Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings : a systematic review and meta analysis
Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in
resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among
individuals living with HIV on ART in resource-poor settings.
Methods: We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE),
Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and
Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, casecontrol,
and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment
regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical
failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and sociodemographic
factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements Results: Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as
compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of
evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/
mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence).
This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with
treatment failure among HIV-positive patients on ART in a resource-limited setting.
Conclusion: This review highlights that low CD4 counts and poor adherence to ART were associated to ART
treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who
have these characteristics in order to prevent ART treatment failure.
were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome
of interest.
Description
CITATION: Lailulo, Y., et al. 2020. Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings : a systematic review and metaanalysis. Systematic Reviews, 9:292, doi:10.1186/s13643-020-01524-1.
The original publication is available at https://systematicreviewsjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
The original publication is available at https://systematicreviewsjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund
Keywords
Immunological failure, Highly active antiretroviral therapy -- Complications -- Developing countries, Systematic reviews (Medical research), Meta-analysis
Citation
Lailulo, Y., et al. 2020. Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings : a systematic review and metaanalysis. Systematic Reviews, 9:292, doi:10.1186/s13643-020-01524-1