This work is designed to determine the epidemiology of HIV/AIDS and opportunistic infections among adult

patients in Imo State. The study was with analytical cross sectional survey design with five research questions

and three hypotheses. The population of this study comprised of 67,527 adults on ART treatment facilities in

Imo State. The sample size for the study was determined using sample size formula by Taro Yamane based on

herpes simplex 2,7.9% had pneumococcal pneumonia, 4.6% had herpes zoster, 9.0%had herpes simplex 1, 3.1%

had molluscum contagiosum, 4.0%mycobacterium avium complex, 2.3% pneumocystis pneumonia and the

highest (30.4%) was oral thrush (oropharyngeal candidiasis).Based on the Pearson chi-square test of association

between socio-demographic profiles, socio-economic status, and HIV/AIDS opportunistic infections among the

study participants, the following conclusions were made: there is a significant association between socio-

demographic profiles and all the HIV/AIDS opportunistic infections among the study participants; there is a

significant association between socio-economic status and some of the HIV/AIDS opportunistic infections

among the study participants and therefore recommends the need for the development of HIV/AIDS-

opportunistic infections preventive programs in Imo State.

Keywords: epidemiology, HIV, AIDS, infection, opportunistic, adult, patients

since then, national HIV prevalence has increased exponentially from 1.8% in 1991 peaking at 5.8% in 2001 and

progressively declining since then to the current figure of 3.1% in 2014 (ANC Survey Report, 2014). As at 2014

Nigeria has the second highest burden of HIV globally with 3.4 million people living with HIV. There is a

considerable regional state variation in HIV prevalence in the country; ranging from 1% in Kebbi State to 12.7%

in Benue State. Partners in the global AIDS response have intensively supported our government and institutions

over the past two decades to scale-up prevention, treatment, care and support. Still, HIV/AIDS remains a leading

cause of the burden of disease and a significant public health menace for our country. Much more is needed in

other to achieve our shared goal of ending AIDS as a public health menace. An AIDS-free Nigeria remains our

goal, with zero new infections, zero AIDS-related discrimination and stigma. The goal can be achieved by fast-

tracking the national response towards ending AIDS in Nigeria. (Aliyu and Ogungbemi, 2021)

has shown an increasing trend in incident rate with the latest annual incidence estimated to be 1170 per 100 000

persons. The importance of HIV Infection as a risk factor is understood by the latest estimate of a 60% HIV

prevalence among incident opportunistic infections cases in Nigeria, relative to a general population HIV

prevalence of 9.6 (Federal Ministry of Health, 2018).

Opportunistic infections are the leading causes of morbidity and mortality among HIV-infected children

contributing to 94.1% of HIV-related deaths (Candiani et al., 2007; Haileamlak et al., 2017; Mermin et al.,

2008). Unless opportunistic infections are treated as early as possible, they markedly affect the treatment

outcomes of PLHIV leading to poor quality of life, hastening disease progression, increasing medical costs,

potentiating the risk of treatment failure, and impairing patient’s response to antiretroviral therapy (ART) drugs

(Sisay et al., 2018). In low- and middle-income countries such as Nigeria, the most frequently occurring

this study.

The broad objective is to examine the determinants of HIV/AIDS- opportunistic infections among adult patients

in ART treatment facilities in Imo State, Nigeria. The specific objectives were to

around 5, 100 sq km. Christianity is the predominant religion. Igbo language is the predominant language and

English language is the official language of communication. The population of Imo State is about 3,927, 563

according to 2006 population census (NBS, 2007).

The population of this study comprised of 67,527 adults on ART treatment facilities in Imo State.

The sample size for the study was determined using sample size formula by Taro Yamane based on finite

population proportion, and 95% confidence level (Yamane, 1973).

n = Sample size required

N = Number of adults on ART treatment facilities in Imo State i.e. 67,527

e = Margin of error (5% or 0.05)

Substituting in the formula;

n = 67527/1+67527(0.05)

= 67527/1+67527(0.0025)

= 67527/1+168.8175

n

= n/1-0.04

= n/0.96

= 3.98/0.96

= 414.5 ≈ 415

The calculation sample size of 415 was used for each of the six study centre given a total sample size of (415 x

6 = 2490). The six study sites were: Imo State Specialist Hospital, Umuguma; General Hospital, Okigwe; St.

Damian Hospital, Okporo; General Hospital, Aboh Mbaise, General Hospital, Awo-Omamma and Joint

Hospital, Mbano.

Selection of rural ART facilities was also done by simple random technique using balloting methods to select

one treatment facility from each of the three senatorial zones. General Hospital Aboh Mbaise was selected from

Owerri zone, General Hospital Awo-Omamma was selected from Orlu zone and Joint Hospital Mbano selected

from Okigwe zone.

Stage 3: (Selection of Participants). The first participants for the study were selected by consecutive sampling

method based on the patients living with HIV/AIDS who presented at each of the six study centres, who met the

inclusion criteria and gave consent for the study. These participants were recruited into the study until the sample

size of 2470 was reached.

Questionnaire was the major instrument for data collection. The instrument contained both closed ended and

test re-test method with a reliability coefficient of 0.82 indicating a good measure of reliability (Onyemekonwu,

The present study found the overall prevalence of HIV/AIDS Opportunistic Infections as 49.7%. The rate is

quite high, possible reason for this high prevalence may be linked to poor and late initiation to anti retroviral

therapy (ART) and consequently lowering of CD4 counts. ART initiation has been reported to be associated

with a reduced incidence of opportunistic infections,

The rate found in this study within range to 46.6% reported among adults in Ibadan Nigeria (Akinyemi et al.,

2017), but higher than 22% in Port Harcourt Nigeria (Okonko et al., 2020). It is higher than 43.97% [95% CI

(38.59, 49.34)] reported in a pooled prevalence in among ART receiving adults in Ethopia (Woldegeorgis et al.,

2023). It is also higher than 33.1% (95% CI = 34.6–44.1) found in a current study in Ghana among newly

diagnosed HIV patients (Puplampu et al., 2024). The findings in the current study are rather lower than overall

prevalence of 55.3% reported in Tigray Ethopia (Woldegeorgis et al., 2023), 57.9% reported in Gabon (Mouinga-

Most other studies also found one or more of the first three most common OIs found in this study as commonest

OI among HIV patients. For instance, in Ibadan South Western Nigerian study (Akinyemi et al., 2017), the

commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5%) and

peripheral neuropathy (14.8%). Also, a study in Port Harcourt South South Nigeria, found the three commonest

OIs amang HIV patients as Candida albicans (vaginosis) (28.9%), TB (22.0%) and oral thrush (11%) (Okonko

et al., 2020). In a study in Kenya, the 3 most common OIs were TB (35%), Herpes Zoster (15.4%) and oral

thrush (8%) (Chepkondo et al., 2020). Another study in Indonesia found the most common types of OIS as

tuberculosis infection (43%), candidacies (21%), and diarrhea (9%) (Sutini et al., 2022). It therefore indicates

that some of the commonest OIs found in this study were also common in other studies. It implies that the risk

factors of the common OIs need to be ideally studied.

In terms of pathogenic class of the organism, infections based on fungi and bacterial and viral infections were

quite high. This is understandable considering that oral thrush (fungus infection), pulmonary TB (bacteriological

infection) and Herpes Simplex 1 (viral infection) dominated the OIs found in this study. It indicates the high

vulnerability of the PLWHA on those organism infections and the need for more surveillance and delicate care

of PLWHA. A central African study (Mouinga-Ondeme, et al., 2023) found high pathogenic classes of the

organism for OIs on bacterial infections (55.4%), viral (39.7%) and parasites (18%). Other HIV/AIDS

opportunistic infections found among the study participants were pneumococcal pneumonia, salmonellosis

(enteric fever), vulva vaginal candidacies are (vaginal thrush).

In this current study, one thousand and one-fifty (46.6%) of the study participants had HIV/AIDS opportunistic

infections that predominately affected the oro-digestive system (gastric intestinal system). Five hundred and

having greater odds of infection. This is in congruent with another finding which showed higher risk for rural or

less developed parts of a country (Girma et al., 2022).

According to Shisana (2009), in South Africa, HIV prevalence is highest in urban informal settlements (19.9%)

followed by rural informal settlements (13.4%), rural formal settlements (10.4%) then urban formal settlements

(10.1%). Urban and rural informal settlements are generally under-resourced and lack some of the basic

necessities such as formal housing, water, sanitation and access to preventive health services. Also, there is a

possibility of reduced effectiveness for therapy administration in the rural areas, which is often the case in most

HIV care facilities in poor countries or limited resource countries (Mongo-Delis, et al., 2019).

The study participants who have living with the disease of less than or equal to five years since living with the

disease were less likely to have TB compared to those who had been in the diseases for at least six years. The

because the younger age groups are more likely to engage in risky sexual behavoiurs. Similarly, some other

studies (Lawn et al. 2005; Moges and Kassa, 2014; Okonko, Anyanwu, Osadebe and Odu, 2018) which reported

higher risk of OI for younger age, compared to older age. This is contrary to findings in Ghate et al., (2009) which

reported that older age was a strong risk factor for developing opportunistic infections. In Akinyemi et al., (2017),

Opportunistic infections such as tuberculosis, oral candidasis, chronic dermatitis, chronic diarrhoea diseases, and

herpes zoster were more prevalent among older adults

Similar to age, the sex of the patients was not found to be significantly associated with opportunistic infection

in this study. This present study finding is in congruent with findings with Okonko et al. (2020) for which more

women were infected with OIs than men but sex showed significant association with major OIs in that study

such as TB, Candida and HBV. In Teeka et al., (2024), the prevalence of OIs was reported higher among females

participants compared to those without any formal form of education. This coincided with findings in some other

studies that find higher odds among PLWHA with lower level of education (Girma et al., 2022; Mouinga-

Ondeme et al., 2024).

It was concluded that The rate of occurrence of opportunistic infection among HIV/AIDS patients is quite high

in the study area indicating that opportunistic infections still remained a challenge among HIV/AIDS patients in

the study area. In addition to other opportunistic infections, Oral thrush, pulmonary TB and herpes simplex 1

constitute more than half of the OIs existing in the study area. It means that parts of the major problem for

individuals with HIV/AIDS in the area are mostly related to fungi, bacterial and viral diseases. Some factors of

socio demographics such as ART location, and years since been infected with HIV are significantly associated

with OI (especially Oral thrush, pulmonary TB and herpes simplex 1).

It was recommended that