Time to occurrence, predictors, and patterns of opportunistic infections incidence among HIV-positive patients attending Antiretroviral Therapy Clinic of Salale University Comprehensive Specialized Hospital: A retrospective cohort study

Abstract

Opportunistic infections (OIs) in HIV patients are infections that are more common or more severe as a result of HIV-mediated immunosuppression. The advances in the capacity of antiretroviral therapy (ART) have diminished the incidence of OIs. However, even in the ART era, HIV-related OIs continue to be major causes of hospitalization and mortality. Therefore, this study aims to identify time to occurrence, predictors, and patterns of OIs incidence among HIV-positive patients attending ART clinic of Salale University Comprehensive Specialized Hospital, Ethiopia. A retrospective cohort study was conducted between 1st September 2016 and 1st September 2021. All 419 patients diagnosed during the study period were recruited. Data were extracted from both patient medical records and ART logbooks. Stata-16 was used for data analysis. Follow-up time was calculated from the date of HIV diagnosis to the date of OIs occurrence or censoring. Cox proportional hazards regression model was used to identify the predictors of OIs incidence. The total person-time of the follow-up was 8656 person-months of observation. During the follow-up time, 199 (47.49%) of the patients had developed OIs. The incidence rate of OIs was 23 (95%CI: 20, 26) per 1000 person-months of observation. The median OIs free survival time was 36 (95%CI: 31, 40) months. Predictors such as residence, cd4 category, baseline hemoglobin level, ART side effects, isoniazid preventive therapy, and chronic disease comorbidity were significantly predicted OIs incidence. The study area’s OIs incidence remained high, requiring prompt action. To reduce the morbidity and mortality associated with OIs, HIV-positive patients with the predictors of rural residence, low CD4 category, low baseline hemoglobin level, ART side effects, not taking IPT, and baseline chronic disease comorbidity necessitate close follow-up and monitoring. Thus, we recommend focused and evidence-informed strategies to address OIs burden and improve outcomes.

Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa

“…All these findings could be explained by the difference between a relatively rural area (current study) and more urbanized settlements. This coincided with previous studies from Ethiopia and the USA, where it was demonstrated that rural/countryside patients with lower levels of education, low income, and limited access to healthcare facilities more readily develop OIs than others [25,[47][48][49].…”

“…Parasitic infection, or oral candidiasis (18%), is one of the main OIs, together with the above-mentioned ones. Generally, oral candidiasis is prevalent among PLWHA, as previously described in Gabon (14.19%), as well as reported in India and Ethiopia [16,25,46]. The prevalence rate reported in the present study was higher than that previously reported in Gabon (14.19% vs. 18%).…”

“…Most HIV-1 infected patients receiving ART in that CTA in Gabon are women, and there is no new finding in this regard [ 17 , 18 , 23 ]. Previous studies conducted in other countries on a similar type (female vs. male) of population have also described that women were the predominant gender [ 24 , 25 ]. We found that 57.9% of PLWHA had developed OIs, of which 18% were parasitic, 39.7% viral, and 55.4% bacterial infections.…”

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

“…These infections are often more severe or unusual due to the weakened immune response of the host or alterations in the microbiota (9,10). The range and frequency of opportunistic infections vary regionally, potentially contributing to mortality, especially in areas with limited healthcare access (10,11). Common opportunistic infections include Tuberculosis (TB), diarrheal diseases, candidiasis, cryptococcosis, cryptosporidiosis, cytomegalovirus (CMV) infections, herpes simplex, mycobacterium avium complex (MAC), pneumocystis pneumonia (PCP), and others such as progressive multifocal leukoencephalopathy (PML), cryptococcal meningitis, and Kaposi's sarcoma (8,9,14).…”