Retention on antiretroviral therapy in person with HIV and viral hepatitis coinfection in Ethiopia: a retrospective cohort study

Abstract

BackgroundHIV coinfection with viral hepatitis B (HBV) or viral hepatitis C (HCV) is not uncommon in Ethiopia. Although the coinfections are presumed to interfere with antiretroviral treatment (ART), this is not widely studied in Sub-Saharan African settings. This study was conducted to determine ART retention in persons coinfected with HIV + HBV or HIV + HCV.MethodsWe reviewed the medical records of HIV-positive adults who initiated ART between 2011 to 2018 in four high-burden hospitals of Addis Ababa. Retention in care was the primary outcome of the study, which was compared between HIV and either HBV or HCV coinfected persons, and HIV-monoinfected persons. A parametric Gompertz regression model was used to compare retention between the coinfected and monoinfected groups.ResultsA total of 132 coinfected persons and 514 HIV-monoinfected individuals who initiated ART in 2011–2018 were compared. At 12-months of follow-up, 81.06% [95% CI: 73.3–86.9%] of the coinfected and 86.96% [95% CI: 83.7–89.6%] of the monoinfected were still on ART care. Cumulative retention in the coinfected group was 68.93% [60.4–76.3%] versus 80.35% [76.6–83.5%, p = 0.0048] in the monoinfected group. The cumulative retention was lower (61.25, 95% CI: 49.9–71.4%) in male coinfected patients than male monoinfected patients (77.77, 95% CI: 71.8–82.7%, p = 0.0041). In contrast, cumulative retention was similar in females in the coinfected group (80.76, 95% CI:67.3–89.5%) versus the monoinfected group (82.29, 95% CI:77.4–86.3%, p = 0.792). Overall, HIV-positive with viral hepatitis coinfection were 24 and 31% less likely to still be on ART care than the monoinfected group at 12 months and overall, with sub-distribution adjusted hazard ratio (AHR) of 0.76(95% CI:0.61–0.96, p = 0.021) and 0.69(95% CI:0.54–0.87, p = 0.002) respectively.ConclusionsWe observed that coinfected individuals are less likely to stay on ART than HIV monoinfected individuals. The low retention in the coinfected group from this study may affect the success of survival gained in people living with HIV (PLHIV) in the long term. More concerted efforts need to be made to retain coinfected individuals at least at the level of monoinfected persons on long-term ART care. Future studies are needed to better understand the difference in retention, preferable in a prospective manner.