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

Authors Asefa A, Asaye Z, Girma A, Hiko D

Received 10 October 2019

Accepted for publication 16 December 2019

Published 31 December 2019 Volume 2019:11 Pages 377—386


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Bassel Sawaya

Adane Asefa,1 Zufan Asaye,2 Abiot Girma,3 Desta Hiko3

1Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia; 2Department of Statistics, College of Natural Science, Mizan-Tepi University, Mizan-Aman, Ethiopia; 3Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia

Correspondence: Adane Asefa
Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia

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 1st January 2010 to 30th 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

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