Factors associated to first line antiretroviral therapy (ART) failure among HIV/AIDS patients at Sanglah Hospital, Bali

Abstract

Background and purpose: The incidence of first line ART failure is increasing in the South East Asia region. The main referral hospital in Bali has recorded an increased use of second line ART due to the first line ART failure. This study aims to explore risk factors associated to first line ART failure.Methods: A case control study was conducted among people living with HIV and AIDS at Sanglah Hospital Denpasar who started first line ART between 2004 and 2013. Cases were those who diagnosed as having clinical treatment failure and still on treatment in 2015. Controls were those with no treatment failure. Sex and year of ART initiation were matched between case and control. Data were obtained from medical records that include initial regiments, HIV mode of transmission, the WHO HIV clinical stage, CD4 count, opportunistic infections, body mass index, hemoglobin level, and drug substitution at the beginning and during treatment. Risk factors were analysed using logistic regression.Results: Out of 68 HIV/AIDS patients with clinical ART failure, 72.1% were confirmed with immunological and 36.8% were confirmed with virological failure. Median time before treatment failure was 3.5 years. Factors associated to ART failure were HIV clinical stage IV (AOR=3.43; 95%CI=1.65-7.13) and being widow/widower (AOR=4.85; 95%CI=1.52-15.53). Patients with TB co-infection have a lower risk for treatment failure due to early diagnosis and treatment through TB-HIV program (AOR=0.32; 95%CI=0.14-0.70).Conclusions: Higher HIV clinical stage at ART initiation increases the risk of treatment failure. HIV-TB co-infection indirectly reduces the risk of treatment failure.

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

“…Contrary to findings from several studies [15][16][17]19,39], some important socio demographic variables like age, sex and educational status were not found to be significant determinants of first line ART failure in the current study. This may be due to difference in socio demographic characteristics of study participants and socio economic differences between the study settings.…”

“…The current study has identified that patients with advanced WHO clinical stage III and IV at the time of initiation of ART were almost two times more likely to fail first-line antiretroviral treatment when compared with stage I and II baseline WHO clinical stage. This finding has similarity with the studies conducted in Sanglah Hospital, Bali Indonesia [15], Senegal [28], and in Harar public hospitals, Eastern Ethiopia [24]. This might be due the fact that advanced WHO clinical stage of HIV disease is associated with high viral load and low CD4 cell count that compromise immunity and may negatively affect response to first-line antiretroviral treatment [29].…”

“…Different studies identified that age <35 years, being male, higher educational level, urban residence, unemployment, advanced clinical stage III/IV, having history of TB co-infection, baseline CD4< 100cell/mm3, baseline BMI <18.5 kg/mm2, poor adherence, lost to follow up, baseline ART regimen, high frequency of alcohol use and smoking as determinant factors of first-line antiretroviral treatment failure [14][15][16][17][18].…”