School of Public Health, CMHS, Wollo University, Dessie, Ethiopia.
School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia.
PLoS One. 2022 Jun 1;17(6):e0269235. doi: 10.1371/journal.pone.0269235. eCollection 2022.
The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern, especially in a low-income country setting. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy in the Ethiopia context. Thus, this study was conducted to determine the rate of treatment failure, death, and their predictors among HIV patients receiving second-line therapy.
A retrospective cohort study was conducted on 642 people living with HIV in Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. Poisson and competitive risk survival models were computed to explore predictors of treatment failure and death, respectively.
During follow-up period, 39 (6.87%, 95% CI: 5-9.2%) of 568 patients had second-line treatment failure with 4.07 per 100 person-year rate of failure. Being on anti-TB treatment [Rate ratio, RR = 2.57 (95% CI: 1.25-5.25)], not having optimal medication adherence [RR = 2.29 (95% CI: 1.09-4.78)], and not timely switched [RR = 5.89 (95% CI: 1.36-25.54)] were positively associated with treatment failure. Similarly, 44 (6.85%, 95% CI: 5-9%) of 642 patients died with 4.5 per 100 person-year rate of death. Being on advanced clinical condition [Sub distribution Hazard ratio, SHR = 2.49 (95% CI: 1.31-4.74)], not having optimal medication adherence [SHR = 2.65 (95% CI: 1.31-4.74)], lower CD4 cell counts, and high viral load measurement were positively associated with death.
A significant number of patients had failed to respond to second-line therapy. A large number of patients had also died. Patient medical profile and monitoring practice were associated with treatment failure and death. Hence, patient-centered monitoring and interventions should be strengthened, besides treatment switch.
在低收入国家环境下，二线抗逆转录病毒疗法（ART）的艾滋病毒（HIV）患者比例正成为日益严重的公共卫生问题。然而，与一线疗法不同，迄今为止，人们对埃塞俄比亚二线疗法的结果知之甚少。因此，本研究旨在确定在接受二线治疗的 HIV 患者中治疗失败、死亡及其预测因素的发生率。
对 2016 年 10 月至 2019 年 11 月在德西综合专科医院接受 HIV 治疗的 642 名患者进行了回顾性队列研究。使用泊松和竞争风险生存模型分别探讨了治疗失败和死亡的预测因素。
在随访期间，568 名患者中有 39 名（6.87%，95%CI：5-9.2%）发生二线治疗失败，失败率为每 100 人年 4.07 例。抗结核治疗（RR=2.57[95%CI：1.25-5.25]）、未达到最佳药物依从性（RR=2.29[95%CI：1.09-4.78]）和未及时换药（RR=5.89[95%CI：1.36-25.54]）与治疗失败呈正相关。同样，642 名患者中有 44 名（6.85%，95%CI：5-9%）死亡，死亡率为每 100 人年 4.5 例。临床状况晚期（Sub distribution Hazard ratio，SHR=2.49[95%CI：1.31-4.74]）、未达到最佳药物依从性（SHR=2.65[95%CI：1.31-4.74]）、较低的 CD4 细胞计数和高病毒载量与死亡呈正相关。
大量患者对二线治疗无反应，大量患者死亡。患者的医疗状况和监测实践与治疗失败和死亡相关。因此，除了治疗转换之外，还应加强以患者为中心的监测和干预措施。
