Predictors of discontinuation of antiretroviral therapy among HIV-infected adults at Hospital Sungai Buloh: A 10-year retrospective cohort study

Abstract

Aims:Discontinuation from antiretroviral therapy (ART) lowers the immunological advantages of human immunodeficiency virus (HIV) treatment and increases the problems related to HIV. Therefore, this study determined the predictors of discontinuation among HIV-infected adults at Hospital Sungai Buloh.Methods:We carried out an institutional-based retrospective cohort study and reviewed the medical records of ART-naïve patients with HIV in Hospital Sungai Buloh, Selangor, Malaysia from January 2007 through December 2016. Discontinuation was defined as not attending the follow-up for 90 days or longer. Simple and multiple logistic regression was used to identify the predictors.Results:Out of 339 patients, 63 (18.6%) experienced discontinuation. Among them, 63.5% were younger than 39 years, 81.0% were male and 62.0% were of Malay ethnicity. Sexual transmission via homosexual and heterosexual routes was the commonest mode of HIV transmission (76.7%). Patients with Malay ethnicity [adjusted Odds ratio (AOR): 2.5, confidence interval (CI): 1.4-4.5, p=0.002], tuberculosis co-infection (AOR: 2.0, CI: 1.1-3.7, p=0.025) and a history of ART regimen switch (AOR: 5.3, CI: 2.2-13.1, p<0.001) were significantly associated with ART discontinuation.Conclusions:The proportion of patients who discontinued ART in our observation presents a challenge to the long-term success of the treatment program. There is a need for special attention to patients with HIV who are Malay, had tuberculosis co-infection, and history of switching to other regimens to avoid discontinuation of therapy.

Keywords

• antiretroviral therapy
• hiv
• loss to follow-up
• tuberculosis
• regime switch