First line Antiretroviral Treatment Failure and Factors Associated with it in Addis Ababa, 2009
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Date
2009-06
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Addis Abeba Universty
Abstract
Background
Monitoring patient response with viral load, which is the gold standard, is not feasible in
resource limited settings. Therefore it’s essential to look for factors that can be used to
identify those patients at higher risk of treatment failure in these settings.
Objective
To explore factors that can be used to identify those at a higher risk of treatment failure.
Method
A Nested case-control study from a cohort of HIV patients on ART at government
hospitals in Addis Ababa was conducted through review of medical records. A total
sample size of 423 with 141 patients with failure of their first line regimen (cases) and
282 patients without failure (controls) is used. Base line socio-demographic and clinical
information were collected. Comparison of survival times were made through Kaplan
Meier and Log-rank tests. Independent predictors of treatment failure were identifies
using multivariate COX regression analysis.
Results
The mean survival time (without treatment failure) was 53 months (95% CI, 50 – 57).
Females were found to have a higher survival time of 57months (95%CI, 52-62, P= 0.01)
and males have a significantly higher risk of developing treatment failure with an
adjusted HR of 1.518 (95%CI, 1.084-2.125, P=0.01). Those with two or more episodes of
poor adherence during their follow-up have a significantly higher adjusted hazard ratio of
4.02 (95% CI, 2.71, 5.96, P=<0.001) compared to those with no episode of poor
adherence. Missed appointment is another independent predictor of treatment failure with
adjusted HR of 1.77 (1.11, 2.96, P= 0.03).
Conclusion
This study has shown that non- adherence to medication and clinic visits are
independently associated with treatment failure. Following patients closely for their level
of adherence and their trend of missing clinic visits can be used to help identify those at
higher risk of treatment failure. Providing intense adherence counseling for these patients
may prevent occurrence of failure.
Description
Keywords
First line Antiretroviral Treatment Failure