Revista de SIDA e investigación clínica

Rate of Immunological Failure and its Predictors among Patients on Highly Active Antiretroviral Therapy at Debremarkos Hospital, Northwest Ethiopia: A Retrospective Follow up Study

Abstract

Yayehirad Alemu Melsew, Mamo Wubshet Terefe, Gizachew Assefa Tessema and Tadesse Awoke Ayele

Background: In a resource-limited setting, patients on antiretroviral treatment are monitored by using immunological and clinical assessment due to the inaccessibility of viral load monitoring. The aim of this study was to assess the rate and predictors of immunological failure among patients taking highly active antiretroviral treatment at Debremarkos hospital, Northwest Ethiopia.

Methods: Retrospective follow up study was conducted at Debremarkos hospital on 509 adults who had started antiretroviral treatment during the period between January 01, 2007 and April 01, 2008. Data were analyzed using SPSS version 20. Life table and Kaplan-Meier curve was used to estimate the cumulative probablities and median time for immunologic failure respectively. Cox proportional hazard model was fitted to compute hazard ratios with their 95% confidence intervals.

Result: The median follow up time was 36 months (Inter Quartile Range (IQR) = 12-49 months). 107 (21%) patients had developed immunological failure with a failure rate of 8 per 100 patient-years of follow up. Recurrent pneumonia infection (Adjusted Hazards Ratio (AHR)=1.62, 95% CI: 1.10, 2.40), unemployment (AHR: 1.74, 95% CI: 1.11, 2.74), inability to work due to health problem (AHR= 2.19, 95%CI: 1.20, 4.02), baseline CD4 count ≤ 100 cells/ mm3 (AHR: 2.16, 95% CI: 1.44, 3.25) and change in body weight (AHR: 4.34, 95% CI: 2.93, 3.23) were significant predictors of immunological failure.

Conclusion: The immunological failure rate was found to be high. Recurrent pneumonia infection, being unemployed, inability to work, baseline CD4count less than 100 cells/mm3 and decrease in body weight were predictors of immunological failure. Early initiation of highly active antiretroviral treatment, attempt to improve Socioeconomic status of patients, and counseling patients to have protein rich diets would prevent early immunologic failure.