Predictors of first-line antiretroviral treatment failure among children on antiretroviral therapy at the University of Gondar comprehensive specialised hospital, North-west, Ethiopia: a 14-year long-term follow-up study

OBJECTIVE: To determine the incidence and predictors of first-line human immune deficiency virus treatment failure among human immune deficiency virus-infected children at the University of Gondar comprehensive specialised hospital in Ethiopia. DESIGN: A retrospective follow-up study. SETTING: University of Gondar comprehensive specialised hospital, North-west, Ethiopia. PARTICIPANTS: Children were among the HIV infected from January 2005 to December 2018. There were 336 children included in the study. The data were entered into EPi Info V.7.2 and then exported to STATA V.14.0 Software for analysis. Both bivariable and multivariable analyses with Cox proportional hazards models were used to identify the predictors of treatment failure. PRIMARY OUTCOME MEASURES: Predictors of first-line antiretroviral treatment failure among children on antiretroviral therapy (ART) during 14 years long-term follow-up study. RESULT: A total of 336 human immunodeficiency virus-infected children participated in this study with 27 058 child years of observation. The overall incidence rate was 2.1 (95% CI 1.57 to 2.78) per 100 child years. Poor adherence (adjusted HR (AHR); 6.5 (95% CI 2.03 to 21.39)), fair adherence (AHR; 6.55 (95% CI 2.64 to 16.53), the presence of opportunistic infection (AHR; 4.22 (95% CI 1.44 to 12.30), clinical staging of III/IV (AHR; 3.08 (95% CI 1.17 to 8.08) and a baseline CD4 count less than 200 cells/mm(3) (AHR; 3.61 (95% CI 1.12 to 11.54)). CONCLUSION: The incidence of first-line ART failure was found to be high. Baseline opportunistic infection, poor and fair adherence, advanced WHO clinical staging III/IV and a CD4 count less than 200 cells/mm(3) were all predictors of first-line treatment failure. Early identification of associated factors and monitoring treatment failure has to be important for the optimal management of HIV-infected children who are receiving ART and to prevent further complications.