Abstract:
Background: Pneumocystis Jiroveci pneumonia (PJP) is an opportunistic infection that can rapidly
progress to on respiratory failure and death if not promptly recognized and treated in high-risk immune
compromised patients. There is limited evidence on incidence and predictors of PJP among Human
Immunodeficiency Virus (HIV) positive patients in comprehensive hospitals of northwest Ethiopia.
Objective: This study was aimed to assess the incidence and predictors of PJP among adults living with
HIV in Northwest Amhara Region Comprehensive Specialized Hospitals.
Methods: An institutional- based retrospective follow-up study were conducted on 769 samples.
Simple random sampling technique was used to select study participants. Data were cleared and entered
into Epi-data version 4.6 and exported to STATA version 14.1 for statistical analysis. Kaplan Meier
estimator and log rank test were done. Bi-variable and multivariable Cox proportional hazard model was
used to explore significant variables. Cox proportional hazards model assumption was checked both
graphically and statistical test using the Schoenfeld residuals test and model goodness of fit was checked
using Cox Snell residual test. An adjusted hazard ratio with their respective 95% CIs and a value of p
less than 0.05 was used to declare the presence of a significant association.
Results: A total of 760 patient records were included the final analysis with 98.8 % response rate, the
incidence rate of PJP among HIV positive patients was 27.8 (95% CI: 22.61, 34.18) per 10,000 personmonths
of observation. The median follow-up time of 46.7 months (IQR 2.3–60 months). Previous
opportunistic infection (AHR 9.62; 2.83-32.72), SAM in nutritional status (AHR 2.31; 1.11-4.82),
Baseline CD4≤ 200 cell/µl 2.25(1.25-4.04), advanced stages of diseases (WHO stage IV) (AHR 4.63;
1.24-17.25) and Tuberculosis (AHR 4.71; 1.52-14.58) were stastically significant predictors of the
outcome variable.
Conclusion and recommendation: In this study, the incidence of pneumocystis Jirovecii pneumonia
was high. In terms of predictors like, previous opportunistic infection, SAM in nutritional status,
Baseline CD4≤ 200 cell/µl, advanced stages of diseases (WHO stage IV) and Tuberculosis were found
to be associated to PJPs. Health services providers should give more emphases during follow-up to
reduce incidence of PJP among HIV positive adult patients on Antiretroviral Therapy
