article · PLoS ONE
A retrospective study in the Tigray region of Northern Ethiopia evaluated treatment failure and associated risk factors among 260 adults and adolescents receiving first-line highly active antiretroviral therapy between 2008 and 2016. Over a median treatment duration of 36 months, 11.5 percent of individuals experienced virological failure, while 6.5 percent experienced immunological failure. Statistical analysis revealed that virological failure was significantly linked to poor medication adherence, age under 40 years, a CD4 count below 250 cells per microlitre, and male gender. Immunological failure was associated with medication non-adherence, tuberculosis co-infection, and a viral load of at least 1,000 copies per millilitre. These outcomes show that treatment failure remains a significant operational challenge in regions scaling up therapy, underscoring that sustaining long-term viral suppression requires targeted interventions to strengthen patient adherence.
Although antiretroviral therapy dramatically improves survival for people living with HIV, treatment failure threatens long-term public health progress. Identifying specific clinical and demographic factors associated with therapy failure helps healthcare providers pinpoint high-risk individuals early. Addressing issues such as poor adherence and tuberculosis co-infection is vital to preventing drug resistance, maintaining immune recovery, and meeting global targets for viral suppression in resource-limited settings.
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BACKGROUND: Human immunodeficiency virus/Acquired immunodeficiency syndrome associated morbidity and mortality has reduced significantly since the introduction of highly active antiretroviral therapy. As a result of increasing access to highly active antiretroviral therapy, the survival and quality of life of the patients has significantly improved globally. Despite this promising result, regular monitoring of people on antiretroviral therapy is recommended to ensure whether there is an effective treatment response or not. This study was designed to assess virological and immunological failure of highly active antiretroviral therapy users among adults and adolescents in the Tigray region of Northern Ethiopia, where scanty data are available. METHODS: A retrospective follow up study was conducted from September 1 to December 30, 2016 to assess the magnitude and factors associated with virological and immunological failure among 260 adults and adolescents highly active antiretroviral therapy users who started first line ART between January 1, 2008 to March 1, 2016. A standardized questionnaire was used to collect socio-demographic and clinical data. SPSS Version21 statistical software was used for analysis. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated to virological and immunological failure. Statistical association was declared significant if p-value was ≤ 0.05. RESULT: A total of 30 (11.5%) and 17 (6.5%) participants experienced virological and immunological failure respectively in a median time of 36 months of highly active antiretroviral therapy. Virological failure was associated with non-adherence to medications, aged < 40 years old, having CD4+ T-cells count < 250 cells/μL and male gender. Similarly, immunological failure was associated with non-adherence, tuberculosis co-infection and Human immunodeficiency virus RNA ≥1000 copies/mL. CONCLUSIONS: The current result shows that immunological and virological failure is a problem in a setting where highly active antiretroviral therapy has been largely scale up. The problem is more in patients with poor adherence. This will in turn affect the global targets of 90% viral suppression by 2020. This may indicate the need for more investment and commitment to improving patient adherence in the study area.
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DOI: 10.1371/journal.pone.0196259
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