article · Frontiers in Pediatrics
Opportunistic infections remain a primary cause of illness and mortality among children living with HIV, despite widespread test-and-treat strategies. An evaluation of medical records from 452 children receiving antiretroviral therapy across comprehensive specialised hospitals in the Amhara region revealed an opportunistic infection incidence rate of 8.64 per 100 person-years. Several critical clinical and behavioural predictors significantly increased infection risk. Children who did not initiate antiretroviral therapy within seven days of diagnosis, those with low CD4 counts, and patients presenting with anaemia faced elevated hazards. Furthermore, inconsistent medication adherence and the absence of tuberculosis-preventive therapy substantially raised vulnerability to secondary infections. Prompt treatment initiation directly boosts immunity and suppresses viral replication, demonstrating the value of rapid therapy, preventive treatments, and robust adherence support.
Opportunistic infections cause more than 90 percent of HIV-related paediatric deaths globally. Identifying specific risk factors, such as treatment delays, anaemia, and poor adherence, enables healthcare providers and public health programmes to intervene early. Targeting these predictors helps healthcare systems safeguard vulnerable children on antiretroviral therapy from preventable, life-threatening secondary illnesses.
The abstract does not indicate a direct commercial application pathway. However, the identified clinical predictors could inform digital clinical decision-support systems or paediatric management protocols utilised by healthcare providers and public health organisations. Any such translation would require integration into existing clinical workflows rather than deployment as a standalone commercial product.
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Introduction Globally, opportunistic infections are the leading causes of morbidity and mortality among HIV-infected children, contributing to more than 90% of HIV-related deaths. In 2014, Ethiopia launched and began to implement a “test and treat” strategy aiming to reduce the burden of opportunistic infections. Despite this intervention, opportunistic infections continue to be a serious public health issue, with limited evidence available on their overall incidence among HIV-infected children in the study area. Objective The study aimed to assess the incidence of opportunistic infections and to identify predictors of their occurrence among HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals in 2022. Methods A multicenter, institution-based retrospective follow-up study was conducted among 472 HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals from May 17 to June 15, 2022. Children receiving antiretroviral therapy were selected using a simple random sampling technique. Data were collected using national antiretroviral intake and follow-up forms via the KoBo Toolbox. STATA 16 was used for data analyses, and the Kaplan–Meier method was used to estimate probabilities of opportunistic infection-free survival. Both bi-variable and multivariable Cox proportional hazard models were employed to identify significant predictors. A P -value <0.05 was taken to indicate statistical significance. Results Medical records from a total of 452 children (representing a completeness rate of 95.8%) were included and analyzed in the study. The overall incidence of opportunistic infections among children receiving ART was 8.64 per 100 person-years of observation. The predictors of elevated incidence of opportunistic infections were: a CD4 cell count below a specified threshold [AHR: 2.34 (95% CI: 1.45, 3.76)]; co-morbidity of anemia [AHR: 1.68 (95% CI: 1.06, 2.67)]; ever having exhibited only fair or poor adherence to ART drugs [AHR: 2.31 (95% CI: 1.47, 3.63)]; never having taken tuberculosis-preventive therapy [AHR: 1.95 (95% CI: 1.27, 2.99)]; and not having initiated antiretroviral therapy within 7 days of HIV diagnosis [AHR: 1.82 (95% CI: 1.12, 2.96)]. Conclusion In this study, the incidence of opportunistic infections was high. Early initiation antiretroviral therapy has direct effect on boosting the immunity, suppressing viral replications and increases the CD4 count, so that the occurrence of opportunistic infection will reduce the incidence of OIs.
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DOI: 10.3389/fped.2023.1107321
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