Immunologic and Clinical Failure of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus within Two Years of Treatment

Abstract

Background. Early initiation of highly active antiretroviral therapy (HAART) decreases human immunodeficiency virus- (HIV-) related complications, restores patients’ immunity, decreases viral load, and substantially improves quality of life. However, antiretroviral treatment failure considerably impedes the merits of HAART. Objective. This study is aimed at determining the prevalence of immunologic and clinical antiretroviral treatment failure. Methods. A cross-sectional study design using clinical and immunologic treatment failure definition was used to conduct the study. Sociodemographic characteristics and clinical features of patients were retrieved from patients’ medical registry between the years 2009 and 2015. All patients who fulfilled the inclusion criteria in the study period were studied. Predictors of treatment failure were identified using Kaplan-Meier curves and multivariable Cox regression analysis. Data analysis was done using SPSS version 21 software, and the level of statistical significance was declared at a p value < 0.05. Results. A total of 770 were studied. The prevalence of treatment failure was 4.5%. The AZT-based regimen (AHR=16.95, 95% CI: 3.02-95.1, p=0.001), baseline CD4 count≥301 (AHR=0.199, 95% CI: 0.05-0.76, p=0.018), and bedridden during HAART initiation (AHR=0.131, 95% CI: 0.029-0.596, p=0.009) were the predictors of treatment failure. Conclusion. The prevalence of treatment failure was lower with the risk being higher among patients on the AZT-based regimen. On the other hand, the risk of treatment failure was lower among patients who started HAART at baseline CD4 count≥301 and patients who were bedridden during HAART initiation. We recommend further prospective, multicenter cohort studies to be conducted to precisely detect the prevalence of treatment failure using viral load determination in the whole country.

Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia

“…The finding of the study is higher than that of the study conducted in southeast Ethiopia: 2.4%, 15 in Mekelle: 11.5%, 9 Asgedom et al’s study: 4.5%, 37 and the study conducted in St. Luke and Tulubolo Hospitals: 6.8% 38 and in Southern Ethiopia: 11.1%. 39 The variation may be due to sampling size, method of analysis as well as the method of treatment failure measurement, for example, in Hailu et al’s study, Yirdaw et al’s study, Haile et al’s study, 9 , 15 , 39 and Bayou et al’s study, 38 prevalence of treatment failure was assessed immunologically, which has a low detection rate of treatment failure.…”

“…22 Similarly, in Asgedom et al’s study, non-adherent study participants were five times more likely to experience immunological failure compared with those who had good adherence. 11 , 37 Also, it is similar to studies conducted in North Ethiopia, 9 , 43 southwest Ethiopia, 30 Northeast Ethiopia, 44 Southeast Ethiopia, 15 a study conducted in Uganda, 41 in Mozambique, 32 in Peru, 34 and a study conducted in India. 28 …”

Prevalence and Predictors of Pediatric HIV Therapy Failure in a Tertiary Hospital in Asmara, Eritrea: A 15-year Retrospective Cohort Study

“…in Ethiopia [15,21]. The observed variation is largely in uenced by study type, treatment duration, VL thresholds, and CD 4 + T cell count thresholds employed, among others [15,16,22].…”

“…In general, studies in Low-and Middle-income Countries (LMIC) have reported TF rates of 10 − 34% among children after 2-3 years of cART [11]. In SSA, estimates of virologic failure (VF), with or without resistance mutations in children, ranging between 13-56% [12][13][14][15]. Also, delays in detecting early TF and subsequent switching to second-line therapy may compromise overall treatment outcomes [7,16].…”

Neuroinflammation in HIV-Related Neuropathic Pain

“…D4T and ddC are notorious among these NRTI drugs and their toxicity has been studied both in vitro and in vivo. D4T is widely used as the first-line regimen in low-income countries with limited resources (Loubiere et al, 2010;Asgedom et al, 2020). D4T-based ART increases the risk of peripheral neuropathy, hyperlactatemia, and other diseases (Menezes et al, 2011).…”