Factors influencing treatment failure in HIV positive adult patients on first line antiretroviral therapy.

BACKGROUND

Risk factors for treatment failure in HIV positive adults have not been studied extensively in Zimbabwe.

AIM

To investigate socio-demographic, psychosocial and antiretroviral drug related factors as possible risk factors for treatment failure.

OBJECTIVE

To compare the accuracy and reliability of CD4 count results in diagnosing treatment failure versus viral load results.

DESIGN

A descriptive cross-sectional survey.

SETTING

Harare Central Hospital adult opportunistic infections clinic.

PARTICIPANTS

One hundred and eighteen (118) HIV positive participants on 1st line antiretroviral therapy (any 1 of stavudine, tenofovir or zidovudine combined with lamivudine and nevirapine or efavirenz) for at least 1 year. Participants were conveniently sampled.

MAIN OUTCOME MEASURES

First line treatment failure as defined according to World Health Organisation (WHO) 2010 guidelines.

RESULTS

Factors associated with higher odds of treatment failure were severe depression [OR 3.7; p-value 0.002; 95% CI 1.6-8.5] and discontinuing ART [OR 4.4; p-value 0.02; 95% CI 1.3-14.7]. Factors associated with lower odds of treatment failure were age = 42 [OR 0.3; p-value 0.007; 95% CI 0.1-0.7], taking ART on time [OR 0.2; p-value 0.02; 95% CI 0.05-0.8], time on ART > 4 years [OR 0.6; p-value 0.02; 95% CI 0.3-0.9] and female sex [OR 0.4; p-value 0.02; 95% CI 0.2-0.8]. There was statistically significant difference between CD4 count and viral load results in diagnosing treatment failure [OR 8.7; p-value 0.0005; 95% CI 3.6-21.2].

CONCLUSION

Severe depression and discontinuing ART predisposed to treatment failure. CD4 counts were not as reliable as viral load measurements in diagnosing treatment failure.