Treatment failure, death, and predictors among PLWHIV on second-line antiretroviral therapy in Dessie Comprehensive Specialized Hospital, northeast Ethiopia: A retrospective cohort study

BACKGROUND: The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern, especially in a low-income country setting. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy in the Ethiopia context. Thus, this study was conducted to determine the rate of treatment failure, death, and their predictors among HIV patients receiving second-line therapy. METHODS: A retrospective cohort study was conducted on 642 people living with HIV in Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. Poisson and competitive risk survival models were computed to explore predictors of treatment failure and death, respectively. RESULTS: During follow-up period, 39 (6.87%, 95% CI: 5–9.2%) of 568 patients had second-line treatment failure with 4.07 per 100 person-year rate of failure. Being on anti-TB treatment [Rate ratio, RR = 2.57 (95% CI: 1.25–5.25)], not having optimal medication adherence [RR = 2.29 (95% CI: 1.09–4.78)], and not timely switched [RR = 5.89 (95% CI: 1.36–25.54)] were positively associated with treatment failure. Similarly, 44 (6.85%, 95% CI: 5–9%) of 642 patients died with 4.5 per 100 person-year rate of death. Being on advanced clinical condition [Sub distribution Hazard ratio, SHR = 2.49 (95% CI: 1.31–4.74)], not having optimal medication adherence [SHR = 2.65 (95% CI: 1.31–4.74)], lower CD4 cell counts, and high viral load measurement were positively associated with death. CONCLUSIONS: A significant number of patients had failed to respond to second-line therapy. A large number of patients had also died. Patient medical profile and monitoring practice were associated with treatment failure and death. Hence, patient-centered monitoring and interventions should be strengthened, besides treatment switch.