Assessment of virological failure among Hiv patients on first line antiretroviral at Kenyatta National Hospital Comprehensive Care Centre, Nairobi Kenya

Abstract

Background: Kenya has recorded a high burden of HIV with 1.5 million HIV + persons by 2015. With the adoption of 2016 ART guideline in Kenya all PLHIV now qualify for ART irrespective of WHO clinical stage, cd4 count, age gender, pregnancy status, co-infected status thus increasing the number of patients likely to develop resistance. Once a patient develops resistance to first line, they are put on second line ART regimen which is more expensive and less tolerable. This study seeks to establish the duration of time patients put on first line ART take before developing virological failure and factors influencing it as a step towards guiding the management in adequate planning and budget allocation for management of these patients Study objective: To assess virological failure among HIV patients on first line ARV at Kenyatta National Referral Hospital Comprehensive Care Centre between the years 2009-2016 Study design and site: This was a retrospective cohort studyconducted at Kenyatta National Referral Hospital Comprehensive Care Centre (KNH-CCC) between 2009 and 2016 with 3 years accrual and 6 years observation periods. The main exposure was poor adherence to first line ART treatment Study population and sample: HIV infected patients enrolled and initiated into first line ART at the centre between 2009 and 2010. 1470 patients wereselected through simple random sampling from the list of these patients in CCC database with complete follow-up records Data collection and analysis: A structured data abstraction tool was used for extracting social-demographic, clinical and virological data from medical records data of the selected patients. The data was entered and stored in Microsoft Access 2013. Data cleaning, coding and analysis wasdone using STATA version 13 SE. The main outcome was the virological failure time. Kaplan Meier estimator was used to estimate the survival function. Log-rank tests was used to compare the survival functions between patients based on adherence to treatment and first line HAART combinations. Log-rank statistic and corresponding p-value will be reported. Results: Generally patients sampled comprised of age 2 months to 72 years where 75% of the patients were below age 42. 10% of the patients were paediatric while adults composed of 90% having female patient being almost double of the men on follow up. At enrolment clients classified in WHO(3 and 4) were 42.2% and 99% of patients were reported to have been screened for TB, 13% of patients on follow up had NCD were 64% of patients were having EFV based regimen and 35.8% had NVP based regimen. 34.8% were reported to have poor adherence. 75% of patients had CD4 of less than 600 cell/ml with 19.7% of patient reported being obese and 11% were underweight. Kaplan Meier estimated that 50% of patient would fail by 36 months after ART initiation for adult’s patients and for paediatric would fail by 42 months after being started on ART. Log rank test conducted showed failure rate differed significantly with relation to age, adherence and regiment type. Adults had 61% risk of virological failure at next time compared to paediatric, patient started on NVP had 18% reduced risk of virological failure compared to ones started on EFV based. Good adherence reduced chance of virological failure by 26% by the next time Conclusion: patients being started on first line ART at KNH-CCC their failure time depended on age, adherence and type of regimen (EFV or NVP) where in general paediatric had longer period on first line compared to adults patients.