Prevalence and predictors of Immunological failure among HIV-infected adults on HAART in Northwestern Tanzania: A cross sectional study
DOI:
https://doi.org/10.4314/tmj.v27i1.188Keywords:
HIV/AIDS, adult, antiretroviral therapy, CD4 lymphocyte count, treatment monitoring, treatment failure, risk factors, TanzaniaAbstract
Background: Guidelines for the treatment of HIV recommend the use of immunological and clinical criteria for treatment monitoring in resource limited settings. Data on the magnitude of immunological treatment failure in sub-Saharan Africa is scarce. This study aimed at assessing the magnitude and factors associated with immunological failure among HIV infected patients on HAART.
Methods: A cross sectional study was conducted at Bugando Medical centre HIV care and treatment centre between February-July 2011, involving HIV-infected patients on first line ART for at least one year. Patients with concurrent infections and critically ill were excluded. A designed questionnaire was used to collect socio-demographic and clinical data of patients. Continuous variables were summarized by median and interquartile ranges (IQRs) and categorical variables were summarized by frequency and percentage. Logistic regression was used to find the predictors of immunological failure.
Results: A total of 274 participants were enrolled for this study. The median duration on ART was 26 months (IQR 12-45). Majority of the participants were female (65.7%); the baseline CD4 count was 139.5 cells/ul (IQR 60-210). Most of the study participants (47.8%) presented with WHO clinical stage 3 at the time of enrollment to the clinic. Out of the 274 study participants, 57% fulfilled the criteria for immunological failure. WHO clinical stage 3 or 4 at ART initiation (p<0.001), low level of reported adherence (p=0.001) and longer duration on ART (p<0.001) were predictors of immunological failure in this cohort.
Conclusion: Immunological treatment failure was very high in this cohort of HIV-infected patients on first line ART. WHO clinical stage 3 or 4 at enrollment, low level of adherence and longer duration on ART were predictors of immunological failure.References
Palella FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med [Internet]. 1998 Mar 26 [cited 2014 Dec 10];338(13):853–60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9516219
Lucas GM, Chaisson RE, Moore RD. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med [Internet]. 1999 Jul 20 [cited 2015 Aug 12];131(2):81–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10419445
Zaccarelli M, Tozzi V, Lorenzini P, Trotta MP, Forbici F, Visco-Comandini U, et al. Multiple drug class-wide resistance associated with poorer survival after treatment failure in a cohort of HIV-infected patients. AIDS [Internet]. 2005 Jul 1 [cited 2015 Aug 12];19(10):1081–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15958840
The United Republic of Tanzania. HIV/AIDS Country Progress Report. Dar es Salaam; 2012.
Ramadhani HO, Thielman NM, Landman KZ, Ndosi EM, Gao F, Kirchherr JL, et al. Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania. Clin Infect Dis [Internet]. 2007 Dec 1 [cited 2014 Jul 29];45(11):1492–8. Available from: http://cid.oxfordjournals.org/content/45/11/1492.long
WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization. 2013.
WHO. Antiretroviral Therapy for HIV infection in Adults and Adolescents: Recommendations for a public health approach [Internet]. Geneva; 2010. Available from: http://www.who.int/hiv/pub/arv/adult2010/en/index.html
Rawizza HE, Chaplin B, Meloni ST, Eisen G, Rao T, Sankalé J-L, et al. Immunologic criteria are poor predictors of virologic outcome: implications for HIV treatment monitoring in resource-limited settings. Clin Infect Dis [Internet]. 2011 Dec [cited 2015 Apr 8];53(12):1283–90. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3246873&tool=pmcentrez&rendertype=abstract
Yirdaw KD, Hattingh S. Prevalence and Predictors of Immunological Failure among HIV Patients on HAART in Southern Ethiopia. PLoS One [Internet]. 2015 Jan [cited 2015 May 23];10(5):e0125826. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4427446&tool=pmcentrez&rendertype=abstract
Kassa D, Gebremichael G, Alemayehu Y, Wolday D, Messele T, van Baarle D. Virologic and immunologic outcome of HAART in Human Immunodeficiency Virus (HIV)-1 infected patients with and without tuberculosis (TB) and latent TB infection (LTBI) in Addis Ababa, Ethiopia. AIDS Res Ther [Internet]. 2013 Jan [cited 2015 Oct 12];10:18. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3718701&tool=pmcentrez&rendertype=abstract
Anude CJ, Eze E, Onyegbutulem HC, Charurat M, Etiebet M-A, Ajayi S, et al. Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria. BMC Infect Dis [Internet]. 2013 Jan [cited 2015 Oct 12];13(1):113. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3599241&tool=pmcentrez&rendertype=abstract
Robbins GK, Daniels B, Zheng H, Chueh H, Meigs JB, Freedberg KA. Predictors of antiretroviral treatment failure in an urban HIV clinic. J Acquir Immune Defic Syndr [Internet]. 2007 Jan 1 [cited 2015 Sep 19];44(1):30–7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2365745&tool=pmcentrez&rendertype=abstract
Haubrich RH, Little SJ, Currier JS, Forthal DN, Kemper CA, Beall GN, et al. The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group. AIDS [Internet]. 1999 Jun 18 [cited 2015 Sep 9];13(9):1099–107. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10397541
Reynolds SJ, Nakigozi G, Newell K, Ndyanabo A, Galiwongo R, Boaz I, et al. Failure of immunologic criteria to appropriately identify antiretroviral treatment failure in Uganda. AIDS [Internet]. 2009 Mar 27 [cited 2015 Jun 24];23(6):697–700. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2720562&tool=pmcentrez&rendertype=abstract
Wabe N, Alemu M. Immunological and Clinical Progress of Hiv-Infected Patients on Highly Active Antiretroviral Therapy in North West Ethiopia. Gaziantep Med J. 2012;18(1):1.
Tarwater PM, Margolick JB, Jin J, Phair JP, Detels R, Rinaldo C, et al. Increase and plateau of CD4 T-cell counts in the 3(1/2) years after initiation of potent antiretroviral therapy. J Acquir Immune Defic Syndr [Internet]. 2001 Jun 1 [cited 2015 Apr 7];27(2):168–75. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11404539