Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008-2011

Allam, Ramesh Reddy; Murhekar, Manoj; Bhatnagar, Tarun; Uthappa, Chengappa K; Nalini, C.; Rewari, Bharat Bhushan; Mehendale, Sanjay

doi:10.1093/trstmh/trv018

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…The observed LTFU, mortality and overall attrition rates in this study were similar to those reported for several countries in sub-Sahara Africa [55–57]. In addition, there was significant variation in retention by site’s patient volume and across the six regions in Nigeria.…”

Section: Discussionsupporting

confidence: 85%

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

et al. 2016

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BackgroundThe Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported.MethodsWe evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models.ResultsAt ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU.ConclusionModerate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.

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Section: Discussionsupporting

confidence: 85%

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

et al. 2016

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“…ART failure is a major challenge to HIV/AIDS management in resource-limited settings including Ethiopia where the diagnosis and management of ART failure is a key problem [9]. The documented findings showed that Virologic and Immunologic failure was 23% and 21.6% respectively among PLWHA who were on ART as reported from Vietnam and India [9,10]. In SSA countries, rates of firstline ART failure vary between 11.1% and 24% [11].…”

Section: Introductionmentioning

confidence: 99%

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Asfaw

Tekelehaimanot

Shewanew

et al. 2019

Preprint

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Background: Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. Methods: A case-control study was conducted in March 2018 on a sample of 384(288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. Results: In this study, higher odds of first-line ART failure was experinced among urban residents (AOR:2.2;95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). Conclusions: This study evidenced that being an urban resident, TB co-infection, poor treatment adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, enhanced adherence counseling should be provided for those urban residents as well as substance users to improve adherence to ART; early screening and management of tuberculosis is highly recommended. Moreover, close follow up of adverse effects of ARVs must be strengthened. Keywords : determinants, first-line ART failure, HIV/AIDS, Jimma Zone, Public hospitals

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“…ART failure is a major challenge to HIV/AIDS management in resource-limited settings including Ethiopia where the diagnosis and management of ART failure is a key problem [9]. The documented findings showed that Virologic and Immunologic failure was 23% and 21.6% respectively among PLWHA who were on ART as reported from Vietnam and India [9,10]. In SSA countries, rates of first-line ART failure vary between 11.1% and 24% [11].…”

Section: Introductionmentioning

confidence: 99%

Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study

Asfaw¹,

Nigusie²,

Shewanow³

et al. 2019

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Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. A case-control study was conducted in March 2018 on a sample of 384 (288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. In this study, higher odds of first-line ART failure was experienced among urban residents (AOR:

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Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008-2011

Abstract: There was low immunological failure rate but high incidence of suboptimal CD4 testing. The ART centre staff needs to be more vigilant about 6-monthly CD4 testing for timely detection of immunological failure and appropriate case management.

Cited by 7 publications

References 22 publications

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study

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