Abstract
BackgroundTreatment failure has become a significant challenge in patients taking antiretroviral therapy (ART). The aim of the present study was to identify risk factors for first-line ART failure among patients attending clinical follow-up.MethodsA 1:2 matched case-control study (by age, sex, and treatment duration since initiated on ART) was conducted from June 2015 to July 2017 on adult patients (aged ≥15 years) who were on ART for at least 6 months. Cases were selected from patients who were switched to second-line ART after first-line ART failure (viral load ≥1000 copies/mL). Controls were randomly selected from patients on first-line ART with viral load < 50 copies/mL. Data were collected using an interview questionnaire, reviewing chart and electronic health records and laboratory tests. Multivariate logistic regression analysis was performed to identify risk factors for treatment failure.ResultsOf the 273 patients who participated in this study, 55% were males. Ninety-one cases were compared with 182 controls. The median age of participants was 40 years and the median duration of treatment since initiated on ART was 69 months. Independent risk factors associated with first-line antiretroviral treatment failure were discontinuation of ART (adjusted odds ratio (AOR) = 9.8, 95% confidence interval (CI): 4.0–23.8), baseline CD4 lymphocyte count ≤50 cells/mm3 (AOR = 3.8, 95% CI: 1.5–9.6) and persistent diarrhea (AOR = 4.4, 95% CI: 1.5–13.2). The risk of ART failure was high and comparable whether the duration of ART discontinuation was greater or less than 1 month (crude odds ratio (COR) = 6.3 and 8. 5 respectively, p-value < 0.001). Frequent eating of a diet containing wheat or barley (AOR = 2.3, 95% CI: 0.9–5.4) showed a trend to be a risk factor for first-line ART failure (p-value = 0.064).ConclusionsOur findings underscore the importance of avoiding ART discontinuation of any duration, early initiation of ART and diarrhea management to prevent first-line ART failure.
Highlights
Treatment failure has become a significant challenge in patients taking antiretroviral therapy (ART)
This study identified discontinuation of ART, baseline CD4 lymphocyte count ≤50 cells/mm3 and persistent diarrhea as independent factors for first-line ART failure
Patients who did experience first-line ART failure were nearly 10 times more likely to have a history of total ART discontinuation (AOR = 9.8, 95% Confidence interval (CI): 4.0–23.8) than those who did not
Summary
Treatment failure has become a significant challenge in patients taking antiretroviral therapy (ART). The aim of the present study was to identify risk factors for first-line ART failure among patients attending clinical follow-up. Worldwide Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a major public health issue. In 2017, over 36.9 million people were living with HIV/AIDS. The most affected continent, Africa, had 25.7 million (70%) people with HIV/. In Ethiopia, about 710, 000 people were living with the disease as of 2017 [1]. The global antiretroviral therapy (ART) coverage increased progressively from 7% in 2005 to 59% in 2017 [2, 3]. The estimated coverages in 2017 were 60 and 59% for Africa and Ethiopia, respectively [1]
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