埃塞俄比亚亚的斯亚贝巴部分公立医院接受二线抗逆转录病毒治疗的成年艾滋病毒/艾滋病患者病毒学失败的发生率及预测因素：回顾性随访研究
Incidence and Predictors of Virological Failure Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospital of Addis Ababa, Ethiopia: Retrospective Follow-Up Study.
作者信息
Zakaria Hamdi Fekredin, Raru Temam Beshir, Hassen Fila Ahmed, Ayana Galana Mamo, Merga Bedasa Taye, Debele Gebiso Roba, Kiflemariam Genet, Kebede Sewnet Adem, Ayele Tadesse Awoke
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
出版信息
HIV AIDS (Auckl). 2022 Jul 8;14:319-329. doi: 10.2147/HIV.S367677. eCollection 2022.
INTRODUCTION
Virological suppression for persons living with HIV (PLHIV) on antiretroviral therapy (ART) reached 85% at the end of 2018, still falling short of the UNAIDS target of 95%. In Ethiopia, there were studies on treatment failure focusing on viral suppression and immunological failure of ART users, but none of them have addressed virological failure for second-line regimens.
OBJECTIVE
This study was aimed to estimate the incidence and predictors of virological failure among HIV patients who were switched to second-line ART at the selected public hospitals in Addis Ababa.
METHODS
An institutional-based retrospective follow-up study was conducted from September 2018 to January 2021 at public hospitals in Addis Ababa. The sample size was determined by using the Schoenfeld formula. Data entry were done by Epi Data version-4.6.0.0 and exported to R-software version-4.1.0 for analysis. Kaplan-Meier methods were used to compare the survival estimates. Cox proportional hazard model was used to identify predictors of virological failure and model adequacy was checked by using the Cox-Snell residuals plot.
RESULTS
Overall 44 (12.22%) HIV/AIDS patients developed virological failure with incidence density of 3.57/1000 Person-Month (PM) with 95% CI of [2.65-4.79]. Age >45 years (AHR=0.36, 95% CI: 0.12-0.99), CD4 count <100cell/mm (AHR=3.02, 95% CI: 1.17-7.78), TB co-infection (AHR=2.48, 95% CI: 1.10-6.33), ATV/r-based second-line regimen (AHR=0.27, 95% CI: 0.11-0.70), and poor adherence at the start of second-line ART (AHR=6.18, 95% CI: 1.93-19.76) were the significant predictors of virological failure.
CONCLUSION
A high incidence of virological failure was noticed. The rate of virological failure was higher for patients who had poor ART adherence, small CD4count, and TB co-infection. Therefore, targeted HIV care interventions shall be provided to young ages and efforts stepped up to improve adherence to ART, which helps to increase immunity and suppress viral replication. In addition, prevention and early detection of TB co-infection are crucial to the patients.
引言
接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（PLHIV）的病毒学抑制率在2018年底达到85%，仍未达到联合国艾滋病规划署95%的目标。在埃塞俄比亚，有关于治疗失败的研究，重点关注ART使用者的病毒抑制和免疫失败，但均未涉及二线治疗方案的病毒学失败情况。
目的
本研究旨在估计在亚的斯亚贝巴选定公立医院转用二线ART的艾滋病毒患者中病毒学失败的发生率和预测因素。
方法
2018年9月至2021年1月在亚的斯亚贝巴的公立医院进行了一项基于机构的回顾性随访研究。样本量通过Schoenfeld公式确定。数据录入使用Epi Data 4.6.0.0版本，并导出到R软件4.1.0版本进行分析。采用Kaplan-Meier方法比较生存估计值。使用Cox比例风险模型识别病毒学失败的预测因素，并通过Cox-Snell残差图检查模型的充分性。
结果
总体而言，44名（12.22%）艾滋病毒/艾滋病患者出现病毒学失败，发病密度为3.57/1000人月（PM），95%置信区间为[2.65 - 4.79]。年龄>45岁（调整后风险比[AHR]=0.36，95%置信区间：0.12 - 0.99）、CD4细胞计数<100个/mm³（AHR=3.02，95%置信区间：1.17 - 7.78）、合并结核病感染（AHR=2.48，95%置信区间：1.10 - 6.33）、基于阿扎那韦/利托那韦（ATV/r）的二线治疗方案（AHR=0.27，95%置信区间：0.11 - 0.70）以及二线ART开始时依从性差（AHR=6.18，95%置信区间：1.93 - 19.76）是病毒学失败的显著预测因素。
结论
注意到病毒学失败的发生率较高。ART依从性差、CD4细胞计数低和合并结核病感染的患者病毒学失败率较高。因此，应针对年轻人提供有针对性的艾滋病毒护理干预措施，并加大力度提高ART依从性，这有助于增强免疫力和抑制病毒复制。此外，结核病合并感染的预防和早期检测对患者至关重要。
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