Search

Background: Medication adherence plays a significant in the success of combination antiretroviral therapy (cART). Therefore, the current investigation was conducted with the objective of comparing adherence and CD4 cell count with respect to virologic failure among HIV-infected adults under cART. Methods: A retrospective study design was conducted on 792 randomly selected HIV-infected adult patients who initiated first-line cART enrolled in the first 10 months of 2012 and followed up to August 2018 by using a simple random sampling technique based on their identification number. Results: The main outcome for the current investigation was the virologic failure which was decreased with successive visits. The area under the receiver operating characteristic curve for adherence and CD4 cell count change were 0.68 and 0.63 with χ2 = 21.2; p-value < 0.001 for the 12-month assessment. Similarly, these areas for the 36th and 60th month assessments were 0.71 and 0.66, with χ2 = 23.2; p-value < 0.001, and 0.73 and 0.71 with χ2 = 24.3; p-value < 0.001 for adherence and CD4 cell count, respectively. Conclusion: Pill count adherence was more accurate compared to CD4 cell count change for assessing virologic responses. Therefore, because of its easy access, simple use, cost-effectiveness, and accuracy, the adherence to cART was in favor of CD4 cell count change for monitoring the healthcare quality of HIV-infected patients. [ABSTRACT FROM AUTHOR]

Background: Treatment failure among the population on second line antiretroviral therapy is a major public health threat. In Ethiopia there has been limited research done on second line treatment failure. Objective: To identify determinants of virologic failure among adults on second line antiretroviral therapy in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Methods: An institution-based unmatched case–control study was conducted from February 1, 2020 to April 30, 2020 on a total of 377 clients in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Clients whose viral load result > 1,000 copies/mL in two consecutive results at least 3 month apart were cases, while ≤ 1,000 copies/mL were controls. The sample size was calculated by using Epi-Info version 7. Cases (94) and controls (283) were selected using a simple random sampling method in a ratio of cases-to-controls of 1:3. The model fitted and binary logistic assumptions were fulfilled with 95% confidence level and P-values< 0.05 were taken as statistically significant. Results: Virologic failure was predicted by poor adherence (AOR=6.060, 95% CI=2.837– 12.944), not disclosing their HIV status (AOR=4.178, 95% CI=1.431– 12.198), OI (AOR=4.11, 95% CI=1.827– 9.246), CD4 count < 100 cells/mm3 (AOR=3.497, 95% CI=1.233– 9.923) and 100– 350 cells/mm3 (AOR=5.442, 95% CI=2.191– 13.513), low BMI < 16 kg/m2 (AOR=7.223, 95% CI=2.218– 23.520), and young age 15– 29 years (AOR=2.898, 95% CI=1.171– 7.170). Conclusion and Recommendations: Determinants of second line ART virologic failure were patients who had poor adherence to ART, not disclosed, opportunistic infection, low CD4 counts < 350 cell/mm3, low BMI (< 16 kg/m2), and young age 15– 29 year patients. Social support, disclosing their HIV status, and getting early treatment for any opportunistic infection is crucial to patients. [ABSTRACT FROM AUTHOR]

Background: Treatment failure has become a significant challenge in patients taking antiretroviral therapy (ART). The aim of the present study was to identify risk factors for first-line ART failure among patients attending clinical follow-up.Methods: A 1:2 matched case-control study (by age, sex, and treatment duration since initiated on ART) was conducted from June 2015 to July 2017 on adult patients (aged ≥15 years) who were on ART for at least 6 months. Cases were selected from patients who were switched to second-line ART after first-line ART failure (viral load ≥1000 copies/mL). Controls were randomly selected from patients on first-line ART with viral load < 50 copies/mL. Data were collected using an interview questionnaire, reviewing chart and electronic health records and laboratory tests. Multivariate logistic regression analysis was performed to identify risk factors for treatment failure.Results: Of the 273 patients who participated in this study, 55% were males. Ninety-one cases were compared with 182 controls. The median age of participants was 40 years and the median duration of treatment since initiated on ART was 69 months. Independent risk factors associated with first-line antiretroviral treatment failure were discontinuation of ART (adjusted odds ratio (AOR) = 9.8, 95% confidence interval (CI): 4.0-23.8), baseline CD4 lymphocyte count ≤50 cells/mm3 (AOR = 3.8, 95% CI: 1.5-9.6) and persistent diarrhea (AOR = 4.4, 95% CI: 1.5-13.2). The risk of ART failure was high and comparable whether the duration of ART discontinuation was greater or less than 1 month (crude odds ratio (COR) = 6.3 and 8. 5 respectively, p-value < 0.001). Frequent eating of a diet containing wheat or barley (AOR = 2.3, 95% CI: 0.9-5.4) showed a trend to be a risk factor for first-line ART failure (p-value = 0.064).Conclusions: Our findings underscore the importance of avoiding ART discontinuation of any duration, early initiation of ART and diarrhea management to prevent first-line ART failure. [ABSTRACT FROM AUTHOR]