Ahmed Mohammed, Merga Hailu, Jarso Habtemu
Department of Public Health, Woldia University, Woldia, Ethiopia.
Department of Epidemiology, Institute of health, Jimma University, Jimma, Ethiopia.
BMC Infect Dis. 2019 Apr 3;19(1):305. doi: 10.1186/s12879-019-3924-4.
Virological treatment failure is a problem that a Human Immune Virus patient faces after starting treatment due to different factors. However, there were few studies done on the predictors of virological treatment failure among adult patients on first-line antiretroviral therapy in Ethiopia in general, and no study was done in the study area in particular. Therefore, the aim of the study was to identify predictors of virological treatment failure among adult patients on first-line antiretroviral therapy in Woldiya and Dessie Hospitals, Northeast Ethiopia.
Hospital based case-control study was conducted in Woldia and Dessie Hospitals from from 12 August 2016-28 February 2018 on 154 cases and 154 controls among adult patients on first-line antiretroviral treatment. All cases were included and comparable controls were selected using stratified random sampling technique. Data were collected by document review using checklists and entered into Epidata version 3.1 and analyzed by SPSS version 21. Multivariable logistic regression analysis was done to identify the independent predictors of virological treatment failure.
In this study, statistically higher odds of virological failure was observed among patients who had current CD4 T-cell count of < 200 mm (AOR = 2.4, 95% CI: 1.35, 4, 18) compared withCD4 T-cell count of > 200 mm, current body mass index(BMI) < 16 kg/m (AOR = 4.2, 95% CI:1.85, 9.51) compared with BMI > 18.5 kg/m, BMI between 16 and 18.5 kg/m (AOR = 3.72, 95% CI: 1.75, 7.92) versus BMI > 18.5 kg/m, poor adherence to antiretroviral therapy (AOR = 5.4, 95% CI: 2.95, 9.97) compared with good adherence.
This study showed that low current CD4 T-cell count and body mass index, as well as poor adherence for ART treatment predicts virological failure. Therefore, deliberate efforts are urgently needed in HIV care through improving their nutritional status by enhancing nutritional education and support, and by strengthening enhanced adherence counseling.
病毒学治疗失败是人类免疫病毒患者开始治疗后因不同因素而面临的一个问题。然而,总体而言,埃塞俄比亚针对接受一线抗逆转录病毒治疗的成年患者病毒学治疗失败的预测因素开展的研究很少,特别是在本研究区域尚未开展此类研究。因此,本研究的目的是确定埃塞俄比亚东北部沃尔迪亚和德西医院接受一线抗逆转录病毒治疗的成年患者病毒学治疗失败的预测因素。
2016年8月12日至2018年2月28日,在沃尔迪亚和德西医院开展了一项基于医院的病例对照研究,研究对象为154例接受一线抗逆转录病毒治疗的成年患者及154例对照。纳入所有病例,并采用分层随机抽样技术选取可比的对照。通过使用检查表进行文档审查收集数据,并录入Epidata 3.1版本,然后用SPSS 21版本进行分析。采用多变量逻辑回归分析确定病毒学治疗失败的独立预测因素。
在本研究中,与CD4 T细胞计数>200/mm相比,当前CD4 T细胞计数<200/mm的患者出现病毒学失败的几率在统计学上更高(调整后比值比[AOR]=2.4,95%置信区间[CI]:1.35,4.18);与体重指数(BMI)>18.5kg/m²相比,当前BMI<16kg/m²的患者出现病毒学失败的几率更高(AOR=4.2,95%CI:1.85,9.51);BMI在16至18.5kg/m²之间的患者与BMI>18.5kg/m²的患者相比,出现病毒学失败的几率更高(AOR=3.72,95%CI:1.75,7.92);与依从性良好相比,抗逆转录病毒治疗依从性差的患者出现病毒学失败的几率更高(AOR=5.4,95%CI:2.95,9.97)。
本研究表明,当前CD4 T细胞计数和体重指数较低以及抗逆转录病毒治疗依从性差可预测病毒学失败。因此,迫切需要通过加强营养教育和支持来改善艾滋病毒感染者的营养状况,并加强依从性咨询,从而在艾滋病毒护理方面做出切实努力。