Antiretroviral treatment failure among HIV-positive adults taking first-line therapy and associated risk factors at Adigrat General hospital, Adigart, Ethiopia 2019: A cross sectional study

Abstract

Background: Human Immunodeficiency Virus (HIV) is a major public health problem globally. Highly active antiretroviral therapy (HAART) has led to profound reduction in the incidence of mortality. However, effective treatment is challenged by the treatment failure. Anti-Retroviral Treatment (ART) Failure may predispose patients to new or recurrent clinical condition. Objective: This study was designed to assess virological and immunological failure of highly active antiretroviral therapy users and associated risk factors at Adigrat General Hospital, Adigrat, Ethiopia. Methods: Institutional based retrospective cross sectional study was conducted. Data were collected by pre-tested structured checklist. The data were entered into Epi-info version 7 and exported into SPSS version 22.0 for analyses. The association between variables was analyzed using multivariate binary logistic regression analysis. The results were presented using text, tables and figure. Result: Seven hundred eighty four patients were included in this study. Of all study participants, 508 (64.8%) were females. More than half participants 376 (47.96%) were in the age range of (31–45) years. The overall prevalence of treatment failure was 27.48%; of this 12.35% of the participants developed immunologic failure and 4.70% of them had both immunologic and virologic failure. Factors that were significantly associated with treatment failure following multivariable analysis were rural resident [AOR = 3.6; 95% CI (1.11–7.36)], WHO stage III/IV [AOR = 2.7; 95% CI (1.21–5.08)], baseline CD4 count (cells/mm3) less than 199 [AOR = 8.11; 95% CI (2.46–19.54)], treatment interruption [AOR = 5.4; 95% CI (2.61–10.45)], poor drug adherence [AOR = 5.9; 95% CI (1.15–12.43)] and TB/HIV co-infection [AOR = 4.6; 95% CI (1.33–12.12). Conclusion: The prevalence of ART failure was higher. Multivariate analysis showed that rural residency, WHO clinical stage III/IV, baseline CD4 count (cells/mm3) less than 200, treatment interruption, poor drug adherence, opportunistic infections and TB/HIV co-infection were significantly associated with treatment failure. Highlights:

Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia

“…The finding of this study is lower than the finding from Adigrat, in which immunologic and virologic overall prevalence of treatment failure was 27.48%. 29 The difference is that in the study done by Demsie et al, the prevalence report was both cumulative overall result of both immunologic and virologic ART treatment failure. Similarly, it is lower than that of the study conducted by Gesesew et al in South West Ethiopia which was 25.1% 30 and Lenjiso et al’s study in Dire Dawa which was 22.7%.…”

“…This is similar to a finding of an Adigrat study in which WHO stages III/IV were significantly associated with treatment failure in multivariable analysis. 29 Likewise, in Huang et al’s study in China, patients with WHO clinical stage IV were 4.16 times more likely when compared with those with stage I. 27 The severe AIDS symptoms which have been categorized under WHO stage III and IV were the predictors for ART regimen treatment failure.…”

HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

“…This finding is difficult to compare within the literature of virologic outcomes in YLWH; we are not aware of any study that reports this kind of association. However, the finding is supported by an investigation from Ethiopia involving adults living with HIV [ 57 ]. Living in a rural area could be an indirect marker of treatment interruption because of reasons such as difficulties in accessing HIV treatment services.…”

“…The high transport costs may be a deterrent to YLWH in seeking routine HIV care, especially if the financial obligation lies with them. Treatment interruption is significantly associated with poor virological and immunological outcomes [ 57 ].…”

Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study

“…Previous studies have identified poor ART adherence, prolonged ART use, suboptimal ART regimens, tuberculosis (TB) co-infection, treatment interruption, opportunistic infections (OIs), rural residency, advanced WHO stage, and low baseline CD4 count as factors associated with an increased risk of HIV VTF [8][9][10][11][12][13][14]. Adherence to ART has been shown to be one of the most important predictors of virologic success and preventing disease progression [15].…”