Prevalence and Factors Associated with Opportunistic Infections in HIV Positive Patients on Antiretroviral Therapy in Uganda

Abstract

Introduction: Opportunistic infections (OIs) remain the single main cause of ill-health and death among HIV/AIDS patients in resource poor countries. We assessed the prevalence of 17 OIs and associated factors among HIV positive patients on highly active antiretroviral therapy (HAART) in Uganda. Methods: Observational data from 2004 to 2013 for adult HIV positive patients (>=15yrs) obtaining care and treatment from the AIDS support organization (TASO) in Uganda were reviewed.  Electronic data were obtained from TASO HIV clinics representing 4 different geographical areas of Uganda. Descriptive statistics were summarized in terms of frequencies and percentages. Logistic regression was used to assess the factors associated with occurrence of OIs. Results: Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66%) were female and one third (34%) were male.  In univariate analysis, significant differences were observed between male and female ART clients with men being older (median age 36yrs IQR 29-43 vs 32 yrs IQR 26-39, p<0.0001); likely to be more educated(>secondary 31% vs 19%, p<0.0001);  likely to be more severely ill(CD4 count<100 26% vs 21%, p<0.0001); were more likely to be married (65% vs 42%, p<0.0001) and were more likely to be formally employed (27% vs 12%,  p<0.0001). Mean annual prevalence for any OI in 2004 was 57.6% and in 2013 was 27.5% (X2trend = 122, b= -0.0283, p <0.0001). The most commonly encountered OIs were geohelminths (35%), diarrhea<1 month (18%) and mycobacterium tuberculosis (11%). Factors associated with any OI after HAART were male gender, if from Northern Uganda, low education (<primary), baseline WHO stages III&IV, stavudine ART regimen, baseline CD4 count <100cells/µl, low baseline weight <55 kg and period 2004-2008 (p<0.05). Conclusion and Recommendations: In these settings, the burden of OIs is still high in spite of increased access to HAART. The prevalence of geohelminthes and diarrhoea is worrying among HIV patients on HAART. Men remain at greater risk of OIs and should be the main target for early HAART initiation.