Nuredin Kedir, Weldegebreal Fitsum, Ayele Firayad, Asefa Fekede
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Medicine (Baltimore). 2025 Jul 25;104(30):e43255. doi: 10.1097/MD.0000000000043255.
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.
监测接受抗逆转录病毒疗法（ART）的患者的病毒载量对于检测治疗失败、耐药性以及二线治疗方案的不当变化至关重要。在当前研究区域，对人类免疫缺陷病毒患者中病毒学失败（VF）的决定因素几乎没有进行过研究。因此，本研究旨在确定在埃塞俄比亚东部希沃特·法纳综合大学医院接受一线抗逆转录病毒治疗的人类免疫缺陷病毒感染者中，导致病毒学失败决定因素的相关因素。2022年11月28日至12月11日进行了一项病例对照研究。我们招募了所有246例符合条件的病例（病毒载量>1000拷贝/毫升的患者），并随机选择了246例对照患者（病毒载量≤1000拷贝/毫升）。数据从患者的病历中提取，包括他们的抗逆转录病毒治疗用药情况、登记信息和随访细节。我们采用二元逻辑回归来拟合双变量和多变量模型，然后在P值≤0.05时宣布具有统计学意义。本研究表明，35岁以下（调整后比值比[AOR]=1.99，95%置信区间[CI]：1.22，3.25）、CD4细胞计数<200个/立方毫米（AOR=6.46，95%CI：3.19，13.09）或200 - 499个/立方毫米（AOR=2.44，95%CI：1.37，4.35）、世界卫生组织临床分期II期（AOR=6.57，95%CI：3.72，11.62）或III期（AOR=4.54，95%CI：1.41，14.58）、机会性感染（AOR=5.03，95%CI：2.02，12.50）、治疗依从性差（AOR=6.38，95%CI：2.64，15.39）以及接受抗逆转录病毒治疗48个月（AOR=8.27，95%CI：3.03，21.13）的患者与对照组相比，病毒学失败的几率更高。治疗依从性差、抗逆转录病毒治疗时间长、年龄小、基线CD4细胞计数低、临床分期II期或III期以及存在机会性感染对病毒学失败有显著影响。需要进行依从性咨询并仔细监测患者，以确保病毒载量得到充分抑制。
