School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Infect Dis. 2020 Jul 1;20(1):460. doi: 10.1186/s12879-020-05177-2.
Although the United Nations program on HIV/AIDS 90-90-90-targets recommends achieving 90% of viral suppression for patients on first-line antiretroviral therapy by 2020, virological failure is still high and it remains a global public health problem. Therefore, assessing the incidence and predictors of virological failure among adult HIV patients on first-line ART in Amhara regional referral hospitals, Ethiopia is vital to design appropriate prevention strategies for treatment failure and preventing the unnecessary switching to second-line regimens.
An institution-based retrospective follow-up study was conducted on 490 adult HIV patients. The simple random sampling technique was used, and data were entered into Epi data Version 4.2.0.0 and was exported to Stata version 14 for analysis. The proportional hazard assumption was checked, and the Weibull regression was fitted. Cox-Snell residual was used to test the goodness of fit, and the appropriate model was selected by AIC/BIC. Finally, an adjusted hazard ratio with a 95% CI was computed, and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors of virological failure.
The overall incidence rate of virological failure was 4.9 events per 1000 person-month observations (95%CI: 3.86-6.38). Users of CPT (AHR = 0.55, 95%CI: 0.31-0.97), poor adherence (AHR = 5.46, 95%CI: 3.07-9.74), CD4 Count <=200 cells/mm (AHR = 3.9, 95%CI: 1.07-13.9) and 201-350 cells/mm (AHR 4.1, 95%CI: 1.12-15) respectively, and NVP based first line drug regimen (AHR = 3.53, 95%CI: 1.73-7.21) were significantly associated with virological failure.
The incidence rate of virological failure was high. CPT, poor adherence, low baseline CD4 count and NVP based first-line drug regimen were independent risk factors associated with virological failure. Therefore, strengthening HIV care intervention and addressing these significant predictors is highly recommended in the study setting.
尽管联合国艾滋病规划署的 90-90-90 目标建议到 2020 年实现 90%接受一线抗逆转录病毒治疗的患者病毒得到抑制，但病毒学失败率仍然很高，这仍是一个全球性公共卫生问题。因此，评估埃塞俄比亚阿姆哈拉地区转诊医院接受一线抗逆转录病毒治疗的成年艾滋病毒感染者的病毒学失败发生率及其预测因素，对于设计适当的治疗失败预防策略以及防止不必要地转向二线方案至关重要。
采用基于机构的回顾性随访研究，对 490 名成年艾滋病毒感染者进行研究。采用简单随机抽样技术，将数据录入 EpiData 版本 4.2.0.0 并导出到 Stata 版本 14 进行分析。检查比例风险假设，拟合威布尔回归。使用 Cox-Snell 残差检验拟合优度，通过 AIC/BIC 选择合适的模型。最后，计算调整后的危险比及其 95%CI，并将多变量分析中 P 值 < 0.05 的变量视为病毒学失败的显著预测因素。
总的病毒学失败发生率为每 1000 人月观察 4.9 例（95%CI：3.86-6.38）。使用 CPT（AHR=0.55，95%CI：0.31-0.97）、依从性差（AHR=5.46，95%CI：3.07-9.74）、CD4 计数 <=200 个细胞/mm（AHR=3.9，95%CI：1.07-13.9）和 201-350 个细胞/mm（AHR=4.1，95%CI：1.12-15）以及基于奈韦拉平的一线药物方案（AHR=3.53，95%CI：1.73-7.21）与病毒学失败显著相关。
病毒学失败发生率较高。CPT、依从性差、基线 CD4 计数低和基于奈韦拉平的一线药物方案是与病毒学失败相关的独立危险因素。因此，在研究环境中，强烈建议加强艾滋病毒护理干预，并解决这些显著的预测因素。
