Incidence of Virological Failure and Associated Factors among Adult HIV-Positive Patients on First Line Antiretroviral Therapy Regimen, Central Ethiopia
International Journal of HIV/AIDS Prevention, Education and Behavioural Science
Volume 4, Issue 2, December 2018, Pages: 44-51
Received: Nov. 10, 2018; Accepted: Nov. 28, 2018; Published: Jan. 7, 2019
Views 229      Downloads 78
Authors
Tamrat Endebu, Department of Public Health, Adama Hospital and Medical College, Adama, Ethiopia; Department of HIV/AIDS, East Shoa Zone Health Office, Adama, Ethiopia
Alem Deksisa, Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
Tibka Moges, Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
Teresa Kisi, Department of Public Health, Adama General Hospital Medical College, Adama, Ethiopia
Temesgen Ensermu, Growth through Nutrition, Save the Children International, Adama, Ethiopia
Article Tools
Follow on us
Abstract
Introduction: Viral replication continued to be a major challenge among patients living with HIV and on antiretroviral treatment. In Adama hospital medical college virological failure incidence and factors associated were not well investigated. The aim of this study is to assess Incidence of virological failure and associated factor among adult HIV-patients on first line antiretroviral therapy regimen in Adama Hospital Medical College, Adama town, East Shoa Zone, Oromia Regional State, Ethiopia. Methods: A retrospective cohort study design, 5 years of follow up, was conducted through reviewed and analyzed data of 445 adult patients who had started ART between January 01, 2013 and April 30, 2018. The Kaplan–Meier method was used to estimate the probability of virological failure at different time points. Incidence of virological failure was calculated per 100 Person-years. The Cox proportional hazards model was used to identify factors associated with virological failure. Results: Out of the total 445 cohort patients who were assessed for viral load, there were 40 (9.0%) virological failures in 1,594 person years of retrospective follow-up. This makes the incidence rate of virological failure 2.5 per 100 person-years of follow-up. The cumulative hazard of virological failure at 1 year, 2 years, 3 years, 4 years and 5 years after starting ART amongst those tested was 1.1%, 4.3%, 6.6%, 9.9% and 12.3% respectively. Age 15-24 years [AHR = 4.13, 95%CI (1.29-13.22)], poor adherence [AHR = 2.62, 95%CI (1.21-5.68)], Short duration on ART taking [AHR = 6.93, 95%CI (2.62-18.33)], and changing ART regimen [AHR = 2.82, 95%CI (1.18-6.75)] were risk factors significantly associated with virological failure. Conclusion and recommendations: Overall there was substantial incidence rate of virological failure. Age 15-24 years, poor adherence, and Short duration on ART taking, and changing ART regimen were risk factors significantly associated with virological failure. Therefore, stakeholders should develop strategies and interventions that may help to minimize virological failure by giving more attention to young (15-24 years) age as well as efforts should be strengthened to improve adherence to antiretroviral therapy.
Keywords
Incidence, Virological Failure, Factors, Ethiopia
To cite this article
Tamrat Endebu, Alem Deksisa, Tibka Moges, Teresa Kisi, Temesgen Ensermu, Incidence of Virological Failure and Associated Factors among Adult HIV-Positive Patients on First Line Antiretroviral Therapy Regimen, Central Ethiopia, International Journal of HIV/AIDS Prevention, Education and Behavioural Science. Vol. 4, No. 2, 2018, pp. 44-51. doi: 10.11648/j.ijhpebs.20180402.13
Copyright
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
World health organization Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection/recommendations for a public health approach second edition, 2016. http://www.who.int/hiv/pub/arv/arv-2016/en/.
[2]
UNAIDS.90–90-90:. An ambitious treatment target to help end the AIDS epidemic. In. October,2014 ed. http://www.unaids.org/sites/default/files/ media_asset/90-90-90_en_0.pdf (accessed 5 Apr 2015). 2014.
[3]
Federal HIV/AIDS Prevention and Control OfficeHIV/AIDS strategic plan 2015-2020 in an investment case approach, Addis Ababa (Ethiopia): Federal HIV/AIDS Prevention and Control Office. 2014, 63 p. https://hivhealthclearinghouse.unesco.org/library/documents/hivaids-strategic-plan-2015-2020-investment-case-approach.
[4]
Ethiopia, Country/Regional Operational Plan (COP/ROP) Strategic Direction Summary 2017. https://www.pepfar.gov/documents/organization/272012.pdf.
[5]
Anita Shet, Ayesha De Costa Virological efficacy with first-line antiretroviral treatment in India: predictors of viral failure and evidence of viral re suppression Tropical Medicine and International Health, 2015 doi:10.1111 /tmi.12563/volume 20.
[6]
Billong SC, Fokam J, Aghokeng AF, Milenge P, Kembou E, Abessouguie I, et al. Population-based monitoring of emerging HIV-1 drug resistance on antiretroviral therapy and associated factors in sentinel site in Cameroon: low levels of resistance but poor program maticpeformance. Plo Sone. 2013;8 (8): e72680.Epub2013/08/31.doi:10.1371/journal.pone.0072680PMID:23991142.
[7]
Kyaw NTT, Harries AD, Kumar AMV, OoMM, Kyaw KWY, Win T, et al. (2017) High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015. PLoS ONE 12(2): e0171780.doi:10.1371/journal.
[8]
Liégeois F, Vella C, Eymard-Duvernay S, et al. Virological failurerates and HIV-1 drug resistance patterns in patients on first-lineantiretroviral treatment in semirural and rural Gabon. J Int AIDS Soc.2012;15(2):17985Liégeois F, Vella C, Eymard-Duvernay S, et al. Virological failurerates and HIV-1 drug resistance patterns in patients on first-lineantiretroviral treatment in semirural and rural Gabon. J Int AIDS Soc.2012;15(2):17985.
[9]
World Health Organization (2013) Global update on HIV treatment: Results, impact and opportunities. http://www.who.int/about/licensing/copyright_form/ en/index.html).
[10]
Federal Ministry of Health.(2014) National Guidelines for comprehensive HIV prevention care and treatment, Ethiopia, 2014.
[11]
Roberts T, Bygrave H, Fajardo E, Ford N. Challenges and opportunities for the implementation of virological testing in Resource -limited settings. J Int AIDS Soc 2012; 15:17324.
[12]
Ma Y, Zhao D, Yu L, Bulterys M, Robinson ML, Zhao Y, et al. Predictors of virologic failure in HIV-1-infected adults receiving first-line antiretroviral therapy in 8 provinces in China. ClinInfect Dis. 2010; 50 (2):2 64±271. doi: 10.1086/649215PMID:20017637.
[13]
Fox MP, Cutsem GV, Giddy J, Maskew M, Keiser O, Prozesky H, et al. Rates and predictors of failure of first-line antiretroviral therapy and switch to second-line ART in South Africa. JAcquir Immune Defic Syndr. 2012; 60(4):428±437.doi:10.1097/QAI.0b013e3182557785PMID:22433846.
[14]
Bayu B, Tariku A, Bulti AB, Habitu YA, Derso T, Teshome DF Determinants of virological failure among patients on highly active antiretroviral therapy in University of Gondar Referral Hospital, Northwest Ethiopia: a case–control study HIV/AIDS - Research and Palliative Care » Volume 9 2017:9 Pages 153—159; DOI https://doi.org/10.2147/HIV.S139516.
[15]
Kazooba P, Nsubuga B, Mayanja, Levin J, Masiira B, Pontiano Kaleebu P. Virological failure on first-line antiretroviral therapy; associated factors and a pragmatic approach for switching to second line therapy–evidence from a prospective cohort study in rural South-Western Uganda, 2004-2011: Pan African Medical Journal. 2018;29:191. doi:10.11604/pamj.2018.29.191.11940.
[16]
Zuo Z, Liang S, Sun X, Bussell S, Yan J, Kan W, et al. (2016) Drug Resistance and. Virological Failure among HIV-Infected Patients after a Decade of Antiretroviral Treatment Expansion in Eight Provinces of China. PLoS ONE11(12): e0166661. doi:10.1371/journal.
[17]
Sisay MM, Ayele TA, Gelaw YA, Tsegaye T, Gelaye KA and Melak MFIncidence and risk factors of frst-line antiretroviral treatment failure among human immunodefciency virus-infected children in Amhara regional state, Ethiopia: a retrospective follow-up study. BMJ Open 2018;8:e019181. doi:10.1136/bmjopen-2017-019181.
[18]
WHO. HIV/AIDS:. Monitoring response to ART and diagnosis of treatment failure. In. June, 2013 ed. http://www.who.int/hiv/pub/guidelines/arv2013/ art/artmonitoring/en/ (Accessed 31 May 2016); 2013.
[19]
Sang RKA, Miruka FO. Factors associated with virologic failureamongst adults on antiretroviral therapy in Nyanza Region, Kenya. IOSR J Dent Med Sci. 2016;15(7):108–121.
[20]
Meriki HD, Tufon KA, Afegenwi MH, et al. Immuno-haematologicand virologic responses and predictors of virologic failure in HIV-1infected adults on first-line antiretroviral therapy in Cameroon. InfectDis Poverty. 2014;3:5.
[21]
Rupérez M, Pou C, Maculuve S, et al. Determinants of virologicalfailure and antiretroviral drug resistance in Mozambique. J Antimicrob Chemother. 2015;70(9):2639–2647.
[22]
Parienti JJ, Massari VR, Descamps D, et al. Predictors of virologic failure and resistance in HIV-infected patients treated withnevirapine- or efavirenz-based antiretroviral therapy. Clin Infect Dis.2004;38(9):1311–1316.
[23]
Tigist Bacha, Birkneh Tilahun, and Alemayehu Worku, Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy BMC Infectious Diseases2012,12:197, http://www.biomedcentral.com/1471-2334/12/197.
[24]
Rabkin JG. HIV and depression: 2008 review and update. Behav Aspects HIV Manag. 2008;5(4):163–171.
[25]
Charles M. Kwobah, Ann W. Mwangi et al,. Factors Associated with First-Line Antiretroviral TherapyFailure amongst HIV-Infected African Patients:A Case-Control Study, World Journal of AIDS, 2012, 2, 271-278http://dx.doi.org/10.4236/wja.2012.24036.
[26]
Bayu. B, Tariku. A, Balcha. A, Ayanaw. Y, Fetene. D. (201) Determinants of virological failure among patients on highly active antiretroviral therapy in University of Gondar Referral Hospital, Northwest Ethiopia press journal: HIV/AIDS-Research and palliative care 8 August 2017978-92-4-15500.
[27]
AIDSinfo. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. 2016.
[28]
Liégeois F, Vella C, Eymard-Duvernay S, et al. Virological failurerates and HIV-1 drug resistance patterns in patients on first-lineantiretroviral treatment in semirural and rural Gabon. J Int AIDS Soc.2012;15(2):17985Liégeois F, Vella C, Eymard-Duvernay S, et al. Virological failurerates and HIV-1 drug resistance patterns in patients on first-lineantiretroviral treatment in semirural and rural Gabon. J Int AIDS Soc.2012; 15(2):17985.
[29]
Jobanputra K, Parker LA, Azih C, 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):e0116144.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186