Determinants of first-line antiretroviral treatment failure among adult patients on treatment in Mettu Karl Specialized Hospital, South West Ethiopia; a case control study

Abstract

Background Antiretroviral therapy has dramatically reduced Human Immunodeficiency Virus related morbidity and mortality. It has also transformed HIV infection into a manageable chronic condition. However, first-line antiretroviral treatment failure continues to grow especially in resource limited settings. Despite this, determinants of first-line antiretroviral treatment failure are not well studied in Ethiopia. Objective To identify determinants of first-line antiretroviral treatment failure among adult patients on antiretroviral therapy in Mettu Karl Specialized Hospital, South West Ethiopia, in 2020. Methods A hospital based case-control study was conducted from October to November 2020. Simple random sampling technique was used to select participants. Interviewer administered questionnaire and record review were used for data collection. Data were entered into epi data version 3.1 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression analysis were used. At the end, variables with P-value < 0.05 at 95% confidence intervals for adjusted odds ratio were considered statistically significant determinants of first line treatment failure. Result A total of 113 cases and 339 controls were included in the study with response rate of 98.6%. Sixty-four (56.6%) of cases and 183 (54.0%) of controls were females. Baseline WHO clinical stage III and IV (AOR = 1.909, 95% CI: (1.103, 3.305), baseline body mass index<18.5kg/m2(AOR = 2.208,95% CI:(1.257,3.877),baseline CD4 cell count <100cells/mm3 (AOR = 3.016, 95% CI: (1.734, 5.246), having history of TB co-infection (AOR = 1.855, 95% CI: (1.027, 3.353), having history of lost to follow up (AOR = 3.235, 95% CI: (1.096, 9.551), poor adherence to medication (AOR = 7.597, 95% CI: (4.059, 14.219) and initiation of treatment after two years of diagnosis with HIV (AOR = 4.979, 95% CI: (2.039, 12.158) were determinants of first-line antiretroviral treatment failure. Conclusion In this study several variables were found to be determinants of first-line antiretroviral treatment failure. Concerned bodies should give more attention to early diagnosis of HIV, early enrollment in chronic HIV care and early initiation of ART before patients develop advanced WHO clinical stages. In addition, focus has to be given for patients with low CD4 count. Regular screening for TB, counseling on optimal adherence to medication and enhancing nutritional status of patients with low body mass index are also crucial to prevent first-line antiretroviral treatment failure.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

“…According to our data, patients with CD4 < 200 cells/mm were 41 times more likely to experience virological failure than were those with CD4 ≤ 200 cells/mm (OR = 41, P < 0.001). In line with our findings, another study reported that the probability of viral treatment failure is nine times greater in these patients than in those with higher CD4 T-cell counts [ 51 – 54 ]. A high level of HIV replication indicates a decreased CD4 + T-cell count and poor immune responses, leading to virological failure [ 55 ].…”

Machine learning to predict virological failure among HIV patients on antiretroviral therapy in the University of Gondar Comprehensive and Specialized Hospital, in Amhara Region, Ethiopia, 2022

“…Patients who had a longer duration of stay on ART had a higher risk of developing virological failure. similarly, previous studies conducted in Waghimra, Northern Ethiopia, and Mettu, South West Ethiopia [ 22 , 86 ] revealed that patients who had been on ART for a longer time were more susceptible to developing virological failure. The possible explanation might be due to the prolonged use of ART, which can increase the risk of developing poor adherence to treatment and unfavorable medication reactions [ 26 ].…”

“…Furthermore, HIV viral load suppression is the most important indicator of successful antiretroviral therapy, progression, and death, as well as the most effective monitoring strategy for confirming a diagnosis and proving ARV treatment failure [ 21 ]. Despite the expanded availability of antiretroviral treatment (ART) around the world, virological failure remains a significant challenge for HIV patients [ 22 , 23 ]. Delays in commencing ART can have serious consequences, particularly for people with tuberculosis or extensive immunosuppression who are at high risk of mortality [ 21 , 24 ].…”

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

“…Late initiation of ART (>30 days) did not appear to be associated with a greater likelihood of VTF (HR: 0.91[95% CI: 0.67-1.27]), contrary to studies affirming the importance of early treatment [48,49]. It may be that an impaired immune system as indicated by the occurrence of OIs, better reflects the risk of developing VTF, rather than late ART initiation.…”