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Human immunodeficiency virus type 1 subtype and other factors associated
with extrapulmonary Cryptococcosis among patients in Thailand with AIDS.
AIDS Research and Human Retroviruses 2003;19(2):85-90.
Amornkul PN, Hu DJ, Tansuphasawadikul S, Lee S, Eampokalap B, Likanonsakul
S, Nelson R, Young NL, Hajjeh RA, Limpakarnjanarat K, Mastro TD.
Abstract
Delineating factors associated with extrapulmonary cryptococcosis (EPC), a
major disease burden among Thailand's AIDS patients, can clarify its pathogenesis
and guide preventive interventions. From November 1993 through June 1996,
enhanced surveillance of 2261 human immunodeficiency virus (HIV)-seropositive
patients in a hospital near Bangkok showed EPC among 561 of 1553 AIDS patients
(36.1%). Univariate analysis results were confirmed by multivariate analyses
of data on 1259 patients. Logistic regression models identified factors significantly
associated with EPC to be male sex (adjusted odds ratio [aOR], 2.0; 95% confidence
interval [CI], 1.3-2.9), age <33 years (aOR, 1.5; 95% CI, 1.2-1.9), severe
immunosuppression (aOR, 1.8; 95% CI, 1.3-2.6), not injecting drugs (aOR,
3.0; 95% CI, 1.7-5.5), and infection with HIV-1 circulating from CRF01_AE
(formerly subtype E) versus subtype B (aOR, 2.3; 95% CI, 1.2-4.5). The association
with CRF01_AE may result from undetermined markers of exposure or viral subtype
effects on host immune responses. Better understanding of the epidemiology
of EPC may reduce EPC incidence through targeted primary prevention and treatment.