{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:15:27Z","timestamp":1783336527929,"version":"3.54.6"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Opportunistic infections remain a significant cause of morbidity among people living with HIV (PLHIV) in sub-Saharan Africa despite expanded access to antiretroviral therapy (ART). This study evaluated the association between immune status, viral load suppression, ART adherence, and the risk of opportunistic infections among HIV-positive patients receiving ART in the rural Eastern Cape, South Africa. Methods: A retrospective cross-sectional study was conducted using clinical records of HIV-positive patients attending an HIV clinic in Mthatha between January 2021 and December 2024. Demographic characteristics, CD4 counts, viral load results, ART regimens, adherence status, and documented opportunistic infections were extracted. Viral load suppression was defined according to WHO guidelines as &lt;1000 copies\/mL. CD4 counts were categorized as &lt;200, 200\u2013499, and \u2265500 cells\/mm3. Multivariable logistic regression analysis was performed to identify independent predictors of opportunistic infections. Results: A total of 155 patients (105 females, 50 males) were included. Females demonstrated significantly higher mean CD4 counts than males (p = 0.037) and better ART adherence (p &lt; 0.001). Tuberculosis, hepatitis B virus, and herpes simplex virus infections were more prevalent among males, whereas candidiasis was significantly more common among females (p = 0.034). In multivariable analysis, CD4 count &lt; 200 cells\/mm3, unsuppressed viral load, and poor ART adherence were independently associated with increased odds of opportunistic infections. Conclusions: Immune suppression and suboptimal ART adherence significantly increase the risk of opportunistic infections among HIV-positive patients in rural South Africa. Strengthening adherence interventions and early immune monitoring may reduce infection burden in high-prevalence settings.<\/jats:p>","DOI":"10.3390\/tropicalmed11070183","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T08:05:38Z","timestamp":1783325138000},"page":"183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Preliminary Analysis of Sex-Based Differences in Immune Status, ART Adherence, and Opportunistic Infections Among HIV-Positive Patients in Rural Eastern Cape, South Africa"],"prefix":"10.3390","volume":"11","author":[{"given":"Ikhona","family":"Ntshobane","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, School of Medicine, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7749-9167","authenticated-orcid":false,"given":"Dominic Targema","family":"Abaver","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, School of Medicine, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha 5100, Eastern Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"ref_1","first-page":"12","article-title":"Opportunistic infections in HIV: Global trends","volume":"115","author":"Sharma","year":"2022","journal-title":"Int. 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