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Kidie AA, Masresha SA, Bizuneh FK. Statistical analysis on the incidence and predictors of death among second-line ART patients in public hospitals of North Wollo and Waghemira Zones, Ethiopia, 2021. Sci Rep 2024; 14:10893. [PMID: 38740783 DOI: 10.1038/s41598-024-60119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Acquired immune deficiency virus, caused by the human immunodeficiency virus, is a significant global health concern. Sub-Saharan Africa particularly Ethiopia faces a high prevalence of human immunodeficiency virus. In low-income settings like Ethiopia, early mortality rates are elevated due to severe opportunistic infections and advanced disease at Anti-retroviral treatment initiation. Despite available treatments, delayed treatment initiation among Human Immunodeficiency Virus -infected individuals in Africa, including Ethiopia, leads to disease progression and increased mortality risk. This study aimed to identify the factors contributing to the death of HIV patients under treatment at second line regimen in public hospitals of North Wollo and Waghemira Zones. A retrospective cohort study with 474 patients was conducted in selected hospitals of North Wollo and Waghemira Zones. A parametric Weibull regression model was employed, and the adjusted hazard ratio served as the measure of association. Variables significantly affected the outcome of the study was determined at a p-value < 0.05, along with a 95% confidence interval for the variables. The patients were within the average age of 38.6(standard deviation ± 12.5) years and majority (45.57%) had no formal education. The overall death incidence rate among second-line anti-retroviral treatment patients was 1.98 per 100-person years [95% CI 1.4-2.9%]. Poor adherence to antiretroviral treatment, male gender, and being underweight significantly increased the hazard of death. Conversely, increased anti-retroviral treatment duration had a significant and negative impact, reducing the hazard of death among patients. The study reveals a high incidence of death among second line anti-retroviral treatment users. Independent predictors include poor adherence, male gender, and underweight status, all significantly increasing the risk of death. On the positive side, the hazard of death decreases with longer anti-retroviral treatment duration. A critical concern and counseling should be given for better ART adherence, to change their nutritional status and for males.
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Affiliation(s)
- Atitegeb Abera Kidie
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia.
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Abuhay HW, Endalew T, Birhan TY, Muche AA. Time to Treatment Failure and Its Predictors Among Second-Line ART Clients in Amhara Region, Ethiopia: A Retrospective Follow-Up Study. HIV AIDS (Auckl) 2024; 16:183-192. [PMID: 38711541 PMCID: PMC11073524 DOI: 10.2147/hiv.s455885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
Background Second-line antiretroviral treatment failure has become a major public health issue, and the time to treatment failure among second-line ART clients varies globally, and the Sub-Saharan African region having a high rate of second-line ART treatment failures. In addition, after the ART treatment guideline changed there is limited information on Ethiopia. Therefore, this study aimed to assess time to treatment failure and its determinants among second-line ART clients in Amhara Region, Ethiopia. Methods A multi-centered retrospective follow-up study was conducted. A random sample of 860 people on second-line ART was selected by using a computer-generated simple random sampling technique from January 30, 2016, to January 30, 2021, at the University of Gondar Compressive Specialized Hospital, Felege Hiwot Compressive Specialized Referral Hospital, and Debre Tabor Compressive Specialized Referral Hospital, in Amhara region, Ethiopia. Data was captured using a checklist. Results A total of 81 (9.4%) ART clients developed second-line treatment failure, with a median follow-up time of 29 months with an interquartile range (IQR: 18, 41]. The risk of second-line treatment failure is higher among patients aged 15 to 30 years (adjusted hazard ratio (AHR) = 2.01, 95% confidence interval (CI): [1.16, 3.48]). Being unable to read and write (AHR = 1.312, 95% CI: [1.068, 1.613]), and poor ART drug adherence (AHR = 3.067, 95% CI: [1.845, 5.099]) were significant predictors of second-line ART treatment failures. Conclusion In the current study, the time to second-line ART treatment failure was high compared with a previous similar study in Ethiopia. Factors like being younger age, ART clients who are not being able to read and write, and having poor ART drug adherence was significant predictors of second-line ART treatment failure.
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Affiliation(s)
- Habtamu Wagnew Abuhay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tizazu Endalew
- University of Gondar Compressive Specialized Hospital, Gondar, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Kassie GA, Wolda GD, Woldegeorgis BZ, Gebrekidan AY, Haile KE, Meskele M, Asgedom YS. Second-line anti-retroviral treatment failure and its predictors among patients with HIV in Ethiopia: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003138. [PMID: 38652716 PMCID: PMC11037545 DOI: 10.1371/journal.pgph.0003138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
Antiretroviral therapy (ART) treatment failure remains a major public health concern, with multidimensional consequences, including an increased risk of drug resistance, compromised quality of life, and high healthcare costs. However, little is known about the outcomes of second-line ART in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the incidence and determinants of second-line ART treatment failure. Articles published in PubMed, Google Scholar, Science Direct, and Scopus databases were systematically searched. All observational studies on the incidence and predictors of treatment failure among patients with HIV on second-line ART were included. A random-effects model was used to estimate the pooled incidence, and subgroup analysis was performed to identify the possible sources of heterogeneity. Publication bias was checked using forest plot, Begg's test, and Egger's test. The pooled odds ratio was also computed for associated factors. Seven studies with 3,962 study participants were included in this study. The pooled incidence of second-line antiretroviral treatment failure was 5.98 (95% CI: 4.32, 7.63) per 100 person-years of observation. Being in the advanced WHO clinical stage at switch (AHR = 2.98, 95% CI: 2.11, 4.25), having a CD4 count <100 cells/mm3 (AHR = 2.14, 95% CI: 1.57, 2.91), poor drug adherence (AHR = 1.78, 95% CI: 1.4, 2.25), and tuberculosis co-infection (AHR = 2.93, 95% CI: 1.93, 4.34) were risk factors for treatment failure. In conclusion, this study revealed that that out of 100 person-years of follow-up, an estimated six patients with HIV who were on second-line antiretroviral therapy experienced treatment failure. The risk of treatment failure was higher in patients who were in an advanced WHO clinical stage, CD4 count <100 cells/mm3, and presence tuberculosis co-infection. Therefore, addressing predictors reduces the risk of treatment failure and maximizes the duration of stay in second-line regimens.
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Affiliation(s)
- Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getahun Dendir Wolda
- School of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu Haile
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mengistu Meskele
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Bizuneh FK, Masresha SA, Yayeh BM, Bizuneh TK. Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort. Health Sci Rep 2024; 7:e1997. [PMID: 38562614 PMCID: PMC10982461 DOI: 10.1002/hsr2.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background In Ethiopia, tuberculosis (TB) is a significant cause of death among individuals living with HIV, especially in resource-limited areas and those who have experienced treatment failure. However, there is the paucity of data regarding TB among treatment failures experienced people living with HIV. This study aimed to estimate the rate and identify predictors of tuberculosis among patients who received second-line treatment in North Wollo, Northeast Ethiopia. Methods A retrospective follow-up study was conducted on 474 HIV-infected patients who experienced treatment failure. The study period ranged from January 2015 to September 30, 2021. The incidence of TB was assessed using a Cox proportional hazard regression model, after ensuring that all assumptions were met. Factors associated with active TB were determined by analyzing adjusted hazard ratios and 95% confidence intervals. Results In a study of 474 HIV-positive patients on second-line antiretroviral treatment, we found an incidence rate of 3.6% with 17 new cases of TB observed over 4412.4 persons per year (PPY). The overall incidence density rate was estimated to be 0.39 cases per 100 PPY (95% CI: 0.239-0.618). Regarding the occurrence of active TB in second-line patients, WHO clinical treatment stage (T3 and T4), missed isoniazid preventive therapy had a significantly higher risk (AHR: 13.225, 95% CI: 2.894-60.434, p = 0.001), while being married was associated with a lower risk (AHR: 0.203, 95% CI: 0.045-0.907, p = 0.001). Conclusion A high incidence of active TB was observed shortly after initiating second-line antiretroviral treatment. Factors such as being in the WHO clinical treatment stage (T3 and T4) and marital status were determinants for active TB. To improve overall survival rates, it is vital to enhance early TB screening and implement effective isoniazid preventive therapy.
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Affiliation(s)
- Fassikaw Kebede Bizuneh
- School of Public Health, College of Health ScienceWoldia UniversityWoldiaAmhara RegionEthiopia
| | | | - Berihun Mulu Yayeh
- School of Public Health, College of Health ScienceWoldia UniversityWoldiaAmhara RegionEthiopia
| | - Tsehay Kebede Bizuneh
- Department of Geography and Environmental Studies, Faculty of Social ScienceBahir Dare UniversityBahir DarNorth West EthiopiaEthiopia
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Hashempour A, Khodadad N, Ziaei R, Rezaei B, Ghasabi F, Falahi S, Kenarkouhi A, Davarpanah MA. Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults. BMC Infect Dis 2024; 24:358. [PMID: 38549051 PMCID: PMC10976689 DOI: 10.1186/s12879-024-09251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/24/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND HIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS. METHODOLOGY This cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure. RESULTS Clinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure. CONCLUSION As the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95-95-95 plan.
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Affiliation(s)
- Ava Hashempour
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Khodadad
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ziaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Rezaei
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Ghasabi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahab Falahi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Azra Kenarkouhi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammad Ali Davarpanah
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Masresha SA, Kidie AA, Alen GD, Mulaw GF, Feleke FW, Kassaw MW, Dejene TM. Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North-East Ethiopia, 2021. Pharmacoepidemiol Drug Saf 2023; 32:978-987. [PMID: 36974512 DOI: 10.1002/pds.5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Acquired immune deficiency syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in human immunodeficiency virus (HIV)/AIDS treatment and care for quality improvements. OBJECTIVE Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021. METHODS Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on virological failure (VF). The study was conducted from February 1 to April 30, 2021. RESULTS The rate of VF in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by 1 year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95% CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95% CI: 0.828, 0.963), respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of making enhanced adherence counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR: 3.374, 95% CI: 1.790, 6.361). CONCLUSION AND RECOMMENDATIONS The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF.
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Affiliation(s)
| | | | - Gedefaw Diress Alen
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | - Tadesse Mamo Dejene
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
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Gidey K, Mache A, Hailu BY, Asgedom SW, Tassew SG, Nirayo YL. Second-Line Antiretroviral Treatment Outcomes and Predictors in Tigray Region, Ethiopia. Infect Drug Resist 2023; 16:4903-4912. [PMID: 37534062 PMCID: PMC10390760 DOI: 10.2147/idr.s419348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Ethiopia has one of the highest HIV burdens in sub-Saharan Africa. Despite the fact that second-line antiretroviral therapy (ART) has been available for more than ten years, studies on its effectiveness are scarce. Objective To assess treatment outcomes and predictors of unfavorable outcomes in HIV patients receiving second-line ART at Ayder Comprehensive Specialized Hospital and Mekelle Hospital. Materials and Methods An institution-based retrospective cohort study was conducted in two hospitals in Tigray Region, Ethiopia. We evaluated 192 patients aged ≥15 years who were switched to second-line from November 2009 to May 2020 after failure of first-line ART. The primary outcome was the time from the initiation of second-line ART to the occurrence of unfavorable treatment outcomes (treatment failure, death, and loss to follow-up). We performed Kaplan-Meier survival estimates to calculate the cumulative incidence rates of unfavorable outcomes. Results The mean age (SD) at the initiation of second-line ART was 39 (10.03) years, and the median CD4 cell count was 121 cells/microL. During a median follow-up of 4.6 years, 24 (12.5%) patients had died, 11 (5.7%) patients were lost to follow up, and 47 (24,4%) patients were experienced treatment failure. The incidence rates for unfavorable outcomes were 7.8 per 100 patients/years. Predictors for unfavorable outcomes were body mass index (BMI) <18.5 (adjusted hazard ratio [aHR] = 2.51, 95% confidence interval (CI): 1.27-4.95) and CD4 counts ≤100 cells/microL (aHR = 1.74, 95% CI: 1.09-2.79). Despite the failure of second-line ART, none of the patients received third-line ART. Conclusion The incidence rate of unfavorable treatment outcomes for second-line ART was found to be high. A low BMI and a low baseline CD4 count were significant predictors of unfavourable outcomes and should be given special consideration in HIV care. A third-line ART regimen should also be considered for people who have failed second-line ART.
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Affiliation(s)
- Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abadi Mache
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Segen Gebremeskel Tassew
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yirga Legesse Nirayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Salvi S, Raichur P, Kadam D, Sangle S, Gupte N, Nevrekar N, Patil S, Chavan A, Nimkar S, Marbaniang I, Mave V. Virological failure among people living with HIV receiving second-line antiretroviral therapy in Pune, India. BMC Infect Dis 2022; 22:951. [PMID: 36528762 PMCID: PMC9758821 DOI: 10.1186/s12879-022-07894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The number of people receiving second-line antiretroviral therapy (ART) has increased as global access to ART has expanded. Data on the burden and factors associated with second-line ART virologic failure (VF) from India remain limited. METHODS We conducted cross-sectional viral load (VL) testing among adults (≥ 18 years) who were registered at a publicly funded ART center in western India between 2014 and 2015 and had received second-line ART for at least 6 months. Sociodemographic and clinical characteristics were abstracted from routinely collected programmatic data. Logistic regression evaluated factors associated with VF (defined as VL > 1000 copies/mL). RESULTS Among 400 participants, median age was 40 years (IQR 34-44), 71% (285/400) were male, and 15% (59/400) had VF. Relative to participants without VF, those with VF had lower median CD4 counts (230 vs 406 cells/mm3, p < 0.0001), lower weight at first-line failure (49 vs 52 kg, p = 0.003), were more likely to have an opportunistic infection (17% vs 3%, p < 0.0001) and less likely to have optimal ART adherence (71% vs 87%, p = 0.005). In multivariable analysis, VF was associated with opportunistic infection (aOR, 4.84; 95% CI, 1.77-13.24), lower CD4 count (aOR 4.15; 95% CI, 1.98-8.71) and lower weight at first-line failure (aOR, 2.67; 95% CI, 1.33-5.34). CONCLUSIONS We found second-line VF in about a sixth of participants in our setting, which was associated with nearly fivefold increased odds in the context of opportunistic infection. Weight could be a useful clinical indicator for second-line VF.
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Affiliation(s)
- Sonali Salvi
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Priyanka Raichur
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Dileep Kadam
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Shashikala Sangle
- grid.452248.d0000 0004 1766 9915Department of Medicine, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jai Prakash Narayan Road, Pune, India
| | - Nikhil Gupte
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Neetal Nevrekar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Sandesh Patil
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Amol Chavan
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Smita Nimkar
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India
| | - Ivan Marbaniang
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology, McGill University, Montreal, QC Canada
| | - Vidya Mave
- grid.452248.d0000 0004 1766 9915Byramjee Jeejeebhoy Government Medical College - Johns Hopkins University Clinical Research Site, BJ Medical College and Sassoon General Hospital, Jai Prakash Narayan Road, Pune, Maharashtra 411001 India ,grid.21107.350000 0001 2171 9311Johns Hopkins University School of Medicine, Baltimore, MD USA
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Mortality and Its Predictors among Adult Human Immune-Deficiency Virus-Infected Patients Attending Their Antiretroviral Treatment at Health Centers, Addis Ababa, Ethiopia: Multicenter Retrospective Cohort Study. AIDS Res Treat 2022; 2022:6128718. [PMID: 36172060 PMCID: PMC9512605 DOI: 10.1155/2022/6128718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/21/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction In resource-limited settings such as Ethiopia, where the prevalence of HIV/AIDS is high, a number of factors, including economic, demographic, behavioral risk, and health factors, affect how long people with AIDS are treated with antiretroviral therapy. Since several aspects of the clinical setup may have an impact on ART patients' survival, this study was conducted in health centers. Determining the mortality rate and survival factors among adult HIV-infected patients receiving ART at health centers in Addis Abeba's Kirkos subcity is the primary goal of this study. Methods A retrospective cohort study was carried out at the health center in Addis Abeba's Kirkos subcity. The source population consisted of all adult HIV-positive patients who were being followed up between December 1, 2014, and October 30, 2019. A total of 665 samples were collected using a computer-generated simple random sampling method in each of the three health centers that were chosen by a lottery system depending on the number of patients in the follow-up. Trained data collectors took the information out of the patient card and the electronic database. Regressions using the Kaplan‐Meier and Cox proportional hazards were employed. Results The incidence of death rate in adult HIV-positive patients was 55 (8.5%) fatalities, translating to a death rate of 3.25 per 100 person-years. The majority of deaths occurred within 6 months of ART initiation. Predictors of mortality were: age above 50 years (AHR = 4.90, 95% CI: 2.00, 11.98), tuberculosis comorbidity (AHR = 3.46, 95% CI: 1.23, 3.33), lack of drug adherence (AHR = 1.76, 95% CI: 1.23, 3.33), co-trimoxazole therapy (AHR = 2.59, 95% CI: 1.37, 4.90), and CD4 cell count less than 200/dl (AHR = 2.77, 95% CI: 1.30, 5.92). Conclusion and Recommendation. Adult HIV-positive individuals had an incidence of the death rate of 55 (8.5%), which equates to 3.25 deaths per 100 person-years. Age category over 50, TB comorbidity, WHO stage IV, lack of medication adherence, co-trimoxazole therapy, body mass index under 18.5 kg/m2, and CD4 cell count under 200/dl were predictors of mortality. Therefore, it is important to focus on prevention, early identification, and treatment of HIV/AIDS for these predictors at all levels of the HIV/AIDS chronic care package in order to increase survival.
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Zakaria HF, Ayele TA, Kebede SA, Jaldo MM, Lajore BA. Joint Modeling of Incidence of Unfavorable Outcomes and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospitals of Addis Ababa, Ethiopia. HIV AIDS (Auckl) 2022; 14:341-354. [PMID: 35923902 PMCID: PMC9342510 DOI: 10.2147/hiv.s368373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background In Ethiopia, second-line anti-retroviral therapy (ART) for HIV/AIDS patients was started some years ago; however, few studies have reported the unfavorable outcomes of second-line ART. Therefore, this study aimed to assess the incidence and predictors of unfavorable outcomes and their association with change in viral load among adult HIV/AIDS patients on second-line treatment at selected public hospitals in Addis Ababa, Ethiopia. Methods A retrospective follow-up study was conducted at selected public hospitals in Addis Ababa, Ethiopia, on 421 HIV/AIDS patients on second-line ART from 2016 to 2021. Cox proportional hazard models with a linear mixed effect model were jointly modeled using the JM package of R software with time-dependent lagged parameterizations, and a 95% confidence interval was used to select significant variables. Results Overall, 89 HIV/AIDS patients developed unfavorable outcomes. The incidence density was 7.48/100 person-years (95% CI: 6.08, 9.2). Secondary and tertiary educational level (AHR=0.47, 95% CI: 0.25, 0.89, and AHR=0.27, 95% CI: 0.1, 0.72), CD4 count less than 100 cells/mm3 (AHR=2.15, 95% CI: 1.21, 3.83), poor adherence (AHR=3.59, 95% CI: 1.73, 7.49), and TB comorbidity (AHR=2.23, 95% CI: 1.21, 4.14) at the start of second-line ART were significant predictors of incidence of unfavorable outcome. Time-dependent lagged value viral load was significantly associated with the risk of unfavorable outcome (AHR=1.28, 95% CI: 1.01, 1.63). Conclusion In the study area, the incidence of an unfavorable outcome of second-line ART was high. Secondary and tertiary educational level, CD4 count less than 100 cells/mm3, poor adherence, and TB comorbidity at the start of second-line ART were significant predictors of incidence of unfavorable outcomes. Thus, strengthening routine viral load measurement, increase patient adherence, intensive counseling, and strong TB screening are needed in the study setting.
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Affiliation(s)
- Hamdi Fekredin Zakaria
- Department of Epidemiology and Biostatistics, School of Public Health, Haramaya University, Harar, Ethiopia
- Correspondence: Hamdi Fekredin Zakaria, Email
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mesfin Menza Jaldo
- Department of Epidemiology and Biostatistics, School of Public Health, Wachemo University, Hossana, Ethiopia
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Zakaria HF, Raru TB, Hassen FA, Ayana GM, Merga BT, Debele GR, Kiflemariam G, Kebede SA, Ayele TA. 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. HIV AIDS (Auckl) 2022; 14:319-329. [PMID: 35836751 PMCID: PMC9275424 DOI: 10.2147/hiv.s367677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Hamdi Fekredin Zakaria
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Temam Beshir Raru
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Correspondence: Temam Beshir Raru, Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. Box: 235, Harar, Ethiopia, Email
| | - Fila Ahmed Hassen
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Galana Mamo Ayana
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Metu University, Metu, Ethiopia
| | - Genet Kiflemariam
- International Institute for Primary Health Care, Addis Ababa, Ethiopia
| | - Sewnet Adem Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medical and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medical and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gwadu AA, Tegegne AS. Determinants of CD4 count and risk for death of HIV infected children under ART. Sci Rep 2022; 12:6867. [PMID: 35477950 PMCID: PMC9046154 DOI: 10.1038/s41598-022-10880-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
The main objective of this study was to identify variables jointly affected for CD4 count and hazard time to death of HIV-infected children under ART at Felege Hiwot Referal and Specialized Hospital. A retrospective cohort study design was conducted on 202 HIV-infected children under ART whose follow-ups were from January 2014 up to December 2018. The descriptive statistics revealed that about 25.2% of HIV-infected children under ART in the study period(Jaunary 2014–December 2018) died and 74.8% were censored. The estimated association parameter in the joint model was − 0.8339 and statistically significant (p value = 0.025). There was a negative relationship between the two response variables namely CD4 count and the risk for death on HIV-positive children under treatment. The level of education of children's parents, level of disclosure of the disease, baseline CD4 count, functional status, and adherence level were statistically and significantly affected for the two response variables, CD4 count and risks for the death of children. Separate and joint models have been compared interims of standard error and the joint model had a small standard error as compared to the separate models. The small standard errors in joint models indicate that the joint model was better in detecting variables that affected the two responses in this regard. Health-related education should be conducted to parents of children for easy recovery of CD4 count and for reducing risks for the death of children.
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Mantshonyane L, Roy J, Levy MZ, Wallis CL, Bar K, Godfrey C, Collier A, LaRosa A, Zheng L, Sun X, Gross R. Participants Switching to Second-Line Antiretroviral Therapy with Susceptible Virus Display Inferior Adherence and Worse Outcomes: An Observational Analysis. AIDS Patient Care STDS 2021; 35:467-473. [PMID: 34788110 DOI: 10.1089/apc.2021.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Evidence on the impact of human immunodeficiency virus (HIV) drug resistance on regimens following treatment failure is varied and inconclusive. Differential medication adherence may explain this variation. We aimed to test the association between drug resistance at first-line antiretroviral therapy (ART) switch and adherence to and virologic failure on subsequent ART. We conducted a secondary analysis of data from an open-labeled randomized trial of second-line ART (ACTG A5234). ART susceptibility was determined from study entry plasma using the Stanford Drug Resistance database version 8.7. Adherence was measured with microelectronic monitors. Three adherence variables and rates of virologic failure (HIV-1 RNA ≥1000 copies/mL) on second-line ART were compared between participants with and without resistance at first-line ART failure. Of 214 participants switching to second-line ART with baseline resistance results, 113 (53%) were men, mean age was 39 years (standard deviation 10.3), and 37 (17%) had susceptible virus at study entry. Cumulative genotypic susceptibility score (cGSS) was inversely associated with adherence, adjusted odds ratio (aOR) 0.15, 95% confidence interval (CI) (0.05-0.40), p < 0.001. The aOR of virologic failure for a one-unit increase in cGSS was 1.72, 95% CI (1.22-2.41), p < 0.001. Participants switched to second-line ART without resistance displayed inferior adherence and had higher rates of virologic failure. Therefore, these individuals warrant additional adherence interventions to help them achieve virologic success. Clinical Trial Registration number: NCT00608569.
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Affiliation(s)
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carole L. Wallis
- Molecular Division, BARC-SA and Lancet Laboratories, Johannesburg, South Africa
| | - Kathrine Bar
- Molecular Division, BARC-SA and Lancet Laboratories, Johannesburg, South Africa
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, US Department of State, Philadelphia, Pennsylvania, USA
| | - Ann Collier
- Division of Allergy and Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Lu Zheng
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Xin Sun
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Robert Gross
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine (Infectious Diseases), School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wedajo S, Degu G, Deribew A, Ambaw F. Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:877-887. [PMID: 34526824 PMCID: PMC8435530 DOI: 10.2147/hiv.s323445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/21/2021] [Indexed: 12/22/2022]
Abstract
Background In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy. Methods A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral re-suppression (viral load less than 1000 copies/mL) and attrition to care. Results Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24–85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17–1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02–1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49–0.91)] had lower likelihood with viral re-suppression. In the current study, attrition to care was 11% (95% CI: 8.7–13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40–4.87)]. Similarly, being not virally re-suppressed [AHR = 6.87 (95% CI: 3.86–12.23)] and CD4 count ≤450 cells/mm3 [AHR = 2.61 (95% CI: 1.40–4.87)] were also positively associated with attrition to care. Conclusion A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patient-centered intervention should be strengthened, besides treatment switch.
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Affiliation(s)
- Shambel Wedajo
- School of Public Health, CMHS, Wollo University, Dessie, Ethiopia
| | - Getu Degu
- School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Deribew
- Nutrition International (NI) in Ethiopia, Addis Ababa, Ethiopia
| | - Fentie Ambaw
- School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia
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Musana H, Ssensamba JT, Nakafeero M, Mugerwa H, Kiweewa FM, Serwadda D, Ssali F. Predictors of failure on second-line antiretroviral therapy with protease inhibitor mutations in Uganda. AIDS Res Ther 2021; 18:17. [PMID: 33882938 PMCID: PMC8059285 DOI: 10.1186/s12981-021-00338-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Failure on second-line antiretroviral therapy (ART) with protease inhibitor (PI) mutations (VF-M) is on the rise. However, there is a paucity of information on the factors associated with this observation in low-income countries. Knowledge of underlying factors is critical if we are to minimize the number of PLHIV switched to costly third-line ART. Our study investigated the factors associated with VF-M. Methods We conducted a matched case–control analysis of patients' records kept at the Joint Clinical Research Center, starting from January 2008 to May 2018. We matched records of patients who failed the second-line ART with major PI mutations (cases) with records of patients who were virologically suppressed (controls) by a ratio of 1:3. Data analysis was conducted using STATA Version 14. Categorical variables were compared with the outcomes failure on second-line ART with PI mutations using the Chi-square and Fisher's exact tests where appropriate. Conditional logistic regression for paired data was used to assess the association between the outcome and exposure variables, employing the backward model building procedure. Results Of the 340 reviewed patients' records, 53% were women, and 6.2% had previous tuberculosis treatment. Males (aOR = 2.58, [CI 1.42–4.69]), and patients concurrently on tuberculosis treatment while on second-line ART (aOR = 5.65, [CI 1.76–18.09]) had higher odds of VF-M. ART initiation between 2001 and 2015 had lower odds of VF-M relative to initiation before the year 2001. Conclusion Males and patients concomitantly on tuberculosis treatment while on second-line ART are at a higher risk of VF-M. HIV/AIDS response programs should give special attention to this group of people if we are to minimize the need for expensive third-line ART. We recommend more extensive, explorative studies to ascertain underlying factors.
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Chanie ES, Bayih WA, Birhan BM, Belay DM, Asmare G, Tiruneh T, Aynalem YAA, Abat BB, Asnakew S, Mekie M, Yitbarek GY, GebreEyesus FA. Incidence of advanced opportunistic infection and its predictors among HIV infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized hospitals, Northwest Ethiopia, 2020: A multicenter retrospective follow-up study. Heliyon 2021; 7:e06745. [PMID: 33912717 PMCID: PMC8063747 DOI: 10.1016/j.heliyon.2021.e06745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study is aimed to assess the incidence of advanced opportunistic infections (OIs) and its predictors among Human Immunodeficiency Virus (HIV) infected children at Debre Tabor referral Hospital and University of Gondar Compressive specialized Hospitals, Northwest Ethiopia, 2020. Methods A retrospective follow-up study was conducted from June 1, 2010, to May 30, 2020. A total of 349 children under the age of 15 who had received Anti-Retroviral Therapy (ART) were included in the study. Data were entered into Epi info version 7.2 and then exported to Stata 14.0 for analysis. Kaplan Meier curve and Log-rank test were used to determine the median survival time and the discrepancy of different categorical variables. The Cox regression model was used to identify the predictors of advanced opportunistic infections. The Adjusted hazard ratio (AHR) at 95% confidence interval (CI) was used to declare statistical significance. Result The incidence rate of advanced opportunistic infection was 5.53 per 100 (95% CI: 4.7, 6.9) Person per year observation (PYO). The median survival time was 113 months and the total follow-up periods were yielding 18882 months. Children presenting with treatment failure, Cotrimoxazole Preventive Therapy (CPT) non-user, low hemoglobin level (<10 mg/dl), and poor/fair level of adherence to ART were less free survival time as compared to their counterparts for advanced opportunistic infections. Conclusion In this study, the median of advanced OIs free survival time was found to be low and the incidence rate was found to be high. The incidence advanced OIs was associated with anemia, treatment failure, and poor/fair level of adherence, cotrimoxazole preventive therapy non-users. Further research should conduct to evaluate and to improve the quality of care in the study area.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhan
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getnet Asmare
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tegenaw Tiruneh
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yared Asmare Aynalem Aynalem
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Biruk Beletew Abat
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Sintayehu Asnakew
- Department Psychiatric, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Maru Mekie
- Department Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getache Yideg Yitbarek
- Department of Biomedical, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Tekliye E, Alemayehu T, Bacha T. Clinical, immunologic and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals in Addis Ababa, Ethiopia. PLoS One 2021; 16:e0249085. [PMID: 33784335 PMCID: PMC8009351 DOI: 10.1371/journal.pone.0249085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Ethiopia launched free access for antiretroviral therapy in 2005. The number of patients on second line antiretroviral treatment has increased with each passing year. The objectives of this study were to describe the clinical, immunological and virologic outcomes of children and adolescents receiving second line anti-retroviral therapy in two referral hospitals, Yekatit 12 and Zewditu Memorial Hospitals, in Addis Ababa, Ethiopia. Methods This was a hospital based retrospective cohort study conducted among children and adolescents aged 18 years and less and receiving a second line antiretroviral drugs. Data was collected using structured questionnaires. Means and percentages were used for nominal variables. Statistical analysis was made using statistical software–SPSS 23.0. Kaplan Meier analysis, long rank test and multivariate Cox proportion model were used to identify factors affecting survival. Results A total of 75 children and adolescents were studied with a mean age of 13.28 years (SD: 4) with a mean treatment period on second line regimens of 35.2 months (SD: 21.8 months). Forty-eight participants were experiencing successful measures (in all three parameters) for their second line anti-retroviral treatment. Ten had virologic treatment failure while seven had died. Both treatment failure and death rates were higher within the first two years of treatment. Poor treatment adherence (Adjusted hazard ratio: 5.1 (95% CI: 1.1–23.2; p-value = 0.02)) and advanced World Health Organization clinical stage at start of the second line antiretrovirals (Adjusted hazard ratio: 7.51 (95% CI: 1.35–18.02; p-value = 0.002)) correlated significantly with survival of children and adolescents receiving treatment. Conclusions The study describes clinical, immunological and virologic outcomes of second line antiretroviral treatment in a pediatric cohort under care in two hospitals in Addis Ababa, Ethiopia. Poor adherence and pre-treatment advanced clinical stages were predictors of survival.
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Affiliation(s)
| | - Tinsae Alemayehu
- American Medical Center, Specialty Clinic for Infectious Diseases and Travel Medicine, Addis Ababa, Ethiopia
- St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Tigist Bacha
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Derseh BT, Shewayerga B, Dagnew Mekuria A, Admasu Basha E. Virological Treatment Failure Among Adult HIV/AIDS Patients from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia. Infect Drug Resist 2020; 13:4417-4425. [PMID: 33328746 PMCID: PMC7735790 DOI: 10.2147/idr.s280966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/28/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose The study aimed at assessing the magnitude of virological treatment failure and associated factors among HIV reactive adults at selected hospitals. Patients and Methods A facility-based cross-sectional study was conducted among 498 study participants who started their first-line HAART from August 2015 to December 2018. Data were collected from patients' charts and face-to-face interviews using a structured questionnaire. The bivariable analysis was executed to select candidate variables at a p-value of less than 0.2. Multivariable logistic regression (forward, stepwise, and conditional) analysis was used to find factors associated with virological failure at a significant level of 5%. A model adequacy check was done by Hosmer and Lemeshow test (p = 0.57). Results More than half 290 (58.2%) of the study participants were women. The median (IQR) age at ART initiation was 40 (15) years. The median (IQR) duration when a virological failure occurred from the initiation of ART treatment was 96 (72) months. The prevalence of virological treatment failure was 10.24% (95% CI: 7.57%, 12.91%). Poor ART drug adherence (AOR = 4.54; 95% CI: 2.09, 9.87), CD4 count less than 250 cell/μL (AOR = 24.88; 95% CI: 11.73, 52.81) and poor quality of life (QoL) (AOR = 2.65; 95% CI: 1.12, 6.25) were independent predictors of virological treatment failure. Conclusion The magnitude of virological ART treatment failure in this study was relatively high. Poor ART drug adherence, patients' having lower CD4 count and poorer quality of life were predictors of treatment failure. Thus, intervention programs that enrich patients' health-related quality of life should be implemented. Moreover, counseling that supplements the importance of drug adherence and reduction of risks that lower CD4 counts should be given emphasis which in turn helps to prevent first-line ART treatment failure.
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Affiliation(s)
- Behailu Tariku Derseh
- Department of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Belay Shewayerga
- Department of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abinet Dagnew Mekuria
- Department of Public Health, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Elyas Admasu Basha
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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Seid A, Cherie N, Ahmed K. Determinants of Virologic Failure Among Adults on Second Line Antiretroviral Therapy in Wollo, Amhara Regional State, Northeast Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:697-706. [PMID: 33204171 PMCID: PMC7666990 DOI: 10.2147/hiv.s278603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
Background Treatment failure among the population on second line antiretroviral therapy is a major public health threat. In Ethiopia there has been limited research done on second line treatment failure. Objective To identify determinants of virologic failure among adults on second line antiretroviral therapy in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Methods An institution-based unmatched case–control study was conducted from February 1, 2020 to April 30, 2020 on a total of 377 clients in six public hospitals of Wollo, Amhara regional state, northeast Ethiopia. Clients whose viral load result >1,000 copies/mL in two consecutive results at least 3 month apart were cases, while ≤1,000 copies/mL were controls. The sample size was calculated by using Epi-Info version 7. Cases (94) and controls (283) were selected using a simple random sampling method in a ratio of cases-to-controls of 1:3. The model fitted and binary logistic assumptions were fulfilled with 95% confidence level and P-values<0.05 were taken as statistically significant. Results Virologic failure was predicted by poor adherence (AOR=6.060, 95% CI=2.837–12.944), not disclosing their HIV status (AOR=4.178, 95% CI=1.431–12.198), OI (AOR=4.11, 95% CI=1.827–9.246), CD4 count <100 cells/mm3 (AOR=3.497, 95% CI=1.233–9.923) and 100–350 cells/mm3 (AOR=5.442, 95% CI=2.191–13.513), low BMI <16 kg/m2 (AOR=7.223, 95% CI=2.218–23.520), and young age 15–29 years (AOR=2.898, 95% CI=1.171–7.170). Conclusion and Recommendations Determinants of second line ART virologic failure were patients who had poor adherence to ART, not disclosed, opportunistic infection, low CD4 counts <350 cell/mm3, low BMI (<16 kg/m2), and young age 15–29 year patients. Social support, disclosing their HIV status, and getting early treatment for any opportunistic infection is crucial to patients.
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Affiliation(s)
- Ali Seid
- Reproductive and Family Health Unit, Dessie Health Science College, Dessie, Ethiopia
| | - Niguss Cherie
- Reproductive and Family Health Unit, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kemal Ahmed
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Subronto YW, Kusmayanti NA, Abdalla AS, Sattwika PD. Nevirapine and tuberculosis predict first-line treatment failure in HIV patients in Indonesia: Case-control study. Ann Med Surg (Lond) 2020; 60:56-60. [PMID: 33133585 PMCID: PMC7584999 DOI: 10.1016/j.amsu.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/24/2020] [Accepted: 10/07/2020] [Indexed: 11/02/2022] Open
Abstract
Introduction Indonesia antiretroviral therapy guideline suggests the use of Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based regiments as first line of HIV treatment and Protease Inhibitor to replace NNRTI when treatment failure occurred. This case-control study was aimed to study factors predicting first-line ART treatment failure among HIV positive patients aged >15 years, non-pregnant, and registered in our institution, Indonesia. Methods Diagnosis of HIV treatment failure was made according to the standard WHO criteria. Demographic and outcome variables were recorded. The association between variables were analyzed by Chi-square test with odds ratios (OR) and 95% confidence intervals (95% CI), followed by multivariate analysis using logistic regression test. Results Twenty-six index cases and 26 age- and sex-matched control cases were included in the study with a mean age of 32.27 ± 8.7 years and 32.88 ± 8.15 years, respectively. Median time for switching to second-line (Lopinavir/ritonavir, LPV/r) was 46.32 ± 30.21 months. Patients presented with tuberculosis and treated by nevirapine as the first-line treatment were 26.6-folds (95% CI: 2.41-293.81, p = 0.007) and 6.7-folds (95% CI: 1.56-28.45, p = 0.011) higher risk for treatment failure, respectively. Conclusions The presence of tuberculosis and the use of nevirapine in first-line treatment were strong predictors for first-line ARV treatment failure, suggesting for closer clinical monitoring for patients with those conditions. A further and larger prospective cohort study is needed to confirm the findings in this study.
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Affiliation(s)
- Yanri Wijayanti Subronto
- Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, 55281, Indonesia.,Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Nur Aini Kusmayanti
- Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Albarisa Shobry Abdalla
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Prenaly Dwisthi Sattwika
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
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Zenebe Haftu A, Desta AA, Bezabih NM, Bayray Kahsay A, Kidane KM, Zewdie Y, Woldearegay TW. Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study. PLoS One 2020; 15:e0239191. [PMID: 32986756 PMCID: PMC7521713 DOI: 10.1371/journal.pone.0239191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to determine the incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy (ART) in public hospitals of Northern Ethiopia. METHODS A retrospective study was conducted from September 1, 2007 to July 30, 2017 on 227 patients. The data were extracted using a retrieval checklist from the patient's charts. The incidence rate of treatment failure was calculated using Kaplan-Meier methods and Cox proportional hazard model was used to assess factors associated with treatment failure. RESULT The study subjects were followed for a total observation of 788.58 person-years with a median follow-up period of 35 (IQR: 17-60) months after switching to second-line ART. About 57 (25.11%) patients developed treatment failure, out of which, 32 (56.14%) occurred during the first two years. The overall incidence of second-line treatment failure was 72.3 per 1000 person years (95%CI: 55.75-93.71) of observation. The Kaplan-Meier estimates of cumulative treatment failure after 1, 2, and around 10 years of follow-up were 12.31% (95%CI: 8.60-17.45%), 14.99% (95%CI: 10.82%-20.57%), and 48.67% (95%CI: 32.45-67.81%) respectively. Age >45 years AHR = 3.33, 95%CI = 1.33-8.31), WHO stage IV (AHR = 3.63, 95%CI = 1.72-7.67), CD4 count <100 cells/mm3 (AHR = 3.79, 95%CI = 1.61-8.91), TB co-morbidity (AHR = 3.39 95%CI = 1.91-6.01) and poor adherence level (AHR = 3.63, 95% CI = 1.89-6.96) at the start of second line ART were significantly associated with second-line ART failure. CONCLUSION Incidence of second-line ART treatment failure in the first 2 years of follow-up was high. The rate of second-line ART failure was higher in patients who started second-line ART with poor drug adherence, CD4 count <100 cells/mm3, TB co-morbidity, age >45 years, and being in WHO stage IV. Therefore, intensive counseling and adherence support should be given along with strong TB screening. Moreover, the government of Ethiopia should consider endorsing third-line ART drugs after careful cost-benefit analysis.
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Affiliation(s)
| | | | | | - Alemayehu Bayray Kahsay
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Yodit Zewdie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Endalamaw A, Mekonnen M, Geremew D, Yehualashet FA, Tesera H, Habtewold TD. HIV/AIDS treatment failure and associated factors in Ethiopia: meta-analysis. BMC Public Health 2020; 20:82. [PMID: 31959136 PMCID: PMC6971997 DOI: 10.1186/s12889-020-8160-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023] Open
Abstract
Background The national burden of human immunodeficiency virus treatment failure and associated factors in the Ethiopian context is required to provide evidence towards a renewed ambitious future goal. Methods We accessed Ethiopian Universities’ online repository library, Google Scholar, PubMed, Web of Science, and Scopus to get the research articles. We run I-squared statistics to see heterogeneity. Publication bias was checked by using Egger’s regression test. The pooled prevalence was estimated using the DerSimonian-Laird random-effects model. We employed the sensitivity analysis to see the presence of outlier result in the included studies. Results The overall human immunodeficiency treatment failure was 15.9% (95% confidence interval: 11.6–20.1%). Using immunological, virological, and clinical definition, human immunodeficiency treatment failure was 10.2% (95% confidence interval: 6.9–13.6%), 5.6% (95% confidence interval: 2.9–8.3%), and 6.3% (95% confidence interval: 4.6–8.0%), respectively. The pooled effects of World Health Organization clinical stage III/IV (Adjusted Odd Ratio = 1.9; 95% CI: 1.3–2.6), presence of opportunistic infections (Adjusted Odd Ratio = 1.8; 95% CI: 1.2–2.4), and poor adherence to highly active antiretroviral therapy (Adjusted Odd Ratio = 8.1; 95% CI: 4.3–11.8) on HIV treatment failure were estimated. Conclusions Human immunodeficiency virus treatment failure in Ethiopia found to be high. Being on advanced clinical stage, presence of opportunistic infections, and poor adherence to highly active antiretroviral therapy were the contributing factors of human immunodeficiency virus treatment failure. Human immunodeficiency virus intervention programs need to address the specified contributing factors of human immunodeficiency virus treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain human immunodeficiency virus treatment adherence. Protocol registration It has been registered in the PROSPERO database with a registration number of CRD42018100254.
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Affiliation(s)
- Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 196, Bahir Dar, Ethiopia.
| | - Mengistu Mekonnen
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demeke Geremew
- Department of Immunology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikadu Ambaw Yehualashet
- Department of comprehensive nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hiwot Tesera
- Student Clinic, Microbiologist, Bahirdar University, Bahir Dar, Ethiopia
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Mulisa D, Tesfa M, Mullu Kassa G, Tolossa T. Determinants of first line antiretroviral therapy treatment failure among adult patients on ART at central Ethiopia: un-matched case control study. BMC Infect Dis 2019; 19:1024. [PMID: 31795955 PMCID: PMC6889620 DOI: 10.1186/s12879-019-4651-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. METHODS A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. RESULT A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. CONCLUSION Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.
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Affiliation(s)
- Diriba Mulisa
- School of Nursing and Midwifery, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia.
| | - Mulugeta Tesfa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getachew Mullu Kassa
- Department of Midwifery, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadesse Tolossa
- School of Nursing and Midwifery, Wollega University, P.O.BOX: 395, Nekemte, Ethiopia
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Baraki AG, Gezie LD, Zeleke EG, Awoke T, Tsegaye AT. Body mass index variation over time and associated factors among HIV-positive adults on second-line ART in north-west Ethiopia: a retrospective follow-up study. BMJ Open 2019; 9:e033393. [PMID: 31551394 PMCID: PMC6773344 DOI: 10.1136/bmjopen-2019-033393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to assess the evolution of body mass index (BMI) of HIV-positive adults on second-line antiretroviral therapy (ART) over time and factors affecting it in north-west Ethiopia. DESIGN An institution-based retrospective follow-up study was conducted using data extracted from 1016 patient cards from February 2008 to February 2016. SETTING Eight referral hospitals from Amhara region, Ethiopia were included. PARTICIPANTS HIV patients who started second-line ART. OUTCOME MEASURES Change in BMI since starting second-line ART. RESULTS Five hundred and thirty-eight (52.95%) participants were males and the median age of the participants was 33 years (IQR: 28; 39). The median follow-up time was 18 months (IQR: 5.2; 32.2). The average change of BMI showed linear increase over time. The amount of BMI increment or decrement according to each variable was shown as β coefficients. Treatment duration (β=0.013, 95% CI 0.004 to 0.022), isoniazid prophylaxis (β=0.87, 95% CI 0.32 to 1.42), cotrimoxazole prophylaxis (β=0.63, 95% CI 0.08 to 1.19), ambulatory functional status (β=-1.16, 95% CI -1.95 to 1.31), bedridden functional status (β=-1.83, 95% CI -2.47 to 1.21), WHO stage III (β=-0.42, 95% CI -0.65 to 0.20), WHO stage IV (β=-0.62, 95% CI -1.02 to 0.22), CD4 count (β=0.001, 95% CI 0.0008 to 0.0015), and time interaction of variables like tertiary educational status (β=0.02, 95% CI 0.01 to 0.04), ambulatory functional status (β=0.03, 95% CI 0.01 to 0.05) and WHO stages III (β=0.01, 95% CI 0.007 to 0.02) were found to be significant predictors. CONCLUSION The BMI of patients has shown linear increment over the treatment time. Factors affecting it have been identified but its effect on cardiovascular disease needs further study.
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Affiliation(s)
- Adhanom Gebreegziabher Baraki
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye Zeleke
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Edessa D, Sisay M, Asefa F. Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0220159. [PMID: 31356613 PMCID: PMC6663009 DOI: 10.1371/journal.pone.0220159] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Increased second-line antiretroviral therapy (ART) failure rate narrows future options for HIV/AIDS treatment. It has critical implications in resource-limited settings; including sub-Saharan Africa (SSA) where the burden of HIV-infection is immense. Hence, pooled estimate for second-line HIV treatment failure is relevant to suggest valid recommendations that optimize ART outcomes in SSA. METHODS We retrieved literature systematically from PUBMED/MEDLINE, EMBASE, CINAHL, Google Scholar, and AJOL. The retrieved studies were screened and assessed for eligibility. We also assessed the eligible studies for their methodological quality using the Joanna Briggs Institute's appraisal checklist. The pooled estimates for second-line HIV treatment failure and its associated factors were determined using STATA, version 15.0 and MEDCALC, version 18.11.3, respectively. We assessed publication bias using Comprehensive Meta-analysis software, version 3. Detailed study protocol for this review/meta-analysis is registered and found on PROSPERO (ID: CRD42018118959). RESULTS A total of 33 studies with the overall 18,550 participants and 19,988.45 person-years (PYs) of follow-up were included in the review. The pooled second-line HIV treatment failure rate was 15.0 per 100 PYs (95% CI: 13.0-18.0). It was slightly higher at 12-18 months of follow-up (19.0/100 PYs; 95% CI: 15.0-22.0), in children (19.0/100 PYs; 95% CI: 14.0-23.0) and in southern SSA (18.0/100 PYs; 95% CI: 14.0-23.0). Baseline values (high viral load (OR: 5.67; 95% CI: 13.40-9.45); advanced clinical stage (OR: 3.27; 95% CI: 2.07-5.19); and low CD4 counts (OR: 2.80; 95% CI: 1.83-4.29)) and suboptimal adherence to therapy (OR: 1.92; 95% CI: 1.28-2.86) were the factors associated with increased failure rates. CONCLUSION Second-line HIV treatment failure has become highly prevalent in SSA with alarming rates during the 12-18 month period of treatment start; in children; and southern SSA. Therefore, the second-line HIV treatment approach in SSA should critically consider excellent adherence to therapy, aggressive viral load suppression, and rapid immune recovery.
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Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
- * E-mail:
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
| | - Fekede Asefa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia
- Center for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, NSW, Australia
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Alene M, Awoke T, Yenit MK, Tsegaye AT. Incidence and predictors of second-line antiretroviral treatment failure among adults living with HIV in Amhara region: a multi-centered retrospective follow-up study. BMC Infect Dis 2019; 19:599. [PMID: 31288748 PMCID: PMC6617674 DOI: 10.1186/s12879-019-4243-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Second-line Antiretroviral Therapy (ART) regimens are used when patients develop treatment failure for first-line drug regimens. It is costly unaffordable and it is not widely available for patients in resource limiting setting, there is a need to maximizing the duration of stay on second-line regimen. This study was conducted to estimate the incidence rate of second-line treatment failure and to identify its predictors among adults living with HIV in the Amhara region. Methods An institution based retrospective follow-up study was conducted from May to June 2017. A total of 1,011 adults on second-line ART who were enrolled between February 2008 and April 2016 were included for final analysis. Kaplan-Meier estimator curves were used to describe the survival function. Semi-parametric proportional hazard model was fitted to identify the predictors of treatment failure. Results The overall incidence of second-line treatment failure was 9.86 per 100 person-years. It was high during the first and the last year of follow-up. The rate of second-line treatment failure was higher for patients who didn’t change second-line regimens (HR: 1.55, 95%CI: 1.18–2.04), who had poor ART adherence (HR: 1.40, 95%CI: 1.06–1.85), and not taking INH (HR: 1.68, 95%CI: 1.23–2.30) as compared to their counter group. The rate of treatment failure for patients who were under WHO clinical stage III at switch (HR: 0.68, 95%CI: 0.50–0.91) was also lower as compared to clients who were under WHO clinical stage I. Furthermore, the rate of treatment failure was higher for clients who were under second-line regimen “TDF-3TC-LPV/r” (HR: 1.55, 95%CI: 1.03–2.32) and “AZT-3TC-LPV/r” (HR: 3.00, 95%CI: 1.86–4.85) as compared to patients under “ABC-ddI-LPV/r” regimens. Conclusions A high incidence rate of second-line treatment failure was noticed in the study setting. The rate of second-line treatment failure was higher for patients who didn’t change drug regimens, who had poor ART adherence, and who were not taking INH. Therefore, addressing significant predictors to prevent treatment failure among ART patients is essential and sustainable monitoring to reduce the risk of treatment failure is also desirable.
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Affiliation(s)
- Muluneh Alene
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.
| | - Tadesse Awoke
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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Bezabih YM, Beyene F, Bezabhe WM. Factors associated with first-line antiretroviral treatment failure in adult HIV-positive patients: a case-control study from Ethiopia. BMC Infect Dis 2019; 19:537. [PMID: 31215397 PMCID: PMC6582596 DOI: 10.1186/s12879-019-4170-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/05/2019] [Indexed: 12/02/2022] Open
Abstract
Background Treatment failure has become a significant challenge in patients taking antiretroviral therapy (ART). The aim of the present study was to identify risk factors for first-line ART failure among patients attending clinical follow-up. Methods A 1:2 matched case-control study (by age, sex, and treatment duration since initiated on ART) was conducted from June 2015 to July 2017 on adult patients (aged ≥15 years) who were on ART for at least 6 months. Cases were selected from patients who were switched to second-line ART after first-line ART failure (viral load ≥1000 copies/mL). Controls were randomly selected from patients on first-line ART with viral load < 50 copies/mL. Data were collected using an interview questionnaire, reviewing chart and electronic health records and laboratory tests. Multivariate logistic regression analysis was performed to identify risk factors for treatment failure. Results Of the 273 patients who participated in this study, 55% were males. Ninety-one cases were compared with 182 controls. The median age of participants was 40 years and the median duration of treatment since initiated on ART was 69 months. Independent risk factors associated with first-line antiretroviral treatment failure were discontinuation of ART (adjusted odds ratio (AOR) = 9.8, 95% confidence interval (CI): 4.0–23.8), baseline CD4 lymphocyte count ≤50 cells/mm3 (AOR = 3.8, 95% CI: 1.5–9.6) and persistent diarrhea (AOR = 4.4, 95% CI: 1.5–13.2). The risk of ART failure was high and comparable whether the duration of ART discontinuation was greater or less than 1 month (crude odds ratio (COR) = 6.3 and 8. 5 respectively, p-value < 0.001). Frequent eating of a diet containing wheat or barley (AOR = 2.3, 95% CI: 0.9–5.4) showed a trend to be a risk factor for first-line ART failure (p-value = 0.064). Conclusions Our findings underscore the importance of avoiding ART discontinuation of any duration, early initiation of ART and diarrhea management to prevent first-line ART failure.
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Affiliation(s)
- Yihienew Mequanint Bezabih
- College of Health Sciences, Arsi University, Arsi, Ethiopia. .,ONIRIS: The Nantes-Atlantic National College of Veterinary Medicine, Nantes, France.
| | - Fekadu Beyene
- College of Health Sciences, Arsi University, Arsi, Ethiopia
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Sharp J, Wilkinson L, Cox V, Cragg C, van Cutsem G, Grimsrud A. Outcomes of patients enrolled in an antiretroviral adherence club with recent viral suppression after experiencing elevated viral loads. South Afr J HIV Med 2019; 20:905. [PMID: 31308966 PMCID: PMC6620522 DOI: 10.4102/sajhivmed.v20i1.905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/17/2019] [Indexed: 12/04/2022] Open
Abstract
Background Eligibility for differentiated antiretroviral therapy (ART) delivery models has to date been limited to low-risk stable patients. Objectives We examined the outcomes of patients who accessed their care and treatment through an ART adherence club (AC), a differentiated ART delivery model, immediately following receiving support to achieve viral suppression after experiencing elevated viral loads (VLs) at a high-burden ART clinic in Khayelitsha, South Africa. Methods Beginning in February 2012, patients with VLs above 400 copies/mL either on first- or second-line regimens received a structured intervention developed for patients at risk of treatment failure. Patients who successfully suppressed either on the same regimen or after regimen switch were offered immediate enrolment in an AC facilitated by a lay community health worker. We conducted a retrospective cohort analysis of patients who enrolled in an AC directly after receiving suppression support. We analysed outcomes (retention in care, retention in AC care and viral rebound) using Kaplan–Meier methods with follow-up from October 2012 to June 2015. Results A total of 165 patients were enrolled in an AC following suppression (81.8% female, median age 36.2 years). At the closure of the study, 119 patients (72.0%) were virally suppressed and 148 patients (89.0%) were retained in care. Six, 12 and 18 months after AC enrolment, retention in care was estimated at 98.0%, 95.0% and 89.0%, respectively. Viral suppression was estimated to be maintained by 90.0%, 84.0% and 75.0% of patients at 6, 12 and 18 months after AC enrolment, respectively. Conclusion Our findings suggest that patients who struggled to achieve or maintain viral suppression in routine clinic care can have good retention and viral suppression outcomes in ACs, a differentiated ART delivery model, following suppression support.
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Affiliation(s)
- Joseph Sharp
- Emory University School of Medicine, Atlanta, United States
| | - Lynne Wilkinson
- Médecins Sans Frontières, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,International AIDS Society, Cape Town, South Africa
| | - Vivian Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carol Cragg
- Provincial Department of Health, Western Cape, Cape Town, South Africa
| | - Gilles van Cutsem
- Médecins Sans Frontières, Cape Town, South Africa.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Fily F, Ayikobua E, Ssemwanga D, Nicholas S, Kaleebu P, Delaugerre C, Pasquier E, Amoros Quiles I, Balkan S, Schramm B. HIV-1 drug resistance testing at second-line regimen failure in Arua, Uganda: avoiding unnecessary switch to an empiric third-line. Trop Med Int Health 2019; 23:1075-1083. [PMID: 30058269 DOI: 10.1111/tmi.13131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The number of patients on second-line antiretroviral therapy is growing, but data on HIV drug resistance patterns at failure in resource-constrained settings are scarce. We aimed to describe drug resistance and investigate the factors associated with extensive resistance to nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), in patients failing second-line therapy in the HIV outpatient clinic at Arua Regional Referral Hospital, Uganda. METHODS We included patients who failed on second-line therapy (two consecutive viral loads ≥1000 copies/mm3 by SAMBA-1 point-of-care test) and who had a drug resistance test performed between September 2014 and March 2017. Logistic regression was used to investigate factors associated with NRTI genotypic sensitivity score (GSS) ≤1. RESULTS Seventy-eight patients were included: 42% female, median age 31 years and median time of 29 months on second-line therapy. Among 70 cases with drug resistance test results, predominant subtypes were A (47%) and D (40%); 18.5% had ≥1 major protease inhibitor mutation; 82.8% had ≥1 NRTI mutation and 38.5% had extensive NRTI resistance (NRTI GSS ≤1). A nadir CD4 count ≤100/ml was associated with NRTI GSS ≤1 (OR 4.2, 95% CI [1.3-15.1]). Thirty (42.8%) patients were switched to third-line therapy, composed of integrase inhibitor and protease inhibitor (60% darunavir/r) +/- NRTI. A follow-up viral load was available for 19 third-line patients at 12 months: 84.2% were undetectable. CONCLUSIONS Our study highlights the need for access to drug resistance tests to avoid unnecessary switches to third-line therapy, but also for access to third-line drugs, in particular integrase inhibitors. Low nadir CD4 count might be an indicator of third-line drug requirement for patients failing second-line therapy.
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Affiliation(s)
- F Fily
- Epicentre, Paris, France.,Service des Maladies Respiratoires et Infectieuses, Hôpital Broussais, Saint-Malo, France
| | - E Ayikobua
- Médecins Sans Frontières-France, Paris, France
| | - D Ssemwanga
- MRC/UVRI Uganda Virus Research Unit, Entebbe, Uganda
| | | | - P Kaleebu
- MRC/UVRI Uganda Virus Research Unit, Entebbe, Uganda
| | - C Delaugerre
- Laboratoire de Virologie, Hôpital Saint Louis, AP-HP, Paris, France.,Université Paris-Diderot, Paris, France
| | - E Pasquier
- Epicentre, Paris, France.,Médecins Sans Frontières-France, Paris, France
| | | | - S Balkan
- Médecins Sans Frontières-France, Paris, France
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30
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Gunda DW, Kilonzo SB, Mtaki T, Bernard DM, Kalluvya SE, Shao ER. Magnitude and correlates of virological failure among adult HIV patients receiving PI based second line ART regimens in north western Tanzania; a case control study. BMC Infect Dis 2019; 19:235. [PMID: 30845924 PMCID: PMC6407235 DOI: 10.1186/s12879-019-3852-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background With a growing access to free ART, switching of ART to second line regimen has also become common following failure of first line ART regimens. Patients failing on first line ART regimens have been shown to stand a high risk of failing on subsequent second line ART regimens. The magnitude of those who are failing virologicaly on second line ART is not documented in our setting. This study was designed to assess the magnitude and correlates of second line ART treatment failure. Methods A retrospective analysis of patients on second line ART for at least 1 year was done at Bugando care and treatment center. Information on demographic, clinical and laboratory data were collected and analyzed using STATA 11. The proportion of patients with Virological failure was calculated and potential correlates of virological failure were determined by logistic regression model. Results In total 197 patients on second line ART were included in this study and 24 (12.18%) of them met criteria for virological failure. The odds of having virological failure on second line ART were independently associated with age of less than 30 years (AOR = 12.5, p = 0.001), being on first line for less than 3 years (AOR = 6.1, p = 0.002) and CD4 at switch to second line ART of less than 200cells/μl (AOR = 16.3, p < 0.001). Conclusion Virological failure among patients on second line ART is common. Predictors of virological failure in this study could assist in planning for strategies to improve the outcome of this subgroup of patients including close clinical follow up of patients at risk, a continued adherence intensification and a targeted resistance testing before switching to second line ART.
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Affiliation(s)
- Daniel W Gunda
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania. .,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania.
| | - Semvua B Kilonzo
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania.,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Tarcisius Mtaki
- Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Desderius M Bernard
- Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Samwel E Kalluvya
- Department of Medicine, Bugando Medical centre, 1370, Mwanza, Tanzania.,Department of medicine, Weill Bugando School of Medicine, 1464, Mwanza, Tanzania
| | - Elichilia R Shao
- Department of Medicine, Kilimanjaro Christian Medical University College, 2240, Moshi, Tanzania
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31
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Chen YC, Lin CY, Strong C, Li CY, Wang JS, Ko WC, Ko NY. Sleep disturbances at the time of a new diagnosis: a comparative study of human immunodeficiency virus patients, cancer patients, and general population controls. Sleep Med 2017; 36:38-43. [PMID: 28735919 DOI: 10.1016/j.sleep.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Sleep disturbances are a prevalent and troubling symptom of patients with highly stressful illnesses, such as human immunodeficiency virus (HIV) and cancer. The aim of this study was to compare the prevalence and incidence of sleep disturbances among persons with HIV, those with cancer, and the general population of Taiwan. METHODS A matched cohort study design was used to compare the risk of sleep disturbances among three groups using reimbursement claims recorded in Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,531 HIV-infected persons were compared with 1493 cancer patients and 1373 general population controls matched by gender and age. Cox proportional hazard regression models were used to test the hazard risk of sleep disturbances among the groups. RESULTS The mean durations between the date of the initial HIV/cancer diagnosis and onset of sleep disturbances of HIV-infected persons, cancer patients, and controls were 1.7, 2.3, and 1.8 years, respectively. The risk of developing sleep disturbances was significantly higher in HIV-infected persons (adjusted hazard ratio [AHR] = 3.74, p < 0.001) and cancer patients (AHR = 2.72, p < 0.001) than in controls. HIV-infected persons had a 20% higher risk of sleep disturbances than cancer patients (AHR = 1.20, p < 0.001). CONCLUSIONS HIV-infected persons exhibited a higher risk of developing sleep disturbances than cancer patients and general population controls. With efficacious treatments for sleep disturbances, we should focus on training and research programs for health care providers to intervene and treat earlier for the present and future health of cancer patients and HIV-infected persons.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jeen-Shing Wang
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
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