Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia

Figures & data

Figure 1 Workflow of the study participants’ inclusion criteria.

Table 1 Socio-Demographic Data of Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV-Positive Adult and Adolescent Patients at Bale Zone Hospitals, Southeast Ethiopia (n = 641)

Variables	Variables Category	Frequency (%)	Time to Virological Failure		Pooled Log Rank	Median (95% CI)
			Suppressed	Not-Suppressed
Age	Mean with a standard deviation	34.24 ±11.08
Sex	Male	240(37.4)	188	52	0.043	38(35.1–40.9)
	Female	401(62.6)	401	66
Residency	Urban	40(62.7)	188	52	0.311	42(39.4–44.6)
	Rural	239(37.3)	401	66		38(36.1–39.9)
Educational status	No formal education	183(28.5)	151	32	0.480	39(37.7–40.3)
	Primary school	242(37.8)	192	50		39(34.1–43.9)
	High school	170(26.5)	139	31		42(33.6–50.4)
	Collage and above	46(7.2)	41	5		40
Occupational status	Farmer	129(20.10)	96	33	0.023	38(32–44)
	Merchant	133(20.7)	111	22		42(38.5–45.5)
	Employee	101(15.8)	93	8		40
	Daily laborer	47(7.3)	38	9
	Housewife	155(24.2)	124	31		39(33.7–44.3)
	Other	76(11.9)	61	15		36(22.3–49.7)
Marital status	Single	111(17.3)	89	22	0.567	42
	Married	363(56.6)	301	62		40(37.7–42.3)
	Divorced	121(18.9)	99	22		39(26.2–51.8)
	Widowed	46(7.2)	34	12
HIV disclosure status	Disclosed	481(75.0)	390	91	0.504	39(37.1–40.9)
	Not disclosed	81(12.6)	69	12		42(33.6–50.4)
	Unknown status	79(12.3)	64	15
BMI during data collection	Mean with a standard deviation	21.41 ± 3.71				21
ART follow-up hospital	MWU-GRH	275(42.9)	217	58	0.116	42(30.7–53.3)
	Robe	207(32.3)	181	26		40(37.9–42.1)
	Ginnir	99(15.4)	75	24		39(34.5–43.5)
	Delomena	60(9.4)	50	10		42(19.3–64.7)

Note: Some variables do not add up to 641 because of missing data.

Abbreviations: BMI, body mass index; ART, anti-retroviral therapy; MWU-GRH, Madda Walabu University Goba referral hospital.

Table 2 Clinically Related Data of Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV-Positive Adult and Adolescent Patients at Bale Zone Hospitals, Southeast Ethiopia (n = 641)

Variables	Variables Category	Frequency (%)	Time to Virological Failure		Pooled Log Rank	Median (95% CI)
			Suppressed	Not Suppressed
Baseline functional status	Ambulatory	85(13.3)	59	26	0.001	39(29.3–48.7)
	Working	539(84.1)	456	83		41(38.3–43.7)
	Bedridden	17(2.7)	8	9		26(10.5–41.5)
Functional status during data collection	Ambulatory	40(6.2)	35	5	0.153	40(37.7–42.3)
	Working	587(91.6)	481	106		36(25.5–47.5)
	Bedridden	14(2.2)	7	7		40(37.6–42.4)
WHO stage at ART initiation	Stage I	276(43.1)	255	21	0.001
	Stage II	133(20.7)	98	35		39(35.8–42.2)
	Stage III	201(31.4)	151	50		36(33.4–38.6)
	Stage IV	31(4.8)	19	12		24(37.6–42.4)
WHO stage during data collection	Stage I	553(86.3)	486	67	0.001
	Stage II	34(5.3)	28	6		42
	Stage III	44(6.9)	8	39		24(20.7–27.3)
	Stage IV	10(1.6)	1	9		18(14.0–22.0)
Hemoglobin level at ART initiation	Mean with a standard deviation	12.35(2.34)				12.3
Hemoglobin level during data collection	Mean with a standard deviation	13.15(2.41)				13
Opportunistic infection	Yes	204(31.8)	145	59	0.001	36(33.8–38.2)
	No	434(67.7)	378	56
Baseline adult ART regimens	1c(AZT+3TC+NVP)	42(6.6)	31	11	0.517	42
	1d(AZT+3TC+EFV)	32(5.0)	26	6		41
	1e(TDF+3TC+EFV)	415(64.7)	343	72		39
	1f(TDF+3TC+NVP)	29(4.5)	22	7		30
	1g(ABC+3TC+EFV)	52(8.1)	41	11
	1h(ABC+3TC+NVP)	1(0.2)	1	0
	1j(TDF+3TC+DTG)	49(7.6)	42	7
	1i(Others_)	14(2.2)	11	3
Adherence	Good	552(86.1)	552	61	0.001
	Fair	63(9.8)	63	41		25(22.7–27.3)
	Poor	26(4.1)	26	16		24(21.6–26.4)
Drug toxicity	Yes	103(16.3)	71	32	0.003	36(33.0–39.0)
	No	527(82.2)	441	86		42(38.9–45.1)
Immunological failure	No	447(85)	410	37	0.001
	Yes	79(15)	9	70		20(15.4–24.6)
Virological failure	No	523(81.6)	523	118		40(37.6–42.4)
	Yes	118(18.4)

Abbreviations: WHO, World Health Organization; ART, anti-retroviral therapy.

Figure 2 Types of frequently occurring opportunistic infections in HIV-positive patients.

Table 3 Predictors of Virological Treatment Failure Using Bivariable and Multivariable Cox Regression Analysis Among Adolescent and Adult ART Clients in Southeast Ethiopia (n = 641)

Variables	Characteristics	Binary Cox-Regression		Multiple Cox-Regression
		P value	CHR (95%)	P-value	AHR (95%)
Baseline functional status	Working
	Ambulatory	0.007	0.541(0.347–0.842)	0.543	0.862(0.534–1.392)
	Bedridden	0.045	2.189(1.019–4.699)	0.209	1.698(0.744–3.879)
WHO stage at ART initiation	Stage I
	Stage II	0.001	3.088(1.795–5.312)	0.025	1.960(1.086–3.537)
	Stage III	0.001	3.391(2.033–5.657)	0.004	2.323(1.317–4.098)
	Stage IV	0.001	7.091(3.474–14.476)	0.001	4.616(2.136–9.974)
WHO stage during data collection	Stage I
	Stage II	0.389	1.445(0.626–3.336)	0.351	1.503(0.639–3.533)
	Stage III	0.001	5.637(3.925–8.875)	0.001	3.309(1.884–5.813)
	Stage IV	0.001	7.789(3.861–15.716)	0.016	3.054(1.227–7.600)
Opportunistic infection	Yes	0.001	2.116(1.466–3.055)	0.127	0.675(0.408–1.118)
Drug toxicity	Yes	0.004	1.814(1.205–2.730)	0.263	1.303(0.819–2.073)
Adherence	Good
	Fair	0.001	3.680(2.505–5.407)	0.006	2.058(1.234–3.432)
	Poor	0.001	5.534(2.534–12.119)	0.008	3.097(1.349–7.108)

Abbreviations: CHR, crude hazard ratio; AHR, adjusted hazard ratio; WHO, World Health Organization.

Figure 3 Kaplan Meier curve analysis of virological treatment failure starting from six months of follow-up.

Figure 4 Relationship between time to virological treatment failure and adherence to antiretroviral medication.