Virological failure among adult HIV positive patients three years after starting antiretroviral treatment at Mankweng Hospital, Limpopo Province, RSA

Abstract

Background: The main goal of HAART is to achieve maximal viral suppression. However, with poor adherence to therapy the chances of achieving and maintaining successful viral suppression are decreased, leading to virological failure. And virological failure has been recognized by WHO as one of the early warning signs of drug resistance. This operational research sought to explore virological failure as a treatment outcome to evaluate program performance at a facility level. Methods: Purposive sampling as per inclusion and exclusion criteria was used to retrospectively review clinical records of the first 700 adult HIV positive patients (350 males and 350 females) who initiated antiretroviral treatment between April 2004 and December 2007 at this adult HIV clinic, were followed up for at least 3 years and treated according to the South African government’s National Department of Health 2004 HIV treatment guidelines for adults and adolescents. Major Results: 268 clinical records, 97 (27.71%) male and 171 (58.86%) female records were eligible for inclusion in the study. The proportion of females was higher (63.8%) than males (32.8%) with an average age of 38.95 years. 24 (8.9%) patients in the study sample experienced virological failure during the study period; 11 (11.3%) males and 13 (7.6%) females. Two-thirds (66.6%) of patients who failed to suppress at their first viral load measurement proceeded to develop virological failure. Overall, there was no association of statistical significance between age, sex, baseline CD4 cell count and baseline regimen, and virological failure at various intervals, p> 0.05. Conclusion: It was a challenge to keep patients in care but those that remained in care had good treatment outcomes with only 8.9% developing virological failure. Failure to suppress at first viral load preceded virological failure in the majority of patients.