Factors associated with virologic failure among adult patients on antiretroviral treatment at selected health-care facilities, Limpopo Province

Abstract

The Human Immunodeficiency Virus (HIV) is a lentivirus (a subgroup of retrovirus) that causes HIV infection and over time causes Acquired Immune Deficiency Syndrome. Highly Active Antiretroviral Therapy (HAART) is the medication whose main function is to hinder the progress from HIV into AIDS. It was introduced in Western countries in 1996. The main goal of HAART is to achieve maximal viral suppression. A quantitative, descriptive, and cross-sectional research design was used to describe factors associated with HIV treatment failure. Clinical records were reviewed retrospectively using the purposive sampling as per inclusion and exclusion criteria of adults who are living with HIV (67 males and 184 females) making a total of 251. These adults commenced their ARV’s treatment between April 2003 and December 2018 at 4 selected facilities. Data were collected using self-developed check list. All data were collected using data from an existing electronic patient management system (tier.net). The 251-checklist was then analyzed utilizing the Statistical Package for Social Sciences (SPSS, version 28). Descriptive statistics were used to analyze and describe and summarized data. Results: association of gender and virologic failure of the adult patients experiencing virologic failure were females with 73.3% and males with 26.7%. With regards to CD4 count: 23.1% of adult patients had the CD4 count of <100 cells/mm on ART initiation, 26.9% had 100 – 200 cells/mm, 31.1% had 201 -350 cell/mm, and 18.9% had >350 cells/mm. WHO clinical staging on ART initiation was 34.3% for stage 01, 36.8% for stage 02,22.8% for stage 03 and 6% for stage 04. ART start regimen; regimen 1a accounted for 92%, followed by 5.9% for regimen 1b and 1.9% for regimen 2. TB and HIV co-infection at ART initiation resulted in 19.2% of the clients experiencing treatment failure as they TB during ART initiation. Viral load results at 12-month were 55.8% for 0 – 1000 copies/ml, 12.9% for 1000 – 10000 copies/ml, 23.5% for 100000 – 1000000 copies/ml and 1.4% for >1000000 copies. Missed appointments: 9.2% clients never missed appointment, 6.4% missed 01 month appointment, 21.6% missed 02 months appointments, 27.9% missed 03 months appointments and 34.7% missed more than 3 months appointments. Lost to follow up: 42% have not been lost to follow-up during the last 24 months, 12% lost to follow-up for 3 months, 15.6% lost to follow-up for 4 months, 17.2% lost to follow-up for 5 months, 4.4% lost to follow-up for 6 months and 8% lost to follow-up for more than 6 months. Prolonged duration on ART: 4.9% of the clients experiencing virologic failure have been on ART for 2 years, 7.8% for 3 years, 9% for 4 years, 12% for 5 years and 66.1% for more than 5 years. All ART doctors/nurses should assess these patients’ latest viral load results during each visit and assess for signs of treatment failure.