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

Abstract

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

Determinants of virological failure among patients on first line highly active antiretroviral therapy (HAART) in Southwest Ethiopia: A case-control study

“…In addition, the odds of virological failure were higher among those who had a history of OI throughout the follow-up period compared with those who had no history of OI throughout the follow-up period. This finding is in line with the studies conducted in Jimma ( 17 ) and Arba Minch towns of Ethiopia ( 35 ) which showed patients with opportunistic infections, such as TB, appear to be at a higher risk of virological failure. This finding also consisted of a study conducted in Nigeria ( 36 ).…”

“…In this study, the odds of virological failure among those who had a history of substance use were higher compared with those who had no history of substance use. This finding is supported by the study conducted at Jimma (17), Addis Ababa (25), and Vietnam (26). This might be since using HAAT drugs and substances simultaneously would be prone to mental health problems resulting in poor adherence characterized by failure to take medication properly; moreover, interrupting the medication which leads finally to first-line ART treatment failure (27).…”

“…Virological failure: Viral load above 1,000 copies/ml based on two consecutive viral load measurements in 3 months, with adherence support following the first viral load test as diagnosed by ART physicians ( 3 , 17 ).…”

Prevalence of, and Factors Influencing First Line Antiretroviral Treatment Failure among Adult HIV Patients at Antiretroviral Treatment Clinic of Mettu Karl Referral Hospital, South Western, Ethiopia: A Prospective Cross Sectional Study, 2021

“…The patients who had failed for fist-line drug are 46% more likely to fail again for second-line drugs and are attributed to the higher number of side effects and have greater likelihood of experiencing drug resistance and treatment fatigue as a result of being on treatment longer [5]. Previous studies reported that various factors including being male gender, illiterate, widower, poor adherence and treatment interruption, WHO clinical stage III and/or IV, low CD4 cell at ART initiation, presence opportunistic infections, low BMI, taking ARV regimen before ART initiation, taking Stavudine and Zidovudine (AZT) based regimen, TB coinfection, substance use and longer duration on ART were significantly associated with first line ART failure [6]. The World Health Organization cites poor access to services, complex drug regimens, pregnancy, mental health disorders, substance abuse, and weak social support as major barriers to adherence [7].…”