Incidence and Predictors of Opportunistic Infections Among Adult HIV Infected Patients on Anti-Retroviral Therapy at Dessie Comprehensive Specialized Hospital, Ethiopia: A Retrospective Follow-Up Study

Abstract

Background Opportunistic infections are the major causes for morbidity and mortality due to HIV infections. Despite advances in HIV diagnosis and management, the incidence of opportunistic infections remains high. This study aimed to assess the incidence and predictors of opportunistic infections among persons living with HIV/AIDS in Ethiopia. Methods A retrospective follow-up study was conducted on 354 samples of adults living with HIV on antiretroviral therapy at Dessie Comprehensive Specialized Hospital. Simple random sampling technique was used to select study participants. The data collection format was taken from national antiretroviral intake and follow-up forms. Epi-data Version 4.6.1 and STATA Version 16 software were used for data entry and data analysis respectively. The Cox-proportional hazards regression model was fitted. Kaplan–Meier survival curve was used to estimate opportunistic infections-free survival time. Both bi-variable and multivariable Cox-proportional hazard regression analysis were done to identify predictors of opportunistic infections. Results Of the total 354 peoples living with HIV, 114 (32.2%) developed OI, with an incidence rate of 13.5 per 100 person-year (95% CI: 10.8–15.6). Advanced World Health Organization clinical disease stage (IV) (AHR: 2.1 (95% CI: 1.16, 3.8)), being bedridden (AHR: 1.66 (95% CI: 1.04, 2.65)), poor adherence (AHR: 1.7 (95% CI: 1.1–2.63), and low CD4 count (AHR: 1.92 95% CI: 1.14–3.22) were significant predictors of OIs. Conclusion Opportunistic infection among HIV/AIDS continues to be a significant public health concern in Ethiopian health care setting. Our results indicate that the incidence of OI is high. Besides, Stage IV HIV status, being bedridden, low CD4 count and poor adherence independently predicts an increased incidence/decreased survival time of OIs among PLWHIV. Early care-seeking and initiation of HAART and continuous follow-up of patients to take their drug timely are essential to curb the incidence of opportunistic infections and improve overall health. Further research on this area is highly recommended.

Cryptococcal meningitis among perinatally HIV‐infected adolescents: Case series on presentation and management challenges

“…However, this apparent low prevalence is likely due to missed diagnosis or low index of suspicion by healthcare workers (HCWs) which is common in HIV care. 13,14 These are because of issues with lack of capacity for laboratory and clinical diagnosis of CM diagnosis in Ghana. Ghana implements the WHO recommended task-sharing policy to address shortage of HCWs and increase access to HIV care.…”

“…Our study reports four cases over a period of 4 years suggestive of a low prevalence. However, this apparent low prevalence is likely due to missed diagnosis or low index of suspicion by healthcare workers (HCWs) which is common in HIV care 13,14 . These are because of issues with lack of capacity for laboratory and clinical diagnosis of CM diagnosis in Ghana.…”

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…TB-associated case mortality accounts for 25%-40% of global deaths and 18%-25% of admissions among PLHIV, despite treatment and detection advances. [13][14][15] In Ethiopia, 5.9% of HIV-positive patients newly enrolled in ART in 2016 had active TB (22). The country is among the top 10 TB burden countries, contributing to 87% of global TB cases (23).…”

Prevalence and determinants of opportunistic infections among HIV-infected adults receiving antiretroviral therapy in Ethiopia: A systematic review and meta-analysis

“…Besides, baseline Nevirapine-based regimens, higher viral load, treatment failure, and hemoglobin levels were factors associated with the development of OIs among adult patients taking ART ( 23 – 25 ). Furthermore, adherence to ART, nutritional status, isoniazid preventive therapy, and cotrimoxazole preventive therapy, place of residence, functional status, gender, age of the PLHIV, CD4 T lymphocytes count, and disclosure status have been associated with the development of OIs among adult PLHIV after initiation of ART ( 24 , 26 – 28 ).…”