Zerihun Ebisa, Tesema Kenesa, Abera Fekadu
Department of Nursing, College of Health Science, Oda Bultum University, Chiro, Ethiopia.
Faculty of Health Science, Rift Valley University, Adama, Ethiopia.
Front Public Health. 2025 Jun 2;13:1440504. doi: 10.3389/fpubh.2025.1440504. eCollection 2025.
Virological failure on first-line antiretroviral therapy (ART) remains a major challenge in the management of HIV/AIDS in resource-limited settings, including Ethiopia. However, the prevalence of virological failure and its associated factors among adult patients on first-line ART in West Hararghe, Ethiopia, are not well documented. Therefore, this study aimed to assess virological treatment failure and its determinants among people living with HIV (PWH) in West Hararghe, Eastern Ethiopia.
A retrospective cohort study was conducted using routine HIV-related data from a health facility providing services in West Hararghe between 01 January 2017 and 31 December 2020. Sociodemographic, behavioral, clinical, and HIV-related data were collected through medical chart reviews. Virological treatment failure was defined as a plasma viral load above 1,000 copies/mL based on two consecutive viral load measurements. A logistic regression model was used to identify factors associated with virological treatment failure.
A total of 257 records of PWH were reviewed and included in this analysis. Of these, 11.67% experienced virological failure while on first-line ART. Baseline undernutrition (AOR = 3.717: 1.051, 13.139), non-disclosure of serostatus (AOR = 4.453: 1.340, 14.793), early (≤ 30 days) ART initiation (AOR = 0.235: 0.064, 0.859), a history of missed daily ART doses (AOR = 3.156: 1.007, 9.891), and the use of a dolutegravir (DTG)-based regimen (AOR = 0.275: 0. 085, 0.895) were statistically associated with virological failure on first-line ART.
Virological failure on first-line ART was found to be significantly high in West Hararghe. Factors such as undernutrition, non-disclosure of serostatus, interruption of ART doses, and the use of DTG-based regimens were identified as significant predictors of virological treatment failure. Healthcare providers should focus on the accelerated initiation of ART (preferably with a DTG-based regimen) and supplemental nutritional therapy for patients with undernutrition.
在包括埃塞俄比亚在内的资源有限地区，一线抗逆转录病毒疗法（ART）出现病毒学失败仍是艾滋病毒/艾滋病管理中的一项重大挑战。然而，埃塞俄比亚哈拉尔格西部接受一线抗逆转录病毒治疗的成年患者中病毒学失败的患病率及其相关因素尚无充分记录。因此，本研究旨在评估埃塞俄比亚东部哈拉尔格西部艾滋病毒感染者（PWH）的病毒学治疗失败情况及其决定因素。
采用回顾性队列研究，利用2017年1月1日至2020年12月31日期间在哈拉尔格西部提供服务的一家医疗机构的常规艾滋病毒相关数据。通过病历审查收集社会人口学、行为、临床和艾滋病毒相关数据。病毒学治疗失败定义为基于连续两次病毒载量测量，血浆病毒载量高于1000拷贝/mL。采用逻辑回归模型确定与病毒学治疗失败相关的因素。
共审查了257份艾滋病毒感染者记录并纳入本分析。其中，11.67%的患者在接受一线抗逆转录病毒治疗时出现病毒学失败。基线时营养不良（调整后比值比[AOR]=3.717：1.051，13.139）、未披露血清学状态（AOR=4.453：1.340，14.793）、早期（≤30天）开始抗逆转录病毒治疗（AOR=0.235：0.064，0.859）、有每日漏服抗逆转录病毒药物剂量的病史（AOR=3.156：1.007，9.891）以及使用基于多替拉韦（DTG）的治疗方案（AOR=0.275：0.085，0.895）与一线抗逆转录病毒治疗的病毒学失败在统计学上相关。
发现哈拉尔格西部一线抗逆转录病毒治疗的病毒学失败率显著较高。营养不良、未披露血清学状态、抗逆转录病毒药物剂量中断以及使用基于DTG的治疗方案等因素被确定为病毒学治疗失败的重要预测因素。医疗服务提供者应关注加速启动抗逆转录病毒治疗（最好采用基于DTG的治疗方案）以及为营养不良患者提供补充营养治疗。
