Desalegn Mitiku, Shitemaw Tewoderos, Tesfaye Mesfin, Getahun Genanew Kassie
Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia.
Menelik II Medical and Health Science College, Addis Ababa, Ethiopia.
Pediatric Health Med Ther. 2024 May 13;15:171-180. doi: 10.2147/PHMT.S452150. eCollection 2024.
BACKGROUND: The causes of virological failure are poorly recognized and investigated. This study aimed to identify determinant factors of viral failure in children taking first-line ART at a randomly selected federal hospital in Addis Ababa, Ethiopia. METHODS: A facility-based unmatched case-control study was carried out from May 10, 2022, to July 20, 2022, G.C. among HIV-infected children on first-line antiretroviral therapy. There were 209 HIV-positive youngsters in the study's overall sample size, comprising 53 cases and 156 controls. Data was gathered by chart review using an organized checklist in English. The data were entered using Epi-data 4.2 and exported into SPSS version 24 for analysis. The relationship between each explanatory variable and the result variable was described using both bivariate and multivariate analysis. An adjusted odds ratio with 95% confidence intervals was conducted, and a p-value <0.05 was considered statistically significant. RESULTS: Being male (AOR= 4.504; 95% CI: 1.498, 13.539), duration on ART exceeding 47 months (AOR=40.6; 95% CI:9.571,172.222), fair and poor drug adherence (AOR=16.348; 95% CI:4.690,56.990), missed clinical appointments (AOR = 3.177; 95% CI: 1.100-9.174), and baseline WHO clinical stage 4 disease (AOR = 6.852; 95% CI: 1.540-30.49) were associated with an increased risk of virological failure. Conversely, a history of drug change and a CD4 count ranging from 250 to 500 cells/mm3 were significantly protective factors (AOR = 0.071; 95% CI: 0.024-0.214 and AOR=0.118; 95% CI: 0.030, 0.464, respectively). CONCLUSION: Being male, duration on ART >47 months, fair and poor adherence, missed clinical appointments, and baseline WHO Stage 4 are factors that increase the odds of virological failure. History of ART Drug change and a CD4 count between 250 and 500 cells/mm3 are factors that decrease the odds of virological failure.
背景：病毒学治疗失败的原因鲜为人知且研究较少。本研究旨在确定在埃塞俄比亚亚的斯亚贝巴一家随机选取的联邦医院接受一线抗逆转录病毒治疗（ART）的儿童中病毒学治疗失败的决定因素。 方法：2022年埃塞俄比亚历5月10日至7月20日，在接受一线抗逆转录病毒治疗的HIV感染儿童中开展了一项基于机构的非匹配病例对照研究。该研究的总样本量为209名HIV阳性青少年，包括53例病例和156例对照。通过使用英文的结构化检查表进行病历审查收集数据。数据使用Epi - data 4.2录入，并导出到SPSS 24版进行分析。使用双变量和多变量分析描述每个解释变量与结果变量之间的关系。计算调整后的比值比及95%置信区间，p值<0.05被认为具有统计学意义。 结果：男性（调整后的比值比[AOR]=4.504；95%置信区间[CI]：1.498，13.539）、ART治疗时长超过47个月（AOR = 40.6；95% CI：9.571，172.222）、药物依从性一般和较差（AOR = 16.348；95% CI：4.690，56.990）、错过临床预约（AOR = 3.177；95% CI：1.100 - 9.174）以及基线WHO临床分期为4期疾病（AOR = 6.852；95% CI：1.540 - 30.49）与病毒学治疗失败风险增加相关。相反，有换药史以及CD4细胞计数在250至500个细胞/mm³之间是显著的保护因素（AOR分别为0.071；95% CI：0.024 - 0.214和AOR = 0.118；95% CI：0.030，0.464）。 结论：男性、ART治疗时长>47个月、依从性一般和较差、错过临床预约以及基线WHO 4期是增加病毒学治疗失败几率的因素。ART换药史以及CD4细胞计数在250至500个细胞/mm³之间是降低病毒学治疗失败几率的因素。
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