埃塞俄比亚东北部南沃洛地区成人艾滋病毒感染者病毒学失败的患病率及预测因素：一项回顾性队列研究
Prevalence and Predictors of Virological Failure Among Adults Living with HIV in South Wollo Zone, Northeast Ethiopia: A Retrospective Cohort Study.
作者信息
Fentie Wendie Teklehaimanot, Workneh Birhanu Demeke
机构信息
Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
出版信息
HIV AIDS (Auckl). 2020 Sep 7;12:393-402. doi: 10.2147/HIV.S266460. eCollection 2020.
BACKGROUND
Highly active antiretroviral therapy has dramatically altered progression of HIV infection and significantly improved patients' quality of life. However, drug resistance with consequent treatment failure raises the need for much more expensive and toxic second-line regimens. Thus, this study aimed at investigating the predictors of virologic failure among adults in Northeast Ethiopia.
METHODS
A retrospective cohort study was carried out among adults who started first-line antiretroviral treatment from September 2005 to January 2018. Data were collected from patients' medical records, entered and validated using EpiData version 3.1 and then exported to SPSS version 20 for analysis. Binary logistic regression was carried out; odds ratio with 95% CI was used to identify covariates associated with virologic failure. Statistical significance was considered at p-value <0.05.
RESULTS
A total of 384 patients with mean age of 35.73±9.44 years were consecutively enrolled; of which, 213 (55.5%) were females, 255 (66.4%) had WHO clinical stage III/IV, and 130 (33.9%) had baseline CD4 count <100 cells/mm. Mean baseline CD4 count was 179 cells/mm (range: 2-853 cells), and 158 (41.1%) participants were on AZT/3TC/NVP. Virological failure was diagnosed among 61 (15.9%) patients. The mean time to virologic failure after initiation of ART was 63.80 months (range: 17-150 months). After adjusting for other confounders, risk of experiencing virologic failure was significantly associated with being divorced (AOR 3.40, 95% CI 1.20-9.59), being naïve to ART (AOR 2.55, 95% CI 1.23-5.28), low (<100) baseline CD4 count (AOR 2.39, 95% CI 1.03-5.54) and nonadherence (AOR 6.73, 95% CI 3.29-13.76).
CONCLUSION
In this study, the prevalence of antiretroviral treatment failure was 15.9%. Being divorced, being naïve to antiretroviral therapy, low (<100 cells/mm) baseline CD4 count and nonadherence were found to be significant predictors of virologic failure. ART programs should focus on early HIV diagnosis and ART initiation as well as enhanced adherence support.
背景
高效抗逆转录病毒疗法显著改变了HIV感染的进程，并显著提高了患者的生活质量。然而，耐药性以及随之而来的治疗失败引发了对更加昂贵且毒性更大的二线治疗方案的需求。因此，本研究旨在调查埃塞俄比亚东北部成年人病毒学治疗失败的预测因素。
方法
对2005年9月至2018年1月开始一线抗逆转录病毒治疗的成年人进行了一项回顾性队列研究。从患者的病历中收集数据，使用EpiData 3.1版本录入并验证，然后导出到SPSS 20版本进行分析。进行二元逻辑回归分析；使用95%置信区间的比值比来确定与病毒学治疗失败相关的协变量。p值<0.05时认为具有统计学意义。
结果
共连续纳入384例平均年龄为35.73±9.44岁的患者；其中，213例（55.5%）为女性，255例（66.4%）处于世界卫生组织临床分期III/IV期，130例（33.9%）基线CD4细胞计数<100个/mm³。平均基线CD4细胞计数为179个/mm³（范围：2 - 853个/mm³），158例（41.1%）参与者接受齐多夫定/拉米夫定/奈韦拉平治疗。61例（15.9%）患者被诊断为病毒学治疗失败。开始抗逆转录病毒治疗后发生病毒学治疗失败的平均时间为63.80个月（范围：17 - 150个月）。在对其他混杂因素进行调整后，病毒学治疗失败的风险与离婚（比值比3.40，95%置信区间1.20 - 9.59）、未接受过抗逆转录病毒治疗（比值比2.55，95%置信区间1.23 - 5.28）、低（<100）基线CD4细胞计数（比值比2.39，95%置信区间1.03 - 5.54）和不依从（比值比6.73，95%置信区间3.29 - 13.76）显著相关。
结论
在本研究中，抗逆转录病毒治疗失败的患病率为15.9%。离婚、未接受过抗逆转录病毒治疗、低（<100个/mm³）基线CD4细胞计数和不依从被发现是病毒学治疗失败的重要预测因素。抗逆转录病毒治疗项目应注重早期HIV诊断和抗逆转录病毒治疗的启动以及加强依从性支持。
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