Incidence and predictors of opportunistic infections in adolescents and adults after the initiation of antiretroviral therapy: A 10-year retrospective cohort study in Ethiopia

Abstract

BackgroundOpportunistic infections (OIs) are the leading cause of morbidity and mortality in people living with the human immunodeficiency virus (PLHIV). However, there are few robust recent data on the rates of OIs and the risk factors that contribute to their occurrence. Therefore, the current study sought to determine the incidence of OIs and identify predictors among adolescents and adults after the initiation of antiretroviral therapy (ART) at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Southern Ethiopia.MethodsA retrospective cohort study design was employed. The study population was adolescents and adults who initiated ART between 1 January 2012 and 31 December 2021. A simple random sampling technique was used to select 537 participants' records. We reviewed the medical records of the sampled individuals from 1 May 2022 to 15 June 2022. KoboCollect version 2021.2.4 and STATA version 14.0 software were used for data collection and analysis, respectively. We calculated the incidence rate per 100 person-years of observation (PYO) with 95% confidence intervals (CIs) for the occurrence of any OIs. The Weibull regression model was fitted after the goodness-of-fit test for the Cox proportional hazard model was deemed inadequate. An adjusted hazard ratio (AHR) with 95% CI was used to identify a significant predictor of OIs. The statistical significance was made at a 5% significance level.ResultsA total of 515 participants contributed to 1,829 person-years of risk, of whom 164 (31.84%) exhibited at least one OI. The overall incidence rate of OIs was 8.97 cases (95% CI: 7.69, 10.44) per 100 PYO. The independent predictors of OIs were being female [AHR: 1.65 (95% CI (1.15, 2.36), P = 0.007)], individuals classified as World Health Organization (WHO) HIV clinical stage III [AHR: 1.98 (95% CI (1.12, 3.51), P = 0.019)], individuals who did not take cotrimoxazole preventive therapy (CPT) [AHR: 2.58 (95% CI (1.62, 4.11), P < 0.001)], mild malnutrition [AHR: 1.62 (95% CI (1.06, 2.54), P = 0.035)], and poor adherence to ART [AHR: 4.21 (95% CI (2.39, 7.44), P < 0.001)].ConclusionThe rate of OIs after the initiation of ART was still high. Moreover, being female, not taking CPT, poor adherence to ART, mild malnutrition, and advanced HIV disease at presentation were found to increase the hazards of developing OIs.

Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings

“…Nevertheless, research reports by Woldegeorgis et al. [ 84 ], and Nicastri et al . [ 85 ] found little evidence for sex differences, which requires a powerful study.…”

“…Findings in line with our study were reported from India [ 71 , 110 ], and Canada [ 111 ]. A high level of sustained medication adherence is required to suppress viral replication, improve immunological outcomes, decrease OIs, minimize hospitalization and inpatient death, decrease the risk of developing ARV drug resistance, and reduce the risk of transmitting HIV [ 84 , 107 , 112 ].…”

Impact factors of Blastocystis hominis infection in persons living with human immunodeficiency virus: a large-scale, multi-center observational study from China

“…, etc.) will emergence [ 42 , 43 ], and PLWH do not seek medical attention at hospitals or clinics when they experience symptoms related to OPIs. Instead, they self-medicate or even neglect seeking any treatment, it may exacerbate their condition and increase mortality.…”

Incidence of Opportunistic Infections in HIV Patients at Anti-Retroviral Therapy (ART) Adherence Unit, Islamabad Pakistan

“…The files provided comprehensive information on HIV status, age, gender, file number, date of admission, residential address, the type of infection presented, appropriate antibiotic therapy administered, and symptoms observed. This data was meticulously organized in Microsoft Excel 2018 to facilitate detailed analysis (7,(19)(20)(21)(22)(23)(24). Following the collection phase, the study encountered the need to exclude 13 patients due to either the lack of specificity regarding the infection or inadequate documentation, resulting in a final sample size of 533 patients.…”