title: Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study.
abstract: The number of patients using second-line antiretroviral therapy (ART) has increased over time. In Ethiopia, 1.5% of HIV infected patients on ART are using a second-line regimen and little is known about its effect in this setting.
  
  
  
  To estimate the rate and predictors of treatment failure on second-line ART among adults living with HIV in northwest Ethiopia.
  
  
  
  An institution-based retrospective follow-up study was conducted at three tertiary hospitals in northwest Ethiopia from March to May 2015.
  
  
  
  356 adult patients participated and 198 (55.6%) were males. Individuals who were on second-line ART for at least 6 months of treatment were included and the data were collected by reviewing their records.
  
  
  
  The primary outcome was treatment failure defined as immunological failure, clinical failure, death, or lost to follow-up. To assess our outcome, we used the definitions of the WHO 2010 guideline.
  
  
  
  The mean±SD age of participants at switch was 36±8.9 years. The incidence rate of failure was 61.7/1000 person years. The probability of failure at the end of 12 and 24 months were 5.6% and 13.6%, respectively. Out of 67 total failures, 42 (62.7%) occurred in the first 2 years. The significant predictors of failure were found to be: WHO clinical stage IV at switch (adjusted HR (AHR) 2.1, 95% CI 1.1 to 4.1); CD4 count <100 cells/mm3at switch (AHR 2.0, 95% CI 1.2 to 3.5); and weight change (AHR 0.92, 95% CI 0.88 to 0.95).
  
  
  
  The rate of treatment failure was highest during the first 2 years of treatment. WHO clinical stage, CD4 count at switch, and change in weight were found to be predictors of treatment failure.
authors.affiliation: Department of Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia.
authors.forename: Adino Tesfahun
authors.initials: AT
authors.lastname: Tsegaye
authors.affiliation: Department of Public Health, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia.
authors.forename: Mamo
authors.initials: M
authors.lastname: Wubshet
authors.affiliation: Department of Statistics and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia.
authors.forename: Tadesse
authors.initials: T
authors.lastname: Awoke
authors.affiliation: Department of Epidemiology and Biostatistics, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia.
authors.forename: Kefyalew
authors.initials: K
authors.lastname: Addis Alene
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care / Q000379:methods*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D005791:Patient Care / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D017211:Treatment Failure; D015431:Weight Loss
chemical_list: D019380:Anti-HIV Agents
keywords: EPIDEMIOLOGY; INFECTIOUS DISEASES; PUBLIC HEALTH