Time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital: a retrospective cohort study

Tewodros Getnet Amera,Yibekal Manaye Tefera,Kassawmar Angaw Bogale

doi:10.1186/s12981-021-00418-z

Tewodros Getnet Amera, Yibekal Manaye Tefera + Show 1 more

Open Access

https://doi.org/10.1186/s12981-021-00418-z

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Abstract

BackgroundAnti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However, information’s on the time of initial regimen discontinuation and its predictors are not well studied.ObjectiveThis study aimed to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia.MethodInstitution-based retrospective cohort study was conducted among 418 HIV patients who started HAART from January 1, 2014, to December 31, 2019. Data were collected from the patient chart using a data extraction tool. The Kaplan–Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation.ResultA total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking > 1 ART pills/day (AHR = 4.1, 95% CI 3.0–6.5), baseline CD4 count < 100 cells/mm3 (AHR = 2.6, 95% CI 1.5–4.7), 100–199 cells/mm3 (AHR = 2.2, 95% CI 1.2–4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI 1.6–4.3) and stage III (AHR = 2.6, 95% CI 1.4–4.3) and TB infection (AHR = 2.3, 95% CI 1.6–3.5).ConclusionMost of the discontinuation occurred after 1 year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count, and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced and initiation of one ART regimen daily is vital for survival on the initial regimen.

Highlights

Anti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia
Work on early detection of human immune deficiency virus (HIV) before the disease is advanced and initiation of one antiretroviral therapy (ART) regimen daily is vital for survival on the initial regimen
In mid-1996, it was discovered that these drugs are far more effective when three or more are taken at the same time. The advent of these highly active antiretroviral treatments has dramatically reduced the morbidity and mortality associated with HIV infection and has improved the prognosis for people living with HIV infection (PLHIV) or Acquired immunodeficiency syndrome (AIDS) [2, 3]

Summary

Introduction

Anti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. In mid-1996, it was discovered that these drugs are far more effective when three or more are taken at the same time The advent of these highly active antiretroviral treatments has dramatically reduced the morbidity and mortality associated with HIV infection and has improved the prognosis for people living with HIV infection (PLHIV) or AIDS [2, 3]

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