Abstract:
Background: The emergence of resistance to the first line Antiretroviral therapy (ART) leads to
a need for more expensive and less tolerable second line drugs. Therefore it is essential to
identify factors associated with increased probability of treatment failure.
Objectives: The aim of this study was to assess clinical and immunologic failure of first line
treatment failure in children and time of switch to second line drugs.
Method: A retrospective cohort study was conducted with chart review of all HIV-infected
children less than 15 years of age, who took HAART for at least six months in the major
hospitals of Addis Ababa. Data was collected, entered and analyzed using Epi info version 3.5.1,
SPSS version 16 and Smart soft ware 2008. The Cox proportional-hazards model was then used
to assess the predictors of factors associated with treatment failure.
Result: A sample size of 1186 children was evaluated. Five hundred seventy seven (48.7%) were
male and 609 (51.3%) were female with mean age of 74(±37SD) months. Out of 167(14.1%)
children who had treatment failure, 80 (6.7%) had clinical failure, 87 (7.3%) immunologic
failure and 18 (1.5%) had both. Patients who had height for age less than -3 z-score(ZS ) with
adjusted hazard ratio(AHR) of 0.429 95% CI(0.291-0.632) were found to have high probability
of treatment failure. Patients with base line CD4 count below 50 (AHR=2.009(1.194-3.380));
with presence of chronic diarrhea after start of ART (AHR= 3.439(1.372-8.623)) and with drug
substitution (AHR=1.695(1.053-2.728)) were also found to be at risk. From all treatment
failures, only 24(14.37%) of patients were switched to second line with a mean delay of
24±31.67SD month.
Conclusions: Having chronic malnutrition and low CD4 at base line and chronic diarrhea after
the start of ART and substitution of drug were found to be predictors of treatment failure in
children. Most of the treatment failure were not detected and are not switched to second line
Recommendation: monitoring of children for treatment failure with the above predictors and
timely switch to second line is mandatory.
