Incidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study

Pendahuluan. Pada negara dengan keterbatasan sumber daya, pengukuran viral load (VL) sebagai prediktor efektivitas terapi antiretroviral (ARV) tidak selalu mudah untuk diakses oleh pasien HIV yang mendapat terapi ARV. Pada penelitian-penelitian sebelumnya, kepatuhan berobat (adherens) diketahui merupakan faktor penting terhadap supresi VL HIV. Penelitian ini bertujuan untuk mengetahui faktor prediktor kegagalan virologis pada pasien HIV yang mendapat terapi ARV lini pertama sesuai paduan ARV terbaru dengan kepatuhan berobat yang baik di Indonesia.Metode. Studi kohort retrospektif dilakukan pada pasien HIV rawat jalan dewasa di Rumah Sakit dr. Cipto Mangunkusumo (RSCM), Jakarta yang memulai terapi ARV lini pertama selama periode Januari 2011-Juni 2014. Pasien HIV dengan kepatuhan berobat baik yang mempunyai data VL 6-9 bulan setelah mulai terapi ARV dimasukkan sebagai subjek penelitian. Kegagalan virologis dinyatakan sebagai nilai VL ≥400 kopi/mL setelah minimal 6 bulan terapi ARV dengan kepatuhan berobat baik. Usia awal terapi ARV, faktor risiko penularan HIV, stadium klinis HIV menurut World Health Organization (WHO), koinfeksi HIV-TB, jumlah CD4 awal terapi, peningkatan jumlah CD4, kadar hemoglobin dan indeks massa tubuh awal terapi, perubahan berat badan selama terapi, dan basis paduan terapi ARV merupakan variabel yang diteliti pada penelitian ini. Hasil. Terdapat 197 pasien sebagai subjek penelitian ini. Kegagalan virologis ditemukan pada 21 pasien (10,7%). Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi merupakan prediktor kegagalan virologis (p = 0,003; OR 5,802, 95% CI= 1,842-18,270). Terdapat peningkatan risiko kegagalan virologis pada pasien dengan terapi ARV berbasis NVP pada saat VL diperiksa, namun tidak bermakna secara statistik (p = 0,060; OR 2,756; 95% CI= 0,958-7,924). Simpulan. Peningkatan CD4 <50 sel/mm3 setelah minimal 6 bulan terapi dapat memprediksi kegagalan virologis pada pasien yang mendapat terapi ARV lini pertama dengan kepatuhan berobat yang baik. Kata Kunci: kegagalan virologis, terapi ARV lini pertama, viral load Predictors of Virological Failure in HIV Patients Receiving First Line Antiretroviral Therapy with Good AdherenceIntroduction. Antiretroviral therapy (ART) effectively suppress HIV replication. Viral load (VL) measurement is better predictor than clinical or immunological criteria to evaluate success or failure of ART. However, in country with limited resources, viral load measurement is not easily accessible by HIV patients receiving ART. Therefore, it is necessary to know which factors that can predict virological failure. In previous studies, adherence was an important factor for suppression of HIV viral load. This study is aimed to know predictors of virological failure in HIV patients receiving recent first line ART regimen with good adherence in Indonesia. Methods. A retrospective cohort study was conducted among adult HIV patients in Out-patient Clinic of Cipto Mangunkusumo Hospital that started ART during periode of January 2011-June 2014. HIV patients with good adherence that had viral load data 6-9 months after initiation of ART were included in this study. Virological failure was defined as viral load ≥ 400 copies/mL after minimum of 6 months therapy with good adherence. Age at starting ART, risk factor for HIV infection, HIV clinical stage, HIV-TB co-infection, baseline CD4 value, CD4 count increase, baseline hemoglobin level and body mass index, weight changes during therapy, and ART based regimen were analyzed in this study. Results. A total of 197 patients were included in this study. Virological failure was found in 21 patients (10,7%). CD4 increase <50 cell/mm3 after minimum 6 months of ART was predictor of virological failure (p = 0,003; OR 5,802, 95%CI 1,842-18,270). Conclusion. CD4 increase <50 cell/mm3 after minimum 6 months therapy can predict virological failure in HIV patients receiving first line ART with good adherence.

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Prognosis of HIV Patients Receiving Antiretroviral Therapy According to CD4 Counts: A Long-term Follow-up study in Yunnan, China

Scientific Reports ◽

10.1038/s41598-017-10105-7 ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 4

Author(s):

Li Ren ◽

Juan Li ◽

Shiyi Zhou ◽

Xueshan Xia ◽

Zhenrong Xie ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Hiv Patients ◽

Cd4 Counts ◽

Follow Up Study ◽

Long Term Follow Up

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Effect of Tuberculosis Co infection on Virological Failure in HIV Patients on First Line of Highly Active Antiretroviral Therapy

International Journal of Current Microbiology and Applied Sciences ◽

10.20546/ijcmas.2017.601.010 ◽

2017 ◽

Vol 6 (1) ◽

pp. 78-81

Author(s):

M. Rajian ◽

P.S. Gill ◽

U. Chaudhary

Keyword(s):

Antiretroviral Therapy ◽

Virological Failure ◽

Highly Active Antiretroviral Therapy ◽

First Line ◽

Hiv Patients ◽

Highly Active

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Predictors of Anemia Among Adult HIV Positive Patients on First-Line Antiretroviral Therapy in Northwest Ethiopia: A Retrospective Follow-Up Study

HIV/AIDS - Research and Palliative Care ◽

10.2147/hiv.s280338 ◽

2021 ◽

Vol Volume 13 ◽

pp. 455-466

Author(s):

Chilot Desta Agegnehu ◽

Mehari Woldemariam Merid ◽

Melaku Kindie Yenit

Keyword(s):

Antiretroviral Therapy ◽

Northwest Ethiopia ◽

Hiv Positive ◽

First Line ◽

Follow Up Study

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Prevalence of virological failure amongst WHO- defined immunological failure HIV patients on first line of highly active antiretroviral therapy in a tertiary care hospital in Haryana, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20161236 ◽

2016 ◽

pp. 1613-1619 ◽

Cited By ~ 1

Author(s):

Manisha Rajian ◽

Paramjeet Gill ◽

Uma Chaudhary

Keyword(s):

Antiretroviral Therapy ◽

Virological Failure ◽

Highly Active Antiretroviral Therapy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

First Line ◽

Hiv Patients ◽

Immunological Failure ◽

Highly Active

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Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

AIDS Research and Therapy ◽

10.1186/s12981-021-00336-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anita Mesic ◽

Alexander Spina ◽

Htay Thet Mar ◽

Phone Thit ◽

Tom Decroo ◽

...

Keyword(s):

Viral Load ◽

Virological Failure ◽

Antiretroviral Treatment ◽

People Living With Hiv ◽

First Line ◽

Hiv Viral Load ◽

Loss To Follow Up ◽

History Of ◽

Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

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1036. Persistence of Guideline-Recommended Antiretroviral Therapy Regimens among Persons Living with HIV Newly Initiating Treatment in the US

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1222 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S548-S549

Author(s):

Joshua P Cohen ◽

Xingzhi Wang ◽

Rolin L Wade ◽

Helena Diaz Cuervo ◽

Dionne M Dionne

Keyword(s):

Antiretroviral Therapy ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Treatment Discontinuation ◽

Forest Plot ◽

Current Guideline ◽

First Line ◽

Persons Living With Hiv ◽

Living With Hiv

Abstract Background Discontinuation of first-line antiretroviral therapy (ART) may lead to poor outcomes for persons living with HIV (PLWH). While single-tablet regimens (STRs) have been associated with greater persistence compared to multi-tablet regimens (MTRs), few real-world studies have assessed persistence with current guideline-recommended ART regimens. The study aims to assess persistence among treatment-naïve PLWH initiating guideline-recommended ART regimens Methods Longitudinal pharmacy claims were extracted from IQVIA’s US LRx database for PLWH initiating ART between Jan 1, 2016 - Jul 31, 2019 (index period), with the observational period up to Jan 31, 2020. Index date was defined as the date of the first ART claim for STRs, or the date of the last filled drug of 1st set of claims for MTRs. Persistence was measured as the number of days until treatment discontinuation (≥ 90-day gap in therapy) and presented via Kaplan-Meier curves. Risk of discontinuation was assessed via Cox proportional hazards models, with BIC/FTC/TAF used as the reference ART regimen. Results Overall, 90,949 PLWH initiated STRs and 20,737 initiated MTRs. Average (SD) age was 43 (14) years, 75% were male, and 75% had commercial insurance. At 6 months of follow-up, 71% of PLWH initiating STRs and 56% initiating MTRs remained on their ART regimen. The proportion remaining on their index regimen at 6 months of follow-up was 79% for BIC/FTC/TAF, 73% for EVG/COBI/FTC/TAF, 71% for DTG/ABC/3TC, 69% for DTG + FTC/TAF, 67% for EFV/FTC/TDF, 62% for EVG/COBI/FTC/TDF, and 38% for DTG + FTC/TDF. Risk of discontinuation was higher for MTRs compared to STRs (hazard ratio [HR]: 1.63, 95% CI: 1.61 - 1.66). Compared to the referent BIC/FTC/TAF, risk of discontinuation was higher for EVG/COBI/FTC/TAF (HR: 1.54, 95% CI: 1.48 - 1.60), DTG/ABC/3TC (HR: 1.58, 95% CI: 1.52, 1.65), DTG + FTC/TAF (HR: 1.83, 95% CI: 1.74 - 1.93), EFV/FTC/TDF (HR: 2.31, 95% CI: 2.21 - 2.41), EVG/COBI/FTC/TDF (HR: 2.58, 95% CI: 2.47 - 2.70), and DTG + FTC/TDF (HR: 6.20, 95% CI: 5.83 - 6.59). Table 1. Persistence with ART by regimen for STR and MTR Figure 1. Forest Plot of Hazard Ratios for Treatment Discontinuation Conclusion Among US adult PLWH, STRs were associated with longer persistence on first-line therapy compared to MTRs. Among STRs, persistence was highest for BIC/FTC/TAF. Disclosures All Authors: No reported disclosures

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Determinants of virological failure among adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia: a case–control study

BMJ Open ◽

10.1136/bmjopen-2019-036223 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036223

Author(s):

Habtamu Mengist Meshesha ◽

Zelalem Mehari Nigussie ◽

Anemaw Asrat ◽

Kebadnew Mulatu

Keyword(s):

Public Health ◽

Antiretroviral Therapy ◽

Virological Failure ◽

Highly Active Antiretroviral Therapy ◽

Case Control Study ◽

Case Control ◽

First Line ◽

Highly Active ◽

Northeast Ethiopia ◽

Control Study

ObjectiveTo identify determinants of virological failure among HIV-infected adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia, in 2019.MethodsAn unmatched case–control study was conducted from April to May 2019. About 130 cases and 259 controls were selected by simple random sampling. Data were extracted from charts of patients using a structured checklist. Multiple logistic regression analysis was performed to identify possible factors. Hosmer-Lemeshow goodness of fit test was used to check the model. Finally, independent predictor variables of virological failure were identified based on adjusted OR (AOR) with 95% CI and a p value of 0.05.ResultsThe odds of virological failure were 2.4-fold (AOR=2.44, 95% CI 1.353 to 4.411) higher in clients aged <35 years compared with older clients, fivefold (AOR=5.00, 95% CI 2.60 to 9.63) higher in clients who did not disclose their HIV status, threefold (AOR=2.99, 95% CI 1.33 to 6.73) higher in clients with poor adherence, and 7.5-fold (AOR=7.51, 95% CI 3.98 to 14.14) higher in clients who had recent CD4 count of ≤250 cells/mm3.Conclusion and recommendationThis study revealed that age, marital status, occupation, disclosure status, baseline functional status, missed clinic visit, current antiretroviral therapy regimen, adherence to treatment and recent CD4 count were significantly associated with virological failure. Therefore, adherence support should be strengthened among clients. Missed clinic visits should also be reduced, as it could help clients better adhere to treatment, and therefore boost their immunity and suppress viral replication.

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