First line antiretroviral treatment failure and associated factors among people living with HIV in northwest Ethiopia

Abstract

Background: Anti-retroviral treatment enhances the immune status and reduces unwanted outcomes. However, develop- ment of treatment failure and drug resistance raises concern over lifelong treatments to chronic diseases such as HIV/AIDS.
 Objectives: This study determined proportion of treatment failure (TF) and identified factors associated with TF among people living with human immunodeficiency virus (HIV) in Bahir Dar, Northwest Ethiopia.
 Methods: Facility based cross sectional study was carried out from November, 2017 to April, 2018. Sociodemographic and clinical data were collected using structured questioner. Blood sample was collected and analyzed for viral load, complete blood count (CBC), liver and kidney function test and CD4 count. A patient is declared as treatment failure when viral load value is higher than 1000 RNA copies/ml in two consecutive viral load analyses within three months interval. Data were entered and analyzed using SPSS version 23. To identify factors associated with TF, logistic regressions model was employed.
 Results: A total of 430 people who had six months and above antiretroviral treatment (ART) follow up were enrolled in the study. Of these, 57.9% were females & the mean age was 38 years. The mean month of ART follow up was 83 months. In the first viral load analysis, 106 (24.7%) of the cohort were virologically failed. These failed people were followed for 3 months with intensive adherence support; then second viral load analysis showed a viralogical failure among 65 people of the second cohort. Thus, the overall viralogical failure or TF was 15.1%. The re-suppression rates were 41(38.7%). Male gender, people with history of drug discontinuation, poor adherence, irregular time of drug intake, multiple sexual practice showed significant association with TF. Moreover, base line and current CD4 counts of <200 cells/ml also demonstrated significant association with TF.
 Conclusion: Significant proportion of treatment failure was reported in the present study. Moreover, behavioral factors such as drug discontinuation, poor adherence, multiple sexual partner were associated with treatment failure. Hence, to avoid TF, regular patient counseling and monitoring should be in place. To identify the predictors for treatment failure, further follow-up study is desirable.
 Keywords: HIV; viral load; treatment failure; Ethiopia.

Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia

“…Consistent results were also seen in a systematic review of mostly African studies (46.1%) and even a similar study done in Bahir Dar, Ethiopia (38.7%). 8 , 21 …”

“… 18 , 19 Adding to this burden, lower VL-suppression rates after EAC were seen in Bahir Dar (38.7%), in contrast to the substantial rates reported by a study in North Wollo (66.4%). 20 , 21 …”

“…18,19 Adding to this burden, lower VL-suppression rates after EAC were seen in Bahir Dar (38.7%), in contrast to the substantial rates reported by a study in North Wollo (66.4%). 20,21 With regard to factors associated with VL suppression after EAC, age, sex, marital status, occupation, level of education and residence are among the sociodemographic characteristics. 2,8,10,12,14,[20][21][22][23][24][25][26][27][28] Clinical factors, nutritional status, duration on ART, ART regimen, WHO clinical stage, adherence, initial CD4 count, initial VL, count and EAC sessions completed have also been reported to have significant associations.…”

“…20,21 With regard to factors associated with VL suppression after EAC, age, sex, marital status, occupation, level of education and residence are among the sociodemographic characteristics. 2,8,10,12,14,[20][21][22][23][24][25][26][27][28] Clinical factors, nutritional status, duration on ART, ART regimen, WHO clinical stage, adherence, initial CD4 count, initial VL, count and EAC sessions completed have also been reported to have significant associations. [7][8][9][10]12,14,[20][21][22][23][24][27][28][29][30][31][32][33][34][35][36][37] Some important variables of potential association (ie, prophylaxis against opportunistic infections and nutritional status) with VL suppression were not considered in previous studies.…”

Non communicable diseases persist despite being overshadowed by Covid-19 globally

“…28 We have several papers on TB: hearing-threshold in drug-resistant TB 29 ; non adherence to MDR-TB treatment in Uganda 30 , and TB/HIV service integration in Kampala. 31 HPV/HIV confection in Kenya 32 , and first line HIV treatment failure in Ethiopia 33 , conclude the HIV papers. We have a series of papers on malaria 34 , septic shock 35 , and wound infection with MRSA 36 concluding the infections disease section.…”