Prevalence, Pattern, and Predictors of Opportunistic Infections in HIV-Infected Children on Antiretroviral Therapy: A Cross-Sectional Study in Plateau State, Nigeria
Keywords:
Advance HIV disease, Children, Nigeria, Opportunistic infections, Prevalence, Risk factorsAbstract
Among children living with Human Immunodeficiency Virus (CLHIV), opportunistic infections (OIs) are a leading cause of morbidity and mortality, especially in sub-Saharan Africa where some of the children with HIV present with advanced HIV disease (AHD)-defined as CD4 count <200cells/μL or WHO clinical stage 3 or 4, or severe immunosuppression in children <5 years. Despite significant scale-up of antiretroviral therapy (ART), data on OI burden in North-Central Nigeria are limited, particularly in paediatric age group. We determined the prevalence, pattern, and independent risk factors for OIs among CLHIV in Plateau State, Nigeria. This descriptive cross-sectional study enrolled 404 HIV infected children aged 6 weeks to 18 years from 12 health facilities in Plateau State in 2017 using multistage sampling. Data on socio-demographics, clinical characteristics, ART and cotrimoxazole preventive therapy (CPT) adherence, CD4 counts, and hemoglobin were collected. Bivariate and multivariate logistic regression was used to identify independent predictors of OIs. The prevalence of any OI was 56.4% (228/404). Pulmonary tuberculosis (PTB) was the most common (31.7%, 128/404), followed by oral candidiasis (9.9%, 40/404), bacterial pneumonia (9.4%, 38/404), and sepsis (6.4%, 26/404). On multivariable analysis, female sex ((AOR = 2.70, 95% CI: 1.41–5.26, p = 0.003), orphan status (AOR = 2.82, 95% CI: 1.49–5.31, p = 0.001), duration of CPT less than two years (AOR = 4.24, 95% CI: 1.66–10.86, p = 0.003), and CD4 count <200 cells/μL (AOR = 5.84, 95% CI: 2.39–14.26, p < 0.001) emerged as independent predictors of OIs. The prevalence of OIs among HIV-infected children in Plateau State remains high, with PTB predominating. The key predictors of OIs were short CPT duration, severe immunosuppression, female sex, and orphanhood. These findings support the need for early ART initiation, sustained CPT adherence, targeted psychosocial support for orphans, and routine immunologic monitoring to reduce OI burden in this vulnerable population.
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