ArticleBMC infectious diseases2026
Incidence of opportunistic infection among people living with HIV in Rwanda; Does treat all policy matter?
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn 2016 the World Health Organization (WHO) recommended a policy of treat-all among people living with HIV(PLWH). The policy requires initiation of antiretroviral therapy (ART) to all PLWH immediately after the HIV diagnosis. Despite the benefits of treat-all policy, due to minimal amount of counselling sessions between HIV diagnosis and treatment initiations, some people who initiated treatment after the adoption of this policy were more likely to disengage from HIV-care and less likely to be adherent. The study assessed the impact of the treat-all policy on the incidence of opportunistic infections (OIs) among PLWH in Rwanda.
methodsWe conducted a retrospective cohort analysis using routinely collected data on adults PLWH who initiated ART across 28-healthcare facilities in Rwanda. OIs assessed included (Tuberculosis, cryptococcal meningitis, oral/oesophageal candidiasis and herpes zoster). Incidence rates of OIs were quantified before and after the adoption of treat-all policy using Poisson regression models. Multivariable Cox proportional hazard regression models were used to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the effect of treat-all policy on OIs.
resultsBetween 2014 and 2019, 982 PLWH were assessed, including 463(47.2%) who initiated ART after the adoption of treat-all policy. Two-thirds (66.3%) were female, and the median age was 37 (interquartile range: 32–43) years. Overall, the incidence of OIs was 3.49 per 100 person-years: 95%CI (2.66–4.60). Incidence of OIs before and after the adoption of treat-all policy was similar (3.33 vs. 3.59, P = 0.456). Pulmonary tuberculosis and herpes zoster were predominant infections, each accounted for 19-cases, while extrapulmonary tuberculosis accounted for 7-cases. Compared to those with no formal education, those with at least primary school education were associated with a decreased risk of OIs [aHR = 0.50; 95%CI (0.28–0.91)]. Presenting with advanced HIV disease (AHD) was associated with a higher risk of OIs [aHR = 10.52; 95%CI (5.15–21.47)].
conclusionIn this cohort of adult PLWH in Rwanda, the treat-all policy was not associated with incidence of OIs. In this era of expanded ART coverage, targeting those with no formal education and addressing stigma to minimize the proportions of PLWH presenting with AHD is beneficial to prevent OIs. CLINICAL TRIAL NUMBER: Not applicable.
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