Epidemiology and Biostatistics Department, School of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
Epidemiology and Biostatistics Department, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
AIDS Res Ther. 2021 Dec 4;18(1):93. doi: 10.1186/s12981-021-00418-z.
Anti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However, information's on the time of initial regimen discontinuation and its predictors are not well studied.
This study aimed to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia.
Institution-based retrospective cohort study was conducted among 418 HIV patients who started HAART from January 1, 2014, to December 31, 2019. Data were collected from the patient chart using a data extraction tool. The Kaplan-Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation.
A total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking > 1 ART pills/day (AHR = 4.1, 95% CI 3.0-6.5), baseline CD4 count < 100 cells/mm (AHR = 2.6, 95% CI 1.5-4.7), 100-199 cells/mm (AHR = 2.2, 95% CI 1.2-4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI 1.6-4.3) and stage III (AHR = 2.6, 95% CI 1.4-4.3) and TB infection (AHR = 2.3, 95% CI 1.6-3.5).
Most of the discontinuation occurred after 1 year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count, and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced and initiation of one ART regimen daily is vital for survival on the initial regimen.
抗逆转录病毒治疗方案的中断成为一个巨大的挑战，导致埃塞俄比亚的治疗临床和免疫获益减少。由于不同替代药物之间的交叉耐药性以及抗逆转录病毒药物在同一类药物之间的重叠毒性，这不仅缩短了治疗的持续时间，也降低了病毒控制的机会。然而，关于初始方案中断的时间及其预测因素的信息尚未得到很好的研究。
本研究旨在评估在埃塞俄比亚 Felege Hiwot 综合专科医院接受高效抗逆转录病毒治疗的 HIV 患者中初始高效抗逆转录病毒治疗方案中断的时间及其预测因素。
这是一项基于机构的回顾性队列研究，共纳入了 418 名于 2014 年 1 月 1 日至 2019 年 12 月 31 日期间开始接受高效抗逆转录病毒治疗的 HIV 患者。使用数据提取工具从患者病历中收集数据。采用 Kaplan-Meier 曲线比较生存率。采用多变量 Cox 比例风险回归分析确定初始方案中断时间的独立预测因素。
共随访了 418 名接受抗逆转录病毒治疗的患者。初始 HAART 中断的发生率为 16.7/100 人年。中位生存时间为 3.5 年。有研究结果表明，以下因素与初始 HAART 中断时间有关：每天服用 >1 片抗逆转录病毒药物（AHR=4.1，95%CI 3.0-6.5）、基线 CD4 计数 <100 个细胞/mm（AHR=2.6，95%CI 1.5-4.7）、100-199 个细胞/mm（AHR=2.2，95%CI 1.2-4.0）、基线世卫组织临床分期 IV（AHR=2.68，95%CI 1.6-4.3）和 III 期（AHR=2.6，95%CI 1.4-4.3）以及结核病感染（AHR=2.3，95%CI 1.6-3.5）。
大多数停药发生在 HAART 开始后 1 年。基线世卫组织临床分期、结核病感染、基线 CD4 计数和每天服用 >1 片抗逆转录病毒药物是初始 HAART 方案中断的预测因素。在疾病进展前早期发现 HIV 并开始每天服用一种抗逆转录病毒药物对于初始方案的生存至关重要。
