Prevalence and management of opportunistic infections in HIV-infected adult patients at Kenyatta National Hospital

Abstract

Background: Advanced HIV infection may be complicated by opportunistic infections (Ols) and other consequences of immune dysfunction. Often, OIs constitute the first manifestation of HIV infection, indicating significant immunodeficiency. Most of HIV / AIDS morbidity and mortality are attributed to OIs associated with low immune status.

Objective: The main objective of this study was to establish the prevalence of HIV -related OIs in adult patients at Kenyatta National Hospital Comprehensive Care Centre (KNH -CCC).

Study design: This was a hospital-based cross-sectional study conducted between July and August 2011 at KNH-CCC. Three hundred and eleven patients' files meeting the inclusion criteria were checked for Ols recorded by the attending clinician on the index visit. Data was analyzed using SPSS version 11.5.

Results: The prevalence of opportunistic infections was 14.1 % (95% CI: 10.7-18.5). Overall, the most commonly reported bacterial infection was pneumonia (6.4%) whereas pulmonary tuberculosis was reported in 3.9% of patients. On multivariate analysis significant association was found between a patients' current 01 status and WHO stage when HIV was diagnosed (AOR= 3.79 [95% CI = 1.43 - 10.03], P=0.007) and duration since HIV diagnosis (AOR 3.89 [95% CI= 1.58-9.59], P=0.003). Out of the 44 patients with at least one 01, 29.5% of them were not managed according to the Kenya National Manual for the Management of Ols and related Conditions. Co-trimoxazole was the most commonly prescribed chemoprophylaxis agent, used by 90.0% of the patients.

Conclusion: There was a high prevalence of OIs among the HIV/AIDS patients at KNHCCC. Bacterial Pneumonia and pulmonary tuberculosis were the most commonly observed OIs.

Recommendations: These findings support the recent WHO recommendations to start ART earlier before profound immune destruction occurs. Adherence of health care providers to Kenya National Guideline 111 management of OIs should be reinforced.