<p>Predictors of Clinical and Immunological Failure Among Patients on First-Line Antiretroviral Therapy (ART) in Southwest Ethiopia</p>

Abstract

Background: Global expanded access to antiretroviral therapy has led to a rapid fall in the number of people dying from HIV-related causes. However, the remarkable achievement recorded in reducing morbidity and mortality has been affected due to the occurrence of firstline ART failure. The study was intended to identify predictors of clinical and immunologic failure of first-line ART in southwest Ethiopia. Methods: A retrospective cohort study was conducted among 737 randomly selected ART patients from 1 st January 2010 to 30 th June 2016. Trained data collectors collected the data from the patients' follow-up charts and electronic databases. The Kaplan Meier (KM) curve was used to describe the probability of survival time to antiretroviral treatment failure. Variables with a p-value of ≤ 0.05 in a multivariable cox-proportional hazard model were statistically significant predictors of first-line ART failure. Results: Among 737 HIV patients on ART followed retrospectively, 445 (60.4%) were females. During the follow-up period, the incidence rate of treatment failure was 7.3 per 100 person-year observations, and the highest rate was observed during the first 6 to 12 months of ART initiation. Not disclosing HIV status (AHR꞊ 2.04, 95% CI: 1.32-3.16), being bedridden (AHR꞊ 2.01, 95% CI: 1.02-3.98) and low hemoglobin at ART initiation (AHR꞊ 2.02, 95% CI: 1.29-3.13) were associated with an increased hazard rate for first-line ART failure. Conclusion: The study showed that predictors of first-line ART treatment failure are modifiable. Therefore, these factors should be addressed during routine care of HIV patients by health care providers to preserve the rapid exhaustion of first-line medications, improve the quality of life of the patients and reduce HIV/AIDS related deaths.

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

“…Furthermore, the odds of virological failure among those who had baseline Hgb < 12 mg/dl were higher compared with those who had baseline Hgb ≥12mg/dl. This finding is supported by the study conducted at Jimma, Ethiopia ( 32 ), Cameron ( 33 ), and South Africa ( 34 ). This might be because patients with anemia are more likely to have advanced immune suppression and a higher rate of co-morbidities that could impose a negative effect on response to ARV treatments.…”

“…This might be because patients with anemia are more likely to have advanced immune suppression and a higher rate of co-morbidities that could impose a negative effect on response to ARV treatments. Evidence from other studies also showed anemia at ART initiation is associated with increased mortality, disease progression (poor virological response), and reduced quality of life ( 32 ).…”