Magnitude of virologic failure and associated factors among adult patients on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2018

Abstract

Background : Viral load monitoring is used as an important marker for diagnosing early treatment failure in patients with HIV infection/AIDS. Ethiopia has started targeted viral load monitoring recently. However, factors leading to virological failure are not well understood. The aim of this study is to assess magnitude of virologic failure and associated factors among adult patient on ART at Debre Markos Referral Hospital, North West Ethiopia. Methods : Cross sectional study was conducted on 304 participants who had started first line HAAR. Data were collected from patients’ chart starting from ART commencement and face to face interview using semi structured questionnaire. Viral load from separated plasma were analyzed according to protocols. The collected data were analyzed using SPSS version 20. Binary and multiple logistic regression models were fitted to identify factors associated with virological failure among adult patient on ART and to control confounding effect. The results were presented as odds ratio (OR) with 95% confidence intervals. Independent associations were considered with p<0.05. Results: Magnitude of virological failure was 10.5%. Lower income, (AOR = 3.5, 95% CI = 1.2 - 10.5, P = 0.024), lack of social support (AOR = 2.9, 95% CI = 1.01 – 8.2, P = 0.024), Interruption of ART, (AOR = 3.5, 95% CI = 1.01 – 12.1, P = 0.046), drug adherence (AOR = 3.6, 95% CI = 1.1 – 11.3, P = 0.028), non-working functional status (AOR = 3.5, 95% CI = 1.2 – 9.7, P = 0.018), WHO stage III or IV (AOR = 2.9, 95% CI = 1.01 – 8.0, P = 0.040), CD4 count < 200 cells/ml (AOR = 3.0, 95% CI = 1.1 – 8.0, P = 0.031) and TB co-infection (AOR = 3.7, 95% CI = 1.2 – 11.3, P = 0.018) were significantly associated with virological failure. Conclusions and recommendations : The prevalence of virologic failure was high. Lower income, lack of social support, interruption of ART, drug non-adherence, baseline non-working functional status, WHO stage, CD4 count < 200 cells/ml and TB co-infection Conducting faith healing, TB co infection, WHO stage III and IV, adherence, and income were determinants of virologic failure. Therefore early identification of associated factors and monitoring of virologic failure has to be strengthened to benefit patients to prevent from further complication. Keywords : HIV, virological failure, ART, Ethiopia

Predictors of Virological Failure after Adherence-Enhancement Counseling among First-Line Adults Living with HIV/AIDS in Kombolcha Town, Northeast Ethiopia

“…Nonadherence to antiretroviral drugs in adult ART clients on adherence-enhancement counseling was a predictor of virological failure. This finding is similar to studies conducted at Gondar University Referral Hospital, 6 Debre Markos Referral Hospital, 17 and Dessie and Woldia referral hospitals, 18 Ethiopia and Zimbabwe, 19 where subjects who had good adherence were more likely to achieve viral load suppression. Survival studies conducted in southwestern Uganda showed that virological failure rates were significantly higher among participants who reported adherence <90% than those who reported good adherence >95%.…”

Determinants of first-line antiretroviral treatment failure among adult patients on treatment in Mettu Karl Specialized Hospital, South West Ethiopia; a case control study

“…Patients who had history of HIV-TB co-infection were around two times more likely to fail first-line antiretroviral treatment when compared to patients who had no history of TB co-infection. Similarly studies conducted in India in 2016 [32], Gutu District, Zimbabwe by 2017 [14], Debre Markos Referral Hospital, North West Ethiopia in 2018 [35], showed that HIV-TB co-infection was independent determinant factors of treatment failure among adult patients on ART. The occurrence of tuberculosis during antiretroviral treatment has multiple effects including pills burden and drug-drug interaction which may lead to first-line treatment failure [36].…”

The Influence of Age-Associated Comorbidities on Responses to Combination Antiretroviral Therapy Among People Living with HIV, at the ART Clinic of Jimma Medical Center, Ethiopia: A Hospital-Based Nested Case-Control Study

“…This is in line with the studies conducted in Ethiopia, Debre-Markos and Arba Minch. 42,43 Finally, the use of cotrimoxazole prophylaxis was significantly associated with virological failure. In this study, patients who did not receive cotrimoxazole prophylaxis were more than twice as likely to develop virological failure as compared to those who did cotrimoxazole prophylaxis.…”