Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia.
Mettu College of Health Sciences, Mettu, Ethiopia.
PLoS One. 2021 Oct 22;16(10):e0258930. doi: 10.1371/journal.pone.0258930. eCollection 2021.
Antiretroviral therapy has dramatically reduced Human Immunodeficiency Virus related morbidity and mortality. It has also transformed HIV infection into a manageable chronic condition. However, first-line antiretroviral treatment failure continues to grow especially in resource limited settings. Despite this, determinants of first-line antiretroviral treatment failure are not well studied in Ethiopia.
To identify determinants of first-line antiretroviral treatment failure among adult patients on antiretroviral therapy in Mettu Karl Specialized Hospital, South West Ethiopia, in 2020.
A hospital based case-control study was conducted from October to November 2020. Simple random sampling technique was used to select participants. Interviewer administered questionnaire and record review were used for data collection. Data were entered into epi data version 3.1 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression analysis were used. At the end, variables with P-value < 0.05 at 95% confidence intervals for adjusted odds ratio were considered statistically significant determinants of first line treatment failure.
A total of 113 cases and 339 controls were included in the study with response rate of 98.6%. Sixty-four (56.6%) of cases and 183 (54.0%) of controls were females. Baseline WHO clinical stage III and IV (AOR = 1.909, 95% CI: (1.103, 3.305), baseline body mass index<18.5kg/m2(AOR = 2.208,95% CI:(1.257,3.877),baseline CD4 cell count <100cells/mm3 (AOR = 3.016, 95% CI: (1.734, 5.246), having history of TB co-infection (AOR = 1.855, 95% CI: (1.027, 3.353), having history of lost to follow up (AOR = 3.235, 95% CI: (1.096, 9.551), poor adherence to medication (AOR = 7.597, 95% CI: (4.059, 14.219) and initiation of treatment after two years of diagnosis with HIV (AOR = 4.979, 95% CI: (2.039, 12.158) were determinants of first-line antiretroviral treatment failure.
In this study several variables were found to be determinants of first-line antiretroviral treatment failure. Concerned bodies should give more attention to early diagnosis of HIV, early enrollment in chronic HIV care and early initiation of ART before patients develop advanced WHO clinical stages. In addition, focus has to be given for patients with low CD4 count. Regular screening for TB, counseling on optimal adherence to medication and enhancing nutritional status of patients with low body mass index are also crucial to prevent first-line antiretroviral treatment failure.
抗逆转录病毒疗法显著降低了与人类免疫缺陷病毒相关的发病率和死亡率。它还将 HIV 感染转变为可管理的慢性疾病。然而，一线抗逆转录病毒治疗失败的情况仍在继续增加，尤其是在资源有限的环境中。尽管如此，在埃塞俄比亚，一线抗逆转录病毒治疗失败的决定因素尚未得到很好的研究。
确定 2020 年在埃塞俄比亚 Mettu Karl 专科医院接受抗逆转录病毒治疗的成年患者中一线抗逆转录病毒治疗失败的决定因素。
这是一项 2020 年 10 月至 11 月期间进行的基于医院的病例对照研究。采用简单随机抽样技术选择参与者。采用访谈员管理的问卷和病历回顾进行数据收集。数据输入 epi data 版本 3.1 并导出到 SPSS 版本 20 进行分析。采用单变量和多变量逻辑回归分析。最后，将 P 值<0.05 的变量纳入调整后的比值比的 95%置信区间，作为一线治疗失败的统计学显著决定因素。
共有 113 例病例和 339 例对照参与了研究，应答率为 98.6%。64 例（56.6%）病例和 183 例（54.0%）对照为女性。基线世界卫生组织临床分期 III 和 IV 期（AOR=1.909，95%CI：（1.103，3.305）），基线体重指数<18.5kg/m2（AOR=2.208，95%CI：（1.257，3.877）），基线 CD4 细胞计数<100cells/mm3（AOR=3.016，95%CI：（1.734，5.246）），有结核合并感染史（AOR=1.855，95%CI：（1.027，3.353）），有失访史（AOR=3.235，95%CI：（1.096，9.551）），药物依从性差（AOR=7.597，95%CI：（4.059，14.219））和 HIV 诊断两年后开始治疗（AOR=4.979，95%CI：（2.039，12.158））是一线抗逆转录病毒治疗失败的决定因素。
在这项研究中，发现了几个一线抗逆转录病毒治疗失败的决定因素。有关部门应更加重视 HIV 的早期诊断，在患者出现晚期世界卫生组织临床分期之前，尽早将其纳入慢性 HIV 护理和早期启动抗逆转录病毒治疗。此外，还必须关注 CD4 计数较低的患者。定期筛查结核病，就最佳药物依从性进行咨询，并改善低体重指数患者的营养状况，对于预防一线抗逆转录病毒治疗失败也至关重要。
