Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy�evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011

Abstract

IntroductionWe investigated factors affecting Virological failure (VF) on first line Antiretroviral Therapy (ART) and evaluated a pragmatic approach to switching to second line ART.MethodsBetween 2004 and 2011, we assessed adults taking ART. After 6 months or more on ART, participants with VL >1000 copies/ml or two successive VL > 400 copies/ml (Conventional VF) received intensified adherence counselling and continued on first-line ART for 6 more months, after which participants who still had VL > 1000 copies/ml (Pragmatic VF) were switched to second line ART. VF rates were calculated and predictors of failure were found by fitting logistic regression and Cox proportional hazards models.ResultsThe 316 participants accrued 1036 person years at risk (pyar), 84 (26.6%) had conventional VF (rate 8.6 per 100 pyar) of whom 28 (33.3%) had pragmatic VF (rate 2.7 per 100 pyar). Independent predictors of conventional VF were; alcohol consumption, (adjusted Hazard Ratio; aHR = 1.71, 95% CI 1.05-2.79, P = 0.03) and ART adherence: per 10% decrease in proportion of adherent visits, (aHR = 1.83, 95% CI 1.50-2.23; P < 0.001). Using reference age group < 30 years, among conventional failures, the adjusted odds ratio (aOR) of pragmatic failure for age group 30-39 years were 0.12, 95% CI 0.03-0.57, P = 0.02 and for age group > 40 years were 0.14, 95%CI 0.03-0.71, P = 0.02. Alcohol consumers had a threefold odds of pragmatic failure than non-alcohol consumers (aOR = 3.14, 95%CI 0.95-10.34, P = 0.06).ConclusionA pragmatic VF approach is essential to guide switching to second line ART. Patient tailored ART adherence counselling among young patients and alcohol users is recommended.

Incidence and Predictors of First Line Anti-Retroviral Therapy Failure among Adults Receiving HIV Care in North West Ethiopia: A Hospital-Based Follow-Up Study

“…Low baseline BMI was found to be predictor of treatment failure, congruent with Studies in other African countries [4,9,15]. Treatment failure in those with low nutritional status might be related to weakened immunity and blunted immune response.…”

“…As in studies in South Africa and Uganda, treatment failure significantly occurred in those with WHO clinical stage 3 and 4 [8,9]. Advanced HIV disease often associated with high viral load and low CD 4 + count.…”

“…This finding was consistent with studies conducted in Ethiopia (AHR (95% CI: 1.86-19.80) = 5.68)), Kenya (AHR (95% CI: 2.20-3.49) = 2.77)) South Africa (AHR (95% CI: 2.13-2.91) = 2.49)) and Uganda (AHR (95% CI: 2.3-11.05) = 5.05)) [7][8][9]12,15]. In fact adherence issue is the pillar for ART users.…”

“…African studies reported incidence of ART failure ranged from 0.96-5.88 per 100 person-year of observation (PYO) [3][4][5]. Documented predictors of treatment failure in Africa include, but not restricted to, younger or older age, male gender, low educational status, high pretreatment viral load, low pretreatment CD 4 count, low base line BMI, advanced HIV disease (WHO clinical stage 3 and 4), presence of opportunistic infections, TB co-infection, type of ART regimen, ART drug toxicities, drug-drug interactions, and inadequate ART adherence [3][4][5][6][7][8][9].…”

Time to viral load suppression and its associated factors in cohort of patients taking antiretroviral treatment in East Shewa Zone, Oromiya, Ethiopia, 2018

“…Plasma viral load suppression was classified as <1,000 copies/ml as suppressed and plasma viral load of >1,000 copies/ml was classified as an unsuppressed plasma viral load. Viral load (HIV-RNA copies/ml of blood plasma) as a surrogate marker for disease progression was first developed enrolling male patients and is currently considered highly predictive of the clinical course of infection [8]. The main objective of this study was to determine the time to virological suppression and its associated factors among people living with HIV taking antiretroviral treatments in East Shewa zone, Oromiya, Ethiopia, 2018.…”