College of Health Sciences, Arsi University, Arsi, Ethiopia.
ONIRIS: The Nantes-Atlantic National College of Veterinary Medicine, Nantes, France.
BMC Infect Dis. 2019 Jun 18;19(1):537. doi: 10.1186/s12879-019-4170-5.
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.
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.
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/mm (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).
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.
治疗失败已成为接受抗逆转录病毒疗法（ART）治疗的患者面临的重大挑战。本研究旨在确定在接受临床随访的患者中，导致一线 ART 治疗失败的相关风险因素。
本研究为 2015 年 6 月至 2017 年 7 月开展的 1：2 配比病例对照研究（按年龄、性别和 ART 开始治疗后的治疗持续时间进行配比），纳入了至少接受 6 个月 ART 治疗的成年患者（年龄≥15 岁）。病例组患者为一线 ART 治疗失败（病毒载量≥1000 拷贝/mL）后转为二线 ART 治疗的患者。对照组为病毒载量＜50 拷贝/mL 的正在接受一线 ART 治疗的患者。通过访谈问卷、查阅图表和电子健康记录以及实验室检测收集数据。采用多变量逻辑回归分析确定治疗失败的相关风险因素。
本研究共纳入了 273 名患者，其中 55%为男性。将 91 例病例与 182 例对照进行了比较。参与者的中位年龄为 40 岁，ART 开始治疗后的中位治疗持续时间为 69 个月。与一线抗逆转录病毒治疗失败相关的独立风险因素包括：ART 停药（调整后的优势比（AOR）=9.8，95%置信区间（CI）：4.0-23.8）、基线 CD4 淋巴细胞计数≤50 个细胞/mm（AOR=3.8，95%CI：1.5-9.6）和持续性腹泻（AOR=4.4，95%CI：1.5-13.2）。无论 ART 停药持续时间大于或小于 1 个月，ART 治疗失败的风险均较高且相当（粗比值比（COR）分别为 6.3 和 8.5，p 值＜0.001）。经常食用含有小麦或大麦的饮食（AOR=2.3，95%CI：0.9-5.4）显示出成为一线 ART 治疗失败的风险因素的趋势（p 值=0.064）。
本研究结果强调了避免任何时长的 ART 停药、尽早开始 ART 治疗和管理腹泻对预防一线 ART 治疗失败的重要性。
