The spectrum of opportunistic infections and malignancies among women on antiretroviral therapy in Ethiopia

Background: Women are disproportionally affected by HIV and are at greater risk of OIs and malignancies. This study investigated the spectrum of OIs and malignancies among women living with HIV (WLHIV) in Ethiopia. Methods: A retrospective longitudinal study was conducted among 3,817 WLHIV on Antiretroviral Treatment (ART) from 2007 to 2019 in Ethiopia. Data on OIs, malignancies, and clinical characteristics were retrieved from medical records. Prevalence, incidence, and mortality rates were measured over 13 years of follow-up. The Kaplan-Meier survival curve and multivariable Cox-proportional hazard regression were used to estimate incidence and identify predictors of OIs and malignancies, respectively. Result: The pooled prevalence of OIs or malignancies was 47%. OIs accounted for 39% and malignancies were 23.3%. The incidence of OIs and malignancies were 19.4 (95%CI:9.2-29.5) and 11.5 (95%CI:2.2-20.8) per 100 person-years of observation, respectively. Incidence of candidiasis was 14.1 per 100 person-years followed by Lymphoma (11.9), Cervical Cancer (11.5), and TB (10.9). The risk of OIs was higher in patients with baseline CD4 count ≤500 cells/mm3 [AHR (95%CI): 2.0 (1.8-2.3)] and VL>1000 copies/ml [AHR (95%CI): 1.5 (1.1-1.9)]. Overall, 24.6% died, and of them, 62.2% had a history of OIs or malignancies. The risk of death was higher among WLHIV with a history of Toxoplasmosis, TB and PCP. Conclusion: OIs and malignancies was recently increasing and two-thirds of all deaths were associated with these co-morbidities. The high rates of OIs and malignancies were attributed to poor treatment outcomes. The finding calls to enhance the diagnosis and treatment of these co-morbidities. ABBREVIATIONS: AIDS: acquired immune deficiency syndrome; CI: confidence interval; EPHI: Ethiopian Public Health Institute; HAART: highly active antiretroviral therapy; HIV: human immunodeficiency virus; HR: hazard ratio; Mg/dl: milligram per deciliter; TB: tuberculosis; PCP: pneumocystis carinii pneumonia; ZJU: Zhejiang University