Prevalence and Predictors of Clinical and Immunological Failure among Adults HIV Patients on HAART in Southern Benin

Abstract

Objective: The purpose of this study was to determine the prevalence of antiretroviral therapy failure and to identify factors associated with failure in HIV infected patients on antiretroviral therapy. Methods: A six years retrospective cohort study was conducted. All HIV- infected patients on antiretroviral therapy for at least 12 months and followed in the outpatient treatment center at the CNHU-HKM in Cotonou were systematically included. The evaluation of the failure was clinical and immunological using the WHO 2010 criteria adapted by the Beninese national HIV/AIDS program. Data was extracted from ESOPE database and analyzed by SPSS 10.0. Multivariable linear regression was performed to identify predictors of antiretroviral treatment failure and p < 0.05 was considered to declare a statistical significance. Results: A total of 268 HIV infected patients were enrolled in the study. The overall prevalence of antiretroviral treatment failure was 35.4% (n=95), including thirty-one cases of clinical failure (11.6%), ten cases of immunological failure (6.3%) and forty-seven cases of clinico-immunological failure (17.5%). The mean age was 37 ± 22 years and the sex ratio was 0.71. Non-adherence to treatment was found to be the main cause of HARRT failure in 71.6% of cases (n=68). High levels of education, polygamy, advanced clinical stage (WHO stage IV) and a history of documented adverse effects were predictors of antiretroviral therapy failure. Difficulties in accessing routine viral loads and second-line molecules did not allow for early diagnosis and good management of HAART failure in Benin. Conclusion: The prevalence of clinical and immunological failure is high in this cohort. It is necessary to facilitate access to routine viral load as the main means of HAART monitoring and to make second-line molecules available.