The Magnitude, Distribution Patterns, and Risk Factors of AIDS-Related Illnesses in Adults on Combined Antiretroviral Therapy in Malawi.

This study describes the burden and spectrum of AIDS-related opportunistic diseases (ODs) in adults living with HIV (ALHIV) receiving combined antiretroviral therapy since the scale-up of free HIV treatment in Malawi. Data on AIDS-related ODs were abstracted from the 2004-2015 medical records and analysed using logistic regression models. 9,953 patients, with median age of 40 years (interquartile range (IQR): 33-48 years), of which 60.8% were females and 86.8% were within active sexual age (15-54 years), were included in the analysis. 65.1% were urban residents and 59.6% were from Southern region. 12,814 AIDS-related opportunistic episodes were extracted: 56.5% were prevalent AIDS-defining conditions and 43.5% were incident and recurrent cases. 7.7% of patients did not manifest any OD. Mycobacterial (36.3%), bacterial (20.8%), fungal (15.8%) and viral (15.1%) aetiological agents were most identified common pathogens. Tuberculosis (34.4%), bacterial pneumonia (11.2%), nontyphoid Salmonella bacteraemia (9.6%), HIV-wasting syndrome (8.9%), candidiasis (6.8%), isosporiasis (5.2%), pneumocystis pneumonia (4.2%) and cryptococcal meningitis (3.7%) were overall, most prevalent ODs. In the multivariate regression, healthcare facility types, gender, age-group, residential area, CD4 count, viral load, treatment initiation eligibility criteria and socio-economic status were identifiable risk factors of AIDS-related opportunistic diseases. The high prevalence of ODs among ALHIV in Malawi regardless of ART status requires establishing and strengthening of efficient strategies for effective prevention, early detection, and proactive management of AIDS-related ODs across all patient groups, regions, and health facilities. Keywords: HIV; AIDS; ART; ALHIV; CD4; Viral Load; AIDS-related opportunistic conditions/diseases.