HIV virologic failure and its predictors among HIV-infected adults on antiretroviral therapy in the African Cohort Study

• DOI: 10.1371/journal.pone.0211344
• Publication Date: 2019-02-05T18:36:39Z
• Authors: Francis Kiweewa; Allahna Esber; Ezra Musingye; Domonique Reed; Trevor A. Crowell; Fatim Cham; Michael Semwogerere; Rosemary Namagembe; Alice Nambuya; Cate Kafeero; Allan Tindikahwa; Leigh Anne Eller; Monica Millard; Huub C. Gelderblom; Babajide Keshinro; Yakubu Adamu; Jonah Maswai; John Owuoth; Valentine Chepkor...; Lucas Maganga; Emmanuel Bahemana; Samoel Khamadi; Merlin L. Robb; Julie A. Ake; Christina S. Polyak; Hannah Kibuuka
• Keywords: Adult; Male; Risk; Adolescent; Science; HIV Infections; Cohort Studies; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Humans; Treatment Failure; Q; R; Middle Aged; Viral Load; 16. Peace & justice; CD4 Lymphocyte Count; 3. Good health; Anti-Retroviral Agents; Africa; Multivariate Analysis; HIV-1; Linear Models; Medicine; RNA, Viral; Female; Research Article

Introduction The 2016 WHO consolidated guidelines on the use of antiretroviral drugs defines HIV virologic failure for low and middle income countries (LMIC) as plasma HIV-RNA ≥ 1000 copies/mL. We evaluated predictors in four African countries. Materials methods included HIV-infected participants a recommended therapy (ART) regimen enrolled Cohort Study between January 2013 October 2017. Studied outcomes were (plasma copies/mL at most recent visit), viraemia 50 visit); persistent two consecutive visits). Generalized linear models used to estimate relative risks with their 95% confidence intervals. Results 2054 this analysis. Viraemia, observed 396 (19.3%), 160 (7.8%) 184 (9%) respectively. Of viraemia, only 57.5% (92/160) had confirmed failure. In multivariate analysis, attending clinical care site other than Uganda sitebeing 2nd line ART (aRR 1.8, CI 1·28–2·66); combinations not first second 3.8, 1.18–11.9), history fever past week 3.7, 1.69–8.05), CD4 count 6.9, 4.7–10.2) missing any day 1·8, 1·27–2.57) increased risk Being therapy, where one receives < 500 predicted Conclusion conclusion, these findings demonstrate that patients established more six months setting frequently experienced while continuing be ART. also show being line, count, remain important should trigger intensified adherence counselling especially absence reliable or readily available viral load monitoring. Finally, sites are different calling further analyses elucidate unique features sites.