BACKGROUND Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. METHODS A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. RESULTS This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having "fair" or "poor" ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. CONCLUSIONS In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, "fair" or "poor" ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.

中文翻译：

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埃塞俄比亚西北部Debre Markos转诊医院接受HIV感染的儿童中ART常见机会感染的发病率：一项回顾性队列研究。

背景技术机会性感染（OIs）是人类免疫缺陷病毒（HIV）儿童发病和死亡的主要原因。为了获得更好的治疗和干预措施，有关感染HIV的儿童中机会性感染发生情况的最新信息至关重要。但是，关于埃塞俄比亚感染艾滋病毒的儿童中常见机会性感染发生率的研究非常有限。因此，本研究旨在确定Debre Markos转诊医院接受抗逆转录病毒治疗（ART）的HIV感染儿童中机会性感染的发生率。方法在Debre Markos转诊医院进行了一项基于设施的回顾性队列研究，研究时间为2005年1月1日至2019年3月31日，其中包括408名接受抗病毒治疗的HIV感染儿童。使用适应于抗逆转录病毒治疗输入和随访表的数据提取表，从感染了艾滋病毒的儿童图表中提取数据。使用Epi-data™3.1版输入数据，并使用Stata™14版进行分析。KaplanMeier生存曲线用于估计机会性感染的无生存期。双变量和多变量Cox比例风险模型均适用于确定机会性感染的预测因素。结果本研究包括2005年1月1日至2019年3月31日期间408例由HIV感染的儿童发起的ART的记录。随访期间机会性感染的总发生率为9.7（95％CI：8.13） ，11.48）每100个儿童年的观察数。随访中最常见的OI为结核，为29.8％。表现为晚期疾病（III和IV）（AHR：1.8，95％CI：1.2、2.7）的儿童，其“坚持”或“不良” ART依从性（AHR：2.6，95％CI：1.8、3.8），没有进行OI预防（AHR：1.6，95％CI：1.1，2.4）和CD4计数或百分比低于阈值（AHR：1.7，95％CI：1.1，2.6）的机会性感染风险更高。结论在这项研究中，艾滋病毒感染儿童中机会性感染的发生率仍然很高。关于预测因素，例如疾病晚期（III和IV），CD4计数或低于阈值的百分比，“合理”或“不良” ART依从性以及不采取OI预防措施，与OI显着相关。不进行OI预防（AHR：1.6，95％CI：1.1，2.4）和CD4计数或低于阈值的百分比（AHR：1.7，95％CI：1.1，2.6）发生机会感染的风险较高。结论在这项研究中，艾滋病毒感染儿童中机会性感染的发生率仍然很高。关于预测因素，例如疾病晚期（III和IV），CD4计数或低于阈值的百分比，“合理”或“不良” ART依从性以及不采取OI预防措施，与OI显着相关。不进行OI预防（AHR：1.6，95％CI：1.1，2.4）和CD4计数或低于阈值的百分比（AHR：1.7，95％CI：1.1，2.6）发生机会感染的风险较高。结论在这项研究中，艾滋病毒感染儿童中机会性感染的发生率仍然很高。关于预测因素，例如疾病晚期（III和IV），CD4计数或低于阈值的百分比，“合理”或“不良” ART依从性以及不采取OI预防措施，与OI显着相关。