Nevirapine and tuberculosis predict first-line treatment failure in HIV patients in Indonesia: Case-control study

Yanri Wijayanti Subronto; Nur Aini Kusmayanti; Albarisa Shobry Abdalla; Prenaly Dwisthi Sattwika

doi:10.1016/j.amsu.2020.10.005

Nevirapine and tuberculosis predict first-line treatment failure in HIV patients in Indonesia: Case-control study

Ann Med Surg (Lond). 2020 Oct 15:60:56-60. doi: 10.1016/j.amsu.2020.10.005. eCollection 2020 Dec.

Authors

Yanri Wijayanti Subronto^{1

2}, Nur Aini Kusmayanti², Albarisa Shobry Abdalla³, Prenaly Dwisthi Sattwika³

Affiliations

¹ Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, 55281, Indonesia.
² Center for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
³ Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.

Abstract

Introduction: Indonesia antiretroviral therapy guideline suggests the use of Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based regiments as first line of HIV treatment and Protease Inhibitor to replace NNRTI when treatment failure occurred. This case-control study was aimed to study factors predicting first-line ART treatment failure among HIV positive patients aged >15 years, non-pregnant, and registered in our institution, Indonesia.

Methods: Diagnosis of HIV treatment failure was made according to the standard WHO criteria. Demographic and outcome variables were recorded. The association between variables were analyzed by Chi-square test with odds ratios (OR) and 95% confidence intervals (95% CI), followed by multivariate analysis using logistic regression test.

Results: Twenty-six index cases and 26 age- and sex-matched control cases were included in the study with a mean age of 32.27 ± 8.7 years and 32.88 ± 8.15 years, respectively. Median time for switching to second-line (Lopinavir/ritonavir, LPV/r) was 46.32 ± 30.21 months. Patients presented with tuberculosis and treated by nevirapine as the first-line treatment were 26.6-folds (95% CI: 2.41-293.81, p = 0.007) and 6.7-folds (95% CI: 1.56-28.45, p = 0.011) higher risk for treatment failure, respectively.

Conclusions: The presence of tuberculosis and the use of nevirapine in first-line treatment were strong predictors for first-line ARV treatment failure, suggesting for closer clinical monitoring for patients with those conditions. A further and larger prospective cohort study is needed to confirm the findings in this study.

Keywords: ART treatment failure; HIV; Indonesia; Nevirapine; Predicting factors; Tuberculosis.