34.0 million adults worldwide were living with Human Immunodeficiency Virus
(HIV) and of these 2.5 million were newly infected with the virus and 1.7 million
died of HIV/ Acquired Immune Deficiency Syndrome (AIDS) in 20111.
In Sub–Saharan Africa, more than 23.5 million people were living with HIV, 1.8
million become newly infected and 1.3 million died of (AIDS) at the end of 20111.
2013, Ethiopia adopted the new WHO integrated guidelines for treatment, in
which adults with CD4 below 500, all pregnant women and all TB patients
independent of CD4 count are eligible for treatment 2.
Ethiopia has now reached a symbolic milestone for curbing the spread of the
epidemic, where the number of newly started clients on ART (on average 58,000
adults each year) has surpassed the number of new infections in adults.
However, patient loss to follow-up and ensuring adherence to ART regimens
remain major challenges of the ART programme 2.
Treatment failure poses a major concern for HIV programs in resource- limited
settings where treatment options are limited.
At the time of
the study, the first-line therapy comprised two NRTIs (stavudine/zidovudine and
lamivudine/tenofovire) and one NNRTI (nevirapine/efavirenz). A gradual
phase-out of stavudine as a first-line agent was recommended in mid-2010 and
strongly recommend in 2013 WHO guideline due to well-recognized metabolic
ART restores immune function and reduces HIV related adverse outcomes 5.
Since the beginning of highly active antiretroviral therapy (HAART) in 2005,
there have been dramatic declines in morbidity and mortality due to HIV in
Ethiopia to reduce epidemics and improve the quality of life 6.
This advantage is eroded when treatment failure develops. Despite the
significant reduction in morbidity and mortality among the HIV-infected
patients receiving combination ART, a considerable number of patients fail to
achieve a sustained virological and immunologic response to therapy 7.
Delayed detection of treatment failure may increase drug toxicity, may lead to
the accumulation of drug resistance- associated mutations, and may result in
increased morbidity and mortality in the population at large 7.
failure can be defined as progression of disease after initiation of HAART.
Failure can be assessed by clinical (recurrence or WHO stage III/IV)
immunologic (a decline in CD4 count), or virologic (a viral rebound above a set
threshold of 1000 copies/ml) criteria 3.
conducted in East Africa reported that
high prevalence of treatment failure (24.6%) and associated factors were
younger age and unsatisfactory adherence 4.
Other studies from Tanzania, Uganda and
Zambia were reported different results as HIV RNA at least 1000 copies/ml from
7.2 to 17.2% across study sites (mean = 9.9%). Factors significantly related to
incomplete adherence included visiting a traditional healer, screening positive
for alcohol abuse, experiencing more HIV symptoms, having an ART regimen
without nevirapine and greater levels of internalized stigma 8.
Identification of risk factors helps to define early predictors of treatment
efficacy that permit better use of these potent drugs, avoid unnecessary side
effects of second-line drug, prevent drug resistance, and decrease economic
burden, especially in a resource-limited setting like Ethiopia due to the
expensiveness of the second-line drug. It will also help as a guide for health
professionals and higher officials to alleviate the problem and to develop
strategies to decrease the rate of treatment failure
The objective of
this study was to determine the prevalence of first-line ART failure and to
identify those risk factors that contribute to treatment failure in the
Ethiopian HIV patients.