Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study

Abstract

Background This study aimed to determine the incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy (ART) in public hospitals of Northern Ethiopia. Methods A retrospective study was conducted from September 1, 2007 to July 30, 2017 on 227 patients. The data were extracted using a retrieval checklist from the patient's charts. The incidence rate of treatment failure was calculated using Kaplan-Meier methods and Cox proportional hazard model was used to assess factors associated with treatment failure. Result The study subjects were followed for a total observation of 788.58 person-years with a median follow-up period of 35 (IQR: 17-60) months after switching to second-line ART. About 57 (25.11%) patients developed treatment failure, out of which, 32 (56.14%) occurred during the first two years. The overall incidence of second-line treatment failure was 72.3 per 1000 person years (95%CI: 55.75-93.71) of observation. The Kaplan-Meier estimates of cumulative treatment failure after 1, 2, and around 10 years of follow-up were 12.31%

Clinical, immunologic and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals in Addis Ababa, Ethiopia

“…Statistical results are expressed using medians and inter-quartile ranges while regression analyses reported using adjusted hazard ratios, confidence intervals and p-value whose significance was taken as less than 0.05. We selected variables for testing based on findings from similar previous studies [ 6 , 8 – 11 , 16 , 18 – 20 , 24 ]. All p-values greater than or equal to 0.001 are reported as they are while p-values less than 0.001 are expressed as p < 0.001.…”

“…Pediatric treatment options are further restricted due to lack of approval, availability of formulations compatible for use by children and fixed-dose combinations. This has been shown to contribute for persistence of children on failed first line antiretroviral drugs and subsequent failure of second line regimens after a brief treatment duration [ 7 , 8 ].…”

“…A study reporting from a pediatric cohort at Tikur Anbessa hospital of Addis Ababa, Ethiopia (mean age: 16 years) showed high rates of virologic failure (18%) and marked delays in identifying a failed first line regimen (71 months) and initiating second line ART (close to 5 months) [ 7 ]. Many others have reported from predominantly adult study populations, leaving insufficient data on children and adolescents [ 8 , 9 ]. The objectives of the study were to describe clinical, virologic and immunological outcomes of children and adolescents at pediatric HIV clinics in two referral hospitals in Addis Ababa, Ethiopia.…”

The First Experience of Effective 3rd Line Antiretroviral Therapy – A Case of 40-Year-Old Female Retroviral-Infected Patient at Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia

“…According to a multicenter study conducted in Northern Ethiopia, the failure rate of second-line treatment was found to be 72.3% per 1000 person years (95% confidence interval: 55.75–93.71). 19 …”

Predictors of Poor Adherence to CART and Treatment Failure at Second-Line Regimens Among Adults in Public Hospitals of Amhara Region, North-Western Ethiopia: A Retrospective Cohort Study

“…Residence, age, educational status, co-morbidity, HIV disclosure status and CD4 count were associated with adherence. 17 , 18 Social support, absence of depression, and absence of substance use were also reported as determinants of adherence to CART. 19 Many studies were conducted on predictors of poor adherence separately but not associated with its effect on second-line regimens.…”