Descriptive epidemiology of opportunistic infections among patients with advanced HIV disease in Kinshasa, Democratic Republic of Congo

BACKGROUND

Although people living with HIV (PLHIV) increasingly have access to antiretroviral therapy (ART) worldwide, the recurrence of advanced HIV disease (AHD) remains a major concern, exposing them to an enhanced risk of opportunistic infections (OIs) and subsequent death. We aimed here to describe the epidemiology of OIs among patients with AHD in Kinshasa (Democratic Republic of Congo, DRC) to inform future actions against AHD-related deaths.

METHODS

A retrospective cohort study was conducted among consecutive AHD patients admitted to Biyela Hospital Center in Kinshasa (DRC)—a peripheral clinic supported by Médecins Sans Frontières (MSF)-Belgium, between June 2021 and December 2023. The diagnosis of OIs was mainly based on MSF’s advanced HIV management guidelines, establishing the diagnosis of tuberculosis using Determine TB-LAM Ag test and/or Xpert MTB/RIF, cryptococcal meningitis using the CrAg LFA antigen test, and malaria and syphilis using the corresponding Rapid diagnostic tests. For other OIs such as cerebral toxoplasmosis, oropharyngeal candidiasis, Pneumocystis jirovecii pneumonia, and nonspecific bacterial infections, diagnosis was essentially based on the clinician’s clinical presumption, due to resource limitations. Descriptive statistics were performed using SPSS version 27.00.

RESULTS

Among the 130 included AHD patients (58.8% female, mean age 42 ± 16 years), 59.2% presented with multiple OIs. The most prevalent OIs were meningeal tuberculosis (61.5%), cerebral toxoplasmosis (51.5%), nonspecific bacterial pneumonia (33.1%), pulmonary tuberculosis (32.2%), cryptococcal meningitis (20.0%), nonspecific bacterial meningitis (18.5%), oropharyngeal candidiasis (17.7%), and cerebral malaria (10.8%). The clinical presentation of meningeal tuberculosis, cerebral toxoplasmosis, nonspecific bacterial pneumonia, nonspecific bacterial meningitis, and pulmonary tuberculosis was mainly characterized by fever (75%, 72.7%, 79.1%, 75%, 67.5%, respectively); cryptococcal meningitis by incoherent speech (77.7%); and oropharyngeal candidiasis by weight loss (68.2%).

CONCLUSIONS

Patients with AHD in Kinshasa (DRC) frequently experience multiple OIs. While the majority of these OIs are commonly recognized in the end-stage of HIV infection (tuberculosis, cerebral toxoplasmosis, cryptococcal meningitis, nonspecific bacterial infections, oropharyngeal candidiasis), cerebral malaria is another condition that should be considered in the DRC context.