Abstract
Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. A case-control study was conducted in March 2018 on a sample of 384 (288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. In this study, higher odds of first-line ART failure was experienced among urban residents (AOR:2.2; 95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (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 longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). This study evidenced that being an urban resident, TB co-infection, poor medication adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, the focus should be given assessment and management of medication compliance for urban residents and longer duration ART users. Assessment and management of substance use disorders are highly recommended besides ARV medication refills. Attention should be given enhanced adherence counseling and peer support to improve adherence. Early screening and management of tuberculosis infection should be strengthened. It is advisable to initiate ART with the recommended TDF-based first-line ART regimens instead of AZT-based.
Highlights
It is estimated that 36.9 million people were living with HIV during 2017
Ethiopia is among the Sub-Saharan Africa (SSA) countries most affected by HIV/AIDS with an estimated 710,000 people living with HIV in 2016 [1, 2]
With regard to substances use, the present study showed that ART users with a history of smoking were 5.9 times increase the odds of developing first-line ART failure than those who did not; ART users with a history of Khat use were two times more likely to develop first-line ART failure than those who did not
Summary
Sub-Saharan Africa (SSA) remains significantly affected, accounting for 69.5% of the people living with HIV (PLWHA). The introduction of highly active antiretroviral therapy (HAART) was a critical milestone in the history of HIV disease resulting in a dramatic reduction of morbidity and mortality, and improvement in the quality of life of PLWHA [3,4,5]. Despite the considerable reduction of morbidity and mortality due to HIV/AIDS after the start of HAART, a significant proportion of patients fail to attain the intended target of viral load suppression to therapy and many of them experience clinical deterioration attributable to ART failure. Treatment failure occurs when a combination of the ARV regimen fails to control HIV infection. This could be virologic, immunologic and/or clinical failure [6, 7]
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