Determinants of therapy failure among adults on first-line antiretroviral therapy in Asmara, Eritrea: a multicenter retrospective matched case–control study

Abstract

Key summary points Why carry out this study? The lack of data regarding the magnitude and possible risk factors for TF in Eritrea makes it difficult to formulate evidence-based improvements in patient management. This study has identified important determinants of therapy failure in Asmara, Eritrea. By undertaking an inquiry into the sociodemographic and clinical risk factors associated with TF, we believe that we have gathered useful information that can be used by clinicians to identify patients who are at a higher risk of TF. Importantly, conflicting findings have also been reported regarding immunologic recovery after cART initiation, particularly the long-term impact of age (note that patients in this setting are relatively old). Therefore, we examined changes in CD4 recovery between cases and controls. What was learned from this study? The study revealed important clinical risk factors for cART therapy failure. The study indicates that treatment response is a multifactorial outcome and control of this epidemic calls for a multifaceted approach involving multiple sectors of the healthcare system in Eritrea. Reduction in late presentation of patients/early diagnosis, prompt treatment initiation, and targeted monitoring and enhancement of adherence. In addition, the need for research on determinants of sub-optimal adherence was implied.

Keywords

• CD4+ cell count
• HIV
• Treatment failure
• Viral load
• Eritrea