Association of CD4+ T Lymphocyte Cell Count and Viral Load with Urinary Bacterial Growth and Antimicrobial Resistance Pattern of Bacterial Isolates among HIV Patients in Ho Municipality, Ghana: A Cross-Sectional Study

Background and Objective : Human immunodeficiency virus (HIV) infection leads to a gradual decline in immune function, increasing vulnerability to opportunistic infections, including urinary bacterial growth (UBG). In immunocompromised individuals, asymptomatic UBG may develop into symptomatic infection. This study investigated the occurrence of UBG among HIV-infected patients in Ho Municipality and evaluated its association with CD4 cell count, viral load, and the antimicrobial resistance profile of the isolated bacteria. Methods : A cross-sectional study was conducted over three months (December 2018-February 2019) among HIV-infected individuals receiving care at the antiretroviral therapy (ART) units of Ho Teaching Hospital (HTH) and Ho Municipal Hospital (HMH), Ghana. The samples were cultured on CLED agar, taking through available relevant biochemical testing for identification following standard protocols. Participants' current CD4(+) T-cell count, viral load, WHO clinical stage, and ART regimen were extracted from medical records at the time of the study. Results : The total prevalence of UBG was 18.5%. The most prevailing Gram-negative bacteria was Escherichia coli (32.14%), whereas the most prevailing Gram-positive bacteria was Staphylococcus aureus (16.07%). There was statistically significant association between viral load (> 1000 copies/mL) and TDF/3TC/NVP ART regimen with UBG in this study. Nitrofurantoin and piperacillin/tazobactam were the most susceptible antibiotics. Conclusion : This study demonstrates that UBG remains a significant clinical problem among the study population, with Escherichia coli identified as the predominant uropathogen. Gram-negative bacteria were the principal contributors to urinary bacterial proliferation, although Gram-positive organisms also accounted for a notable proportion of isolates. The significant association of the elevated viral load (> 3 log) with UBG may be explained by viral replication and its effects on immune function. Nitrofurantoin and piperacillin/tazobactam exhibited the highest in vitro activity against the isolates. Furthermore, a high prevalence of multidrug resistance was detected. These findings collectively underscore the significance of regular microbiological surveillance and the implementation of targeted antimicrobial therapy for the effective management of urinary bacterial infections in individuals living with HIV.