pneumonia (66 cases, 29.3%) were the most frequent opportunistic infections, and their prevalence was significantly lower in ART (+) patients than ART (-) patients. Non-Hodgkin lymphoma and Kaposi sarcoma were observed in 30.1% and 16.2% of ART (-) patients, and 37.9% and 15.2% of ART (+) patients, respectively. Malignant lymphoma was the most frequent cause of death, followed by cytomegalovirus infection regardless of ART. Non-acquired immunodeficiency syndrome (AIDS)-defining cancers such as liver and lung cancer caused death more frequently in ART (+) patients (9.1%) than in ART (-) patients (1.5%; P = 0.026).

Conclusions: The prevalence of infectious diseases and malignancies were revealed in autopsy cases of HIV infection in Japan. The prevalence of cytomegalovirus infection and pneumocystis pneumonia at autopsy were lower in ART (+) patients than ART (-) patients. Higher prevalence of non-AIDS defining malignancies among ART (+) patients than ART (-) patients suggests that onsets of various opportunistic infections and malignancies should be carefully monitored regardless of whether the patient is receiving ART.

Show MeSH
Related in: MedlinePlus