Virological and immunological failure of HAART and associated risk factors among adults and adolescents in the Tigray region of Northern Ethiopia

Abstract

BackgroundHuman immunodeficiency virus/Acquired immunodeficiency syndrome associated morbidity and mortality has reduced significantly since the introduction of highly active antiretroviral therapy. As a result of increasing access to highly active antiretroviral therapy, the survival and quality of life of the patients has significantly improved globally. Despite this promising result, regular monitoring of people on antiretroviral therapy is recommended to ensure whether there is an effective treatment response or not. This study was designed to assess virological and immunological failure of highly active antiretroviral therapy users among adults and adolescents in the Tigray region of Northern Ethiopia, where scanty data are available.MethodsA retrospective follow up study was conducted from September 1 to December 30, 2016 to assess the magnitude and factors associated with virological and immunological failure among 260 adults and adolescents highly active antiretroviral therapy users who started first line ART between January 1, 2008 to March 1, 2016. A standardized questionnaire was used to collect socio-demographic and clinical data. SPSS Version21 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to virological and immunological failure. Statistical association was declared significant if p-value was ≤ 0.05.ResultA total of 30 (11.5%) and 17 (6.5%) participants experienced virological and immunological failure respectively in a median time of 36 months of highly active antiretroviral therapy. Virological failure was associated with non-adherence to medications, aged < 40 years old, having CD4+ T-cells count < 250 cells/μL and male gender. Similarly, immunological failure was associated with non-adherence, tuberculosis co-infection and Human immunodeficiency virus RNA ≥1000 copies/mL.ConclusionsThe current result shows that immunological and virological failure is a problem in a setting where highly active antiretroviral therapy has been largely scale up. The problem is more in patients with poor adherence. This will in turn affect the global targets of 90% viral suppression by 2020. This may indicate the need for more investment and commitment to improving patient adherence in the study area.

Treatment Failure among People living with HIV taking Antiretroviral Therapy in Ethiopia

“…The finding of 11% VF in this study was lower than those studies from a number of lower than the figures from a number of low and middle income countries (10,17,(23)(24)(25)(26). The 88.1% VLS in this study is consistent with the finding of a previous cross-sectional study from Ethiopia in Tigray region which reported that TF was 11.5% while it is higher than a figure from a study conducted in Gondar(4.5%) (23,27). Despite having an overall high virological success, the level of virological suppression achieved in the subsequent viral load measurement among the patients with initial VF was low (35.3%).…”

HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis

“…Studies found through databases search were done between 2005 and 2016. Eight of the studies were conducted in the Amhara region, whereas five in Addis Ababa [13,[21][22][23][24], three in Oromia [18,25,26], one in Tigray [14], and one in SNNPR [27]. Three studies were done by case-control study design [24,28,29], four studies by cross-sectional [14,[30][31][32], and eleven by cohort study design [13, 15-18, 21-23, 25-27].…”

“…Eight of the studies were conducted in the Amhara region, whereas five in Addis Ababa [13,[21][22][23][24], three in Oromia [18,25,26], one in Tigray [14], and one in SNNPR [27]. Three studies were done by case-control study design [24,28,29], four studies by cross-sectional [14,[30][31][32], and eleven by cohort study design [13, 15-18, 21-23, 25-27]. Ten studies were done on adult population [13, 16, 17, 21, 23-25, 28, 29, 32], six on children [15,18,22,26,27,31], and two on all age group [14,30] (Table 1).…”

“…Three studies were done by case-control study design [24,28,29], four studies by cross-sectional [14,[30][31][32], and eleven by cohort study design [13, 15-18, 21-23, 25-27]. Ten studies were done on adult population [13, 16, 17, 21, 23-25, 28, 29, 32], six on children [15,18,22,26,27,31], and two on all age group [14,30] (Table 1).…”

“…A higher viral load may lead to HIV treatment failure, which is becoming a threat of different African countries, like in Burkina Faso (6.4%) [10], Ghana (15.7%) [11], and Tanzania (14.9%) [12]. In Ethiopia, virological, immunological, and clinical failure is found in the range between 1.3% [13] to 11.5% [14], 2.1% [15] to 21% [16], and 3.1% [17] to 12.3% [18], respectively.…”