Predictors of Clinical and Immunological Failure Among Patients on First-Line Antiretroviral Therapy (ART) in Southwest Ethiopia

Abstract

Background

Global expanded access to antiretroviral therapy has led to a rapid fall in the number of people dying from HIV-related causes. However, the remarkable achievement recorded in reducing morbidity and mortality has been affected due to the occurrence of first-line ART failure. The study was intended to identify predictors of clinical and immunologic failure of first-line ART in southwest Ethiopia.

Methods

A retrospective cohort study was conducted among 737 randomly selected ART patients from 1^st January 2010 to 30^th June 2016. Trained data collectors collected the data from the patients’ follow-up charts and electronic databases. The Kaplan Meier (KM) curve was used to describe the probability of survival time to antiretroviral treatment failure. Variables with a p-value of ≤ 0.05 in a multivariable cox-proportional hazard model were statistically significant predictors of first-line ART failure.

Results

Among 737 HIV patients on ART followed retrospectively, 445 (60.4%) were females. During the follow-up period, the incidence rate of treatment failure was 7.3 per 100 person-year observations, and the highest rate was observed during the first 6 to 12 months of ART initiation. Not disclosing HIV status (AHR꞊ 2.04, 95% CI: 1.32–3.16), being bedridden (AHR꞊ 2.01, 95% CI: 1.02–3.98) and low hemoglobin at ART initiation (AHR꞊ 2.02, 95% CI: 1.29–3.13) were associated with an increased hazard rate for first-line ART failure.

Conclusion

The study showed that predictors of first-line ART treatment failure are modifiable. Therefore, these factors should be addressed during routine care of HIV patients by health care providers to preserve the rapid exhaustion of  first-line medications, improve the quality of life of the patients and reduce HIV/AIDS related deaths.

Keywords:

• ART
• ART failure
• antiretroviral therapy
• HIV
• survival analysis

Acknowledgments

We would like to pass our special gratitude to Jimma University, Institute of Health Sciences for providing all support to undertake this study. We would also like to thank JUSH for providing all the necessary information for our work.

Abbreviations

AHR, Adjusted Hazard Ratio; COR, Crude Hazard Ratio; AIDS, Acquired Immune Deficiency Syndrome; ART, Antiretroviral Therapy; BMI, Body Mass Index; Hg, Hemoglobin; HIV, Human Immune Deficiency Virus; JUSH, Jimma University Specialized Hospital; OIs, Opportunistic infections; WHO, World Health Organization.

Compliance with Ethical Standards

Ethical clearance to undertake the study was obtained from the Institutional Review Board of Institute of Health Sciences, Jimma University. Permission was also obtained from Jimma University Specialized Hospital (JUSH) administrative body before document review. All information collected from clients’ documents was kept anonymous and confidential.

Data Sharing Statement

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Author Contributions

All authors contributed to the conception research questions, setting the objective, designing the study, and data acquisition, analysis, and interpretation. A manuscript was drafted by AA and ZA. All authors contributed towards critically revising the paper, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no competing interests.