Abyi Adi Public General Hospital, Abyi Adi, Tigray, Ethiopia.
Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.
PLoS One. 2020 Sep 28;15(9):e0239191. doi: 10.1371/journal.pone.0239191. eCollection 2020.
This study aimed to determine the incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy (ART) in public hospitals of Northern Ethiopia.
A retrospective study was conducted from September 1, 2007 to July 30, 2017 on 227 patients. The data were extracted using a retrieval checklist from the patient's charts. The incidence rate of treatment failure was calculated using Kaplan-Meier methods and Cox proportional hazard model was used to assess factors associated with treatment failure.
The study subjects were followed for a total observation of 788.58 person-years with a median follow-up period of 35 (IQR: 17-60) months after switching to second-line ART. About 57 (25.11%) patients developed treatment failure, out of which, 32 (56.14%) occurred during the first two years. The overall incidence of second-line treatment failure was 72.3 per 1000 person years (95%CI: 55.75-93.71) of observation. The Kaplan-Meier estimates of cumulative treatment failure after 1, 2, and around 10 years of follow-up were 12.31% (95%CI: 8.60-17.45%), 14.99% (95%CI: 10.82%-20.57%), and 48.67% (95%CI: 32.45-67.81%) respectively. Age >45 years AHR = 3.33, 95%CI = 1.33-8.31), WHO stage IV (AHR = 3.63, 95%CI = 1.72-7.67), CD4 count <100 cells/mm3 (AHR = 3.79, 95%CI = 1.61-8.91), TB co-morbidity (AHR = 3.39 95%CI = 1.91-6.01) and poor adherence level (AHR = 3.63, 95% CI = 1.89-6.96) at the start of second line ART were significantly associated with second-line ART failure.
Incidence of second-line ART treatment failure in the first 2 years of follow-up was high. The rate of second-line ART failure was higher in patients who started second-line ART with poor drug adherence, CD4 count <100 cells/mm3, TB co-morbidity, age >45 years, and being in WHO stage IV. Therefore, intensive counseling and adherence support should be given along with strong TB screening. Moreover, the government of Ethiopia should consider endorsing third-line ART drugs after careful cost-benefit analysis.
本研究旨在确定在埃塞俄比亚北部公立医院接受二线抗逆转录病毒治疗（ART）的 HIV 感染青少年和成人患者中治疗失败的发生率和相关因素。
对 2007 年 9 月 1 日至 2017 年 7 月 30 日期间的 227 名患者进行了回顾性研究。使用检索检查表从患者病历中提取数据。使用 Kaplan-Meier 方法计算治疗失败的发生率，并使用 Cox 比例风险模型评估与治疗失败相关的因素。
研究对象共观察了 788.58 人年，中位随访时间为二线 ART 后 35（IQR：17-60）个月。约有 57（25.11%）名患者发生治疗失败，其中 32（56.14%）发生在头两年。二线治疗失败的总发生率为每 1000 人年 72.3 例（95%CI：55.75-93.71）。1、2 年和 10 年随访后累积治疗失败的 Kaplan-Meier 估计值分别为 12.31%（95%CI：8.60-17.45%）、14.99%（95%CI：10.82%-20.57%）和 48.67%（95%CI：32.45-67.81%）。年龄>45 岁 AHR = 3.33，95%CI = 1.33-8.31）、世界卫生组织（WHO）IV 期（AHR = 3.63，95%CI = 1.72-7.67）、CD4 计数<100 个/毫米 3（AHR = 3.79，95%CI = 1.61-8.91）、合并结核病（AHR = 3.39 95%CI = 1.91-6.01）和治疗开始时药物依从性差（AHR = 3.63，95%CI = 1.89-6.96）与二线 ART 治疗失败显著相关。
在随访的头 2 年中，二线 ART 治疗失败的发生率较高。在开始二线 ART 时药物依从性差、CD4 计数<100 个/毫米 3、合并结核病、年龄>45 岁和 WHO 期 IV 的患者中，二线 ART 失败的比率较高。因此，应给予强化咨询和药物依从性支持，并进行结核病筛查。此外，埃塞俄比亚政府应在进行仔细的成本效益分析后考虑批准三线 ART 药物。
