Impact of the introduction of a package of care involving early detection of opportunistic infections, a prospective multicenter cohort study of people living with HIV/AIDS in Brazil.

BACKGROUND

Opportunistic infections (OIs) significantly contribute to morbidity and mortality in advanced HIV disease. This study evaluates the efficacy of point-of-care (POC) diagnostics for tuberculosis (TB), histoplasmosis, and cryptococcosis in routine HIV care in Brazil.

METHODS

A prospective multicenter cohort study was conducted across five hospitals enrolling people living with HIV (PLHIV) with CD4+ T-cell count <200 cells/mm3 or OI symptoms, regardless of CD4 count, HIV-naïve patients, those initiating treatment, and individuals with unsuppressed viral load lost to follow-up (>3 months). POC tests included VISITECT CD4 Advanced Disease, TB LAM Ag (Abbott), GeneXpert MTB/RIF (Cepheid), Histoplasma antigen LFA (MiraVista), and CrAg LFA (IMMY). Patients were followed at 30 and 90 days. Retrospective data for six months pre-study was collected for comparison.

FINDINGS: Among 419 PLHIV (55% cisgender men, 44% cisgender women, 1% transgender; mean age: 42 years, SD ± 11.1), 46% had confirmed OIs: TB (34%), cryptococcosis (12%), histoplasmosis (10%). Co-infections were frequent, with TB and histoplasmosis (44%). Cryptococcal meningitis and severe histoplasmosis were diagnosed in 5% and 6%, respectively. TB LAM was positive in 27% of tested patients, with 74% having disseminated TB. POC testing increased detection rates for TB, (1.8-fold) cryptococcosis (2.8-fold), and histoplasmosis (2.8-fold) compared to historical data. Survival rates were 87% at 30 days and 80% at 90 days, with cryptococcal antigenemia associated with higher mortality.

INTERPRETATION: POC testing improved OI diagnosis, aligning with WHO guidelines. These findings highlight the importance of integrating rapid diagnostics into HIV programs and the need for further research on long-term outcomes.

FUNDING: Pan American Health Organization.