Tsegaye Adino Tesfahun, Alemu Wagaye, Ayele Tadesse Awoke
Department of Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Institute of Public Health, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics Ethiopia, Dilla University, College of Medicine and Health Sciences, Dilla, Ethiopia.
Pan Afr Med J. 2019 Jun 6;33:89. doi: 10.11604/pamj.2019.33.89.16626. eCollection 2019.
Mortality of adult patients who are on antiretroviral therapy (ART) is higher in low-income than in high-income countries. After the failure of standard first-line treatment, patients switch to second-line regimens. However, there are limited data about the outcome of patients after switching to a second-line regimen in the study area. This study aimed to measure the rate of mortality and its determinants among HIV patients on second-line ART regimens.
Multicenter institution based retrospective follow up study was conducted among 1192 adult patients who started second-line ART between 2008 and 2016 in eight selected hospitals of Amhara region. Patients who started second-line treatment after the failure of first-line treatment were included. Patient medical records, registration books, and computer database were used to collect the data. Time to death after a switch to second-line ART was the primary outcome of interest. Cox proportional hazard model was fitted to identify determinant factors of mortality.
Among 1192 patients who were on second-line ART, 136 (11.4%) died with 3,157 person-years of follow up. Over the study period, the mortality rate was 4.33 per 100 person-years. Not taking isoniazid preventive therapy (IPT) (Adjusted Hazard Ratio (AHR): 6.6; 95% CI: 2.9, 15.0), did not make modification on second-line regimen (AHR: 4.4; 95% CI: 2.8, 6.8), poor clinical adherence (AHR: 2.5; 95% CI: 1.4, 4.5), functional status of bedridden (AHR: 2.7; 95% CI: 1.5, 4.8), and having attained a tertiary level of education (AHR: 0.4; 95% CI: 0.2, 0.8) were independent determinants of mortality.
The incidence rate of mortality was high and most of the deaths occurred within 12 months after switching to second-line ART. Higher mortality among adult HIV-infected patients was associated with poor adherence, no formal education, not taking IPT, being bedridden at the time of the switch, and not modifying second-line treatment. Improving treatment adherence of patients by providing consistent adherence counseling, providing INH prophylaxis and monitoring patient's regimen more closely during the first twelve months after switch could decrease mortality of HIV patients on a second-line regimen.
接受抗逆转录病毒治疗（ART）的成年患者在低收入国家的死亡率高于高收入国家。在标准一线治疗失败后，患者会改用二线治疗方案。然而，在研究区域内，关于患者改用二线治疗方案后的预后数据有限。本研究旨在衡量接受二线抗逆转录病毒治疗方案的HIV患者的死亡率及其决定因素。
在阿姆哈拉地区八家选定医院对1192名在2008年至2016年期间开始二线抗逆转录病毒治疗的成年患者进行了基于多中心机构的回顾性随访研究。纳入一线治疗失败后开始二线治疗的患者。使用患者病历、登记册和计算机数据库收集数据。改用二线抗逆转录病毒治疗后的死亡时间是主要关注的结局。采用Cox比例风险模型来确定死亡率的决定因素。
在1192名接受二线抗逆转录病毒治疗的患者中，有136名（11.4%）在3157人年的随访期内死亡。在研究期间，死亡率为每100人年4.33例。未接受异烟肼预防性治疗（IPT）（调整后风险比（AHR）：6.6；95%置信区间：2.9，15.0）、未对二线治疗方案进行调整（AHR：4.4；95%置信区间：2.8，6.8）、临床依从性差（AHR：2.5；95%置信区间：1.4，4.5）、卧床功能状态（AHR：2.7；95%置信区间：1.5，4.8）以及达到高等教育水平（AHR：0.4；95%置信区间：0.2，0.8）是死亡率的独立决定因素。
死亡率发生率较高，且大多数死亡发生在改用二线抗逆转录病毒治疗后的12个月内。成年HIV感染患者较高的死亡率与依从性差、未接受正规教育、未接受IPT、改用时卧床以及未调整二线治疗有关。通过提供持续的依从性咨询来提高患者治疗依从性，提供异烟肼预防措施，并在改用后的头十二个月内更密切地监测患者的治疗方案，可以降低接受二线治疗方案的HIV患者的死亡率。
