Predictors of first-line antiretroviral therapy failure amongst HIV-infected adult clients at Woldia Hospital, Northeast Ethiopia
Predictors of first-line antiretroviral therapy failure amongst HIV-infected adult clients at Woldia Hospital, Northeast Ethiopia
复制标题
DOI：
10.1371/journal.pone.0187694
复制
发表时间：
2017-11-02
期刊：
影响因子：
3.7
通讯作者：
Fentaye, Fasil Walelign
中科院分区：
文献类型：
--
作者：
Babo, Yohannes Demissie;Alemie, Getahun Asres;Fentaye, Fasil Walelign
背景由于在资源有限的情况下，用于治疗结果监测的病毒载量检测的可用性有限，确定抗逆转录病毒治疗失败的预测因素将有助于选择将从有针对性地使用病毒载量监测中获益最多的客户。在研究领域，对治疗失败的预测因子知之甚少。这项研究的目的是确定埃塞俄比亚东北部Woldia医院HIV感染者中一线抗逆转录病毒治疗失败的预测因素。在这项研究中，抗逆转录病毒治疗失败被定义为符合WHO制定的临床和/或免疫学标准。病例为接受失败的一线方案和积极随访的成年客户，而对照组为接受36个月及以上非失败的一线方案和积极随访的成年客户。将数据输入Epi Info版本7，并导出至SPSS版本20进行分析。二元逻辑回归模型被用来确定预测ART failure.ResultsA共59例和245对照被纳入分析。63%的参与者为女性，ART入组时的中位年龄为33岁（IQR; 28，40）。病例组和对照组的中位基线CD 4计数无显著差异（105（IQR = 60-174）vs.131（IQR = 72.5-189.0）; p = 0.301）。失败组的CD 4峰值计数中位数（230（IQR = 123-387））显著低于非失败组（463（IQR = 348.5-577））[p< 0.001]。高峰CD 4计数（AOR = 0.993; 95% CI 0.990，0.996）和ART持续时间较长（AOR = 0.923; 95% CI 0.893，0.954）可保护治疗失败。此外，基于司他夫定的方案（AOR = 3.47; 95% CI 1.343，10.555），低基线BMI（AOR = 2.75; 95% CI 1.012，7.457），失业（AOR = 4.93; 95%CI 1.493，16.305）和正规教育水平（AOR = 5.15; 95%CI 1.534，17.276）是治疗失败的独立显著预测因子。一线抗逆转录病毒治疗持续时间较短、基于d4 T的治疗方案、低基线BMI、失业和正规教育水平与治疗失败率增加显著相关。应加强对患者的初始一线治疗，并进行适当的随访，并通过各种生计举措改善其社会经济地位。
BackgroundDue to the limited availability of viral load testing for treatment outcome monitoring in resource limited settings, identifying predictive factors of antiretroviral treatment failure will help in selecting clients who will benefit most from the targeted use of viral load monitoring. Little is known about the predictors of treatment failure in the study area. This study was conducted to determine factors that predict first-line antiretroviral therapy failure among HIV-infected adult clients at Woldia Hospital, Northeast Ethiopia. For this study, antiretroviral therapy treatment failure was defined as the fulfillment of clinical and/or immunological criteria set by WHO.MethodsCase-control study was carried out from November to December 2014. Cases were adult clients who were on failing first line regimen and on active follow up while controls were those adult clients on a non-failing first-line regimen for 36 months and above and on active follow up. Data was entered in to Epi Info version 7 and was exported to SPSS version 20 for analysis. Binary logistic regression model was used to identify predictors of ART failure.ResultsA total of 59 cases and 245 controls were included in the analysis. Sixty three percent of the participants were females and the median age at ART enrollment was 33 years (IQR; 28, 40). The median baseline CD4 count was not significantly different among cases and controls (105 (IQR = 60-174)vs.131 (IQR = 72.5-189.0); p = 0.301). The median peak CD4 count in the failure group (230 (IQR = 123-387)) was significantly low compared to the non-failure group (463 (IQR = 348.5-577)) [p< 0.001]. High peak CD4count (AOR = 0.993; 95% Cl 0.990, 0.996) and longer duration on ART (AOR = 0.923; 95% Cl 0.893, 0.954) were protective of treatment failure. In addition stavudine based regimen (AOR = 3.47; 95% Cl 1.343,10.555), low baseline BMI (AOR = 2.75; 95% Cl 1.012, 7.457), unemployment(AOR = 4.93; 95% Cl 1.493,16.305) and formal educational level (AOR = 5.15; 95% Cl 1.534,17.276) were independently significant predictors of treatment failure.ConclusionsIn this setting low peak CD4count, shorter duration on first line ART, d4T based regimen, low baseline BMI, unemployment and formal educational level were significantly associated with increased treatment failure. Retaining patients on their initial first line regimen with appropriate follow up and improving their socioeconomic status through various livelihood initiatives should be strengthened.