Occurrence of Severe Opportunistic Infections in Children Living with HIV Under Regular Follow-Up in Lubumbashi: Associated Factors and Clinical Implications

Introduction: Despite expanded access to antiretroviral therapy (ART), opportunistic infections (OIs) remain a leading cause of morbidity and mortality among children living with HIV in sub-Saharan Africa. In the Democratic Republic of Congo, the persistence of severe OIs in children under regular follow-up suggests the presence of underrecognized risk factors. This study aimed to identify factors associated with the occurrence of severe OIs among HIV-infected children in Lubumbashi. Methods: We conducted a retrospective, analytical study from January 2020 to December 2024 at the HIV/AIDS Center of Excellence in Lubumbashi. A total of 175 children aged 2 to 14 years were included. Clinical, biological, nutritional, and behavioral data were analyzed using Jamovi software. Results: Severe OIs were reported in 33.1% of cases. Factors significantly associated with adverse outcomes (death or sequelae) included CD4 count < 500 cells/mm³, ART adherence < 80%, delayed HIV diagnosis, and missed clinic visits. Conversely, adherence ≥ 95% was associated with a favorable outcome in 92.3% of cases. Conclusion: Severe OIs remain common among children living with HIV despite regular care. Optimizing early diagnosis, improving ART adherence, and implementing targeted support strategies are essential to reduce HIV-related complications and improve pediatric outcomes in resource-limited settings.