HIV/AIDS Treatment Failure and its Determinant Factors among First Line HAART Patients at Felege-Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Abstract

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. Objective:The aim at this study was to assess the prevalence of HIV/AIDS treatment failure and its determinants factors of patients on first line HAART at Felegehiwot Referral Hospital. Methods:Cross sectional study was conducted on 421 participants who had started first line HAART during August 2016 to September 2016. Data were collected from patients' chart starting from ART commencement and face to face interview using structured questionnaire. CD4 T-cells from whole blood and viral load from separated plasma were analyzed according to protocols. The collected data were enter in to EPI info version 3.5.1 and transfer to and analyzed using SPSS packages version 20. Descriptive statistics, odds ratio, positive and negative predictive values, life table, receiver operating characteristics curves, bi-variate and multiple logistic regression were used to analysis. Independent associations were considered with p<0.05.Result: Among the 421 participants enrolled, 292 (69.4%) were adult and 129 (30.6%) were children. More than half 243 (57.7%) of the participants were females. The adult median age at ART initiation was 38.0 years with inter quartile rage (IQR) 10 and for children 9.8 years with IQR 4.The median duration of treatment failure from initiation of treatment was 87 months (IQR 110-65 months). A total of 45 (10.7%) participants were found to have treatment failure. The median CD4 T-cells at initiation of Anti retroviral therapy were 147 cells/µl (IQR 226-84.5). The median time to detect virological failure was 47 months. Sensitivity of immunologic failure of predicting virological failure was 62.2%. Clinical stage II 374 (88.8%) was the predominant clinical stage. Conclusion:The prevalence of treatment failure in this study was 10.7%. Long duration on treatment, conducting faith healing, immunologic failure, high medication dosage, and ambulatory functional status at baseline and not feeling privacy during consultation and counseling were found to be significant predictors of treatment failure.Therefore early identification of associated factors and monitoring treatment failure has to be strengthened to benefit patients from prevent further complication.

Immunological recovery, failure and factors associated with CD-4 T-cells progression over time, among adolescents and adults living with HIV on Antiretroviral Therapy in Northern Ethiopia: A retrospective cross sectional study

“…Considering the recent WHO definition, this finding was lower compared with the study conducted in Felege-hiwot hospital Bahir Dar, Ethiopia (15.9%) [25], 6.5% in Tigray region [17], 15.7% in Federal Police Referral Hospital (FPRH) Ethiopia [23], 13.2% in Gondar referral Hospital [16], 6.1% in the Somali region of Ethiopia [29]. However, based on the findings of the WHO definition 2013 immunological failure were higher compared to different studies [16, 17, 23, 25, 29]. These variations might be due to the application of different WHO definitions, which was changed over time or it could be a real difference.…”

“…However, the current finding was higher compared with studies conducted in the capital city of Addis Ababa, which were 115 cells/μL [23] and 177 cells/μL [24]. Similarly, lower median CD4+ counts were reported from the Tigray region (162 cells/μL) [17], Felege-hiwot referral hospital, Bahir Dar, Ethiopia (147 cells/μL) [25], southern Ethiopia (156 cells/μL) [26] and Kenya (152 cells/μL) [27]. Nonetheless, a study conducted in Liberia revealed a higher median CD4+ count (238 cells/μL) [28].…”

“…This study has revealed immunological failure in 2.14% and 19.42% of the patients based on WHO 2016 and 2013 definitions respectively [11, 12]. Considering the recent WHO definition, this finding was lower compared with the study conducted in Felege-hiwot hospital Bahir Dar, Ethiopia (15.9%) [25], 6.5% in Tigray region [17], 15.7% in Federal Police Referral Hospital (FPRH) Ethiopia [23], 13.2% in Gondar referral Hospital [16], 6.1% in the Somali region of Ethiopia [29]. However, based on the findings of the WHO definition 2013 immunological failure were higher compared to different studies [16, 17, 23, 25, 29].…”

<p>Virological Treatment Failure Among Adult HIV/AIDS Patients from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia</p>

“…The finding was consistent with the study conducted in guinea 13.7% 23 and Bahir Dar 10.7%. 24 However, when compared with other studies, for instance, a study conducted in coastal Kenya (6%), 25 Debre Markos hospital (21%), 26 Colombia (29%), 18 Sweden, Honduran (74%), 19 and China (28%), 20 it was low. This discrepancy may be due to most clients on first-line ART treatment failure shift to second-line ART.…”

“…However, this result contradicts studies done in the Tigray region of northern Ethiopia, Gondar, and Felege-Hiwot Referral Hospitals. 17,24,31 These variations may be related to the type of data collection method. In our study, the data on adherence were collected from one-month recall self-reported missed doses, and not directly collecting from the patients' charts.…”