Clinical and immunological failure among HIV-positive adults taking first-line antiretroviral therapy in Dire Dawa, eastern Ethiopia

Abstract

Background Access to antiretroviral therapy (ART) in Ethiopia has been scaled up since the introduction of the service in 2003. Free ART was launched in 2005, resulting in fewer new human immunodeficiency virus (HIV) infections and deaths from acquired immunodeficiency syndrome (AIDS). However, immunological and clinical failures for first-line ART due to poor adherence and other factors have received less attention. Thus, this study aims to determine the magnitude and associated factors of clinical and immunological failure among HIV-positive adults after six months of first-line ART in Dire Dawa, Eastern Ethiopia. Methods A facility-based cross-sectional study was conducted using secondary data of patients on ART in all health facilities providing ART services in Dire Dawa. A total of 949 samples were collected. The data were entered into Epidata version 3.02, and the analysis was performed using SPSS version 16.0. Univariate and multivariate analyses were performed to determine the magnitude of clinical and immunological failure and identify factors significantly associated with the outcome variable. Results The magnitude of clinical and immunological failure was 22.7% ( n = 215). Of these, 33 (15%) patients were switched to second-line ART. CD4 count ≤100 cells/mm3 (AOR: 1.78, 95% CI: 1.18–2.69), poor adherence (AOR: 2.5, 95% CI: 1.19–5.25), restarting after interruption of ART (AOR: 1.93, 95% CI: 1.23–3.07), regimen change (AOR: 1.50, 95% CI: 1.05–2.15), ambulatory/bedridden functional status at the last visit on ART (AOR: 2.41, 95% CI: 1.22–4.75) and patients who died (AOR: 3.94, 95% CI: 1.64–9.45) had higher odds of failure. Conclusion The magnitude of clinical and immunological failure was high. To curb this problem, initiation of ART before the occurrence of severe immune suppression, early detection and management of failure and improved adherence support mechanisms are recommended. Restarting treatment after interruption and regimen changes-should-be-made-cautiously.

<p>Prevalence and Predictors of Virological Failure Among Adults Living with HIV in South Wollo Zone, Northeast Ethiopia: A Retrospective Cohort Study</p>

“…This research also revealed that patients with low (<100 cells/mm3) baseline CD4 cell count were greater than twice more likely to have treatment failure compared to patients with baseline CD4 cell count of >200 cells/mm3 (AOR 2.39, 95% CI 1.03-5.54). Similar findings were reported by several studies conducted in Ethiopia, 9,18,37,41,42 Europe, 38 Vietnam, 45 and Peru. 40 However, no statistically significant association was found by multivariate analysis between treatment failure and the following covariates: sex, age, residency, body mass index, educational level, social drug use, tuberculosis coinfection, baseline WHO clinical stage and first-line ART regimen.…”

“…This finding was in agreement with studies done in Southern Ethiopia 11.1%, 24 Northwest Ethiopia 14.7%, 10 Northern Ethiopia 11.5%, 32 Addis Ababa, Ethiopia 19.8%, 33 Uganda 11%, 34 Tanzania 19%, 27 India 16.5% 35 and China 11.8%. 11 However; our finding was lower than findings of prior researches conducted in Southwest Ethiopia 25.1%, 36 Eastern Ethiopia 22.7%, 37 Mozambique 24.4%, 8 Europe 23.4%, 38 Canada 37.1%, 12 Vietnam 23%, 13 Saudi Arabia 23.8%, 39 and Peru 24%. 40 On the other hand, this result was significantly higher than what were reported by studies conducted in different parts of the world like Northern Ethiopia 4.1%, 9 South Eastern Ethiopia 2.4%, 41 a multicenter cohort in Ethiopia 7.4%, 42 Kenya 6%, 43 India 3.9%, 44 and Vietnam 6.6%.…”

“…Nonadherence to ART regimens was the strongest predictor of treatment failure as patients with poor adherence were found to be greater than six times at risk of facing treatment failure compared to their counterparts (AOR 6.73, 95% CI 3.29-13.76). Similarly, studies conducted in Northern Ethiopia, 9,32,46 Northeast Ethiopia, 47 Southeast Ethiopia, 41 Eastern Ethiopia, 37 Uganda, 34 Mozambique, 8 India, 35,48 China, 11 Canada 12 and Peru 40 showed that nonadherence was one of the main factors significantly associated with antiretroviral treatment failure.…”

Risk Factor Of Substitution ARV First Line People Living With HIV/AIDS In General Hospital Buleleng Bali

“…Different conditions found in other studies that lying and ambulatory functional beds increase the risk of treatment failure (AHR = 2.71 95% CI = 1.33 to 5.51, P = 0.006), although this does not directly increase the risk of ARV substitution (Enderis et al, 2019). Likewise in other studies that ambulatory / bedridden functional status at the last visit on ART (AOR: 2.41, 95% CI: 1.22-4.75) in cases of failure of ARV therapy (Lenjiso et al, 2019).…”

“…ARV substitution is a replacement for ARV drugs that are still classified as the original first-line group. Substitution is one of the toxicity monitoring benchmarks determined by WHO, because the risk of treatment failure is very likely to occur in those who experience substitution (Enderis et al, 2019;Lenjiso et al, 2019;Shearer et al, 2014;WHO, 2018 ). Monitoring ARV drug toxicity is an important component of a patient monitoring system (WHO, 2018).…”