The aim of this study is to assess maternal treatment outcomes to antiretroviral therapy initiated before or during pregnancy in HIV-1 infected women and associated factors in southwest Ethiopia. Hospital based retrospective cohort study was conducted from January 1st 2008 to December 31st 2012.The data were processed using SPSS version 16 (Chicago: SPSS Inc., 2007). A p-value of < 0.05 was considered statistically significant. Among the 202 study participants, 169(83.6%) and 142(70.3%) had good immunological and clinical outcomes respectively. In adjusted logistic regression analysis, unknown HIV status prior to pregnancy (AOR=0.158, 95% CI=(0.041-0.602), P=0.007), Baseline CD4 count < 200 (AOR = 0.023, 95%CI= (0.003-0.190), P=0.000), baseline WHO clinical stage III (AOR=7.673, 95%CI=1.640-35.892, P=0.010), Highly Active Antiretroviral Therapy initiation during pregnancy (AOR=0.349,95% CI=0.157-0.776,P=0.010) were identified as independent predictors of maternal treatment outcomes. In conclusion, Women who started Highly Active Antiretroviral Therapy before pregnancy had good clinical outcome compared to those who started during pregnancy. The independent predictors of maternal outcomes were HIV status prior to pregnancy, baseline CD4 count before initiation of Highly Active Antiretroviral Therapy, time of Highly Active Antiretroviral Therapy initiation, world health organization clinical stage before initiation of Highly Active Antiretroviral Therapy and duration of treatment with Highly Active Antiretroviral Therapy.

Background: Combination antiretroviral therapy (cART) is the cornerstone of managing patients with HIV infection. Once cART is initiated, patients generally remain on medications indefinitely. However, antiretroviral regimens commonly require changes which often involve switches of multiple medications simultaneously. The maximal regimen durability with regard to safety and efficacy is a critical factor for long-term success of ART since modification to cART has a number of challenges.Objectives: To assess the rate, time to change, reasons and predictors of treatment modification among HIV/AIDS patients at Pawe General Hospital.Method: Hospital based retrospective cohort study was conducted among adult HIV/AIDS patients on follow-up in Pawe Hospital from 01 April 2017 to 30 April 2017. Patients who started cART at Pawe General Hospital from January 2012 to December 2016 were included. Data abstraction tool was used to collect data from patient chart. Data were analyzed using SPSS version 21. Descriptive statistics were used to summarize patient socio-demographics characteristics and rate of regimen modification. Bivariate and multivariate Cox proportional hazard were performed to identify the predictors. Result: Over a median follow-up period of 21 months (IQR 6 - 38), 62 (14.5%) patients modified their initial regimens (incidence rate (IR); 7.66 per 100 person years [95% CI: 5.84 – 9.50]). Toxicity was the most common reason (72.6%). In multivariate Cox regression model, WHO stage III/IV at initiation(AHR;2.39, 95% CI: 1.23 – 4.66), AZT based initial NRTI backbone (AHR; 8.19, 95% CI: 4.55 - 14.73), low baseline hemoglobin ((< 7 g/dl [AHR; 6.32, 95% CI: 1.40 – 28.58] and 7-9.9 g/dl [AHR 4.21, 95% CI: 1.92 - 9.22]) and co-medication with cART (AHR 1.73, 95% CI: 1.03 - 2.89) were associated with increased risk of treatment modification.Conclusion: Initial regimen modification rate was lower in this population than cohorts in resource-rich settings. Special attention should be given for patients who are at advanced disease stage, AZT based regimen, low baseline hemoglobin and taking additional medications other than cART.