Incidence and predictors of opportunistic infections among HIV-infected adults under antiretroviral therapy, northern Ethiopia

Introduction: Opportunistic infections (OIs) remain a significant cause of morbidity and mortality among HIV-infected individuals, despite advancements in antiretroviral therapy (ART), especially in middle- and low-income countries. The incidence and predictors of these infections remain largely unknown. Therefore, this study aimed to investigate the incidence, median survival time, and predictors of OIs among HIV-infected adults receiving ART at Adigrat General Hospital in northern Ethiopia. Methods: A hospital-based retrospective cohort study was conducted among 362 HIV- infected adults on ART, enrolled from September 1, 2013, to December 31, 2017. Data were extracted from medical records, and Kaplan-Meier analysis, log- rank test and Cox regression were used to determine the probability of survival, compare survival among categories of variables, and estimate the effect size of adjusted hazard ratios for opportunistic infections, respectively. Results: A total of 106 (29.28%) were diagnosed with OIs, giving an overall incidence rate of 13.5 per 100 person-years. The median survival time to an OI event was 13 months. The independent predictors of OIs for this cohort were a baseline CD4 count <200 cells/mm³ (AHR=1.96, 95%CI; 1.27, 3.01), a current CD4 count <200 cells/mm³ (AHR=2.53, 95%CI; 1.39, 4.60), a baseline hemoglobin level <12.5 g/dl (AHR=2.6, 95%CI 1.49-4.53). Similarly, being in a state of poor/fair adherence (AHR=4.45, 95%CI 2.16-9.16), a baseline weight <50 kg (AHR=2.22, 95%CI 1.09-4.45), a functional status of ambulatory/bedridden (AHR=3.06, 95%CI 1.50-6.21), unemployment status (AHR=2.32, 95%CI 1.49-3.61), and working part-time (AHR=4.09, 95%CI 1.57-10.71) were significant predictors. Conclusions: The overall incidence of OIs among HIV-infected patients in this region was high. Interventions targeting patients with low CD4 counts, anemia, and socioeconomic challenges are crucial to improve outcomes and reduce the burden of OIs.