Incidence and Risk Factors of Opportunistic Infections in HIV-Infected Adults on Antiretroviral Therapy

Abstract

Although the majority of people living with HIV in Thailand receive antiretroviral therapy, which helps suppress the replication of virus and improve the immune system, the mortality rate for people living with HIV remains high. Opportunistic infections are found to be the leading cause of morbidity and mortality in this population. This research aimed to study the incidence and risk factors of opportunistic infections in HIV-infected adults receiving the highly effective antiretroviral therapy (HAART) who visited Takhli Hospital, Nakhon Sawan from January 2005 - September 2019. After obtaining human ethics approval, medical records of the study population were retrieved from the Takhli Hospital database (HOSxP database) and were reviewed. Incidence rates of opportunistic infections were analyzed by the Kaplan-Meier method and multifactorial variables were assessed using the Cox regression model. Of the 280 HIV infected adults, 50.7% were male, and the median age at HAART initiation was 36.8 years (interquartile range: 30.4 - 43.9 years). The incidence of opportunistic infections was 14.08 per 1,000 person-years (95% Confidence Interval [95% CI]: 10.06 - 19.71). The risk factors for opportunistic infections in HIV-infected adults were receiving efavirenz antiretroviral drug (Adjusted Hazard Ratio [HR_adj] = 3.07, 95% CI: 1.44-6.50) and having a CD4 lymphocyte count ≤350 cells/mm³ (HR_adj = 5.43, 95% CI: 2.08-14.17). Overall, our findings suggest that caution should be exercised when initiating the antiretroviral therapy for newly infected HIV patients, particularly with the efavirenz-based regimen, and the CD4 lymphocyte numbers should be taken into consideration to minimize the occurrence of opportunistic infections.