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Richterman A, Dorvil N, Rivera V, Bang H, Severe P, Lavoile K, Pierre S, Apollon A, Dumond E, Pierre Louis Forestal G, Rouzier V, Joseph P, Cremieux PY, Pape JW, Koenig SP. Predictors of Clinical Outcomes among People with HIV and Tuberculosis Symptoms after Rapid Treatment Initiation in Haiti. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.19.24309189. [PMID: 38946994 PMCID: PMC11213038 DOI: 10.1101/2024.06.19.24309189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Introduction Few studies have evaluated baseline predictors of clinical outcomes among people with HIV starting antiretroviral therapy (ART) in the modern era of rapid ART initiation. Methods We conducted a secondary analysis of a randomized controlled trial of two rapid treatment initiation strategies for people with treatment-naïve HIV and tuberculosis symptoms at an urban clinic in Haiti. We used logistic regression models to assess associations between baseline characteristics and (1) retention in care at 48 weeks, (2) HIV viral load suppression at 48 weeks (among participants who underwent viral load testing), and (3) all-cause mortality. Results 500 participants were enrolled in the study 11/2017-1/2020. Eighty-eight (18%) participants were diagnosed with tuberculosis, and ART was started in 494 (99%). After adjustment, less than secondary education (adjusted odds ratio [AOR] 0.21, 95% CI 0.10-0.46), dolutegravir initiation (AOR 2.57, 95% CI 1.22-5.43), age (AOR 1.42 per 10-year increase, 95% CI 1.01-1.99), and tuberculosis diagnosis (AOR 3.92, 95% CI 1.36-11.28) were significantly associated with retention. Age (AOR 1.36, 95% CI 1.05-1.75), dolutegravir initiation (AOR 1.75, 95% CI 1.07-2.85), and tuberculosis diagnosis (AOR 0.50, 95% CI 0.28-0.89) were associated with viral suppression. Higher CD4 cell count at enrollment (unadjusted odds ratio [OR] 0.69, 95% CI 0.55-0.87) and anemia (OR 4.86, 95% CI 1.71-13.81) were associated with mortality. Conclusions We identified sociodemographic, treatment-related, clinical, and laboratory-based predictors of clinical outcomes. These characteristics may serve as markers of sub-populations that could benefit from additional interventions to support treatment success after rapid treatment initiation.
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Affiliation(s)
- Aaron Richterman
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Nancy Dorvil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Heejung Bang
- University of California, Davis School of Medicine, Davis, California, United States of America
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kerylyne Lavoile
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumond
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medical College, New York, New York, United States of America
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean W Pape
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
- Weill Cornell Medical College, New York, New York, United States of America
| | - Serena P Koenig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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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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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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Wisaksana R, Hartantri Y, Hutajulu E. Risk Factors Associated with Unsuppressed Viral Load in People Living with HIV Receiving Antiretroviral Treatment in Jawa Barat, Indonesia. HIV AIDS (Auckl) 2024; 16:1-7. [PMID: 38292561 PMCID: PMC10823181 DOI: 10.2147/hiv.s407681] [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: 04/08/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction The success rate of antiretroviral therapy (ART) was sufficiently high globally that by 2030, Human Immunodeficiency Virus (HIV) infection would no longer become a significant health issue. The evaluation of the success rate of ART in Indonesia is still fairly low, with estimates that 6.1% of the total population living with HIV. This is affected by treatment failure and limitations of viral load (VL) testing. We investigated the risk factors for failure of VL suppression in HIV patients on ART. Methods An institution-based cross-sectional study was conducted among 1203 subjects, medical records of adult HIV patients in Jawa Barat, who followed the Viral Load Months Program from the government in 2020. Data were taken using total sampling technique and analyzed with multivariate logistic regression model using SPSS version 21 software. Results Of the 1203 subjects, 5.2% had unsuppressed VL and 94.8% had suppressed VL. The results showed that a nevirapine-based regimen was the main factor increasing unsuppressed risk (Prevalence Odds Ratio (POR) 3.75 (95% CI: 1.41-9.99, p-value 0.008)). The other factors are ART duration <5 years (POR 2.46; 95% CI: 1.22-4.97, p-value 0.012), WHO clinical stage III-IV (POR 2.30; 95% CI: 1.30-4.08, p-value 0.004), and loss to follow-up history (POR 2.28, 95% CI: 1.03-5.07). Meanwhile, the zidovudine-based regimen reduced the risk of failure (POR 0.34 (95% CI: 0.12-0.96)). Conclusion Several factors could contribute to unsuppressed VL in HIV patients receiving ART, which warrants further investigations.
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Affiliation(s)
- Rudi Wisaksana
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Yovita Hartantri
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Elisabeth Hutajulu
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Hasan Sadikin General Hospital, Bandung, Indonesia
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Rebolledo-Ponietsky K, Al-Kassab-Córdova A, Lucchetti-Rodríguez A, Cabieses B, Rodriguez-Morales AJ, Mezones-Holguín E. Highly active antiretroviral therapy discontinuation time is associated with therapeutic failure among human immunodeficiency virus (HIV)-infected immigrant adults: A cohort study from a Peruvian referral hospital during the Venezuelan exodus. Trop Med Int Health 2023. [PMID: 37414409 DOI: 10.1111/tmi.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To evaluate the association between Highly Active Antiretroviral Therapy (HAART) discontinuation time and therapeutic failure (TF) in Venezuelan immigrants with HIV that restart HAART. METHODS We carried out a retrospective cohort study in a large hospital in Peru. We included Venezuelan immigrants who restarted HAART and were followed over at least 6 months. The primary outcome was TF. Secondary outcomes were immunologic (IF), virologic (VF) and clinical (CF) failures. The exposure variable was HAART discontinuation, categorised as no discontinuation, less than 6 months, and 6 months or more. We applied generalised linear models Poisson family with robust standard errors to calculate crude (cRR) and adjusted (aRR) relative risks by statistical and epidemiological criteria. RESULTS We included 294 patients, 97.2% were males, and the median age was 32 years. Out of all the patients, 32.7% discontinued HAART for less than 6 months, 15.0% discontinued for more than 6 months and the remaining 52.3% did not discontinue. The cumulative incidence of TF was 27.9%, 24.5% in VF, 6.0% in IF and 6.0% in CF. Compared with non-discontinued HAART patients, the discontinuation for less than 6 months (aRR = 1.98 [95% CI: 1.27-3.09]) and from 6 months to more (aRR = 3.17 [95% CI: 2.02-4.95]) increased the risk of TF. Likewise, treatment discontinuation of up to 6 months (aRR = 2.32 [95% CI: 1.40-3.84]) and from 6 months to more (aRR = 3.93 [95% CI: 2.39-6.45]) increased the risk of VF. CONCLUSIONS HAART discontinuation increases the probability of TF and VF in Venezuelan immigrants.
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Affiliation(s)
| | - Ali Al-Kassab-Córdova
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Aldo Lucchetti-Rodríguez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital Nacional Arzobispo Loayza, Servicio de Enfermedades Infecciosas y Tropicales, Ministerio de Salud, Lima, Peru
| | - Baltica Cabieses
- Facultad de Medicina Clínica Alemana, Centro de Salud Global Intercultural, Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Alfonso J Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de las Américas-Institución Universitaria Visión de las Américas, Pereira, Risaralda, Colombia
- Master's Program in Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Edward Mezones-Holguín
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Epi-gnosis Solutions, Piura, Peru
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Masaba R, Woelk G, Siamba S, Ndimbii J, Ouma M, Khaoya J, Kipchirchir A, Ochanda B, Okomo G. Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001007. [PMID: 36962996 PMCID: PMC10021395 DOI: 10.1371/journal.pgph.0001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
Despite large numbers of patients accessing antiretroviral treatment (ART) in Kenya, few studies have explored factors associated with virologic failure in Western Kenya, specifically. We undertook a study in Homa Bay County, Kenya to assess the extent of virologic treatment failure and factors associated with it. This was an observational retrospective study conducted from September 2020 to January 2021. Data were abstracted from the records of patients who had been on ART for at least six months at the time of data collection after systematic sampling stratified by age group at ART initiation (0-14 and 15+ years), using probability proportion to the numbers of patients attending the facility. Confirmed viral treatment failure was defined as viral load ≥1000 copies/ml based on two consecutive viral load measurements after at least three months of enhanced adherence counseling. Data were analyzed using descriptive statistics and Cox regression modeling. Of the 2,007 patients sampled, 160 (8.0%) had confirmed virologic treatment failure. Significantly higher virologic treatment failure rates were identified among male patients 78/830 (9.4%) and children 115/782 (14.7%). Factors associated with virologic treatment failure (VTF), were age 0-14 years, adjusted hazard ratio (AHR) 4.42, (95% Confidence Interval [CI], 3.12, 6.32), experience of treatment side effects AHD: 2.43, (95% CI, 1.76, 3.37), attending level 2/3 health facility, AHR: 1.87, (95% CI: 1.29, 2,72), and history of opportunistic infections (OIs), AHR: 1.81, (95% CI, 1.76, 3.37). Children, attendees of level 2/3 health facilities, patients with a history of OIs, and those experiencing treatment side-effects are at risk of VTF. Increased focus on children and adolescents on screening for drug resistance, administration of and adherence to medication, and on effective information and education on side-effects is critical. Additionally, there is need for increased training and support for health care workers at primary level care facilities.
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Affiliation(s)
- Rose Masaba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States of America
| | - Stephen Siamba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - James Ndimbii
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Millicent Ouma
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - Jacob Khaoya
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | | | - Boniface Ochanda
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
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Nyongesa MK, Mwatasa MH, Kagonya VA, Mwambingu G, Ngetsa C, Newton CRJC, Abubakar A. HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast. BMC Infect Dis 2022; 22:449. [PMID: 35545757 PMCID: PMC9092782 DOI: 10.1186/s12879-022-07428-w] [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: 09/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18-24 years from the Kenyan coast. METHODS Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL. RESULTS Among these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH. CONCLUSIONS In this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.
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Affiliation(s)
- Moses K. Nyongesa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.12380.380000 0004 1754 9227Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mwaganyuma H. Mwatasa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Vincent A. Kagonya
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Gabriel Mwambingu
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Caroline Ngetsa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Charles R. J. C. Newton
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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Getaneh T, Negesse A, Dessie G, Desta M. The impact of tuberculosis co-infection on virological failure among adults living with HIV in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2022; 27:100310. [PMID: 35284661 PMCID: PMC8913348 DOI: 10.1016/j.jctube.2022.100310] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Tuberculosis (TB) is the most common serious opportunistic infection among people with Human Immunodeficiency Virus (HIV) infection and are considered as the double burden diseases of the world. TB is the leading cause of death among people living with HIV, accounting one in three HIV related deaths. Although TB is responsible for high burden of virological unsuppressed in Ethiopia, there is no national level evidence. Therefore, this systematic review and meta-analysis was aimed at estimating the pooled burden of virological unsuppressed among adults with both HIV-TB and impact of TB on virological failure in Ethiopia. Methods The finding of this meta-analysis was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists. Major data bases PubMed, Scopus, Cochrane Library, Science Direct and Google scholar were searched to access articles. Cochran’s Q statistic quantified with inverse variance was computed to check heterogeneity. Funnel plot visualization and Egger’s test were fitted to assess publication bias across included studies. Random effects model meta-analysis using STATA version-15 statistical software was used to estimate the pooled effect with respective 95% confidence intervals. Results A total of 15 primary studies reporting on impact of tuberculosis on virological unsuppressed among adults living with HIV in Ethiopia were eligible for this meta-analysis. Accordingly, the pooled prevalence of virological unsuppressed among adults with both HIV-TB in Ethiopia was 39.09% (95% CI: 29.04, 49.15). In addition, the odds of virological unsuppressed among adults with both HIV-TB was 2.46 times higher when compared with adults living with HIV infection alone (OR = 2.46, 95% CI: 1.74, 3.46). Conclusion The present systematic review and meta-analysis evidenced that the pooled prevalence of virological unsuppressed among adults with both HIV-TB was much higher than virological unsuppressed among adults living with HIV alone. Moreover, the odds of virological failure among adults with both HIV-TB was significantly higher when compared with among only HIV infection in Ethiopia. Therefore, strengthening TB prevention interventions, early identification and managing the case and prioritizing viral load monitoring and adherence support among adults living with HIV are recommended.
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Mamo A, Assefa T, Negash W, Takelign Y, Sahiledinigl B, Teferu Z, Mohammed M, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Tahir A, Desta F, Regassa T, Takele A, Regassa Z, Atilaw D. Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia. HIV AIDS (Auckl) 2022; 14:73-85. [PMID: 35250314 PMCID: PMC8892571 DOI: 10.2147/hiv.s354716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Antiretroviral therapy (ART) regimen failure is linked to an increased risk of disease progression and death, while early detection of ART failure can help to prevent the development of resistance. This study aimed to evaluate virological and immunological ART failure and predictors among HIV-positive adult and adolescent clients in southeast Ethiopia. Methods A retrospective cohort study was implemented from January 2016 to November 30, 2020; all HIV-positive nave patients on follow-up during the study period from four hospitals were included. Virological and immunological treatment failure was the primary outcome of the study. Cox proportional hazards regression models were employed for analysis. Hazard ratios with 95% confidence intervals were reported and variables with p-values <0.05 were considered statistically significant predictors of treatment failure. Results A total of 641 HIV patients’ charts were reviewed, 62.6% of the study participants were females. Of the total study participants, 18.4% and 15% developed virological and immunological ART regimen treatment failure respectively. The median time to virological failure was 40 months. WHO stage IV [AHR = 4.616; 95% CI: (2.136–9.974)], WHO stage III [AHR = 2.323; 95% CI: (1.317–4.098)], poor adherence to HAART regimen [AHR = 3.097; 95% CI: (1.349–7.108)], and fair adherence [AHR = 2.058; 95% CI: (1.234–3.432)] were significantly associated with virological treatment failure among adolescent and adult study participants in southeast Ethiopia. Conclusion The prevalence of virological treatment failure was 18.4% (95% CI: 15.4 −21.4) and the prevalence of immunological treatment failure was 15% (95% CI: 11.8–18.4). WHO clinical stage III/IV and non-adherence were independent predictors of virological ART treatment failure. Early management of clinical WHO stages and improving patients’ ART regimen adherence are important to decrease the prevalence of ART regimen treatment failure.
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Affiliation(s)
- Ayele Mamo
- Madda Walabu University, Goba Referral Hospital, Pharmacy Department, Bale Goba, Ethiopia
- Correspondence: Ayele Mamo, Tel +251913512089, Email
| | - Tesfaye Assefa
- Madda Walabu University, Goba Referral Hospital, Nursing department, Bale Goba, Ethiopia
| | - Wegene Negash
- Madda Walabu University, Goba Referral Hospital, Nursing department, Bale Goba, Ethiopia
| | - Yohannes Takelign
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Biniyam Sahiledinigl
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Zinash Teferu
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Mesud Mohammed
- Madda Walabu University, Goba Referral Hospital, Pharmacy Department, Bale Goba, Ethiopia
| | - Damtew Solomon
- Madda Walabu University, Goba Referral Hospital, Biomedical Department, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Madda Walabu University, Goba Referral Hospital, Biomedical Department, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Madda Walabu University, Goba Referral Hospital, Surgery Department, Bale Goba, Ethiopia
| | - Demsu Zenbaba
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Alelign Tasew
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Anwar Tahir
- Madda Walabu University, Goba Referral Hospital, Nursing department, Bale Goba, Ethiopia
| | - Fikereab Desta
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Tadele Regassa
- Madda Walabu University, Goba Referral Hospital, Biomedical Department, Bale Goba, Ethiopia
| | - Abule Takele
- Madda Walabu University, Goba Referral Hospital, Public Health Department, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Madda Walabu University, Goba Referral Hospital, Nursing department, Bale Goba, Ethiopia
| | - Daniel Atilaw
- Madda Walabu University, Goba Referral Hospital, Biomedical Department, Bale Goba, Ethiopia
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