Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study

Abstract

BackgroundThe number of patients using second-line antiretroviral therapy (ART) has increased over time. In Ethiopia, 1.5% of HIV infected patients on ART are using a second-line regimen and little is known about its effect in this setting.ObjectiveTo estimate the rate and predictors of treatment failure on second-line ART among adults living with HIV in northwest Ethiopia.SettingAn institution-based retrospective follow-up study was conducted at three tertiary hospitals in northwest Ethiopia from March to May 2015.Participants356 adult patients participated and 198 (55.6%) were males. Individuals who were on second-line ART for at least 6 months of treatment were included and the data were collected by reviewing their records.Primary outcome measureThe primary outcome was treatment failure defined as immunological failure, clinical failure, death, or lost to follow-up. To assess our outcome, we used the definitions of the WHO 2010 guideline.ResultThe mean±SD age of participants at switch was 36±8.9 years. The incidence rate of failure was 61.7/1000 person years. The probability of failure at the end of 12 and 24 months were 5.6% and 13.6%, respectively. Out of 67 total failures, 42 (62.7%) occurred in the first 2 years. The significant predictors of failure were found to be: WHO clinical stage IV at switch (adjusted HR (AHR) 2.1, 95% CI 1.1 to 4.1); CD4 count <100 cells/mm3 at switch (AHR 2.0, 95% CI 1.2 to 3.5); and weight change (AHR 0.92, 95% CI 0.88 to 0.95).ConclusionsThe rate of treatment failure was highest during the first 2 years of treatment. WHO clinical stage, CD4 count at switch, and change in weight were found to be predictors of treatment failure.

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

“…This is in agreement with other studies conducted in developing countries that have shown that male HIV patients are more likely to present to HIV care facilities with advanced disease as compared to their female counterparts [23,24]. Moreover, studies conducted in Ethiopia and South Africa have cited advanced HIV/AIDS as a critical predictor for failure on secondline ART [25,26]. Furthermore, research has shown that males are more prone to virological failure while on second-line ART than females [27,28], attributable to poor adherence and higher odds of alcohol consumption while on ART [29,30].…”

HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis

“…Report from one study showed that lower baseline body mass index (BMI) (AOR = 2.8; 95% CI: 1.01-7.5) [28] and patients who had height for age in the third percentile or less (AHR = 3.3; 95% CI: 1.0-10.6) [22] were more likely to expose to HIV treatment failure. On the other hand, weight change per 1 kg increase (AHR = 0.9, 95% CI: 0.9-0.9) [17], and < 50 kg weight at baseline (AHR = 0.58, 95% CI:0.38-0.89) [13] were less likely to expose to HIV treatment failure.…”

“…A higher viral load may lead to HIV treatment failure, which is becoming a threat of different African countries, like in Burkina Faso (6.4%) [10], Ghana (15.7%) [11], and Tanzania (14.9%) [12]. In Ethiopia, virological, immunological, and clinical failure is found in the range between 1.3% [13] to 11.5% [14], 2.1% [15] to 21% [16], and 3.1% [17] to 12.3% [18], respectively.…”

Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia

“…A higher viral load may leads to HIV treatment failure, which is becoming a threat of different African countries, like in Burkina Faso (6.4%) (12), Ghana (15.7%) (13), and Tanzania (14.9%) (14). In Ethiopia, virological, immunological, and clinical failure found to be in the range between 1.3% (15) to 11.5% (16), 2.1% (17) to 21% (18), and 3.1% (19) to 12.3% (20) respectively.…”