Incidence of opportunistic infections and its predictors among HIV/AIDS patients on antiretroviral therapy in Gondar University Comprehensive and Specialized Hospital, Ethiopia

Abstract

Introduction: Opportunistic infections (OIs) are the leading cause of morbidity and mortality among adults living with HIV. Current and accurate information about the occurrence of opportunistic infections in HIV-infected adults is critical for developing more effective treatments and interventions. However, few studies have been conducted in Ethiopia on the prevalence of common opportunistic infections in HIV-infected adults. Thus, the purpose of this study was to determine the prevalence and predictors of opportunistic infections among HIV-infected adults receiving antiretroviral therapy (ART) at the comprehensive specialized hospital affiliated with the University of Gondar.

Methods: Between January 11, 2015, and January 10, 2021, a retrospective cohort study was conducted at the University of Gondar comprehensive specialized hospital. A total of 715 HIV-infected adults on ART were included in the study. Data were extracted from the charts of HIV-infected adults using a data extraction form adapted from the ART entry and follow-up forms. Epi-dataTM Version 4.5 was used to enter data, and StataTM Version 16 was used to analyze the data. The time interval between opportunistic infections was estimated using the Kaplan Meier survival curve. To identify risk predictors of opportunistic infections, bivariate and multivariate semi-parametric and parametric regression models were fitted.

Result: This study included the records of 715 HIV-infected adults-initiated ART between January 11, 2015, to January 10, 2021. During the follow-up period, the overall incidence of opportunistic infections was 4.1 (95 percent CI 3.74 to 4.44) per 10,000 person-year observation, with a median of 57 months (IQR = 40–69 months). Pneumocystis’ pneumonia at 90(16.51%) was the most encountered OI at follow-up. Adults are presenting with baseline CD4 < 200 cells/µl counts (AHR = 1.41, 95% CI 1.18 to 1.69), bedridden baseline functional status (AHR = 1.35, 95% CI 1.01 to 1.82), WHO clinical stage II (AHR = 5.87, 95% CI 3.97 to 8.69) and WHO clinical stage III (AHR = 5.85, 95% CI 3.55 to 9.65) were notably associated with the incidence of opportunistic infections development.

Conclusions: Opportunistic infections are uncommon among HIV-infected adults in this study. In terms of predictors, such as a low CD4 count and an advanced WHO stage (II or III), bedridden functional status was found to be significantly associated with OIs.

Keywords:

• Adults
• antiretroviral therapy
• HIV
• opportunistic infections
• Ethiopia

Acknowledgment

The authors would like give expressions their gratitude to the health care professionals at the University of Gondar compressive specialized Hospital for their generosity and invaluable assistance in collecting data and retrieving charts. Moreover, the authors wish to express their gratitude to the data collectors and supervisors.

Authors’ contributions

The research concept, design, data collection, analysis, and interpretation, as well as the initial manuscript write-up. Collecting data, analyzing and interpreting it, and editing the manuscript. The final manuscript draft has been read and approved by all authors participations.

Consent to participate and approval of the ethics

The Public Health Institute, the College of Medicine, and Health Sciences, University of Gondar’s ethical review committee granted clearance and approval to conduct the research under the reference letter Ref No/IPH 22/07/2021. Due to the fact that this study analyzed secondary data from patient charts, we were granted an informed consent waiver. To maintain confidentiality, the data collection tool did not include names or other personally identifiable information such as unique identification numbers.

Consent for publication

Not applicable.

Data and materials accessibility

The corresponding author will have the right access to the data upon request.

Disclosure statement

No potential conflict of interest was reported by the author(s).