Burden and predictors of advanced HIV disease among people living with HIV at Zewditu Memorial Hospital in Addis Ababa, Ethiopia

Background Globally, about 630,000 (500,000–820,000) deaths occur annually among people living with HIV (PLHIV). Advanced HIV disease (AHD) continues to be an important contributor to HIV-related mortality in sub-Saharan Africa. Despite a significant positive association with mortality, the prevalence and factors that lead to AHD in Addis Ababa have not been studied well. Thus, this study aimed at investigating the prevalence and contributing factors of AHD in Addis Ababa, Ethiopia. Methods We conducted a facility-based cross-sectional study among PLHIV attending Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Data were collected through an interviewer-administered questionnaire and abstraction of 414 sturdy participants’ medical records using Open Data Kit. In the current study, AHD was defined using the objective criterion of a CD4 count < 200 cells/μL. Analysis was done using SPSS version 28 for descriptive and analytic statistics, and statistical significance was set at p < 0.05. Results The overall prevalence of AHD, as well as among ART-naive and ART-experienced individuals, was 29.7% (95% CI: 25.4–34.4%), 51.4% (95% CI: 34.4–68.1%), and 27.6% (95% CI: 23.1–32.4%), respectively. Very severe and severe AHD accounts for 21.9% (95% CI: 15.0–30.3%) and 17.9% (95% CI: 11.5–25.8%) of the study participants, respectively. Further analysis of the determinants revealed that AHD was more likely to manifest in men (AOR of 2.41, 95% CI: 1.23–4.74); manual and service workers such as daily laborers, drivers, cleaners, and security guards (AOR of 2.75, 95% CI: 1.18–6.40); those with lower average monthly incomes of 5,001–10,000 birr (AOR of 3.27, 95% CI: 1.11–9.64) and less than 5,000 birr (AOR of 4.14, 95% CI: 1.49–11.54); the malnourished individuals (AOR of 5.82, 95% CI: 1.97–17.18); and those non-adherent to ART (AOR of 9.88, 95% CI: 4.32–22.03). Conclusion The burden of AHD remains substantial, disproportionately affecting ART-naïve individuals. Male sex, low monthly income, being a manual and service worker, malnutrition, and ART non-adherence were key factors associated with HIV progression. Implementing the WHO-recommended AHD package may help reduce AHD and improve clinical outcome and ultimately death.