Factors Associated With Hiv Treatment Failure
Abstract
Background: The availability of HAAR T has had a profound positive effect on
HIV morbidity and mortality. However, the occurrence of primary treatment
failure is a drawback to this success resulting in higher cost of treatment and
poor outcomes. It is therefore important to establish the factors that are
associated with primary HIV treatment failure. These factors can be used to
identify patients at high risk of early treatment failure, and to screen for
treatment failure resulting in earlier diagnosis.
Objectives: To determine the factors associated with HIV treatment failure.
Design: Nested case control study
Subjects: Adult HIV patients in 18 HIV clinics run by AMPATH in Western
Kenya.
Methods: All previously, treatment naive patients started on HAART and
subsequently diagnosed to have treatment failure between Feb 2006 and August
2008, formed the study cases. The control group was made up of; previously
treatment naive patients started on HAART at similar time to the cases and who
had sustained immunologic response. Data on demographic, clinical
characteristics and laboratory parameters was extracted from the AMPATH
medical records database. The data was then analyzed.
Results: Data on 12027 patients was analyzed, with 5709 in the cases and 6314
in the controls. Factors that were associated with increased risk of immunologic
failure were age above 45 (O.R 1.21), male gender (O.R 1.22) and urban
residence (O.R 1.09).Perfect adherence and first line effavirenz based regimen
were protective
Conclusion: Poor adherence, male gender, age above 45yrs and living in an
urban area, are risk factors for immunologic treatment failure.
Citation
Master of Medicine in Internal Medicine, The University Of Nairobi, 2009Publisher
University of Nairobi. Faculty of Medicine