Predictors of antiretroviral therapy failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia

Abstract

6 www.thelancet.com/lancetgh Published Online April 8, 2016 Icahn School of Medicine at Mount Sinai, New York, NY, USA (K Niemeyer, A King MPH, N Henning MD); WWO/AHF Family Health Clinic, Addis Ababa, Ethiopia (S Mengistu MD) Correspondence to: Katherine Niemeyer, 50 E 98th Street, New York, NY 10029, USA katherinem.niemeyer@gmail. com Predictors of antiretroviral therapy failure in an urban HIV/AIDS clinic in Addis Ababa, Ethiopia Katherine Niemeyer, Akilah King, Sophie Mengistu, Nils Hennig Abstract Background With the federal scale-up of antiretroviral therapy (ART) in Ethiopia, survival and quality of life for people with HIV/AIDS has increased. However, some patients do not respond to ART. Failure to suppress viral replication leads to increased morbidity and mortality, making early diagnosis of treatment failure imperative for the reduction of negative outcomes for patients. In this quality improvement project, we aimed to fi nd predictors of treatment failure that can be used, with clinical and immunological monitoring, to guide diagnosis of fi rst-line ART failure.Background With the federal scale-up of antiretroviral therapy (ART) in Ethiopia, survival and quality of life for people with HIV/AIDS has increased. However, some patients do not respond to ART. Failure to suppress viral replication leads to increased morbidity and mortality, making early diagnosis of treatment failure imperative for the reduction of negative outcomes for patients. In this quality improvement project, we aimed to fi nd predictors of treatment failure that can be used, with clinical and immunological monitoring, to guide diagnosis of fi rst-line ART failure. Methods We undertook a retrospective chart review and analysed baseline characteristics of 55 male and female patients, aged 2–54 years, on second-line ART and 55 control patients matched for age, gender, and treatment who continued to respond to fi rst-line ART at the World Wide Orphans/AIDS Healthcare Foundation (WWO/AHF) Family Health Clinic in Addis Ababa, Ethiopia. We used bivariate analyses, and included signifi cant variables in logistic regression modelling. Findings Three factors were signifi cant predictors of treatment failure: the presence of at least 1 month of fair or poor adherence (OR 15·7, 95% CI 1·8–136·7; p=0·01); previous treatment at another clinic before the WWO/AHF Family Health Clinic (1·4, 1·2–13·7; p=0·02); and tuberculosis symptoms at baseline (3·6, 1·1–12·3; p=0·04). In adult patients (n=58), two separate factors were signifi cant predictors of treatment failure: non-use of soft drugs, such as marijuana and khat (0·02, 0·001–0·445; p=0·02), and low baseline CD4 count (0·985, 0·972–0·999; p=0·03) Interpretation Predictors of ART failure can be used for early identifi cation of patients at high risk of fi rst-line treatment failure. Subsequent rapid transition to second-line therapy could result in better outcomes and care for these patients at the WWO/AHF Family Health Clinic in Addis Ababa, Ethiopia. The association between non-use of soft drugs and failure of fi rst-line ART should be explored further. Funding Arnold Institute for Global Health, Icahn School of Medicine at Mount Sinai. Copyright © Niemeyer et al. Open Access article distributed under the terms of CC BY. Declaration of interests We declare no competing interests.