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 follow-up 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.

Keywords: Anti-retroviral therapy; Children; Ethiopia; HIV; Opportunistic infections.

Fig. 1

Common types of OIs during follow-up time among HIV-infected children at Debre Markos Referral Hospital from 2005 to 30th March, 2019

Fig. 2

Kaplan-Meier survival curves to compare the OIs-free survival time of HIV-infected children on ART with different categories of WHO clinical stages at Debre-Markos Referral Hospital from 2005 to 30th March, 2019

Fig. 3

Kaplan-Meier survival curves to compare the OIs-free survival time of HIV-infected children on ART with different categories of CD4 counts or % at Debre-Markos Referral Hospital from 2005 to 30th March, 2019

Fig. 4

Kaplan-Meier survival curves to compare the OIs-free survival time of HIV-infected children on ART with different categories of ART drug adherence at Debre-Markos Referral Hospital from 2005 to 30th March, 2019

Fig. 5

Kaplan-Meier survival curves to compare the OIs-free survival time of HIV-infected children on ART with different categories of OI prophylaxis at Debre-Markos Referral Hospital from 2005 to March 2019