Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.3
, Sep
t
em
b
e
r
20
15, pp
. 172
~179
I
S
SN
: 225
2-8
8
0
6
1
72
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Incidence of Opportunistic
Infections among Adult HIV
Positi
ve Peopl
e
Recei
v
ing Co-
t
rim
o
xazol
e Proph
y
laxis
Yihun
Tariku
1
,
Ya
liso
Ya
ya
2
, De
gu
Jere
ne
3
, Alemu Tam
i
so
4
1,2
Arba Minch
C
o
lleg
e
of
Health
Science, Arba M
i
nch, Eth
i
opia
3
Department
of
Preventiv
e Medicine, Schoo
l of
P
ublic He
alth
, A
ddis Ababa Un
iv
ersit
y
,
Eth
i
opi
a
4
Departm
e
nt of Public
He
alth
,
C
o
lle
g
e
of
Medicine and
Health
Scienc
e, Arba Min
c
h University
, Ethiopia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
J
u
n 28, 2015
Rev
i
sed
Ju
l 29
,
20
15
Accepted Aug 12, 2015
In Ethiop
ia, Co
-trimoxazole pr
oph
y
l
axis th
erap
y
(CPT)
used
to pr
even
t
opportunistic
in
fections among
people li
ving with HIV is the standard of
practice; however incid
e
nce of
opportuni
stic inf
ection and their
predictor
s
are rarely
do
cu
mented in th
e countr
y
.
Th
is was a retrospectiv
e follow up
stud
y
to d
e
scrib
e
the in
cid
e
nce and pr
edictors
of opportunistic infections
among 244 adults receiving
CP
T. Par
ticipan
ts
were followed f
o
r a med
i
an
time of 72 weeks. During a study
per
i
od
a total
of 53opportunistic infections
were recorded;
making the overall
inci
d
e
nce r
a
te 23
.9/100 p
e
rson-
y
e
ars.
High incid
e
nce
of opportunistic infections
is likely
to o
ccur
if
: the
clients
were married (adjusted hazard r
a
tio
(AHR) 1.9
65;(95% CI: 1.1
09, 3.451),
had histor
y
of
tubercu
l
osis tr
eatme
nt (AHR: 2.34(95% CI:1.05, 5
.
24))
,
pati
ents
who are indic
a
ted for
CP
T becaus
e
of both clinic
al
and W
H
O
clinical staging
criter
i
a(AHR 2.418
(95% CI:1.02, 5
.
72 ),an
d had poor
adheren
ce to CPT (AHR, 2.11 (95% CI
: 1.19-3.72)). Eventhoug
h adherence
is non-substitutable strat
e
g
y
to prevent
opportun
i
stic infection
,
th
e cohort of
HIV patien
t
s fa
i
l
ed
to adh
e
re
to
CPT, which
in
t
u
rn resulth
igh in
ciden
ce o
f
opportunistic in
fections
among them, th
erefor
e
improving ad
herence as
guidelin
e should
be a priority
to
prevent OIs among people liv
ing
with HIV
in th
e stud
y
region.
Keyword:
Oppo
rt
u
n
i
stic in
fection
s
Co
-
t
r
i
m
o
x
azo
l
e
pr
oph
ylax
is
th
erap
y
HI
V
Ar
ba M
i
nc
h
h
o
s
pi
t
a
l
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Al
em
uTam
i
s
o,
Dep
a
rtm
e
n
t
Pub
lic Health,
C
o
l
l
e
ge
of
M
e
di
ci
ne a
n
d
He
a
l
t
h
Sci
e
nces
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
, So
ut
her
n
Et
hi
o
p
i
a
.
Em
a
il: ale
m
u
t
a
m
iso
@
yah
o
o
.
co
m
1.
INTRODUCTION
Hum
a
n Im
m
une Vi
rus
(H
I
V
)
i
s
one
of t
h
e
w
o
rl
d heal
t
h
a
n
d
devel
opm
ent
chal
l
e
ng
es, a
n
d m
o
re t
h
an
3
4
m
illio
n
p
e
op
le are liv
ing
with
HIV and
aroun
d
m
ill
io
n n
e
w i
n
fections o
c
cu
rred
i
n
th
e year
2
011
[1
],[2
].
R
e
gar
d
i
n
g
pre
v
ent
i
o
n a
n
d c
o
nt
r
o
l
o
f
H
I
V/
A
I
DS
Et
hi
opi
a i
s
sh
owi
n
g
rem
a
rka
b
l
e
res
u
l
t
s
wi
t
h
1.
5 %
of
ad
ul
t
H
I
V
pr
ev
alen
ce [
3
]. How
e
v
e
r
,
opp
or
tu
n
i
stic in
fectio
ns (OIs) co
n
tinu
e
to b
e
a m
a
j
o
r cau
se of m
o
rb
id
i
t
y an
d
m
o
r
t
ali
t
y f
o
r
p
e
op
le liv
ing w
ith
HI
V
i
n
th
e cou
n
t
r
y
[
4
],[
5
]. Pr
ophylax
is ag
ain
s
t
co
mm
o
n
O
I
s is a
reco
mm
en
d
e
d
strateg
y
to imp
r
ov
e th
e
q
u
a
l
ity o
f
life
of
peo
p
l
e in
f
e
cted
w
ith
H
I
V
t
h
rou
gh pr
ev
en
ting ear
ly
m
o
rbidity
and
m
o
rtality
[4]
,
[
6
]
.
C
o
-t
ri
m
oxazol
e
(a com
b
i
n
at
i
on
of s
u
l
f
am
etho
xaz
o
l
e
an
d t
r
i
m
et
hop
ri
m
)
is a br
oad s
p
ec
t
r
um
safe,
well to
lerated,
lo
w-co
st, and
wid
e
ly av
ailable an
ti
m
i
cro
b
i
al ag
en
t
u
s
ed
as
stan
d
a
rd care fo
r
p
e
op
le liv
ing
with
HI
V a
n
d al
s
o
use
d
i
n
pri
m
ary
heal
t
h
car
e t
o
t
r
eat
va
ri
ous
i
n
fect
i
o
ns
[
6
]
-
[
10]
.
T
h
e
Et
hi
o
p
i
a
n
n
a
t
i
onal
g
u
i
d
e
lin
e recommen
d
s
CPT for p
e
o
p
l
e liv
in
g
with
HIV if o
n
e
o
f
th
e fo
llo
wi
n
g
co
nditio
n
s
is fu
lfilled
:
1
.
WHO clinical stage 2, 3
or 4
in the
absence of CD4 count, 2.
WHO clini
cal stage 3 or 4
irres
p
ective of
CD4
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Inci
dence
of
Opport
unistic Infections Among Ad
ult HIV Positif People
Recei
ving ....
(Yihun Tarik
u
)
17
3
l
e
vel
,
3. C
D
4
cou
n
t
<
35
0 c
e
l
l
/
m
m
3
, 4. TB
-HI
V
co
-i
n
f
e
c
t
e
d pat
i
e
nt
or
5. pat
i
e
nt
wi
t
h
a doc
um
ent
e
d p
r
i
o
r
hi
st
ory
o
f
P
n
e
u
m
o
cy
sti
s
C
a
ri
ni
Pne
u
m
oni
a (
P
C
P
)
[6]
,
[7]
.
St
udi
es c
o
nfi
r
m
e
d t
h
at
C
P
T
si
gni
fi
ca
nt
l
y
r
e
duce
s
m
o
rbi
d
i
t
y
and m
o
rt
al
it
y
i
n
HI
V p
o
si
t
i
v
e pe
opl
e
even in the
area where
the
drug is
hi
gh
ly resisted or m
a
laria is end
e
mi
c [9]
-
[
1
7]
.
Neve
rt
hel
e
ss
, t
h
e
gl
o
b
al
im
ple
m
entatio
n
of CPT
has
been rate
d as
s
u
b-optim
al [1
4],[18].
In Ethi
opia CPT
is taki
ng
place in 2006
but
litt
le h
a
s
b
e
en kn
own
abo
u
t
th
e in
ci
d
e
n
c
e
o
f
co
mm
o
n
OI
s su
ch
as b
a
cterial p
n
e
u
m
o
n
i
a,
d
i
arrh
ea disease,
sep
ticemia, en
teritis, m
a
laria o
r
PCP am
o
ng HIV
po
sitiv
e
p
e
op
le
o
n
CPT [4
]. Th
is stud
y aim
e
d
to
describ
e
the incide
nce of com
m
on OIs
am
ong
HIV positive people
on CPT at Arba
Minch Hospit
al since 2003
whic
h
p
r
ov
id
es car
e
t
o
co
hor
ts of
p
e
o
p
l
e
w
ith
HI
V.
2.
R
E
SEARC
H M
ETHOD
2.
1.
Stud
y setting
Thi
s
st
u
d
y
wa
s co
nd
uct
e
d at
Ar
ba M
i
nc
h
Hos
p
i
t
a
l
(AM
H
)
w
h
i
c
h i
s
l
o
cat
ed at
Ar
ba
M
i
nch t
o
w
n
,
Gam
o
Gofa Z
one
, So
ut
h Et
hi
o
p
i
a
whi
c
h i
s
500
km
i
n
sout
h
of A
d
di
s Aba
b
a. T
h
e h
o
spi
t
a
l
pr
ovi
de
s
co
m
p
reh
e
n
s
iv
e HIV care t
o
all HIV
p
o
s
itiv
e
p
e
op
le
within
Gam
o
Gofa zon
e
o
r
ou
t.
It is also
o
n
e
of few
Et
hi
o
p
i
a
n
ho
s
p
i
t
a
l
s
wh
o st
art
e
d C
P
T t
o
pat
i
e
nt
s at
t
h
e fi
rst
t
i
m
e. The
ser
v
i
ces are
pr
ovi
de
d by
m
u
l
tid
iscip
lin
ary tea
m
wh
ich
in
clud
es p
h
y
sician
s, nu
rses, pu
b
lic h
ealth
p
r
o
f
essio
n
a
ls, lab
o
r
at
o
r
y
tech
no
log
i
sts,
p
h
a
rm
acists, d
a
ta cl
erk
s
an
d
v
o
l
u
n
t
eer who are adh
e
ren
c
e
sup
p
o
r
ters.
In case of illn
ess, the
hos
pi
t
a
l
t
r
eat
s
pat
i
e
nt
s acc
or
d
i
ng t
o
t
h
e
n
a
t
i
o
nal
g
u
i
d
el
i
n
e f
o
r
H
I
V
m
a
nagem
e
nt
.
2.
2.
Patien
t selec
t
ion
A
ll adu
lt p
a
tien
t
s who
w
e
r
e
r
e
g
i
ster
ed
f
r
om
Sep
1
,
2
008 up
to
Au
g 30
, 20
11
i
n
chro
nic H
I
V
care
cl
i
n
i
c
pl
us
wh
o
had
bot
h m
e
di
cal
rec
o
r
d
c
h
art
a
n
d
AR
T
fol
l
o
w
u
p
c
h
ar
t
were
i
n
cl
ude
d i
n
t
h
e
st
u
d
y
.
Th
i
s
peri
od
was sel
ect
ed i
n
or
der
t
o
h
a
ve t
h
e rece
nt
p
o
ssi
bl
e
7
2
week
(t
hi
s
pe
ri
od i
s
c
o
nsi
d
e
r
e
d
t
h
e t
i
m
e peri
od
i
n
whi
c
h C
P
T i
s
effect
i
v
e
)
fol
l
o
w
u
p
t
i
m
e
[19]
. Out
of 7
6
8
pat
i
e
nt
s regi
st
ered wi
t
h
i
n
t
h
e gi
ven
peri
od
, 24
4
pat
i
e
nt
s bec
o
m
e
el
i
g
i
b
l
e
and f
o
l
l
o
we
d f
o
r m
a
xi
m
u
m
of 72
week
s (1
.3
8 pe
rso
n
y
ears)
bas
e
d o
n
t
h
e t
i
m
e
whe
n
CPT was in
itiated
as sho
w
n
i
n
Fi
g
u
re
1
.
Fig
u
re 1
.
Parti
c
ip
an
t
inclu
s
ion
flowch
art, Arb
a
Min
c
h
Ho
sp
ital,
Eth
i
op
ia
2.
3.
Stud
y design and
d
a
ta
c
o
llection
A
ret
r
os
pect
i
v
e
fol
l
o
w u
p
st
udy
was use
d
. A
st
r
u
ct
ured a
n
d pretested
data collection
checklist
was
pre
p
are
d
a
nd
u
s
ed t
o
col
l
ect
dem
ogra
phi
c,
basel
i
n
e cl
i
n
i
c
al
and hem
a
t
o
l
ogi
cal
cha
r
act
e
r
i
s
t
i
c
s and f
o
l
l
o
w
up
co
nd
itio
n of t
h
e p
a
tien
t
s. Two
h
ealth
p
r
o
f
essio
n
a
ls
wh
o h
a
d
b
ach
el
o
r
d
e
gree wit
h
a sp
ecial train
i
n
g
fo
r HIV
care were selected
to re
view records.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
1
72
–
17
9
17
4
2.
4.
St
at
ist
i
ca
l analy
s
is
Dat
a
were
ent
e
red
i
n
t
o
Epi
n
f
o
7.
1.
0 an
d anal
y
zed
using t
h
e Statistical Packa
g
e
for the
Socia
l
Sci
e
nce (
SPS
S
)
so
ft
wa
re pac
k
age
,
ve
rsi
o
n
20
. T
h
e m
a
i
n
outc
o
m
e
variables are m
o
rbi
d
ity (m
a
l
aria, diarrhea
,
p
n
e
u
m
o
n
i
a, PCP and
en
teritis) an
d ti
m
e
to
o
ccurren
ce
of
m
o
rb
id
ity within
72
week
s.
Su
rv
i
v
al ti
m
e
was calcu
lated in
week
s b
e
t
w
een
th
e date o
f
CPT in
itiati
o
n
an
d
(1
) th
e
d
a
te o
f
ev
en
t
(m
orbidity
),
(2
) the
date tra
n
s
f
er
red
o
u
t (
T
O
)
,
(3
) th
e d
a
t
e
of t
h
e
fi
rst
m
i
ssed a
p
poi
nt
m
e
nt
f
o
r
l
o
st
case
s
, a
n
d
(4) th
e
d
a
te on wh
ich
th
e
p
a
tien
t
co
m
p
leted
th
e 72
week
s
of fo
llo
w up
.
Th
e Kap
l
an
Meier and
Log
rank
test
use
d
to esti
m
a
t
e
survival
probability and com
p
are survi
v
al curves
respect
ively. The Cox proporti
onal hazard
m
o
d
e
l was
used
t
o
assess th
e
relatio
n
s
h
i
p b
e
t
w
een
b
a
selin
e
v
a
riab
les an
d m
o
rb
id
ity after ch
eck
i
ng
pr
o
p
o
r
t
i
onal
ha
zard
ass
u
m
p
t
i
on usi
n
g gl
o
b
al
go
o
dne
ss-
of
-fi
t
t
e
st
(Sc
hoe
n
f
e
l
d'
s
m
e
t
hod)
.
2.
5.
Ethical appr
oval
In
stitu
tion
a
l eth
i
cal app
r
o
v
a
l
was
o
b
t
ain
e
d fro
m
th
e research
and
p
ublicatio
n
co
mmittee eth
i
cal
rev
i
ew b
o
a
rd
of u
n
i
v
e
rsity o
f
Gond
ar, In
stitute
o
f
Pub
lic
Health
. We o
b
t
ai
n
e
d
written
p
e
rmissio
n
fro
m
Gam
o
Go
fa z
o
ne a
d
m
i
ni
st
rat
i
on
an
d
AM
H.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Pa
rticipa
n
t pro
f
ile
Betw
een
Sep
t
em
b
e
r
,
2
0
0
8
and
Aug
u
s
t
2
011, 12
09
patien
t
s w
e
r
e
en
ro
lled in
ch
ron
i
c A
R
T clin
ic, o
f
t
h
em
768
pat
i
e
nt
s were
o
n
C
P
T but
o
n
l
y
24
4 pat
i
e
nt
s w
ho
have
b
o
t
h
m
e
di
cal
recor
d
and AR
T fol
l
ow
up
chart
were
incl
ude
d i
n
the
study (Fi
g
ure
1).
3.
2.
Descripti
o
n
of study subject
and incidence
of OIs
Out
o
f
2
4
4
pat
i
e
nt
s 1
59 (
5
7%)
were fem
a
l
e
wi
t
h
m
ean age of
34
.1y
ear
s (S
D:
10
.1
) an
d m
o
st
of t
h
em
were
u
n
em
pl
oy
ed an
d
u
r
ba
n
dwel
l
e
r
as s
h
o
w
n
i
n
Tabl
e
1.
Tabl
e 1. Dem
ogra
p
hi
c
cha
r
act
eri
s
t
i
c
of
pa
rt
i
c
i
p
ant
s
at
Ar
ba M
i
nch H
o
spi
t
a
l
Character
Nu
m
b
er
Percen
t
Sex
M
a
le 105
43
Fem
a
le 139
57
Occupation
Em
ploy
ed
52
21.
3
Self-e
m
p
loyed
61
25
Unem
p
l
oy
ed
131
53.
7
E
ducation level
No form
al education
54
22.
1
Pr
im
ary 90
36.
9
Secondar
y
76
31.
1
T
e
r
tiar
y
24
9.
8
Residence
Ur
ban 207
84.
8
Rur
a
l 37
15.
2
Fa
m
i
l
y
size
1 -
3
114
46.
7
>3 130
53.
3
Age gr
oup
< or
= 23
27
11.
1
24 – 33
105
43
34 – 43
76
31.
1
>or
= 44
36
14.
8
Marital
status
M
a
rr
ied 142
58.
2
Other 102
41.
8
Par
ticip
an
ts con
t
r
i
bu
ted fo
r 22
1.327
p
e
r
s
on
-year
s (PY)
o
f
fo
llo
w up and
av
er
ag
e
p
e
r
i
od
o
f
fo
llow-up
was 4
7
.
17
(S
D± 2
8
.
7
)
wee
k
s. T
h
e m
e
di
an C
D
4 c
o
u
n
t
was 1
57
(I
QR
:
79 - 2
4
1
) ce
l
l
s
/
m
m
3
. Of t
h
e 24
4
part
i
c
i
p
a
n
t
s
16
1 (6
6%
) ha
d C
D
4 < 2
00 ce
l
l
s
/m
m
3
, 226 (92.6%) we
re on
ART
and 63 (25.8%)
ha
d poor
adhe
re
nce
t
o
d
r
u
g
s,
o
f
whi
c
h 22
(
3
4
.
9%
) de
v
e
l
ope
d OI
.
Du
ri
n
g
t
h
e
fol
l
ow
up
peri
od
,
53 case
s
we
r
e
reco
rde
d
as
havi
ng
OI
s, 1
1
we
re l
o
st
t
o
fol
l
o
w u
p
,
5
t
r
ans
f
er
red
o
u
t
,
1
4
st
o
ppe
d t
r
eatm
e
nt
, 3
4
di
ed a
n
d
12
7
di
d
not
de
vel
o
p
event
d
u
ri
ng
f
o
l
l
o
w
u
p
.
Fi
ft
y
t
h
ree
cases m
a
ke the overall i
n
cidence
rate
23.9/
1
00
PY (9
5
%
CI
; 18
.3
, 29
.5
) of
th
em
37
%
w
e
r
e
m
a
lar
i
a, 2
4
.5%
were
p
n
e
u
m
o
n
ia, 1
6
.9
%
were en
teritis, 13
.2
% were
d
i
arrh
ea and
3
.
8
%
were PCP. Two
o
r
m
o
re disease
ep
isod
es
were
repo
rted
in 2 (3
.8
%) clien
t
s an
d on
ly 3 (5
.7%)
p
a
tien
t
s
were ad
m
i
tted
to
h
o
s
p
ital.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
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SN
:
225
2-8
8
0
6
Inci
dence
of
Opport
unistic Infections Among Ad
ult HIV Positif People
Recei
ving ....
(Yihun Tarik
u
)
17
5
3.
3.
Ass
o
ciati
o
n
of OIs with
b
a
se
line and
follow up ch
ar
acte
ristics
Ov
erall cu
m
u
l
a
tiv
e p
r
ob
ab
ility o
f
su
rv
iv
al beyo
nd
72
week
s was 0.74
and
th
e m
e
d
i
an
s
u
rv
iv
al ti
m
e
was 5
9
.
7
(
9
5
%
C
I
:
56.
2,
6
2
.
5
)
.
C
o
m
p
are pat
i
e
nt
s wi
t
h
TB
t
r
eatm
e
nt
hi
st
ory
,
a
dhe
re
nce t
o
C
P
T, c
r
i
t
e
ri
a t
o
in
itiate CPT and
m
a
rital statu
s
, h
a
d
si
g
n
i
ficant asso
ciatio
n with
surv
i
v
al ti
me (Figure
2
-
5
belo
w
resp
ectively).
B
a
sel
i
n
e C
D
4
cou
n
t
[C
HR
0.
83
1
(9
5% C
I
:
0.
47
, 1
.
48
)]
an
d
WH
O cl
i
n
i
c
al
st
ages [C
H
R
1.
49
(
95%
C
I
:
0.
8
5
,
2
.
6
2
)] h
a
d
no
asso
ciatio
n with surv
i
v
al tim
e.
Fig
u
re
2
.
Kap
l
an
–
M
eier curve of
p
r
o
b
a
b
ility o
f
rem
a
in
in
g
free
fro
m
OIs
o
v
e
r tim
e, b
y
TB treatm
e
n
t
h
i
sto
r
y
Fig
u
re
3
.
Kap
l
an
–
M
eier curve of
p
r
o
b
a
b
ility o
f
rem
a
in
in
g
free
fro
m
OIs
o
v
e
r tim
e, b
y
lev
e
l of adh
e
ren
ce to
Co
-
t
r
i
m
o
x
azo
l
e
pr
oph
ylax
is
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
1
72
–
17
9
17
6
Fig
u
re
4
.
Kap
l
an
–
M
eier curve of
p
r
o
b
a
b
ility o
f
rem
a
in
in
g
free
fro
m
OIs
o
v
e
r tim
e, b
y
criteria to
i
n
itiat
e
Co
-
t
r
im
oxazol
e
p
r
op
hy
l
a
xi
s
Fig
u
re
5
.
Kap
l
an
–
M
eier curve of
p
r
o
b
a
b
ility o
f
re
m
a
in
in
g
free
fro
m
OIs
o
v
e
r tim
e, b
y
marital statu
s
Mu
ltip
le v
a
riab
le cox
regressio
n
an
alysis rev
ile th
at
adh
e
ren
ce to
C
P
T was an
im
p
o
r
tant p
r
ed
icto
r
of
ri
sk
fo
r o
p
p
o
r
t
uni
st
i
c
i
n
f
ect
i
o
n, C
H
R
was
2.
08
7
(9
5% C
I
:
1.
20
8,
3.
6
0
4
)
f
o
r
pat
i
e
nt
s wi
t
h
p
o
o
r a
d
here
n
ce t
o
C
P
T
an
d A
H
R
was 2.
10
8 (
9
5
%
C
I
1.
19
4-
3.
7
2
)
as
s
h
o
w
n
i
n
Tabl
e 2.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Inci
dence
of
Opport
unistic Infections Among Ad
ult HIV Positif People
Recei
ving ....
(Yihun Tarik
u
)
17
7
Table 2. Pre
d
ic
tors of
opportunistic infections
am
ong HIV positive patient
4.
DIS
C
USSI
ON
Here
we desc
ri
be i
n
ci
de
nce
o
f
OI
s by
dem
ogra
p
hi
c,
basel
i
ne cl
i
n
i
cal
con
d
i
t
i
on a
nd
fol
l
ow
up
res
u
l
t
of 244 HIV
pa
tients
receiving
Co-trim
oxazole prophyla
xis and
followe
d up
for m
e
di
an 59.7
wee
k
s in Arba
M
i
nch h
o
s
p
i
t
a
l
.
In t
h
ese pat
i
ent
s
di
ag
nosi
s
and t
r
eat
m
e
nt
heel
ed acc
or
di
n
g
t
o
t
h
e nat
i
onal
st
an
d
a
rd o
f
tr
eat
m
e
n
t
b
u
t
so
m
e
d
i
ag
no
sis
w
e
r
e
cond
u
c
ted
syndr
o
m
eical
ly
m
a
y ex
ag
g
e
r
a
te in
cid
e
n
ce
r
a
te.
This st
udy i
ndicated that, t
h
e overall i
n
cidence
ra
t
e
of
O
I
s i
n
pat
i
e
nt
s
on
C
P
T
was
2
3
.
9
/
1
00
P
Y
(9
5%
C
I
;
18
.
3
, 29
.5
), w
h
i
c
h
u
s
ual
l
y
occ
u
r
r
ed wi
t
h
i
n
th
e first 22
week
s
p
r
im
arily
d
u
e
t
o
m
a
lar
i
a and
p
n
e
u
m
o
n
i
a, it is h
i
gh
er com
p
ar
ed
to
o
b
s
er
v
a
tion
a
l study f
r
o
m
So
u
t
h A
f
r
i
ca h
a
s r
e
p
o
r
t
ed
i
n
cid
e
nce r
a
t
e
0.
48/
10
0
pe
rso
n
m
ont
h
[2
0]
b
u
t
l
o
wer t
h
a
n
fi
ndi
ng
f
r
om
C
o
ˆ t
e
d
’
I
v
oi
re
[
2
1]
. L
o
w
i
n
ci
de
nce
rat
e
o
b
se
rv
ed i
n
prese
n
t
st
u
d
y
m
i
ght
be d
u
e t
o
co
nsi
d
e
r
i
n
g
onl
y
m
a
jor C
o
-t
ri
m
oxazol
e
p
r
eve
n
t
a
bl
e i
n
fe
ct
i
ons.
In
ou
r
st
udy
m
a
laria was m
a
jo
r ty
pe
o
f
OI
s w
h
ich is
g
r
ea
ter tha
n
fi
ndi
n
g
s
fr
om
Coˆ te
d’
I
voi
re (
3
.
9
/
1
0
0
PY
) a
n
d
Uga
n
da
(3.7/
1
00PY) [21],[22], this gr
eater rate of malaria proba
b
ly because
of
two things, the fi
rst one is the place is
very e
ndem
i
c area for m
a
laria and the
second reas
on is
by
t
h
e t
i
m
e of fol
l
ow
u
p
any
fe
brile case was
treated
as m
a
l
a
ri
a usi
n
g sy
nd
rom
i
c app
r
oach
. B
u
t
t
h
e
fi
n
d
i
n
g i
s
c
onsi
s
t
e
nt
wi
t
h
fi
n
d
i
n
g
fr
om
M
a
l
a
wi
[
23]
.
The
rat
e
of
pn
eum
oni
a i
s
hi
g
h
er c
o
m
p
ared t
o
t
h
e re
sul
t
from
C
o
ˆ t
e
d
’
I
voi
re 2
.
7/
10
0
PY [
2
1]
b
u
t
l
o
wer c
o
m
p
ared
wi
t
h
fi
n
d
i
n
g
fr
om
M
a
l
a
wi
[
23]
.
I
nci
d
e
n
ce
rat
e
of
di
a
r
r
h
ea
wa
s hi
ghe
r i
n
Ug
anda
a
n
d
M
a
l
a
wi
10
.2/
1
0
0
PY a
n
d
37/
10
0
PY
res
p
ect
i
v
el
y
[
22]
,
[
2
3
]
.
In t
h
i
s
st
udy
,
pat
i
e
nt
s ha
vi
n
g
p
o
o
r a
dhe
re
nce ha
d a si
g
n
i
fi
cant
l
y
hi
gh
ri
sk
of
devel
o
pi
n
g
O
I
s t
h
a
n
p
a
tien
t
s h
a
v
i
ng
go
od
adh
e
r
e
n
ce (
A
H
R
w
a
s 2
.
108
9
5
% CI
1.194
-3
.7
2)
; th
is h
i
gh
r
a
te of
in
f
ection
in
p
oor
ly
adhe
re patients
is
m
i
ght
be inconsistence or
i
n
approp
riat
e use
of
drug
reduce the e
ffi
cacy. In t
h
is s
t
udy,
marital statu
s
o
f
p
a
tien
t
s
sign
ifican
tly affect in
cid
e
n
c
e
o
f
OIs;
u
n
m
a
rred
pat
i
e
nt
s are
ne
arl
y
t
w
o t
i
m
es at
ri
sk
of
devel
opi
ng
C
o
-t
ri
m
oxazo
l
e
preve
n
t
a
bl
e
OIs;
l
e
ss su
p
p
o
r
t
fo
r ad
he
r
e
nce f
o
r
unm
arri
ed
pat
i
e
nt
s
m
i
ght
in
crease
risk of d
e
v
e
l
o
p
i
n
g
OIs. Patien
t
s i
n
itiated
CP
T i
f
th
ey m
eet b
o
t
h
WHO clinical stag
in
g and
CD4
co
un
t m
o
re lik
e d
e
v
e
l
o
p
OIs
th
an
p
a
tien
t
s in
itiated
b
y
ethe
r of th
e criteria; th
is
mig
h
t
b
e
p
a
tien
t
s started
if
they m
eet both criteria were i
n
a
dva
nce
d
st
a
g
e
of
di
sease
st
at
us.
I
n
th
is st
u
d
y
patien
t
s categ
or
ized
in
to
t
w
o
baselin
e CD
4
cou
n
t
(
C
D4
count < 2
0
0
cell/
mm
3
and C
D
4
≥
200
cell/
mm
3
) were eq
u
a
l l
i
k
e
ly affected
b
y
m
o
rb
id
ity; th
is
fi
ndi
ng i
s
c
onsi
s
t
e
nt
wi
t
h
fi
n
d
i
n
gs f
r
o
m
ot
he
r
st
udi
es
[1
0]
,[
1
4
]
,
[
17]
,
[
2
4
]
,
[
2
5]
. Thi
s
fi
n
d
i
n
g re
veal
t
h
at
p
a
t
i
e
nt
s by
base
l
i
n
e
WHO cl
i
n
i
cal
st
age (
W
H
O
st
ag
e
Characteristics
Nu
m
b
er
PY
Event
CHR
(95
%
CI
)
AHR
(95
%
CI
)
Education
No f
o
r
m
al educati
o
n
54
44.
44
16
1
1
Pri
m
a
r
y
90
87.
21
19
0.
64 (
.
33-
1.
24)
0.
647 (
0
.
329,
1.
27
1)
Secondar
y
76
67.
54
16
0.
67 (
.
33-
1.
34)
0.
677 (
0
.
335,
1.
36
8)
Tertia
ry
24
22.
13
2
0.
26 (
.
06-
1.
13)
0.
252 (
0
.
057,
1.
11
3)
Marit
a
l st
at
us
Mar
r
ied
142
131.
88
25
1
1
No
t m
a
rried
102
89.
44
28
1.
63 (
.
95-
2.
79)
1.
965 (
1
.
109,
3.
45
1)
Residence
Urban
207
186.
23
41
1
1
Rural
37
35.
10
12
2.
09 (
1
.
21-
3.
60)
1.
244 (
0
.
635,
2.
43
6)
Fa
m
ily si
ze
1-
3
114
106.
88
21
1
1
4-
12
130
114.
44
32
1.
42 (
0
.
81-
2.
45)
1.
74 (
0
.
96,
3.
16)
Weight
244
221.
33
53
0 .
99 (
.
95-
1.
00)
0.
992 (
0
.
963,
1.
02
0)
WHO
st
age
I &
I
I
104
102.
13
19
1
1
III
&
IV
140
119.
19
34
1.
49 (
0
.
85,
2.
62)
1.
35 (
0
.
69,
2.
66)
CD4 count
< 200
161
139.
33
36
1
1
≥
200
83
82
17
.
831 (
.
47,
1.
48)
0.
678 (
.
36,
1.
26)
TB treat
m
en
t
Yes
55
53.
08
7
1
1
NO
189
168.
25
46
2.
04 (
0
.
92,
4.
53)
2.
34(
1.
05,
5.
24)
F
unct
i
onal s
t
at
us
Wo
rk
in
g
159
149.
67
40
1
1
Am
bulator
y & bedr
idden
85
71.
65
13
0.
66 (
0
.
35,
1.
24)
0.
645 (
0
.
337,
1.
23
6)
Criteria
to indica
tion CPT
CD4 count/ W
H
O
stage
51
55.
5
6
1
1
Both
193
165.
83
47
2.
6 (
1
.
07,
5.
84)
2.
418 (
1
.
02,
5.
72)
Adherenc
e
Good
181
165.
63
31
1
1
Poor
63
55.
69
22
2.
09 (
1
.
21-
3.
60)
2.
108 (
1
.
19-
3.
72)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
1
72
–
17
9
17
8
1 o
r
2 a
n
d
WHO st
a
g
e 3
o
r
4) e
q
u
a
l
l
y
at
risk o
f
devel
opi
ng
OI
s;
t
h
i
s
fi
ndi
ng i
s
c
o
n
s
i
s
t
e
nt
wi
t
h
res
u
l
t
s
fr
om
ot
he
r st
u
d
i
e
s
[
9
]
,
[
17]
,
[
2
4
]
.
Limitatio
n
of
the
s
t
ud
y
Because
of t
h
e
retrospective
nature of the
data co
llection,
we relied on the available inform
ation for
t
h
e n
u
m
b
er a
n
d t
y
pes
o
f
di
s
eases re
p
o
rt
e
d
d
u
ri
ng
f
o
l
l
o
w
u
p
.
Som
e
of
t
h
e di
a
g
nose
s
were
p
r
es
um
pti
v
e as
th
ere
was lim
it
ed
cap
acity to
mak
e
d
e
fin
ite
d
i
agn
o
sis.
5.
CO
NCL
USI
O
N
In
ci
d
e
n
c
e rate
o
f
OIs am
o
n
g
HIV
po
sitiv
e
peo
p
l
e t
r
eated at Arb
a
Mi
n
c
h
Ho
sp
ital ART
clin
ic was
hi
g
h
. M
o
re im
po
rt
ant
l
y
, pat
i
e
nt
po
or a
dhe
r
e
nce t
o
C
P
T was associ
at
e
d
wi
t
h
hi
g
h
ri
s
k
of i
n
ci
denc
e
rat
e
of
OIs. Th
e
n
e
ed to
streng
th
en
th
e strateg
i
es t
o
enh
a
nce adherence t
o
CPT
is st
ron
g
ly
re
com
m
e
nded
.
F
u
tu
re
researc
h
sh
o
u
l
d
be d
one
usi
n
g pr
os
pect
i
v
el
y
desi
gn t
o
i
d
e
n
t
i
f
y
anot
h
e
r c
a
use f
o
r hi
gh i
n
ci
de
nce rat
e
of O
I
s
an
d pro
p
e
r time fo
r i
n
itiatio
n
o
f
CPT.
ACKNOWLE
DGE
M
ENTS
We
wou
l
d lik
e
to
ackno
wled
ge Arb
a
Min
c
h
Ho
sp
ital ART
clin
ic staffs
and
d
a
ta co
llectors.
AUTH
O
R
S’
CO
NTRIB
U
T
I
ONS
YT desi
gne
d t
h
e st
udy
, s
upe
rvi
s
e
d
dat
a
col
l
ect
i
on, anal
y
zed t
h
e dat
a
an
d dra
f
t
s
t
h
e m
a
nu
scri
pt
.
DJ
estab
lish
e
d
t
h
e HIV coho
rt at
th
e ho
sp
ital.
YY
p
a
rticip
at
ed
in
d
e
sign
of
th
e stud
y an
d
in
terpretatio
n
o
f
th
e
d
a
ta. AT,
critically
rev
i
ews
th
e p
a
p
e
r and
re-stru
c
tu
re
d the m
a
n
u
s
crip
t.
All au
t
h
or
s
r
e
a
d
and
ap
pro
v
e
d
th
e
fi
nal
m
a
nuscri
p
t
.
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0
6
Inci
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Opport
unistic Infections Among Ad
ult HIV Positif People
Recei
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u
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9
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in J
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ht
y C. A
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e
re
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o
w
n
ing R., Rans
om
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t
al.
,
"Effec
t
of co-trim
oxazol
e
proph
y
l
axis, an
ti
retrovir
a
l ther
ap
y, and inse
cti
c
id
e-tre
a
te
d bedn
ets on the frequency
of malaria in
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i
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