Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study

Abstract

Background: Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. Methods: A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and followup forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. Results: This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having "fair" or "poor" ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. Conclusions: In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, "fair" or "poor" ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.

Incidence of advanced opportunistic infection and its predictors among HIV infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized hospitals, Northwest Ethiopia, 2020: A multicenter retrospective follow-up study

“…Underweight or stunting was defined as weight for age Z-score < À2 SD for under-five children and BMI for age Z-score < À2 SD for older children [17].…”

“…However, in Sub-Saharan countries, life expectancy among HIV infected patients is far from the general population [7,12,14], due to OIs [15]. Regardless of increasing access to effective HIV prevention, diagnosis, and treatment worldwide [16], OIs are the leading causes of morbidity and mortality among HIV-infected children [17,18].…”

“…Despite the incidence of OIs after initiation of ART is a decline dramatically worldwide [13,19], they are a leading cause of poor quality of life, hospitalization, and poor adherence among HIV infected children in Ethiopia [5,21,22]. Besides, OIs remains a major cause of morbidity and mortality among this vulnerable population [7], which contributes to 94.1% of HIV-related deaths [17,18]. Advanced OIs are a life-threatening cause of morbidity and mortality associated with HIV [6], markedly in HIV infected children [23,24].…”

Time to detection of anemia and its predictors among children living with HIV at Debre Tabor and University of Gondar Compressive Specialized Hospitals, 2020: a multicentre retrospective follow-up study

“…Underweight or stunting was defined as weight for age Z-score < − 2 Standard deviation (SD) under-five children and BMI (Body Mass Index) for age Z-score < − 2 SD for older children [ 25 ].…”

“…According to the Ethiopian ART guidelines, the WHO stages I -II OIs includes Asymptomatic infection, Herpes zoster, and Persistent generalized lymphadenopathy. In addition, the WHO stages III-IV OIs includes unintentional weight loss of more than 10% body weight, recurrent upper respiratory tract infections, chronic diarrhea > 1 month, Prolonged fever > 1 month, Oral candidiasis, TB, HIV wasting syndrome, Pneumocystis carinii (juvenii) pneumonia (PCP), Toxoplasmosis of the brain, Extrapulmonary tuberculosis, Kaposi's sarcoma, and HIV encephalopathy [31][32][33].…”