TITLE:
Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal
AUTHORS:
Selly Ba, Ndeye Diama Ba, Lamanatou Sembene, Thierno Souleymane Baal Anne, Habibatou Dia, Jean Louis Ndiaye, Ndeye Mery Dia Badiane, Cheikh Tidiane Ndour
KEYWORDS:
Antiretroviral Treatment, Adverse Therapeutic Outcomes, Associated Factors
JOURNAL NAME:
World Journal of AIDS,
Vol.10 No.1,
March
20,
2020
ABSTRACT:
Background: Optimizing antiretroviral therapy is an essential step to reach the 90 -
90 - 90 targets. Despite tremendous progress made for antiretroviral treatment
(ART) to be accessible in countries with limited resources, health care
providers continue to face challenges due to the under-optimization of ART due
to therapeutic failures and poor retention. Objectives: To determine the
prevalence of adverse therapeutic outcomes in a decentralized health care center
and to determine associated factors. Patients and Methods: This is a
cross-sectional descriptive and analytical study targeting PLHIV, aged 18 years
and over, on first line antiretroviral treatment (ART), monitored onsite from
February 1st to December 31st, 2018. A data collection form was completed from
medical records (clinical, immuno-virological, therapeutic and evolutionary).
Data were also collected from interviews with patients for additional socio-demographic
information including the level of HIV knowledge. Data were captured and
analyzed using EPI 2002 and R software. Proportions were compared using the chi
-square and Fisher tests and logistic regression. A value of p Results: 331 patients were enrolled with HIV-1
profile in 89% of the cases. A proportion of 55% was married and 98% came from
the rural area. 80% were either not or poorly educated. The median of age was
44 ± 11 years with a F/M ratio of 3.5. 30% that had not shared their HIV
status, and more than half had a low knowledge of HIV transmission. At
baseline, 56% were symptomatic at WHO stage 3 or 4. They had severe immunosuppression
with a median CD4 count of 217 ± 187 cells/mm3; the viral load was
detectable in half of the patients with a median viral load (VL) of 97,000 ± 70,569 cp/ml. The
antiretroviral regimens combined 2 nucleoside reverse transcriptase inhibitor
(NRTI) with 1 no nucleoside reverse transcriptase inhibitor (NNRTI) in 88% of
the cases. The median duration of follow-up was estimated at 60 ± 43 months.
The prevalence of adverse therapeutic outcomes was 36% (119 patients). The
proportion of virological failure was 19%, lost follow up was 20% and the mortality was 4%. The adverse therapeutic
outcomes were associated with the age less than 25 years (p = 0.007) and with a
late diagnosis (CD4 T cells at baseline less than 200 cell/mm3, p = 0.02). Conclusion:
These results suggest the need to make new therapeutic classes available for
first-line treatment and to promote actions improving retention in care.