Clinical, Immunological and Social Correlates of OpportunisticInfections Among Children Living with Human ImmunodeficiencyVirus in North-Central Nigeria: A Multicentre Cross-sectional Analysis
Keywords:
Paediatric HIV, Opportunistic infections, Risk factors, CD4 count, Socioeconomic status, Nigeria,Abstract
Opportunistic infections (OIs) remain clinically relevant among children living with human
immunodeficiency virus (HIV), particularly in settings where late diagnosis, advanced HIV disease (AHD),
malnutrition, social vulnerability and interrupted treatment support overlap. Despite global antiretroviral therapy (ART)
scale-up, children continue to have lower treatment access and continuity than adults. This study examined clinical,
immunological, social correlates of documented OIs among children receiving HIV care in Plateau State, North-Central
Nigeria. Methods: This multicentre cross-sectional study included 404 HIV-infected children aged 6 weeks to 18 years
attending 12 paediatric HIV facilities from March to September 2017. Multistage sampling was used. Data were obtained
from caregiver interviews, clinical and anthropometry assessment, and medical/laboratory records. Associations with OI
status were examined using Pearson chi-square or Fisher's exact tests, Mann-Whitney U test for non-normal continuous
variables, crude odds ratios (ORs), trend analysis and exploratory unadjusted joint-exposure analyses. Results: OIs were
present in 228/404 children (56.4%). Mean age was 10.6±4.1 years; (60.4%) were female, 64.1% had low socioeconomic
status, and 45.0% were orphans. OI prevalence showed a marked CD4 gradient: 47.4% at <200 cells/μL, 31.8% at 200-
349 cells/μL, 29.0% at 350-499 cells/μL, and 8.5 at ≥500 cells/μL (trend p<0.001). Crude correlates included female sex
(OR 1.90, 95% CI 1.08–3.32; p=0.024), poor ART adherence (OR 1.97, 95% CI 1.06–3.66; p=0.029), poor CPT
adherence (OR 1.82, 95% CI 1.02–3.23; p=0.039), anaemia (OR 3.13, 95% CI 1.43–6.84; p<0.001) and guardian rather
than parental care (OR 3.30, 95% CI 1.89–5.78; p<0.001). ART status, CPT status and household crowding considered
alone were not significant. Conclusion: OIs clustered across immunological, adherence, socioeconomic and caregiving
domains. Paediatric HIV services should prioritise children with severe immunosuppression, advanced clinical disease,
adherence difficulties, incomplete immunisation, anaemia, orphanhood and non-parental care. Targeted clinical
surveillance should integrate adherence support, tuberculosis screening, immunisation review, nutritional assessment
and social services referrals.
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