SPECTRUM OF OPPORTUNISTIC INFECTIONS AMONG PEOPLE LIVING WITH HIV ATTENDING AN ART CENTRE IN KHYBER PAKHTUNKHWA

Abstract

Background: Opportunistic infections continue to be a significant source of morbidity, hospitalization and mortality in people living with HIV, especially in those who have advanced immunosuppression, poor ART adherence and/or unsuppressed viral load. Information about the incidence of opportunistic infections in HIV clients in Khyber Pakhtunkhwa is limited. Objective: To determine the frequency and spectrum of opportunistic infections and identify associated clinical and treatment-related factors among people living with HIV attending two antiretroviral therapy centres in Khyber Pakhtunkhwa. Methodology: This was a multicentre descriptive cross sectional study carried out in the ART centres of Divisional Headquarters Teaching Hospital, KDA, Kohat and Mufti Mahmood teaching hospital, Dera Ismail Khan from January to July 2025. The HIV infected adult population consisted of 400 adults with confirmed HIV infection who were enrolled by consecutive sampling. A structured form was used to collect sociodemographic data, clinical, laboratory, treatment and opportunistic-infection data. Frequencies and percentages were computed and associations were evaluated with chi-square or Fisher's exact test. The independent predictors of OI were determined using multivariable binary logistic regression. A p value<0.05 was taken as statistically significant. Results: The mean age of the participants was 37.8 ± 10.6 years, and 274 (68.5%) were male. At least one opportunistic infection was identified in 176 (44.0%) participants. Pulmonary tuberculosis was the most frequent infection, affecting 58 (14.5%) patients, followed by oral candidiasis in 46 (11.5%), chronic diarrhoeal illness in 34 (8.5%), bacterial pneumonia in 30 (7.5%), and herpes zoster in 24 (6.0%). Opportunistic infections occurred in 78.2% of patients with CD4 counts below 200 cells/mm³, compared with 15.0% of those with CD4 counts of at least 500 cells/mm³ (p < 0.001). A CD4 count below 200 cells/mm³, poor ART adherence, WHO clinical stage IV, absence of viral suppression, and lack of cotrimoxazole prophylaxis remained independent predictors of opportunistic infections. Conclusion: Opportunistic infections affected a substantial proportion of people living with HIV attending the participating ART centres. Tuberculosis was the predominant infection. Advanced immunosuppression, poor treatment adherence, unsuppressed viral load, and absence of prophylaxis were the major associated factors. Early diagnosis, sustained ART adherence, regular CD4 and viral-load monitoring, and timely preventive treatment are required to reduce the burden of opportunistic infections.