Factors associated with first-line antiretroviral treatment failure in adult HIV-positive patients: a case-control study from Ethiopia

Abstract Background Information on treatment failure (TF) in People living with HIV in data-poor jurisdictions is necessary to counter the rapidly escalating epidemic of TF to first-line combined anti-retroviral therapies (cART) in sub-Saharan Africa (SSA). In this study, we examined the risk factors associated with TF in Asmara, Eritrea.Methods: A multicenter, retrospective 1:2 matched (by age and gender) case-control study was conducted in four major hospitals in Asmara, Eritrea on adults aged >15 years who were on treatment for at least 6 months. Cases were patients with viral load ≥1000 copies/mL anytime between 2019-2021 and/or patients switched to second line cART. Controls were randomly selected from patients on first-line ART with viral load < 1000 copies/mL. Data was extracted using a checklist from the master data set and analyzed using SPSS version 26. Multivariable logistic regression analysis was conducted to identify risk factors for TF. All p-values were 2-sided and the level of significance was set at p < 0.05 for all analyses.Results: Of the 1068 participants, 585 (54.7%) were females. The median age at treatment initiation was 46 years (interquartile range (IQR): 39–51). Median time to combined antiretroviral therapy (cART) failure was 37 months (IQR =24–47). In multivariate analysis factors associated with increased likelihood of virologic failure (VF) were the type of initially used nucleoside reverse transcriptase inhibitors (NRTI) backbone ( (Zidovudine+Lamivudine (AZT+3TC): adjusted odds ratio (aOR): 2.70; 95% Confidence interval (CI): 1.65-4.41, p-value<0.001), (Abacavir+lamivudine (ABC+3TC): aOR: 4.73; 95%CI: 1.18-18.92, p-value=0.028), and (Stavudine+Lamivudine (D4T+3TC): aOR: 5.00; 95% CI: 3.03-8.20, p-value<0.001), prior exposure to ART (aOR: 2.28; 95%CI:1.35–3.86; p=0.002), record of sub-optimal drug adherence (aOR: 3.08; 95%CI: 2.22–4.28; p<0.001), ambulatory/bedridden at presentation (aOR:1.61; 95%CI: 1.12-4.28; p-value=0.010), presence of comorbidities (aOR: 2.37; 95%CI: 1.36-4.10, p-value=0.002), duration of cART (<5 years: aOR: 5.90; 95% CI: 3.95-8.73, p-value<0.001), and use of SMX-TMP prophylaxis ( aOR : 2.00, 95%CI, 1.44-2.78, p-value<0.001). Conclusion: Our findings underscore the importance of optimizing cART adherence, diversification of cART regimens, and interventions directed at enhancing early HIV diagnosis, prompt initiations of treatment and improved patient focused monitoring of treatment response.

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Determinants of first line antiretroviral therapy treatment failure among adult patients on ART at central Ethiopia: un-matched case control study

BMC Infectious Diseases ◽

10.1186/s12879-019-4651-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Diriba Mulisa ◽

Mulugeta Tesfa ◽

Getachew Mullu Kassa ◽

Tadesse Tolossa

Keyword(s):

Logistic Regression ◽

Treatment Failure ◽

Case Control Study ◽

Case Control ◽

First Line ◽

Matched Case ◽

Lost To Follow Up ◽

Matched Case Control Study ◽

Control Study

Abstract Background In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. Methods A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. Result A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. Conclusion Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.

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Predictive Markers of First Line Failure of Anti-Retroviral Therapy in HIV Positive Patients in Pakistan

10.53350/pjmhs2115123238 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3238-3240

Author(s):

M. Waqar Aslam ◽

A. Ashar Ghuman ◽

Saveela Sadaqat ◽

Saif Ullah ◽

M. Akram ◽

...

Keyword(s):

Case Control Study ◽

Case Control ◽

Hiv Treatment ◽

Predictive Markers ◽

Cd4 Count ◽

Hiv Positive ◽

First Line ◽

Retrospective Case ◽

Treatment Centre ◽

Control Study

Background: HIV treatment centres register HIV positive patients, specially trained doctors prescribe Antiretroviral Therapy to the selected cases that fulfill the criteria for initiation of HAART. Aim: To establish predictive markers of failure of 1st line ART in HIV positive patients on first line ART under treatment in HIV Treatment Centre of PIMS Islamabad. Study design: Retrospective case control study. Methodology: Retrospective case control study done at HIV Treatment Centre at PIMS Islamabad. Cases were patients who failed 1st line ART and started on second line ART from November 2005 to June 2020. Patients responding well to first line ART since more than five years or more were taken as controls. Various factors were analyzed in both groups and compared to find their level of significance. Data was analyzed by SPSS software, version 25 as qualitative variables were expressed as frequencies and percentages. Results: CD4 count of all 38 patients was below 300 on diagnosis. In 21 patients (55.3%) CD4 count initially increased but there was no rise in CD4 count in 17 patients (44.7%) after start of 1st line ART. Conclusion: We concluded that CD4 count is one of the most important predictive markers in success or failure of ART. Rising number of CD4 count on follow up visits gives a strong indication that patient is responding well to the prescribed treatment and is likely to benefit from the current regimen of ARVs for a longer period in future. Keywords: Predictive Markers, CD4 count, Viral Load, HIV, ART, Compliance and Co-morbidities

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Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

Systematic Reviews ◽

10.1186/s13643-020-01524-1 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Yishak Lailulo ◽

Marcel Kitenge ◽

Shahista Jaffer ◽

Omololu Aluko ◽

Peter Suwirakwenda Nyasulu

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Antiretroviral Treatment ◽

Poor Adherence ◽

Hiv Positive ◽

Strength Of Evidence ◽

Factors Associated ◽

Resource Poor ◽

Living With Hiv ◽

Antiretroviral Treatment Failure

Abstract Background Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings. Methods We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, case-control, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and socio-demographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest. Results Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting. Conclusion This review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number: 2019 CRD42019136538.

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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

10.21203/rs.2.11281/v1 ◽

2019 ◽

Author(s):

Amrachu Bekele Asfaw ◽

Aderajew Nigusie Tekelehaimanot ◽

Tamirat Shewanew ◽

Esayas Kebede Gudina ◽

Masrie Getnet ◽

...

Keyword(s):

Treatment Failure ◽

Treatment Adherence ◽

Case Control Study ◽

Case Control ◽

Public Hospitals ◽

Urban Resident ◽

First Line ◽

Southwest Ethiopia ◽

Poor Treatment ◽

Control Study

Abstract Background: Identifying determinant factors of antiretroviral therapy (ART) treatment failure are crucial to achieving 90-90-90 treatment target to help end AIDS epidemic by 2020. However, evidences on determinants of first line ART failure in Ethiopia are limited. Hence, the aim of this study was to assess determinants of first line ART failure among patients attending ART care in selected Public Hospitals Jimma, Southwest Ethiopia. Methods: A case control study was conducted in March 2018 on sample of 384(288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). All available cases were enrolled in the study whereas controls were selected using simple random sampling. Cases were HIV patients aged 15 years or older who were on first line ART regimen with documented treatment failure (virologic, immunologic or clinical). Controls were HIV patients aged 15 years or older who were on first line ART regimen but without evidence of therapeutic failure. Data was extracted from electronic database and supplemented by data collected through interviewer administered questionnaire. Bivariate and Multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence interval were used to report independently associated factors with the first line ART failure at P-value<0.05. Results: Median ages of cases and controls were 28 (IQR 25-32) and 27 (IQR23-33), respectively. Being urban resident (AOR:2.2; 95%CI: 1.1, 3.6), smoking (AOR:5.9; 95%CI:3.2, 10.8), Khat use (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherence (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 median duration on treatment of more than 73 months (AOR:1.9; 95% CI:1.2, 3.3) were independently associated with first line treatment failure. Conclusions: Multiple factors such as being urban resident, TB co-infection, poor treatment adherence, and zidovudine based regiment were independently associated with first line ART failure. Thus, strategies designed to curb the HIV pandemic should focus on these factors, among others, to achieve the ambitious target of ending AIDS pandemic by 2020 set by UNAIDS. Key words: determinants, first line ART failure, HIV/AIDS, Jimma Zone, Public hospitals

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