The influence of age-associated comorbidities on responses to Combination antiretroviral therapy among people living with human Immunodeficieny virus at the antiretroviral therapy clinic of jimma Medical center , south west ethiopia

Abstract

Background: With the increased use of highly active antiretroviral therapy (HAART), Human Immunodeficiency Virus (HIV) mortality rates are declining and the life expectancy of people living with the Human Immunodeficiency Virus (PLHIV) has dramatically improved. Consequently, the majority of people living with HIV are living longer and facing a higher burden of age-associated chronic comorbidities. This could lead to an increase in polypharmacy and the risk of potentially serious drug-drug interactions (DDIs), which can cause medication toxicity, loss of efficacy, and treatment failures. Objective: This study aimed to assess the influence of age-associated comorbidities on the therapeutic outcomes of HAART among PLHIV at the antiretroviral therapy (ART) clinic of Jimma Medical Center, South West Ethiopia. Methods: A hospital based nested case-control study design was conducted among adult HIV infected patients at the ART clinic of Jimma Medical Center from January 3 to June 2, 2022. Data were collected on socio-demographic, clinical characteristics of patients, comorbidities and medication related information by interviewing patients and by reviewing patients’ medical charts from all adult PLHIV that fulfill the inclusion criteria. The data were entered into Epi Data version 4.6.0.2 for cleaning and analyzed using a statistical package for social sciences software (SPSS) version 26.0. Logistic regressions were used to identify factors associated with treatment outcome. An odds ratio and confidence interval of 95% was used and the level of statistical significance was considered at a p-value < 0.05. Results: A total of 224 patients (112 cases and 112 controls) were included in the study. The magnitude of immunologic and virologic failure among the study groups were (23.2% and 15.2% in the case group versus 4.5% and 11.6% in the control group) (p<0.001). Independent predictors of immunological failure were being male (Adjusted Odds Ratio (AOR) = 3.079 [1.139-8.327], having non-communicable disease comorbidity [p<0.001, AOR: 10.573 (2.810-39.779)], age ≥ 50 years (Adjusted Odds Ratio (AOR) = 2.855 [1.023-7.965], p = 0.045), history of alcohol intake (AOR = 3.648 [1.118-11.897], p = 0.032), and having a baseline CD4+ count of < 200cells/uL [p= 0.034; AOR: 3.862 (1.109-13.456). Similarly, being alcoholic [p= 0.042; AOR: 3.111 (1.044-9.271)], having a baseline CD4+ count of < 200cells/uL [p= 0.007; AOR: 5.111 (1.547-16.892)], a low level of patients medication adherence [p= 0.003; AOR: 5.920 (1.810-19.362)], bedridden baseline functional status [p= 0.020; AOR: 3.902 ( 1.237-12.307)], and not using cotrimoxazole prophylaxis [p= 0.033; AOR: 2.735 (1.084-6.902)] were found to be an independent predictor of virologic treatment failure but patients who were older (age≥50 years) were less likely to have virological failure [p=0.002; AOR: 0.155 (0.047-0.512)]. Conclusion: Immunological failure was higher in patient’s comorbid with chronic age-associated comorbidities. However, there were no statistically significant association between the existence of age-associated chronic comorbidities and virological failur