Incidence of Pneumocystis Jiroveci Pneumonia and its predictors among HIV positive adult patients on Antiretroviral Therapy in Northwest Amhara Region Comprehensive Specialized Hospitals, Ethiopia. A retrospective follow-up study

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