Predictors of Clinical and Immunological Failure Among Patients on First-Line Antiretroviral Therapy (ART) in Southwest Ethiopia

BACKGROUND: Global expanded access to antiretroviral therapy has led to a rapid fall in the number of people dying from HIV-related causes. However, the remarkable achievement recorded in reducing morbidity and mortality has been affected due to the occurrence of first-line ART failure. The study was intended to identify predictors of clinical and immunologic failure of first-line ART in southwest Ethiopia. METHODS: A retrospective cohort study was conducted among 737 randomly selected ART patients from 1(st) January 2010 to 30(th) June 2016. Trained data collectors collected the data from the patients’ follow-up charts and electronic databases. The Kaplan Meier (KM) curve was used to describe the probability of survival time to antiretroviral treatment failure. Variables with a p-value of ≤ 0.05 in a multivariable cox-proportional hazard model were statistically significant predictors of first-line ART failure. RESULTS: Among 737 HIV patients on ART followed retrospectively, 445 (60.4%) were females. During the follow-up period, the incidence rate of treatment failure was 7.3 per 100 person-year observations, and the highest rate was observed during the first 6 to 12 months of ART initiation. Not disclosing HIV status (AHR꞊ 2.04, 95% CI: 1.32–3.16), being bedridden (AHR꞊ 2.01, 95% CI: 1.02–3.98) and low hemoglobin at ART initiation (AHR꞊ 2.02, 95% CI: 1.29–3.13) were associated with an increased hazard rate for first-line ART failure. CONCLUSION: The study showed that predictors of first-line ART treatment failure are modifiable. Therefore, these factors should be addressed during routine care of HIV patients by health care providers to preserve the rapid exhaustion of first-line medications, improve the quality of life of the patients and reduce HIV/AIDS related deaths.