Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study

Abstract

Background: Opportunistic infections in human immune deficiency virus infected individuals are infections that are more frequent or more severe because of HIV mediated immunosuppression. When we say recurrence opportunistic infections, it’s due to either reinfection or relapse of the disease previously occurred. This study will incorporate predictors like duration on anti-retroviral therapy and regimen change, which previous study did not address. Objective: objective of this study is to assess the incidence and predictors of recurrence of opportunistic infection among adult HIV/AIDS patient attending anti-retroviral therapy clinic at public health facilities in Arba Minch Town. Methods and Materials: Facility based retrospective follow up study was conducted among 450 HIV/AIDS patient who enrolled at public health facilities in Arba Minch Town from Sep 11, 2013 to Sep 15, 2018. Sampling frame from ART registration book and patient card was prepared. Simple random sampling technique from patient record was employed. Structured questionnaire was used. Assumption of observational independence was checked by using variance inflation factor and proportional hazard assumption was also checked by goodness of fit test and time dependent covariate. Bivariate and multivariable cox regression analysis with respective crude hazard ratio and adjusted hazard ratio was used to identify independent predictors for reoccurrence of opportunistic infection. P < 0.05 with 95% CI was considered as significantly associated with the dependent variable Result: A total of 450 HIV patients attending public health facilities in Arba Minch Town were followed over the last six and half year study. The incidence rate of reoccurrence of opportunistic infections was 11.5 (95% CI: 9.6-13) per 1000 person months. Among the reoccurred opportunistic infections, opportunistic pulmonary tuberculosis (PTB) was the major one 22(17.5%).Predictors that were associated significantly with reoccurrence were recent functional status (AHR=2.317, 95%CI (1.249-4.299)) for ambulatory and (AHR=3.457, 95%CI (1.839- 6.499)) for bed ridden patients, recent body mass index (AHR=0.540, 95%CI (0.300-0.970)) , recent CD4+ (AHR= 0.226, 95%CI (0.129-0.397)) and duration of anti-retroviral therapy taken(AHR=0.253,95%CI(0.141-0.453)) for up to 3 years duration and(AHR=0.093,95%CI(0.048-0.183))for above 3 years duration. Conclusion and recommendation: The findings of this study indicated that recent functional status, recent body mass index, recent CD4+ and duration on anti-retroviral therapy were found to be important predictors. The result imply the need for designing strategies that help affected people to cope with problems of functional status enhance patients CD4+/immunity, and activities targeting those HIV/AIDS patient with low BMI and implement activities incorporating nutritional support have to be planned, integrated and acted up on by stakeholder