Magnitude and correlates of virological failure among adult HIV patients receiving PI based second line ART regimens in north western Tanzania; a case control study

Gunda, Daniel W.; Kilonzo, Semvua B.; Mtaki, Tarcisius; Bernard, Desderius M.; Kalluvya, S; Shao, Elichilia R

doi:10.1186/s12879-019-3852-3

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…In addition, the study found that a baseline CD4 count of greater than 100cells/mm3 is a protective factor for first-line ART treatment failure. For this finding similar existing evidences upkeep this finding [ 17 , 20 – 22 ]. This suggests the higher CD4 count, the lower viral load which protects against treatment failure.…”

Section: Discussionsupporting

confidence: 81%

Magnitude of first line antiretroviral therapy treatment failure and associated factors among adult patients on ART in South West Shoa, Central Ethiopia

et al. 2020

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Background First-line antiretroviral treatment failure has become a public health concern in high, low and middle-income countries with high mortality and morbidity In Ethiopia, around 710,000 peoples were living with HIV and 420,000 of them were receiving ART in 2017. Little is known about the magnitude of first-line ART treatment failure and its associated factors in Ethiopia, particularly in the study area. Therefore, this study was aimed to find the magnitude of first-line ART treatment failure and its associated factors among adult patients attending ART clinic at Southwest shoa zone public hospitals. Methods Institutions based cross-sectional study was employed from February 1 to April 2, 2019. An interviewer administered questionnaire was used to collect data from 350 adult patients on ART using a systematic random sampling technique. The collected data were coded and entered into Epidata version 3 and exported to STATA SE version 14 for analysis. Bivariable and multivariable logistic regression was done to identify factors associated with first-line ART treatment failure. At 95% confidence level strength of association was measured using Odds ratio. Variables with a p-value of ≤ 0.25 in the bivariable analysis were considered as a candidate variable for multivariable analysis. To get the final variables step-wise backward selection procedure was used and those in the final model were selected at a p-value <0.05. Finally, texts, simple frequency tables, and figures were used to present the findings. Results In this study the magnitude of first-line ART treatment failure was 33.42%. Absence of baseline opportunistic infection AOR = 0.362 (95%CI0.178, 0.735), Staying on first-line ART for <5 years AOR = 0.47 (95%CI 0.252, 0.878), Nevirapine containing ART regimen AOR = 3.07 (95%CI 1.677, 5.63), Baseline CD4 count ≥100 cells/mm3 AOR = 0.299 (95%CI 0.152 0.591), absence of opportunistic infections after ART initiation AOR = 0.257 (95%CI 0.142, .467), time taking greater than an one-hour to reach health facility AOR 1.85 (95%CI 1.022 3.367) were significantly associated with first-line ART treatment failure. Conclusion The magnitude of first-line ART treatment failure was high in the study area. Base-line opportunistic infection, duration on first-line ART, NVP based ART, Baseline CD4 count level, OI after ART initiation, and time it takes to reach health facility were independent determinants of first-line ART treatment failure.

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Section: Discussionsupporting

confidence: 81%

Magnitude of first line antiretroviral therapy treatment failure and associated factors among adult patients on ART in South West Shoa, Central Ethiopia

et al. 2020

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“…The association between adherence and treatment failure was based on six cross-sectional studies [ 14 , 35 , 37 , 40 , 42 , 47 ]. The results as presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

et al. 2020

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Background Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings. Methods We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, case-control, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and socio-demographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest. Results Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting. Conclusion This review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: 2019 CRD42019136538.

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“…This is line with a study conducted in south Africa and Northwestern Tanzania which shows poor adherence was a strong predictor of second-line ART failure. 12,19 In Rwanda and Kenya, patients who were on second line ART with good adherence to ART were also significantly associated with viral suppression. 20,21 It is evident that individuals missing more than three doses from BID dose or more than one dose from daily dose of ART per month are associated with an increased risk of virological failure, leading to reduced immunity.…”

Section: Discussionmentioning

confidence: 99%

“…11 A higher rate of virological failure of 17.7% was reported in India among patients who were on second line ART beyond 1 year and a much higher rate of virological failure of 37% was also recently reported from Myanmar Asia among patients who were on second line ART. 12 In a resource limited setting the rates of second-line failure have been demonstrated to be as high as 38% by 36 months. 13 The three 90 treatment target sets the goal by 2020: 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status accessing treatment, and 90% of people on treatment having suppressed viral loads.…”

Section: Introductionmentioning

confidence: 99%

<p>Determinants of Virologic Failure Among Adults on Second Line Antiretroviral Therapy in Wollo, Amhara Regional State, Northeast Ethiopia</p>

Seid¹,

Cherie²,

Kotb³

2020

HIV

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Background Treatment failure among the population on second line antiretroviral therapy is a major public health threat. In Ethiopia there has been limited research done on second line treatment failure. Objective To identify determinants of virologic failure among adults on second line antiretroviral therapy in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Methods An institution-based unmatched case–control study was conducted from February 1, 2020 to April 30, 2020 on a total of 377 clients in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Clients whose viral load result >1,000 copies/mL in two consecutive results at least 3 month apart were cases, while ≤1,000 copies/mL were controls. The sample size was calculated by using Epi-Info version 7. Cases (94) and controls (283) were selected using a simple random sampling method in a ratio of cases-to-controls of 1:3. The model fitted and binary logistic assumptions were fulfilled with 95% confidence level and P -values<0.05 were taken as statistically significant. Results Virologic failure was predicted by poor adherence (AOR=6.060, 95% CI=2.837–12.944), not disclosing their HIV status (AOR=4.178, 95% CI=1.431–12.198), OI (AOR=4.11, 95% CI=1.827–9.246), CD4 count <100 cells/mm 3 (AOR=3.497, 95% CI=1.233–9.923) and 100–350 cells/mm 3 (AOR=5.442, 95% CI=2.191–13.513), low BMI <16 kg/m 2 (AOR=7.223, 95% CI=2.218–23.520), and young age 15–29 years (AOR=2.898, 95% CI=1.171–7.170). Conclusion and Recommendations Determinants of second line ART virologic failure were patients who had poor adherence to ART, not disclosed, opportunistic infection, low CD4 counts <350 cell/mm 3 , low BMI (<16 kg/m 2 ), and young age 15–29 year patients. Social support, disclosing their HIV status, and getting early treatment for any opportunistic infection is crucial to patients.

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Magnitude and correlates of virological failure among adult HIV patients receiving PI based second line ART regimens in north western Tanzania; a case control study

Cited by 20 publications

References 33 publications

Magnitude of first line antiretroviral therapy treatment failure and associated factors among adult patients on ART in South West Shoa, Central Ethiopia

Magnitude of first line antiretroviral therapy treatment failure and associated factors among adult patients on ART in South West Shoa, Central Ethiopia

Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

<p>Determinants of Virologic Failure Among Adults on Second Line Antiretroviral Therapy in Wollo, Amhara Regional State, Northeast Ethiopia</p>

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