Prevalence of anti-retroviral treatment failure and salvage therapy in university of Benin Teaching Hospital Edo state, Nigeria

Abstract

Background: Human immunodeficiency virus (HIV) infection caused by HIV-1 and HIV-2 has reached pandemic proportion with sub Saharan Africa having the highest incidence and prevalence. With the advent of anti-retroviral drugs (ARV), the morbidity and mortality of people living with HIV/AIDS (PLWHA) has improved. With long term therapy with ARVs however, problems arise due to poor adherence. The concept of “salvage therapy” was conceived subsequent to experiencing multiple treatment failures to ARV combinations. It implies a final attempt, in the battle against HIV/AIDS. Objective: To determine the prevalence of treatment failure and use of salvage therapy amongst patients receiving Highly Active Anti-retroviral therapy in the University of Benin Teaching Hospital. Methodology: This study was a cross sectional evaluation of the care and treatment programme. All patients receiving HAART in the treatment programme of the University of Benin Teaching Hospital with a confirmed diagnosis of HIV/AIDS aged 15 years and above were admitted in the study. Data analysis was done using frequency tables, means and proportions.
Results: A total of 9449 patients have received anti-retroviral drugs. 3345 were males while 6095 were females giving a male to female ratio of 1:2 The total number of treatment failures to first line ART was 112 out of 9449 giving a prevalence of 1st line ART failure of 1.19% .The male to female ratio of treatment failure to 1st line drugs was 1:1.5. Most of the first line treatment failures occurred in the 30-40 age group and was more frequent amongst the males (1.3%) compared to females (1.1%) (relative risk =1.18). The total number of patients on salvage therapy was 4. The prevalence of second line failure in this programme was 3.58% while the prevalence of use of salvage regimes was 0.04%. The prevalence of second line treatment failure among the males was 2.3% and amongst the females it was 4.41%.Salvage therapy occured more in the 30-40 age salvage group (50%) and in the female sex (75%).The male to female ratio of the use of regime was 1:3. Treatment failure and salvage therapy though low in prevalence in this study, requires a high index of suspicion for its early detection and management which will improve the quality of life of the patients.

Key words: Treatment failure, salvage therapy, HIV/AIDS