Time to First-Line Antiretroviral Treatment Failure and Its Predictors among HIV-Positive Children in Shashemene Town Health Facilities, Oromia Region, Ethiopia, 2019

Abstract

With expanding pediatric antiretroviral therapy access, children will begin to experience treatment failure and require second-line therapy. In resource-limited settings, treatment failure is often diagnosed based on the clinical or immunological criteria which occur way after the occurrence of virological failure. Previous limited studies have evaluated immunological and clinical failure without considering virological failure in Ethiopia. The aim of this study was to investigate time to first-line antiretroviral treatment failure and its predictors in Shashamene town health facilities with a focus on virological criteria. Methods. A retrospective cohort study was conducted in three health facilities of Shashamene town, Oromia Regional State, from March 1 to 26, 2019. Children aged less than 15 years living with HIV/AIDS that were enrolled on ART between January 1, 2011, and December 30, 2015, in Shashamene town health facilities were the study population. Data were extracted using a checklist, entered into EpiData version 3.1, and exported to SPSS version 20 for data analysis. Cox proportional hazard regression was used to determine the predictors of time to first-line treatment failure. Result. The median survival time to virological failure was 30 months with IQR of 24.42 to 44.25. Baseline WHO stages 3 and 4 with AHR = 5.69 (95% CI: 2.07–15.66) and NVP-based NNRT at initial treatment with AHR = 2.72 (1.13–6.54) were the independent predictors of time to treatment failure. Conclusion. The median survival time of first-line antiretroviral treatment failure was moderate in the study area as compared to other studies. The incidence density of treatment failure in this study was low as compared to other studies. The finding also demonstrated that children treated with nevirapine-based nonnucleoside reverse transcriptase inhibitors at initial and advanced WHO clinical stages at baseline were at higher risk of treatment failure.

Virological failure of first-line antiretroviral therapy in children living with HIV in Indonesia and associated factors

“…15 The mean time from first-line therapy to virological failure was 29 months in our study, similar to that of 30 months reported by an Ethiopian study. 17 For the last 15 years in Indonesia, ARV backbone regimens have been limited to nevirapine and efavirenz; both of which were reported to be ineffective among African populations with high perinatal exposure. 15 However, exposure risk was not a determinant of virological failure in our study, since almost all subjects had missed perinatal prevention.…”

“…15 In other studies, wasting and stunting were not always measured as separate factors, although WHO stage 3 or 4 was reported as an important factor in virological failure, with HIV wasting as one criteria. 10,14,15,17,20 Findings of WAZ <-1 and HAZ <-1.9 showed that clinical failure had already taken place. Ineffective regimen use and lack of scheduled VL monitoring may explain this late detection of virological failure.…”

“…9,15 Several factors that are known to increase the risk of virological failure on CLHIV include younger age at diagnosis or treatment initiation, WHO stage 3 and 4, lower CD4 count, nevirapine (NVP)-based regimen, and treatment interruption. 10,11,[16][17][18][19][20][21] This study aimed to determine the incidence of treatment failure with first-line ART in situations of limited VL monitoring in Indonesia, as well as to identify the predictors of treatment failure in order to assist clinicians in monitoring their patients more closely.…”

Factors Affecting Virological Failure in Children Receiving First-Line Antiretroviral Therapy in Ethiopian Healthcare Facilities: A Retrospective Analysis

“…8 Virological Failure (VF) among paediatric population taking ART in Ethiopia is 18.3%. 9 Keeping patients on a failing regimen leads to the reversal of clinical conditions of patients to the pretreatment state and development of drug-resistant strains. Once drug-resistant virus starts transmitting in the population, the consequences will be devastating.…”

Predictors of Viral Load and Medication Adherence Among HIV-Positive Adults Under Treatment at Felege-Hiwot Comprehensive Specialized Hospital, North-West, Ethiopia

“… 6 In the Amhara region, including the catchment area of Felege Hiwot Comprehensive Specialized Hospital (FHCSH), many antiretroviral therapy (ART) users did not seriously adhere to their prescribed medication. 7 Due to this, most of the ART users in the region have less than 95% of the prescribed medication and over 30% of the patients are poor adherents. 8 …”