埃塞俄比亚东北部塞科塔接受一线抗逆转录病毒治疗的艾滋病毒患者的抗逆转录病毒治疗失败及相关因素
Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia.
作者信息
Nega Jemberu, Taye Solomon, Million Yihenew, Rodrigo Chaturaka, Eshetie Setegn
机构信息
Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia.
Department of Pathology, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
出版信息
AIDS Res Ther. 2020 Jul 10;17(1):39. doi: 10.1186/s12981-020-00294-z.
BACKGROUND
Antiretroviral treatment has played a pivotal role in the reduction of HIV/AIDS-related morbidity and mortality. However, treatment options can be impaired by the development of antiretroviral treatment failure. Regular monitoring of the Human Immunodeficiency Virus treatment outcome via viral load tests is the key approach. There is a scarcity of information about HIV treatment failure and risk factors in the study area. Therefore, the study was aimed to assess antiretroviral treatment failure and associated factors among patients on first-line antiretroviral treatment at Tefera Hailu Memorial Hospital, Sekota, northeast Ethiopia.
METHODS
A hospital-based cross-sectional study was conducted on 295 patients on first-line antiretroviral treatment from Nov. 2018 to Apr. 2019. Socio-demographic and clinical variables were collected using a pretested questionnaire, and blood specimen was collected for PCR viral load and CD4 + cell count estimation. Data were entered into Epi-Info and exported to SPSS for analysis. A binary logistic regression model was used to identify associated factors, and P value < 0.05 was considered as statistically significant.
RESULTS
Of the 295 subjects on first-line ART, 49 (16.6%) and 18 (6.1%) experienced virological and immunological failures, respectively. The failure of the former was associated with poor adherence (AOR: 6.367, P < 0.001), CD4 + count < 500 cells/µL (AOR: 4.78, P = 0.031) and shorter (6-24 months) duration on ART (AOR: 0.48, P = 0.048), while poor treatment adherence (AOR: 11.51, P = 0.012) and drug interruption (AOR: 6.374, P = 0.039) were the independent risk factors for latter. Immunological tests to predict virological failures showed as sensitivity, specificity, PPV, and NPV were 20.4%, 96.7%, 55.5%, and 86.0%, respectively.
CONCLUSIONS
The rate of ART failure was considerably high. Poor adherence, low CD4 + count, prolonged ART, and drug interruption were found to be the most predictor variables for virological and immunological failures. The discrimination power of the immunological parameter was low in comparison to virological measurements as standard methods. Therefore, the study highlighted the need for more attention and efforts to curb associated factors and maximize virological tests for monitoring treatment failures.
背景
抗逆转录病毒治疗在降低与艾滋病毒/艾滋病相关的发病率和死亡率方面发挥了关键作用。然而，抗逆转录病毒治疗失败的发生可能会损害治疗选择。通过病毒载量检测定期监测人类免疫缺陷病毒治疗结果是关键方法。在该研究区域，关于艾滋病毒治疗失败及其危险因素的信息匮乏。因此，本研究旨在评估埃塞俄比亚东北部塞科塔的特费拉·海卢纪念医院接受一线抗逆转录病毒治疗的患者中抗逆转录病毒治疗失败及其相关因素。
方法
2018年11月至2019年4月，对295例接受一线抗逆转录病毒治疗的患者进行了一项基于医院的横断面研究。使用预先测试的问卷收集社会人口统计学和临床变量，并采集血样用于PCR病毒载量和CD4 +细胞计数评估。数据录入Epi-Info并导出到SPSS进行分析。采用二元逻辑回归模型确定相关因素，P值<0.05被认为具有统计学意义。
结果
在295例接受一线抗逆转录病毒治疗的受试者中，分别有49例（16.6%）和18例（6.1%）经历了病毒学失败和免疫学失败。前者的失败与依从性差（调整后比值比：6.367，P<0.001）、CD4 +计数<500个细胞/微升（调整后比值比：4.78，P = 0.031）以及抗逆转录病毒治疗时间较短（6 - 24个月）（调整后比值比：0.48，P = 0.048）相关，而治疗依从性差（调整后比值比：11.51，P = 0.012）和药物中断（调整后比值比：6.374，P = 0.039）是后者的独立危险因素。用于预测病毒学失败的免疫学检测显示，其敏感性、特异性、阳性预测值和阴性预测值分别为20.4%、96.7%、55.5%和86.0%。
结论
抗逆转录病毒治疗失败率相当高。发现依从性差、CD4 +计数低、抗逆转录病毒治疗时间延长和药物中断是病毒学和免疫学失败的最主要预测变量。与作为标准方法的病毒学测量相比，免疫学参数的辨别能力较低。因此，该研究强调需要更多关注并努力控制相关因素，并最大限度地利用病毒学检测来监测治疗失败情况。
Zotero 插件