The Magnitude and Profile, Distribution Patterns and Associated Factors of AIDS-related Opportunistic Diseases in Adults on Antiretroviral Therapy in Malawi

Abstract

\n Background\n\nOver one million people in Malawi are HIV infected and many suffer from AIDS-related opportunistic diseases (ODs). However, little is known about the clinical profiles of these ODs and their associated risk factors. We describe the burden and spectrum of ODs in HIV-infected adults on combined antiretroviral therapy (cART) since the countrywide scale-up of free HIV treatment.\nMethods\n\nA retrospective chart review was conducted across all three regions in Malawi. Clinical data on prevalent and incident AIDS-related ODs in patients commenced cART from 2004–2015 were abstracted from case notes between March and May 2016.\nResults\n\nA total of 9,953 patients were included in the analysis. 60.84% were females and relatively younger than males with mean age difference of 4.75\u2009±\u20092.9 years. Overall mean age was 40.72\u2009±\u200912.19 years. 86.85% were young and middle-aged adults of productive age-group (15–54 years). 65.08% were urban residents and 59.55% were from Southern region. 12,814 AIDS-related opportunistic events were extracted: 56.54% were prevalent AIDS-defining clinical conditions and the rest were incident AIDS-recurrent cases. 7.65% of patients had no OD manifestation. Commonly occurring aetiological agents were mycobacterial (36.31%), bacterial (20.77%), fungal (15.77%) and viral (15.11%) pathogens. Overall, the most prevalent ODs were mycobacterium tuberculosis (34.39%), bacterial pneumonia (11.21%), nontyphoid Salmonella bacteraemia (9.57%), HIV-wasting syndrome (8.93%), candidiasis (6.81%), isosporiasis (5.24%), pneumocystis pneumonia (4.02%) and cryptococcal meningitis (3.72%). In the multivariable logistic regression, healthcare facility types, gender, age-group, geographical location, CD4 cell count, viral load levels, treatment initiation eligibility criteria and low socio-economic status were statistically significantly associated with manifestation of AIDS-related opportunistic diseases.\nConclusion\n\nODs were highly pervasive among HIV-infected adults in Malawi including treatment-experienced patients which affect largely the productive population. Strategies for effective prevention, early detection and proactive management of AIDS-related opportunistic diseases need to be established and strengthened across all patient groups, in all regions and across all ART health facilities regardless of their levels.