Abstract
Background:The African continent accounts for over 70% of people infected with Human Immunodeficiency Virus (HIV). The HIV sero-prevalence rate in Africa is estimated at 4.3%. In developed countries, such as France, pneumocystis is indicative of AIDS in 30% of patients; however, in Africa, pulmonary tuberculosis (TB) is the most-documented opportunistic infection (OI) and the leading cause of death in HIV-infected patients. In 2016, Cameroon had 32,000 new cases of OI and 29,000 deaths as a result of these infections. However, there is little existing data on the epidemiological profile of OIs in Cameroon, which is why we conducted this study in accredited HIV treatment centers and care/treatment units in the two cities of Douala and Yaounde, Cameroon.Methods:This was a retrospective descriptive and analytical study carried out in 12 accredited HIV treatment centers in the cities of Yaoundé and Douala, Cameroon, over a period of seven months from October 2017 to April 2018. A stratified sampling method was used with three sampling levels: the city, type of health facility and size of active files. Ethical clearance and administrative authorization were obtained from the appropriate authorities and data were collected using a pre-tested survey form. The data collected was entered and analyzed using Epi Info version 3.5.4.Results:Out of a total of 1,617 HIV-infected patients sampled, 419 (25.9%) had at least one OI. Of these patients with an OI, 246 or 65% had a baseline CD4 count of <200/mm3. There was a significant relationship between the male gender and the onset of OI (OR = 1.47; p = 0.01). Age ≥ 50 years was associated with the occurrence of OI (OR = 2.57; p = 0.01). A CD4 count of <200/mm3 was also associated with the risk of developing an OI (OR = 3.12; p = <0.01).Conclusion and Global Health Implications:The prevalence of OI is high among people living with HIV (25.9%). Shingles was the most common OI found followed by pulmonary tuberculosis. Male gender, age ≥ 50 years, and CD4 <200/mm3 were the most common factors associated with the occurrence of these OI. These findings suggest that public health interventions for reducing HIV related co-morbidities (and implicitly mortality) should especially target the male gender for greater impact in addition to other measures.
Highlights
The African continent accounts for over 70% of people infected with Human Immunodeficiency Virus (HIV).The HIV sero-prevalence rate in Africa is estimated at 4.3%
An opportunistic infection (OI) is an infection caused by a microorganism that is often present in the environment or even in the body, but cannot cause a disease as long as the immune system is preserved.When this immune system becomes compromised, the microorganism seizes the “opportunity” to develop and cause the occurrence of an infection.[4]
Most Acquired Immunodeficiency Syndrome (AIDS)-related deaths result from these OIs which are often caused by parasites, bacteria, fungi and other viruses.5The classification of HIV patients into clinical stages, as proposed by the World Health Organization (WHO), takes into consideration different OI some of which include:seborrheic dermatitis,shingles, respiratory tract infections, oral candidiasis, oral hairy leukoplakia, pulmonary tuberculosis, severe bacterial infections, pneumocystis, recurrent bacterial pneumonia, cerebral toxoplasmosis, cryptosporidiosis and chronic isosporosis, extrapulmonary cryptococcosis, Kaposi sarcoma, extrapulmonary tuberculosis among others.[6]
Summary
The African continent accounts for over 70% of people infected with Human Immunodeficiency Virus (HIV).The HIV sero-prevalence rate in Africa is estimated at 4.3%. In developed countries, such as France, pneumocystis is indicative of AIDS in 30% of patients; in Africa, pulmonary tuberculosis (TB) is the most-documented opportunistic infection (OI) and the leading cause of death in HIV-infected patients. In Africa, pulmonary tuberculosis is the leading cause of death in HIV-infected patients.[8] In France, pneumocystis is indicative of AIDS in 30% of patients followed by esophageal candidiasis, which accounts for 22%.8. In France, pneumocystis is indicative of AIDS in 30% of patients followed by esophageal candidiasis, which accounts for 22%.8 In Ethiopia, the prevalence of opportunistic infection was found to be 33.6% among HIV patients in the nation’s capital,Addis Ababa.[9]
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