A study of 112 adults with advanced HIV disease receiving care in Guyana found that one in five had at least one opportunistic infection, with approximately one-third of those affected showing no obvious symptoms.
The research also identified gaps between testing and treatment, with fewer than seven in 10 participants starting antiretroviral therapy and fewer than four in 10 receiving tuberculosis preventive treatment, according to findings shared by the Georgetown Public Hospital Corporation (GPHC).
Dr Tariq Jagnarine presented the findings at the 19th Guyana Medical Research Conference, held under the theme “The Evolution of Medicine Through Technological Advancements and Beyond the Stethoscope.”
The study examined rapid testing for tuberculosis (TB), cryptococcosis and histoplasmosis among adults receiving HIV care at seven healthcare facilities between February 2024 and March 2025. These opportunistic infections can cause serious illness in people whose immune systems have been weakened by HIV.
Twenty-four participants, or 21.4 per cent, had at least one of the infections. TB was the most frequently detected, affecting 15.2 per cent of participants, followed by cryptococcosis at 6.3 per cent and histoplasmosis at 2.7 per cent.
The detection of infections in patients without obvious symptoms underscored the importance of screening people with advanced HIV rather than relying solely on signs of illness, GPHC said.
Patients who tested positive also experienced higher mortality during follow-up. Within 30 days, 20.8 per cent of those with positive screening results had died, compared with 6.8 per cent of those who tested negative. At 90 days, the proportions were 37.5 per cent and 11.4 per cent, respectively.
The presentation identified failure to initiate antiretroviral therapy (ART) as the strongest independent predictor of adverse outcomes among the factors examined. The reported adjusted odds ratio was 2.23, with a 95 per cent confidence interval of 1.38 to 3.68, indicating higher odds of an adverse outcome among participants who had not started treatment.
Other factors associated with adverse outcomes included a CD4 count below 50 cells per cubic millimetre, disseminated histoplasmosis and hospitalisation. Higher haemoglobin levels were associated with lower odds of an adverse outcome.
“Delayed ART, not diagnosis, is the strongest driver of adverse outcomes,” the presentation’s summary stated.
The findings nevertheless showed that access to testing did not consistently translate into treatment. All participants completed CD4 testing, which assesses immune function, while 85 per cent completed the full rapid diagnostic screening panel.
However, 69.3 per cent initiated ART, the medication used to control HIV; 60.6 per cent received cotrimoxazole, also known as Septrin; and 38.3 per cent received TB preventive therapy.
The presentation described TB preventive treatment as the most critical gap in the delivery of advanced HIV care, noting a progressive fall-off across the stages of care.
Researchers recommended routine screening of eligible patients entering or returning to HIV treatment services, improved access to diagnostic tests, reliable medicine supplies and stronger arrangements for treatment and follow-up.
According to GPHC, the study demonstrated that rapid screening for several opportunistic infections could be implemented across participating facilities. Its limitations included the relatively small sample size.
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