Impact of the National Access to Antiretroviral Program on the incidence of opportunistic infections in Thailand

The National Access to Antiretroviral Program caused a decline in HIV mortality in Thailand, but its impact on opportunistic infections (01) remains unknown. The aim of this study was to compare the incidence of different Ols before and after the initiation of highly active antiretroviral therapy (HAART). Data from a prospective cohort at a hospital in northern Thailand were analysed. In total, 704 patients enrolled from July 2000 to October 2002 and not on HAART were followed up until October 2004. In addition, 409 patients who started HAART between April 2002 and January 2004 were followed up for 24 months. The impact of HAART on Ols was analysed using Cox proportional hazard models. HAART was associated with a strong reduction in Ols. The reduction appeared to vary by type: tuberculosis (TB), adjusted hazard ratio (AHR) = 0.2 (95% CI 0.1-0.5); pneumocystis pneumonia (PCP), AHR = 0.03 (95% CI 0.007-0.1); cryptococcal meningitis, AHR = 0.2 (95% CI 0.1-0.5); and penicilliosis, AHR = 0.1 (95% CI 0.06-0.3). In conclusion, HAART was very effective in reducing Ols, especially PCP. TB and cryptococcal meningitis remained frequent in the early phase of antiretroviral drug therapy. More attention to prophylaxis as well as earlier diagnosis and starting treatment for these Ols is recommended. (C) 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.