Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy

Singini, Isaac; Campbell, Thomas; Smeaton, Laura; Kumarasamy, Nagalingeswaran; Rosa, Alberto La; Taejareonkul, Sineenart; Safren, Steven A.; Flanigan, Timothy P.; Hakim, James; Hughes, Michael D.; team, Pearls study

doi:10.1080/15284336.2016.1201300

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…Plasma HIV-1 RNA is not available for routine viral load monitoring in resource-limited countries such as Ethiopia. 18 Hence, WHO 32 and several other studies 10 11 33 recommended immunological success as a surrogate marker for the virological suppression. In the current study, 19.7% of patients had IF; said in another way, 80.3% of patients had immunological success.…”

Section: Discussionmentioning

confidence: 99%

“…Immunological failure (IF) was considered as a surrogate marker for virological failure. 10 11 Thus, IF vividly influences the performance of a virological suppression goal of the UNAIDS (Joint United Nations Programme on HIV and AIDS) 90-90-90 targets 12 that aimed at achieving 90% of the virological success of patients on ART. Research has reported an IF magnitude of 23%–33.1% in Europe, 13 9%–18% in Asia 14 15 and 11%–39% in Africa.…”

Section: Introductionmentioning

confidence: 99%

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Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study

et al. 2018

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ObjectiveTo assess the prevalence, trend and associated factors for immunological failure (IF), and the magnitude of antiretroviral therapy (ART) shift among adults infected with HIV in Southwest Ethiopia.SettingA retrospective cohort study was undertaken using the data from ART clinic at Jimma University Teaching Hospital from 21 June 2003 to 15 March 2015.ParticipantsRetrospective analysis of 4900 HIV-infected adult patient records dating from June 2003 to March 2015 was conducted.Primary outcome measureThe primary outcome was IF defined when cluster for differentiation 4 (CD4) count falls to the baseline (or below) or persistent CD4 levels below 100 cells/mm3 after 6 months of ART treatment. The analyses included descriptive and inferential statistics.Results546 (19.5%) adults had developed clinical failure (CF), 775 (19.7%) adults had developed IF and 1231 (25.1%) had developed either CF or IF or both. The prevalence of IF was consistently high throughout the decade. Age 25 to ≤50 years adjusted OR (AOR 1.5, 9% CI 1.2 to 2.4), being female (AOR 1.8, 95% CI 1.3 to 1.9), late presenter for HIV care (AOR 2.2, 95% CI 1.6 to 2.7) and having baseline CD4 count below 200 cells/mm3 (AOR 5.5, 95% CI 4.1 to 7.4), and having no history of HIV testing before diagnosis (AOR 0.7, 95% CI 0.5 to 0.9) were the predictors for IF. Only 29 (0.9%) adults infected with HIV were shifted to second-line ART regimen.ConclusionsThe magnitude of CF or IF or both was found significant and consistently high throughout the calendar year although ART shift was found minimal. HIV-infected adult patients with IF were early age adults, females, late presenters for HIV care, and those who had low baseline CD4 counts and history of HIV testing before diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study

et al. 2018

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“…In Ethiopia the increased coverage of free cART program has enrolled hundreds of thousands of patients, with an overall cART coverage reaching 73% [3]. Improved factors like medication coverage, baseline CD4 count, and medication adherence over time have been linked to successful virological suppression [4, 5]. With all these documented progresses, treatment of HIV faces many challenges, out of these; treatment failure is a major concern.…”

Section: Introductionmentioning

confidence: 99%

Predictors of treatment failure, time to switch and reasons for switching to second line antiretroviral therapy in HIV infected children receiving first line anti-retroviral therapy at a Tertiary Care Hospital in Ethiopia

Haile

Berha

2019

BMC Pediatr

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BackgroundTreatment failure and delay in switching to second line regimen are major concerns in the treatment of HIV infected children in a resource limited setting. The aim of this study was to determine the prevalence and predictors of first line antiretroviral therapy (ART) regimen failure, reasons and time taken to switch to second line antiretroviral (ARV) medications after treatment failure among HIV-infected children.MethodsA retrospective cohort study was conducted February 2003 to May 2018 in HIV-clinic at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. All HIV infected children ≤15 years of age and who were taking first line ART for at least 6 months were included. Data abstraction format was used to collect the data from patients’ chart and registry. Binary and multivariable logistic regression statistics were used.ResultsOut of 318 enrolled HIV-infected children, the prevalence of treatment failure was found to be 22.6% (72/318), among these 37 (51.4%) had only immunologic failure, 6 (8.3%) had only virologic failure and 24 (33.3%) had both clinical and immunological failure. The mean time taken to modify combination antiretroviral therapy (cART) regimen was 12.67 (4.96) weeks after treatment failure was confirmed. WHO Stage 3 and 4 [Adjusted Odds Ratio (AOR), 3.64, 95% CI 1.76–7.56], not having both parents as primary caretakers [AOR, 2.72 95% CI, 1.05–7.06], negative serology of care takers [AOR, 2.69 95% CI, 1.03–7.03], and cART initiation at 11 month or younger were predicting factors of treatment failure. Of the 141 (47.9%) children who had regimen switching or substitution, treatment failure (44.4%) and replacement of stavudine (d4T) (30.8%) were major reasons. Only 6.6% patients had received PMTCT service.ConclusionOne fifth of the patients had experienced treatment failure. Advanced WHO stage at baseline, not being taken care of by mother and father, negative sero-status caretakers, and younger age at initiation of cART were the predictors of treatment failure. PMTCT service uptake was very low. There was a significant time gap between detection of treatment failure and initiation of second line cART. Half of the patients encountered regimen switching or substitution of cART due to treatment failure and replacement of stavudine (d4T).

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“…In sub-Saharan Africa, virological failure has reportedly ranged from 9% to 24% of PLWH on ART, whether recently initiated or after prolonged use [3][4][5][6][7][8]. While the World Health Organization (WHO) and most endemic countries have drafted guidelines for the management of virological failure, poor management of virological failure persists in many contexts [9][10][11]. Moreover, those with persistent failure are known to suffer poor outcomes and higher rates of mortality [12].…”

Section: Introductionmentioning

confidence: 99%

Who’s slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first‐line HIV treatment in Uganda and South Africa

et al. 2021

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Objectives: HIV virological failure remains a major threat to programme success in sub-Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood.The objective of this paper is to identify those characteristics among people failing first-line antiretroviral therapy (ART). Methods:We enrolled a cohort of adults in HIV care experiencing virological failure on first-line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. Results: Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49-56%] stated that they had > 90% adherence and 75% (95% CI 72-77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86-92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months.Conclusions: Patients failing first-line ART in sub-Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug

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Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy

Cited by 5 publications

References 17 publications

Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study

Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study

Predictors of treatment failure, time to switch and reasons for switching to second line antiretroviral therapy in HIV infected children receiving first line anti-retroviral therapy at a Tertiary Care Hospital in Ethiopia

Who’s slipping through the cracks? A comprehensive individual, clinical and health system characterization of people with virological failure on first‐line HIV treatment in Uganda and South Africa

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