The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY
Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali.
Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients.
Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively.
Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.
2. Damtie D, Yismaw G, Woldeyohannes D, Anagaw B. Common opportunistic infections and their CD4 cell correlates among HIV-infected patients attending at antiretroviral therapy clinic of Gondar University Hospital, Northwest Ethiopia. BMC Res Notes 2013;6:534.
3. Seage GR, Losina E, Goldie SJ, Paltiel AD, Kimmel AD, Freedberg KA. The relationship of preventable opportunistic infections, HIV-1 RNA, and CD4 cell counts to chronic mortality. J Acquired Immune Defic Syndr 2002;30:421-8.
4. Gebo KA, Fleishman JA, Moore RD. Hospitalizations for metabolic conditions, opportunistic infections, and injection drug use among HIV patients: trends between 1996 and 2000 in 12 states. J Acquired Immune Defic Syndr 2005;40:609-16.
5. Buchacz K, Baker RK, Moorman AC, Richardson JT, Wood KC, Holmberg SD, et al. HIV outpatient study (HOPS) investigators. Rates of hospitalizations and associated diagnoses in a large multisite cohort of HIV patients in the United States, 1994–2005. AIDS 2008;22:1345-54.
6. Bonnet F, Chene G, Thiebaut R, Dupon M, Lawson Ayayi S, Pellegrin JL, et al. Groupe d'Epidemiologie clinique du SIDA en aquitaine (GECSA). Trends and determinants of severe morbidity in HIV?infected patients: the ANRS CO3 aquitaine cohort, 2000–2004. HIV Med 2007;8:547-54.
7. Palella Jr FJ, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. HIV Outpatient study investigators mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquired Immune Defic Syndr 2006;43:27-34.
8. Cascade Collaboration. Effective therapy has altered the spectrum of cause-specific mortality following HIV seroconversion. AIDS 2006;20:741-9.
9. Hooshyar D, Hanson DL, Wolfe M, Selik RM, Buskin SE, McNaghten AD. Trends in perimortal conditions and mortality rates among HIV-infected patients. AIDS 2007;21:2093-100.
10. Lewden C, May T, Rosenthal E, Burty C, Bonnet F, Costagliola D, et al. Changes in causes of death among adults infected by HIV between 2000 and 2005: The “Mortalite 2000 and 2005” surveys (ANRS EN19 and Mortavic). J Acquired Immune Defic Syndr 2008;48:590-8.
11. Solomon FB, Angore BN, Koyra HC, Tufa EG, Berheto TM, Admasu M. Spectrum of opportunistic infections and associated factors among people living with HIV/AIDS in the era of highly active antiretroviral treatment in dawro zone hospital: a retrospective study. BMC Res Notes 2018;11:604.
12. Khanal VK, Jha N, Karki P, Paudel IS. Opportunistic infections and clinical profile of HIV/AIDS patients: a study from eastern region of Nepal. Nepal Med Coll J 2014;16:194-7.
13. Alemayehu M, Yisehak Y, Alaro W, Alemayehu B. Opportunistic infections among HIV/AIDS patients taking ante-retroviral therapy at tertiary care hospital in Wolaita zone, southern Ethiopia. J AIDS Clin Res 2017;8:2.
14. Halgarkar CS, Nilekar SL. HIV prevalence and the co-relation of different opportunistic infections with CD4 cell count. Indian Medical GAZETTE; 2014. p. 157-60.
15. Mitiku H, Weldegebreal F, Teklemariam Z. Magnitude of opportunistic infections and associated factors in HIV-infected adults on antiretroviral therapy in eastern Ethiopia. HIV/AIDS (Auckl) 2015;7:137-44.
16. Bhaumik P, Debnath K, Sinha B. Spectrum of opportunistic infections among HIV/AIDS patients of Tripura. J Indian Acad Clin Med 2013;14:218-21.
17. BS Chavan, VR MR, Arshad M, Sayana SB. Factors influencing the substitution of art in HIV/AIDS patients on first line highly active antiretroviral therapy. Asian J Pharm Clin Res 2014;7:117-20.
18. Kumar R, Bishnoi BR. Opportunistic infections among HIV patients attending tertiary care hospital, Bikaner, Northern Western Rajasthan, India. Int J Med 2018;4:58-61.
19. Sharma SK, Kadhiravan T, Banga A, Goyal T, Bhatia I, Saha PK. Spectrum of clinical disease in a series of 135 hospitalized HIV-infected patients from north India. BMC Infect Dis 2004;4:52.
20. Kumawat S, Kochar A, Sirohi P, Garhwal J. Socio-demographic and clinical profile of HIV/AIDS patients on HAART era at a tertiary care hospital in North-West Rajasthan, India. Int J Community Med Public Health 2016;3:2088-93.
21. Insaniputri P, Supardi S, Andrajati R. Comparison of zidovudine combination and tenofovir combination on the effectiveness of therapy and side effects in hiv/aids patients in rsal mintohardjo. Asian J Pharm Clin Res 2017;10:93-6.
22. Jain S, Singh AK, Singh RP, Bajaj JK, Damle AS. Spectrum of opportunistic fungal infections in HIV-infected patients and their correlation with CD4+counts in western India. J Med Microbiol Infectious Disease 2014;2:19-22.
23. Shelburne SA, Hamill RJ. The immune reconstitution inflammatory syndrome. AIDS Rev 2003;5:67–79.
24. French MA, Price P, Stone SF. Immune restoration disease after antiretroviral therapy. AIDS 2004;18:1615–27.
25. Lawn SD, Bekker LG, Miller RF. Immune reconstitution disease associated with mycobacterial infections in HIV-infected individuals receiving antiretrovirals. Lancet Infect Dis 2005;5:361–73.
26. Meintjes G, Lawn SD, Scano F, Maartens G, French MA, Worodria W, et al. Tuberculosis-associated immune reconstitution inflammatory syndrome: case definitions for use in resource-limited settings. Lancet Infect Dis 2008;8:516-23.
27. A PK, GP, Sn M, Ap S, Swamy V, Rama S. Clinical outcomes of use of hydroxychloroquine in paradoxical tuberculosis-immune reconstitution inflammatory syndrome in HIV-infected patients. Asian J Pharm Clin Res 2018;11:439-41.
28. Indira P, Kumar PM, Shalini S, Vaman K. Opportunistic infections among people living with HIV (PLHIV) with diabetes mellitus (DM) attending a tertiary care hospital in coastal city of South India. PloS One 2015;10:e0136280.
29. Iroezindu MO, Ofondu EO, Hausler H, Van Wyk B. Prevalence and risk factors for opportunistic infections in HIV patients receiving antiretroviral therapy in a resource-limited setting in Nigeria. J AIDS Clin Res 2013;3:1-9.
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