ABSTRACT

Background: Immunological treatment failure (ITF) is a common challenge among HIV-infected patients on first-line ART in resource-limited settings. This study aimed to determine the magnitude of ITF and its predictors among adult HIV-infected patients on ART in Mbeya Region, Tanzania.

Methods: This was a cross sectional, retrospective study which analyzed data of HIV-infected patients (≥ 15years) on ART. Data were collected from patients enrolled at health facilities in Mbeya region from January 2010 to June 2016. Data were obtained from the HIV care and treatment clinic (CTC) electronic database and patients’ CTC - 2 cards and were analyzed to determine the factors influencing the ITF.

Results and discussion: A total of 2,565 patients’ records were reviewed and followed retrospectively for median duration of 24.5[13.6-43.6] months. Of these 64.4% (1653/2,565) were female and the median age was 41 (IQR: 35-48) years. The median baseline CD4 count was 194 (IQR: 92-344) cells/μl. ITF was reported in 42.8% (1237/2,565) patients. There was a significant association between ITF and baseline CD4 of ≥ 350cell/μl (OR = 7.2, 95%CI = 5.7 – 9.2, p < 0.001), increased age (OR = 1.01, 95% CI =1.002 – 1.020], p = 0.012), being the patient from district council designated hospital (OR = 1.2, 95%CI =1.1 – 1.5, p = 0.008), hemoglobin < 8g/dL (OR = 1.4, 95%CI 1.1 – 1.8, p = 0.017), longer duration from HIV diagnosis to AR initiation (OR = 1.9, 95% CI = 1.2 – 3.0, p = 0.006) and Zidovudine (AZT) based regimen (OR = 1.3, 95%CI = 1.1-16, p = 0.010).

Conclusion: There was a high prevalence of immunological treatment failure. Significant predictors of ITF were age, baseline CD4 of ≥ 350cell/μl, being patient from district hospital, anaemia, longer duration from HIV diagnosis to ART initiation and AZT-based ART regimen. Health care providers should be guided to focus on predictors of immunological failure so that they
do early switching to second line ART.