Joint Modeling of Incidence of Unfavorable Outcomes and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospitals of Addis Ababa, Ethiopia.

IF 1.5 Q4 INFECTIOUS DISEASES

HIV AIDS-Research and Palliative Care Pub Date : 2022-07-27 eCollection Date: 2022-01-01 DOI:10.2147/HIV.S368373

Hamdi Fekredin Zakaria, Tadesse Awoke Ayele, Sewnet Adem Kebede, Mesfin Menza Jaldo, Bereket Abrham Lajore

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引用次数: 0

Abstract

Background: In Ethiopia, second-line anti-retroviral therapy (ART) for HIV/AIDS patients was started some years ago; however, few studies have reported the unfavorable outcomes of second-line ART. Therefore, this study aimed to assess the incidence and predictors of unfavorable outcomes and their association with change in viral load among adult HIV/AIDS patients on second-line treatment at selected public hospitals in Addis Ababa, Ethiopia.

Methods: A retrospective follow-up study was conducted at selected public hospitals in Addis Ababa, Ethiopia, on 421 HIV/AIDS patients on second-line ART from 2016 to 2021. Cox proportional hazard models with a linear mixed effect model were jointly modeled using the JM package of R software with time-dependent lagged parameterizations, and a 95% confidence interval was used to select significant variables.

Results: Overall, 89 HIV/AIDS patients developed unfavorable outcomes. The incidence density was 7.48/100 person-years (95% CI: 6.08, 9.2). Secondary and tertiary educational level (AHR=0.47, 95% CI: 0.25, 0.89, and AHR=0.27, 95% CI: 0.1, 0.72), CD4 count less than 100 cells/mm³ (AHR=2.15, 95% CI: 1.21, 3.83), poor adherence (AHR=3.59, 95% CI: 1.73, 7.49), and TB comorbidity (AHR=2.23, 95% CI: 1.21, 4.14) at the start of second-line ART were significant predictors of incidence of unfavorable outcome. Time-dependent lagged value viral load was significantly associated with the risk of unfavorable outcome (AHR=1.28, 95% CI: 1.01, 1.63).

Conclusion: In the study area, the incidence of an unfavorable outcome of second-line ART was high. Secondary and tertiary educational level, CD4 count less than 100 cells/mm³, poor adherence, and TB comorbidity at the start of second-line ART were significant predictors of incidence of unfavorable outcomes. Thus, strengthening routine viral load measurement, increase patient adherence, intensive counseling, and strong TB screening are needed in the study setting.

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在埃塞俄比亚亚的斯亚贝巴选定的公立医院中，接受二线抗逆转录病毒治疗的成年艾滋病毒/艾滋病患者的不良结局发生率和病毒载量随时间变化的联合建模

背景:在埃塞俄比亚，针对艾滋病毒/艾滋病患者的二线抗逆转录病毒治疗(ART)几年前就开始了;然而，很少有研究报道二线抗逆转录病毒治疗的不良后果。因此，本研究旨在评估在埃塞俄比亚亚的斯亚贝巴选定的公立医院接受二线治疗的成年艾滋病毒/艾滋病患者中不良结局的发生率和预测因素及其与病毒载量变化的关系。方法:对2016 - 2021年在埃塞俄比亚亚的斯亚贝巴选定公立医院接受二线抗逆转录病毒治疗的421例HIV/AIDS患者进行回顾性随访研究。Cox比例风险模型与线性混合效应模型采用R软件的JM包联合建模，采用随时间变化的滞后参数化，采用95%置信区间选择显著变量。结果:总体而言，89例HIV/AIDS患者出现不良结局。发病率密度为7.48/100人年(95% CI: 6.08, 9.2)。中等和高等教育水平(AHR=0.47, 95% CI: 0.25, 0.89, AHR=0.27, 95% CI: 0.1, 0.72)， CD4细胞计数小于100个/mm3 (AHR=2.15, 95% CI: 1.21, 3.83)，不良依从性(AHR=3.59, 95% CI: 1.73, 7.49)，以及结核病合合性(AHR=2.23, 95% CI: 1.21, 4.14)是二线ART治疗开始时不良结局发生的重要预测因素。时间依赖的滞后值病毒载量与不良结局的风险显著相关(AHR=1.28, 95% CI: 1.01, 1.63)。结论:研究区二线抗逆转录病毒治疗不良反应发生率高。中等和高等教育水平、CD4细胞计数低于100个/mm3、依从性差以及二线抗逆转录病毒治疗开始时的结核病合并症是不良结局发生率的重要预测因素。因此，在研究环境中需要加强常规病毒载量测量，增加患者依从性，强化咨询和强有力的结核病筛查。

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来源期刊

HIV AIDS-Research and Palliative Care INFECTIOUS DISEASES-

CiteScore

3.00

自引率

6.70%

发文量

审稿时长

16 weeks

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