Determinants of virological failure among people living with HIV receiving first-line antiretroviral therapy in Hiwot Fana Comprehensive University Hospital, Eastern Ethiopia.

Monitoring viral load among patients receiving antiretroviral therapy (ART) is essential to detecting treatment failures, drug resistance, and inappropriate changes to second-line treatment regimens. Determinants of virological failure (VF) among human immunodeficiency virus patients has been scarcely studied in the current study area. Therefore this study aimed to determine the factors that contribute to determinants of virological failure among people living with human immunodeficiency virus receiving first-line ART in Hiwot Fana Comprehensive University Hospital, Eastern Ethiopia. A case-control study was conducted from November 28 to December 11, 2022. We recruited all 246 eligible cases (patients with a viral load of >1000 copies/mL) and randomly selected 246 control patients (viral load ≤1000 copies/mL). Data were extracted from the patient's medical records, including their ART intake, registration, and follow-up details. We employed binary logistic regression to fit both bivariable and multivariable models, and then statistical significance was declared at a P-value of ≤.05. This study showed that age under 35 years (AOR = 1.99, 95%CI: 1.22, 3.25), CD4 count of <200 cells/mm3 (AOR = 6.46, 95% CI: 3.19, 13.09) or 200-499 cells/mm3 (AOR = 2.44, 95% CI: 1.37, 4.35), World Health Organization clinical stage II (AOR = 6.57, 95% CI: 3.72, 11.62) or III (AOR = 4.54, 95% CI: 1.41, 14.58), opportunistic infections (AOR = 5.03, 95% CI: 2.02, 12.50), poor adherence to treatment (AOR = 6.38, 95% CI: 2.64, 15.39), and duration on ART for 48 months (AOR = 8.27, 95% CI: 3.03, 21.13) had higher odds of virologic failure compared to their counterparts. Poor adherence to therapy, longer ART duration, younger age, a low baseline CD4 count, clinical stages II or III, and the presence of opportunistic infection had a significant impact on VF. Adherence counseling and careful monitoring of patients are required to ensure sufficient suppression of viral load.