Virological and Immunological Antiretroviral Treatment Failure and Predictors Among HIV Positive Adult and Adolescent Clients in Southeast Ethiopia

Incidence Rate, Survival Rate, and Predictors for Virological Failure Among Adult TB/HIV Coinfected Clients

Background: Tuberculosis increases human immunodeficiency virus replication and accelerates human immunodeficiency virus progression in both tuberculosis and human immunodeficiency virus coinfected patients. The objective of this study was to determine the incidence rate, survival rate, and predictors for virological failure among adult tuberculosis/human immunodeficiency virus coinfected clients. Methods: A retrospective cohort study was conducted at the University of Gondar Compressive Specialized Hospital from March 2017 to 2022. Secondary data sources were extracted based on inclusion criteria for adult tuberculosis/human immunodeficiency virus coinfected patients. The Cox proportional hazards model was used for adult tuberculosis/human immunodeficiency virus coinfected patients data. Result: The overall incidence rate of virological failure was 9.23 per 1000 person-months observations. Out of 148 coinfected patients, about 24.3% had virological failure. More than half of the patients, 52.7% and 54.1% in this study had a CD4 cell count ≥ 200/mm3 and a weight < 50 kg, respectively. Gender (hazard ratio = 1.3291, 95% CI: 1.1878-1.4873), bedridden functional status (hazard ratio = 4.7174; 95% CI: 1.2263-14.1470), WHO clinical Stage IV (hazard ratio = 1.1122, 95% CI: 1.2072-5.9693), patients with opportunistic infections (hazard ratio = 1.2849, 95% CI: 1.4289-3.8504), cotrimoxazole preventive therapy users (hazard ratio = 0.2039, 95% CI: 0.0496-0.8386), patients disclosure status (hazard ratio = 0.1609, 95% CI: 0.0279-0.9286), baseline viral load count < 1000 (hazard ratio = 0.0819, 95% CI: 0.3619-0.8447), and CD4 cell count ≥ 200 (hazard ratio = 0.2728, 95% CI: 0.0749-0.9924) were significant predictors at 5% level of confidence for time to virological failure. Conclusion: The incidence and survival rate of virological failure were high. The current study revealed that male coinfected patients, bedridden functional status, WHO clinical Stage IV, and opportunistic infections other than tuberculosis were associated with a higher time to virological failure while patients disclosed the disease to a family member, cotrimoxazole preventive therapy users, baseline viral load < 1000 copies/mL, and CD4 cell count ≥ 200/mm3 had significantly lower time to virological failure. Therefore, public health organizations should be given special attention based on these important predictors to improve their health and prolong the lives of coinfected patients.

Virological outcomes of antiretroviral therapy and its determinants among HIV patients in Ethiopia: Implications for achieving the 95-95-95 target

BACKGROUND

Despite significant advancements in HIV treatment, virological outcomes remain a critical issue. Ethiopia did not meet the 90:90:90 targets set for 2020, which aimed for 90% of people on antiretroviral therapy to achieve viral suppression. As the country shifts its focus toward the 95:95:95 targets for 2030-seeking to achieve 95% viral suppression among those on ART-it is crucial to deepen our understanding of viral suppression and the factors that influence it.

METHODS

Virological suppression was examined among 410 HIV-positive individuals on ART using the EPHIA survey. The survey employed a two-stage, stratified sampling design across urban areas in nine regions and two city administrations. Data analysis was conducted with STATA version 18, and multicollinearity was assessed using variance inflation factors. A logistic regression model identified significant determinants of viral suppression, with variables having a p-value of ≤0.05 considered statistically significant in the multivariable analysis.

RESULTS

The findings revealed that 364 participants (88.78%) achieved viral suppression. Key determinants of virological outcomes included a higher wealth level (AOR = 2.67, 95% CI: 1.15-6.22), the presence of active TB (AOR = 0.27, 95% CI: 0.14-0.57), hepatitis B virus (AOR = 0.20, 95% CI: 0.10-0.31), and the utilization of HIV support group care (AOR = 3.14, 95% CI: 1.35-6.30).

CONCLUSION

Viral suppression among HIV patients is 88.78%, which even falls short of the WHO's 90% target for 2020, indicating the substantial work required to achieve 95% by 2030. To improve virological outcomes, it is crucial to increase support for low-income patients, enhance management of co-infections like TB and hepatitis B, and expand access to HIV support groups for better adherence and care.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

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.

Genotypic resistance testing improves antiretroviral treatment outcomes in a cohort of adolescents in Cameroon: Implications in the dolutegravir-era

Acquired drug resistance (ADR) is common among adolescents living with perinatal HIV (APHI) in sub-Saharan Africa (SSA). Personalized management has the potential to improve pediatric antiretroviral therapy (ART), even in the presence of long-term treatment and HIV-1 subtype diversity. We sought to evaluate the effect of HIV-1 mutational profiling on immuno-virological response and ADR among APHI. A cohort-study was conducted from 2018-2020 among 311 APHI receiving ART in Cameroon. Clinical, immunological and virological responses were measured at enrolment (T1), 6-months (T2) and 12-months (T3). Immunological failure (IF: CD4 #x003C;250 cells/mm3), VF (viremia ≥1,000 copies/ml), and ADR were analyzed, with P#x003C;0.05 considered significant. Mean age was 15(±3) years; male-female ratio was 1:1; median [IQR] ART-duration was 36[21-81] months. At T1, T2, and T3 respectively, adherence-level was 66.4, 58.3 and 66.5%; 14 viral clades were found, driven by CRF02_AG (58.6%); ADR-mutations favored increased switch to second-line ART (16.1, 31.2, and 41.9%, P#x003C;0.0001). From T1-T3 respectively, there were declining rates of IF (25.5, 18.9, and 9.83%, P#x003C;0.0001), VF (39.7, 39.9, and 28.2%, P=0.007), and HIVDR (96.4, 91.7, and 85.0%, P=0.099). Predictors of ADR were being on first-line ART (P=0.045), high viremia at enrolment (AOR=12.56, P=0.059), and IF (AOR=5.86, P=0.010). Of note, optimized ART guided by mutational profile (AOR=0.05, P=0.002) was protective. Moreover, full Tenofovir+Lamivudine+Dolutegravir efficacy was predicted in 77 and 62% of APHI respectively after first- and second-line failure. Among APHI in this SSA setting, viral mutational profiling prompts the use of optimized Dolutegravir-based ART regimens, leading to improved immuno-virological response and declining ADR burdens. Thus, implementing personalized HIV medicine in this vulnerable population would substantially improve ART response and the achievement of the 95-95-95 goals in these underserved populations.

Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana

BACKGROUND

Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana.

METHOD

This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana.

RESULTS

A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex.

CONCLUSIONS

A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.

Factors Influencing Survival Status of HIV/AIDS after HAART in Huzhou City, Eastern China

Background

Highly active antiretroviral therapy (HAART) can effectively reduce the risk of death and opportunistic infections in patients with HIV/AIDS. The aim of this study was to analyse the survival status and its influencing factors in HIV/AIDS after HAART.

Methods

The data on patients' sociodemographic characteristics, treatment information, and follow-up results from the Information Management System of the Chinese Center for Disease Control and Prevention were obtained. Bivariate and stepwise multivariate Cox proportional hazards regression model analyses were performed.

Results

A total of 1812 participants were included in this study, of which 1716 were still alive (survival group) and 96 had died (death group). The results indicated that respondents who were elderly (HR = 1.053, 95% CI: 1.037–1.069, P < 0.01), who had heterosexual transmission (HR = 2.422, 95% CI: 1.314–4.465, P < 0.01) and whose current WHO clinical stage was stage III or IV (HR = 2.399, 95% CI: 1.215–4.735, P < 0.05) were more likely to have died; respondents whose baseline CD4⁺ T-lymphocyte count was equal to or more than 200 cells/μL (HR = 0.412, 95% CI: 0.275–0.616, P < 0.05) were unlikely to have died.

Conclusions

It is recommended that HAART be provided to HIV/AIDS patients at an early clinical stage and that the health services for HIV/AIDS patients after taking medicines be strengthened, which will help promote adherence to therapeutic regimens and improve quality of life.