Predictors of a high incidence of opportunistic infections among HIV-infected children receiving antiretroviral therapy at Amhara regional state comprehensive specialized hospitals, Ethiopia: A multicenter institution-based retrospective follow-up study

Gebrehiwot Berie Mekonnen; Binyam Minuye Birhane; Melaku Tadege Engdaw; Wotetenesh Kindie; Amare Demsie Ayele; Amare Wondim

doi:10.3389/fped.2023.1107321

Predictors of a high incidence of opportunistic infections among HIV-infected children receiving antiretroviral therapy at Amhara regional state comprehensive specialized hospitals, Ethiopia: A multicenter institution-based retrospective follow-up study

Front Pediatr. 2023 May 2:11:1107321. doi: 10.3389/fped.2023.1107321. eCollection 2023.

Authors

Gebrehiwot Berie Mekonnen¹, Binyam Minuye Birhane^{1

2}, Melaku Tadege Engdaw³, Wotetenesh Kindie⁴, Amare Demsie Ayele⁵, Amare Wondim⁵

Affiliations

¹ Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
² School of Public Health, University of Technology Sydney, Sydney, NSW, Australia.
³ Social and Population Health Unit, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
⁴ Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia.
⁵ Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Specialized Hospital, University of Gondar, Gondar, Ethiopia.

Abstract

Introduction: Globally, opportunistic infections are the leading causes of morbidity and mortality among HIV-infected children, contributing to more than 90% of HIV-related deaths. In 2014, Ethiopia launched and began to implement a "test and treat" strategy aiming to reduce the burden of opportunistic infections. Despite this intervention, opportunistic infections continue to be a serious public health issue, with limited evidence available on their overall incidence among HIV-infected children in the study area.

Objective: The study aimed to assess the incidence of opportunistic infections and to identify predictors of their occurrence among HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals in 2022.

Methods: A multicenter, institution-based retrospective follow-up study was conducted among 472 HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals from May 17 to June 15, 2022. Children receiving antiretroviral therapy were selected using a simple random sampling technique. Data were collected using national antiretroviral intake and follow-up forms via the KoBo Toolbox. STATA 16 was used for data analyses, and the Kaplan-Meier method was used to estimate probabilities of opportunistic infection-free survival. Both bi-variable and multivariable Cox proportional hazard models were employed to identify significant predictors. A P-value <0.05 was taken to indicate statistical significance.

Results: Medical records from a total of 452 children (representing a completeness rate of 95.8%) were included and analyzed in the study. The overall incidence of opportunistic infections among children receiving ART was 8.64 per 100 person-years of observation. The predictors of elevated incidence of opportunistic infections were: a CD4 cell count below a specified threshold [AHR: 2.34 (95% CI: 1.45, 3.76)]; co-morbidity of anemia [AHR: 1.68 (95% CI: 1.06, 2.67)]; ever having exhibited only fair or poor adherence to ART drugs [AHR: 2.31 (95% CI: 1.47, 3.63)]; never having taken tuberculosis-preventive therapy [AHR: 1.95 (95% CI: 1.27, 2.99)]; and not having initiated antiretroviral therapy within 7 days of HIV diagnosis [AHR: 1.82 (95% CI: 1.12, 2.96)].

Conclusion: In this study, the incidence of opportunistic infections was high. Early initiation antiretroviral therapy has direct effect on boosting the immunity, suppressing viral replications and increases the CD4 count, so that the occurrence of opportunistic infection will reduce the incidence of OIs.

Keywords: CD4; HIV-infected; antiretroviral therapy; children; opportunistic infection; predictors.

Grants and funding

Financial support was received from University of Gondar. The funding institution had no role in the preparation of the manuscript or in the decision to publish.