First-line antiretroviral treatment failure and associated factors in HIV patients at University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia

Ayalew, Mohammed Biset; Kumilachew, Dawit; Belay, Assefa; Getu, Samson; Teju, Derso; Endale, Desalegn; Tsegaye, Yemisirach; Wale, Zebiba

doi:10.2147/hiv.s112048

Cited by 45 publications

(22 citation statements)

References 19 publications

(17 reference statements)

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“…Furthermore, immunological failure was found to be 6.1% (95% CI 3.4–9.5). The finding was in line with those of studies conducted in Ethiopia and reported 3.8–6.8% [ 16 , 21 , 22 ]. However, it was lower than the results of other studies in Ethiopia 15–21% [ 9 , 14 , 23 ], Tanzania19% [ 24 ], and Shenzhen China 18.4% [ 12 ].…”

Section: Discussionsupporting

confidence: 92%

Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia

et al. 2020

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Background Antiretroviral treatment has played a pivotal role in the reduction of HIV/AIDS-related morbidity and mortality. However, treatment options can be impaired by the development of antiretroviral treatment failure. Regular monitoring of the Human Immunodeficiency Virus treatment outcome via viral load tests is the key approach. There is a scarcity of information about HIV treatment failure and risk factors in the study area. Therefore, the study was aimed to assess antiretroviral treatment failure and associated factors among patients on first-line antiretroviral treatment at Tefera Hailu Memorial Hospital, Sekota, northeast Ethiopia. Methods A hospital-based cross-sectional study was conducted on 295 patients on first-line antiretroviral treatment from Nov. 2018 to Apr. 2019. Socio-demographic and clinical variables were collected using a pretested questionnaire, and blood specimen was collected for PCR viral load and CD4 + cell count estimation. Data were entered into Epi-Info and exported to SPSS for analysis. A binary logistic regression model was used to identify associated factors, and P value < 0.05 was considered as statistically significant. Results Of the 295 subjects on first-line ART, 49 (16.6%) and 18 (6.1%) experienced virological and immunological failures, respectively. The failure of the former was associated with poor adherence (AOR: 6.367, P < 0.001), CD4 + count < 500 cells/µL (AOR: 4.78, P = 0.031) and shorter (6–24 months) duration on ART (AOR: 0.48, P = 0.048), while poor treatment adherence (AOR: 11.51, P = 0.012) and drug interruption (AOR: 6.374, P = 0.039) were the independent risk factors for latter. Immunological tests to predict virological failures showed as sensitivity, specificity, PPV, and NPV were 20.4%, 96.7%, 55.5%, and 86.0%, respectively. Conclusions The rate of ART failure was considerably high. Poor adherence, low CD4 + count, prolonged ART, and drug interruption were found to be the most predictor variables for virological and immunological failures. The discrimination power of the immunological parameter was low in comparison to virological measurements as standard methods. Therefore, the study highlighted the need for more attention and efforts to curb associated factors and maximize virological tests for monitoring treatment failures.

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Section: Discussionsupporting

confidence: 92%

Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia

et al. 2020

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“…In the current meta-analysis, 22,849 study participants were represented by 18 studies. The prevalence treatment failure reported was between (4.1%) [17] and (22.2%) [15] and the sample sizes of the studies ranged from 225 [16] to 4809 [21].…”

Section: Resultsmentioning

confidence: 99%

Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

Assemie

Alene

Ketema

et al. 2019

glob health res policy

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BackgroundAntiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia.MethodsRelevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies.ResultsFrom 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure.ConclusionIn this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.

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“…Sociodemographic characteristics, including age, gender, occupation, residence, marital status, religion, and educational status, were collected from each study participant using a structured questionnaire developed from the literature. 21 , 28 Relevant clinical characteristics of participants (weight, WHO clinical stage, CD4 + T-cell count, HAART regimen, adherence with and duration on HAART, initial regimen, types of co-infections, adverse effects, and reason for drug switching) were retrieved from medical records by trained nurses using a data extraction checklist ( S1 file ).…”

Section: Methodsmentioning

confidence: 99%

<p>Immunological Response During HAART and Determinants of Current CD4<sup>+</sup> T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia</p>

Manaye¹,

Abateneh²,

Kebede³

et al. 2020

HIV

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Purpose After the initiation of highly active antiretroviral therapy (HAART), successful HAART is characterized by an increase in the CD4 + count. Several factors affect the CD4 + T-cell count. This study aimed to assess the immunological response during HAART and determinants of the current CD4 + T-cell count among HIV/AIDS patients on HAART. Patients and Methods A hospital-based cross-sectional study was conducted from February 1 to April 1, 2017. A total of 423 HIV/AIDS patients on HAART were enrolled using simple random sampling. Descriptive statistics, and bivariate and multiple regression analyses were conducted. Variables with p -value <0.2 in the bivariate analysis were entered in the multiple regression models. p -Values <0.05 and 95% confidence intervals were used to identify determinants of the current CD4 + T-cell count. Results The mean CD4 + T-cell count gradually increased until 8 years on HAART but declined thereafter. An increased current CD4 + T-cell count was observed among patients with an initial regimen of pediatric d4T-3TC-NVP [ β =185.5, 95% CI (8.8, 362.2)] ( p =0.040), with increased baseline CD4 + T-cell count [ β =0.468, 95% CI (0.342, 0.594)] ( p <0.0001), and with long duration on HAART [ β =18.0, 95% CI (9.9, 26.1)] ( p <0.0001), whereas a decreased level of current CD4 + T-cell count was observed among males [ β =−72.7, 95% CI (−114.5, –30.9)]) ( p <0.0001) and those with poor baseline adherence [ β =−108.9, 95% CI (−210.9, −7.0)] ( p =0.036) and viral load >1000 copies [ β =−189.2, 95% CI (−243.5, −134.9)] ( p <0.0001). Conclusion The trend in immunological response was not increased linearly throughout the HAART duration. Sex, type of initial regimen, baseline adherence, baseline CD4 + count, viral load, and duration on HAART were independent determinants of current CD4 + count. These determinants could be addressed by regular monitoring of HIV patients on HAART, and special attention should be paid to male patients.

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First-line antiretroviral treatment failure and associated factors in HIV patients at University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia

Cited by 45 publications

References 19 publications

Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia

Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia

Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

<p>Immunological Response During HAART and Determinants of Current CD4<sup>+</sup> T-Cell Count Among HIV/AIDS Patients Attending University of Gondar Referral Hospital, Northwest Ethiopia</p>

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