Factors associated with virological failure among people living with HIV on highly active anti- retroviral therapy followed at university teaching hospital of Kigali/CHUK

Abstract

Combination antiretroviral therapy (CART), also referred to as highly active antiretroviral therapy (HAART), is cornerstone of management of patients with human immunodeficiency virus (HIV) ailment. The objective of HAART is to suppress ribonucleic acid (RNA) viremia while increasing cluster differentiation 4 (CD4) T lymphocytes with subsequent improvement in clinical status, decreased risk of HIV transmission and prolonging life expectancy of HIV positive people to resemble that of the overall population. Unfortunately, this benefit erodes upon treatment failure. This study investigated factors of virological failure in HIV-positive individuals receiving HAART followed at the University Teaching Hospital of Kigali /Centre Hospitalière Universitaire de Kigali (CHUK) HIV Clinic. Methodology: This was a one-year observational cohort prospective study. HIV+ Patients aged 15 years and older with last viral load equal to or greater than 1000 copies/mL in the study period were recruited using a convenience sampling method. Socio-demographic data, HIV related information, and general health information were recorded using a pre-formed questionnaire. Participants were followed for 12 months (May 2021 to May 2022) while data including viral suppression and factors relating to clinical, biological, psychological, pharmacy refill, and nutrition were recorded. Data were entered into Epidata version 3.1 before being exported to stata version 13 for analysis. To study the relationship between the outcome (Viral load suppression) and possible predictors, Chi-square test and logistic regression (binary and multivariable logistic regression analysis) were utilized. P value was considered significant if ≤ 0.05). Results: 129 total HIV-positive patients completed the study, 80(62%) were female, and median age was 33 (IQR: 24-49). Of all participants, 26(20.16%) had virological failure while 79.84% were virologically suppressed. Male sex (aOR= 4.04, 95% CI: 1.22-13.36, p= 0.022), history of opportunistic infection (aOR=9.13, 95%CI: 2.15-38.7, p=0.003), taking more than 4 pills a day (aOR=20.63 95%CI: 6.02-70.7, p<0.001), and presence of comorbidities (OR=6.5, 95%CI 2.44-14.29, p˂0.001) were found to be associated with virological failure. Conclusion: The proportion of sustained virological failure in our study was 20.16%. Male gender, history of opportunistic infection, presence of comorbidities, and pills burden were associated with virological failure.