Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study
Volume 4, Issue 2, June 2019, Pages: 13-24
Received: Mar. 16, 2019;
Accepted: Oct. 14, 2019;
Published: Oct. 23, 2019
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Amrachu Bekele Asfaw, Public Health Department, Disease Prevention and Control Unit Mizan Teferi, Southwest, Ethiopia
Aderajew Nigusie, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
Tamirat Shewanow, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Esayas Kebede Gudina, Departments of Internal Medicine, Jimma University, Jimma, Ethiopia
Masrie Getnet, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Demuma Amdisa, Department of Health Behaviour and Society, Jimma University, Jimma, Ethiopia
Tefera Belachew Lemma, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
Lelisa Sena Dadi, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. A case-control study was conducted in March 2018 on a sample of 384 (288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. In this study, higher odds of first-line ART failure was experienced among urban residents (AOR:2.2; 95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). This study evidenced that being an urban resident, TB co-infection, poor medication adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, the focus should be given assessment and management of medication compliance for urban residents and longer duration ART users. Assessment and management of substance use disorders are highly recommended besides ARV medication refills. Attention should be given enhanced adherence counseling and peer support to improve adherence. Early screening and management of tuberculosis infection should be strengthened. It is advisable to initiate ART with the recommended TDF-based first-line ART regimens instead of AZT-based.
Amrachu Bekele Asfaw,
Esayas Kebede Gudina,
Tefera Belachew Lemma,
Lelisa Sena Dadi,
Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study, Rehabilitation Science.
Vol. 4, No. 2,
2019, pp. 13-24.
UNAIDS. Global AIDS Monitoring. Geneva, Switzerland: UNAIDS; 2018.
UNAIDS: Report on the global AIDS epidemic. Geneva, Switzerland: UNAIDS; 2017.
Babo YD, Alemie GA, Fentaye FW. Predictors of first-line antiretroviral therapy failure amongst HIV-infected adult clients at Woldia Hospital, Northeast Ethiopia. PLoS One. 2017; 12 (11): 1–19.
Leng X, Liang S, Ma Y et al. HIV virological failure and drug resistance among injecting drug users receiving first-line ART in China. BMJ Open. 2014; 4 (e005886): 1–8.
WHO: The use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a Public Health Approach; Geneva, Switzerland: WHO; 2016.
Patrikar S, Shankar S, Kotwal A, Basannar DR, Bhatti V, Verma R, et al. Predictors of first-line antiretroviral therapy failure and burden of second-line antiretroviral therapy. MJAFI. 2017 Jan 1; 73 (1): 5–11.
Subhasish Kamal Guha DM. Management of Failure of Antiretroviral Treatment; 2016.
Haile D, Takele A, Gashaw K, Demelash H, Nigatu D. Predictors of Treatment Failure among Adult Antiretroviral Treatment ( ART ) Clients in Bale Zone Hospitals, South Eastern Ethiopia. PLoS One. 2016; 11 (10): 2–8.
Allam RR, Murhekar M V, Bhatnagar T, Uthappa CK, Nalini C. Predictors of immunological failure and determinants of suboptimal CD4 testing among adults with HIV on first-line antiretroviral therapy in Andhra Pradesh, India, 2008–2011. Trans R Soc Trop Med Hyg. 2017; 109 (March 2015): 325–33.
Huong DTM, Bannister W, Phong PT, Kirk O, Peters L, Mih B, et al. Factors associated with HIV-1 virological failure in an outpatient clinic for HIV-infected people in Haiphong, Vietnam. Int J STD AIDS [Internet]. 2011 [cited 2017 Nov 4]; 22 (659): 659–64.
Hawkins C, Ulenga N, Liu E, Aboud S, Mugusi F, Chalamilla G, et al. HIV virological failure and drug resistance in a cohort of Tanzanian HIV-infected adults. Journal Antimicrob Chemother. 2016; 71 (10.1093/jac/dkw051): 1966–74.
Anthony Kapesa et al. Determinants of immunological failure among clients on the first-line treatment with highly active antiretroviral drugs in Dar es Salaam, Tanzania. Asian Pac J Trop Biomed. 2014; 4 ((suppl2)): s620-624.
El-khatib Z, Katzenstein D, Marrone G, Laher F, Mohapi L, Morris L, et al. Adherence to Drug-Refill Is a Useful Early Warning Indicator of Virologic and Immunologic Failure among HIV Patients on First-Line ART in South Africa. PLoS One. 2011; 6 (3): 1–10.
Biset Ayalew et al. First-line antiretroviral treatment failure and associated factors in HIV patients at the University of Gondar Teaching Hospital, Gondar, Northwest Ethiopia. Dove press. 2016; 8 (10.2147/HIV): 141–6.
Gesesew HA, Ward P, Woldemichael K, et al. Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia : a retrospective cohort study. BMJ Open. 2018; 8 (e017413): 1–10.
Assefa et al. The effect of incident tuberculosis on immunological response of HIV patients on highly active antiretroviral therapy at the University of Gondar hospital, northwest Ethiopia: a retrospective follow-up study. BMC Infect Dis. 2014; 14 (468): 1–8.
Melsew YA, Terefe MW, Tessema GA, Ayele TA. AIDS & Clinical Rate of Immunological Failure and its Predictors among Patients on Highly Active Antiretroviral Therapy at Debremarkos Hospital, Northwest Ethiopia : A Retrospective Follow up Study. J AIDS Clin Res. 2013; 4 (5): 1–4.
Bekelech Bayou et al. Assessment of the magnitude and associated factors of immunological failure among adult and adolescent HIV-infected patients in St. Luke and Tulubolo Hospital, Oromia Region, Ethiopia. PanAfrican Med J. 2015; 21 (291): 1–10.
Pollack TM, Duong HT, Pham TT, Do CD, Colby D. Cigarette smoking is associated with high HIV viral load among adults presenting for antiretroviral therapy in Vietnam. PLoS One. 2017; 12 (3): 1–11.
Ruperez et al. Determinants of virological failure and antiretroviral drug resistance in Mozambique. Journal Antimicrob Chemother. 2017; 70 (9): 2639–47.
Istri C et al. Factors associated with first-line antiretroviral therapy ( ART ) failure among HIV / AIDS patients at Sanglah Hospital, Bali. Public Heal Prev Med Arch. 2017; 5 (1): 4–11.
Datay et al. Associations With Virologic Treatment Failure in Adults on Antiretroviral Therapy in South Africa. J Acquir Immune Defic Syndr. 2010; 54 (5): 489–95.
J. d. Ndahimana et al. Drug resistance mutations after the first 12 months on antiretroviral therapy and determinants of virological failure in Rwanda. Trop Med Int Heal. 2016 Jul; 21 (7): 928–35.
Jorge et al. Risk factors associated with virologic failure in HIV-infected patients receiving antiretroviral therapy at a public hospital in Peru. PMC. 2014; 30 (1): 42–8.
Matare T, Shambira G, Gombe NT, Tshimanga M, Bangure D et al. Factors Associated with Human Immunodeficiency Virus First-Line Treatment Failure in Zvishavane District, Austin J HIV/AIDS Res. 2015; 2 (1): 1–6.
Jobanputra K, Parker LA, Azih C, Okello V, Maphalala G, Kershberger B, et al. Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland. PLoS One. 2015; 10 (2): 1–12.
Fujie Zhang et al. Predictors of Virologic Failure in HIV-1 – Infected Adults Receiving First-Line Antiretroviral Therapy in 8 Provinces in China. Infect Dis Soc Am. 2017; 50 (2): 264–71.
Musa BM, Musa B, Muhammed H, Ibrahim N. Incidence of tuberculosis and immunological profile of TB / HIV co-infected patients in Nigeria. Ann Thorac Med. 2015; 10 (3): 185–92.
Kamugisha E, Chomboko CL, Kabyemera RM, and KB. Prevalence and Predictors of Immunological Treatment Failure among HIV Infected Adults on the First-line Antiretroviral Therapy in Mbeya Region, Tanzania. Mathews J HIV/AIDS. 2018; 3 (1): 1–9.
Getnet Y. Determinants of First-Line Antiretroviral Treatment Failure in Public Hospitals of Addis Ababa, Ethiopia : Unmatched Case-Control Study. J Biol Agric Healthc. 2014; 4 (15): 1–13.
Kwobah Charles et al. Factors Associated with First - Line Antiretroviral Therapy Failure amongst HIV - Infected African Patients : A Case - Control Study. World J AIDS. 2012; 2: 271–8.
FMOH: National Guidelunes for comprehensive HIV Prevention, Care and Treatment. Addis Ababa, Ethiopia: FMOH; 2017.
Niemeyer et al. Predictors of antiretroviral therapy failure in an urban HIV / AIDS clinic in Addis Ababa, Ethiopia. Lancet Glob Heal. 2016; 4: S6.
Nuredin Nassir Azmach. Adherence to Antiretroviral Therapy and Associated Factors Among Adult ARV Users in Arba Minch Hospital, Cent African J Public Heal. 2017; 3 (2): 19–26.
Bayu et al. Determinants of virological failure among patients on highly active antiretroviral therapy in the University of Gondar Referral Hospital, Northwest Ethiopia : a case-control study. Dove Med Press. 2017; 9 (3): p153-157.
UNAIDS: 90-90-90 an ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS; 2014.
WHO: Patient monitoring guidelines for HIV care and antiretroviral therapy (ART). Switzerland, Geneva: WHO; 2004.
FMOH: National Guidelines for Comprehensive HIV Prevention, Care and Treatment. Addis Ababa, Ethiopia: FMOH; 2014.
Omar YS, Jenkins A, Altena MVR, Tuck H, Hynan C, Tohow A, et al. Khat Use : What Is the Problem and What Can Be Done ? Hindawi Publ Corp. 2015; 2015: 1–7.
Meriki HD, Tufon KA, Afegenwi MH, Nyindem BA, Atanga PN, Anong DN, et al. Immuno-haematologic and virologic responses and predictors of virologic failure in HIV-1 infected adults on first-line antiretroviral therapy in Cameroon. Open Access. 2014; 3 (5): 1–11.
Hailu GG, Hagos DG, Hagos AK, Wasihun G, Dejene TA. Virological and immunological failure of HAART and associated risk factors among adults and adolescents in the Tigray region of Northern Ethiopia. PLoS One. 2018; 30 (5): 1–17.
V Diaz-Brito et al. Post-exposure prophylaxis for HIV infection : a clinical trial comparing lopinavir/ritonavir versus atazanavir each with zidovudine/lamivudine. Int Med Press. 2012; 17 (10): 337–46.
Teshome W, Assefa A. Predictors of Immunological Failure of Antiretroviral Therapy among HIV Infected Patients in Ethiopia : A Matched Case-Control Study. PLoS One. 2014; 9 (12): 1–13.
W. Kipp et al. Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda. AIDS Care. 2010; 22 (3): 271–8.
Fong Raymond, Cheng Allen C., Vujovic Olga HJF. Factors associated with virological failure in a cohort of combination antiretroviral therapy at Alfred Hospital Australia. CSIRO. 2013; 10 (5): 442–7.