Predictors of opportunistic infections among people living with HIV: a prospective cohort study from a tertiary care setting in India

Opportunistic infections (OIs) remain a leading cause of morbidity and mortality among people living with HIV (PLHIV). Early identification of high-risk individuals is vital to guide the preventive measures and the efficient use of healthcare resources. We conducted a prospective longitudinal cohort study involving 223 PLHIV at a tertiary care center in Western India. Baseline demographic, clinical, and laboratory data were collected, including CD4 count, nutritional status, serum albumin, and ART (antiretroviral therapy) history. Patients were followed for the development of OIs. Logistic regression was used to identify independent predictors of OIs. Kaplan-Meier curves were used to assess OI-free survival across different groups. Out of 223 patients, 97 (43.5%) developed at least one OI. The maximum duration of follow-up was 36 months for OI development. Tuberculosis (41.2%), candidiasis (16.5%), and NTM (Non-tuberculous mycobacteria) infections (11.3%) were the most common OIs. On multivariable analysis, low body mass index (BMI < 18.5 kg/m²; OR 2.5, 95% CI 1.1-4.2, p = 0.037), hypoalbuminemia (OR 2.3, 95% CI 1.2-3.5, p = 0.011), and CD4 count < 250 cells/µL (OR 2.1, 95% CI 1.3-4.2, p = 0.043) were identified as independent predictors of OIs. Kaplan-Meier analysis showed significantly reduced OI-free survival among patients with albumin < 2.5 g/dL (adjusted HR 1.8; 95% CI 1.1-2.9; p = 0.017) and BMI < 18.5 kg/m² (adjusted HR 2.1; 95% CI 1.3-3.2; p = 0.001). Low BMI, hypoalbuminemia, and CD4 count < 250 cells/µL are independent predictors of OIs in PLHIV. Integrating these markers can mitigate the OI-related adverse outcomes, particularly in low-resource healthcare settings.