Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy

Patrikar, Seema; Shankar, Subramanian; Kotwal, Atul; Basannar, D.R.; Bhatti, V.K.; Verma, Rajesh; Mukherji, Sandip

doi:10.1016/j.mjafi.2016.09.008

Cited by 19 publications

(20 citation statements)

References 14 publications

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“…widower [21], poor adherence and treatment interruption [22][23][24][25], WHO clinical stage III and/or IV [24][25][26], low CD4 cell at ART initiation [6,19,26,27], presence of opportunistic infections [6,24,25], low BMI [6,28], taking ARV regimen before ART initiation [22,24], taking Stavudine and Zidovudine (AZT)…”

Section: Introductionmentioning

confidence: 99%

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Asfaw

Tekelehaimanot

Shewanew

et al. 2019

Preprint

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Background: Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. Methods: A case-control study was conducted in March 2018 on a sample of 384(288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. Results: In this study, higher odds of first-line ART failure was experinced among urban residents (AOR:2.2;95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). Conclusions: This study evidenced that being an urban resident, TB co-infection, poor treatment adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, enhanced adherence counseling should be provided for those urban residents as well as substance users to improve adherence to ART; early screening and management of tuberculosis is highly recommended. Moreover, close follow up of adverse effects of ARVs must be strengthened. Keywords : determinants, first-line ART failure, HIV/AIDS, Jimma Zone, Public hospitals

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Section: Introductionmentioning

confidence: 99%

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Asfaw

Tekelehaimanot

Shewanew

et al. 2019

Preprint

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“…Moreover, the rising number of patients on second-line ART presents limited options to providers of HIV/AIDS care, more so those in developing Africa whose health systems are still dependent on foreign aid to provide ART [10,11]. Beyond the high cost of second-line regimens, failure on rst-line ART has been mostly associated with poor adherence [12,13], which, if not addressed, means that patients initiated on second-line ART are also likely to fail on this regimen. Failure on second-line ART (having two subsequent viral counts of or greater than 1000 copies/ml, done at least 3-6 months apart) means that care providers have to switch such patients to third-line ART [9] which is associated with a higher pill burden and toxicities [14].…”

Section: Second-line Antiretroviral Therapymentioning

confidence: 99%

Predictors of Failure on Second-line Antiretroviral Therapy with Protease Inhibitor Mutations in Uganda

Musana

Ssensamba

Nakafeero

et al. 2020

Preprint

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Introduction Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations is on the rise. However, there is a paucity of information on the factors associated with this observation in the context of low-income countries. Knowledge of underlying factors is key if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with failure on second-line ART with PI mutations. Methods We conducted a matched case-control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14, and descriptive statistics comparing cases and controls were generated. Categorical variables were compared with the outcome, failure on second line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure was done. Results Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous Tuberculosis treatment. Males (aOR 2.64 CI: 1.0-4.64), type of second-line ART (aOR 3.92 CI: 1.15-13.38), and Tuberculosis treatment while on second-line ART (aOR7.08 CI: 2.35-21.29) highly predicted failure on second-line ART with PI mutations. Conclusion Males and patients concomitantly on Tuberculosis treatment while on second-line ART are at a higher risk of failing on second-line ART with PI mutations. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. More extensive explorative studies to ascertain underlying factors are recommended.

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“…In accordance to World Health Organization (WHO) recommendations, antiretroviral therapy (ART) should be initiated in all people living with HIV, regardless of WHO clinical stage and CD4 + T-cell count (Anonymous, 2016a). Unfortunately, failure is not a rare outcome of ART, which remains the subject of empirical studies (Boettiger et al, 2014;Patrikar et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…ART failure is associated with a variety of factors: poor adherence to medication, missed visits, a higher baseline viral load, a lower baseline CD4 + T-cell count, a low absolute neutrophil count, low BMI, and opportunistic infections (Lucas et al, 1999;Lundgren et al, 2002;Robbins et al, 2007;Patrikar et al, 2017). Treatment failure can be assessed through monitoring of viral load, CD4 + T-cell count, and a new or recurrent clinical event.…”

Section: Introductionmentioning

confidence: 99%

Human Leukocyte Antigens Class II Alleles Affecting the Response to 5–7 Year Antiretroviral Therapy in A Latvian Cohort

Jasinskis

Koļesova

Kolesovs

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Antiretroviral therapy (ART) aims at suppressing viral replication and strengthening immune system in patients with HIV-1. Human Leukocyte Antigens (HLA) are among factors responsible for effectiveness of ART. The aim of this study was to determine the effect of HLA Class II alleles on the response to long-time ART, assessed by a change in CD4+ T-cell count in relation to viral load. The sample included 69 patients (17 females and 52 males) aged 20 to 50 with HIV-1 infection, who were undergoing ART in the Latvian Centre of Infectious Diseases. The median period of observation was 5.7 years. CD4+ T-cell count and viral load were analysed at the baseline and end of the period of observation. HLA typing was performed by polymerase chain reaction with low resolution sequence specific primers. Multiple hierarchical linear regression analysis confirmed that an increase in HIV-1 viral load was associated with a decrease in the level of CD4+ T-cell count. In addition, HLA-DRB1*04 and HLA-DQB1*06:01 alleles contributed negatively to the level of CD4+ T-cell count.

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Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy

Abstract: Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.

Cited by 19 publications

References 14 publications

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in selected Public Hospitals Jimma, Southwest Ethiopia a Case Control Study

Predictors of Failure on Second-line Antiretroviral Therapy with Protease Inhibitor Mutations in Uganda

Human Leukocyte Antigens Class II Alleles Affecting the Response to 5–7 Year Antiretroviral Therapy in A Latvian Cohort

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