TITLE:
Predictive Factors Associated with Therapeutic Failure of First-Line Antiretroviral Therapy in People Living with HIV Monitored at Seven Large Cohort Sites in Conakry, Guinea (2019-2024)
AUTHORS:
Niouma Nestor Leno, Thierno Saidou Diallo, Moussa Fanta Keita, Sâa Pascal Kamano, Abdoulaye Maciré Camara, Sidikiba Sidibé
KEYWORDS:
First-Line Antiretroviral Therapy Failure, HIV/AIDS, Incidence, Associated Factors, Conakry
JOURNAL NAME:
Open Journal of Epidemiology,
Vol.15 No.3,
June
6,
2025
ABSTRACT: Background: This study aimed to evaluate the incidence of first-line antiretroviral therapy (ART) failure and identify associated predictive factors among people living with HIV in Conakry, Guinea. Methods: A retrospective cohort analysis was conducted across seven major HIV care sites. Eligible participants were ART-naive at treatment initiation, aged 15 years or older, and had received ART for at least six months by March 30, 2024. The study included 19,464 patients enrolled between April 1, 2019, and March 30, 2024, with follow-up until September 30, 2024. Data was extracted from medical records, pharmacy logs, and SMR databases. Statistical analyses included descriptive summaries, chi-square, Fisher’s exact, and Wilcoxon tests. Kaplan-Meier curves estimated treatment failure incidence over time, and the log-rank test compared survival distributions. Cox regression with backward stepwise selection was used to identify factors independently associated with first-line ART failure. Results: The median follow-up duration was 36.20 months (about 3 years). The overall incidence of first-line ART failure was 14.83% (95% CI: 13.67 - 16.93), corresponding to 4.92 failures per 100 person-years. Virological failure accounted for 9.87% and immunological failure accounted for 4.96% of the total. ART failure increased significantly with time on treatment, from 1.49% at six months to 47.82% at 60 months. Multivariate analysis revealed three key predictors of treatment failure: lack of formal education (adjusted Hazard Ratio [HR]: 1.482), a baseline CD4 count below 100 cells/mm3 (adjusted HR: 4.049), and HIV-tuberculosis co-infection at ART initiation (adjusted HR: 4.223). Conclusion: This study reveals a high incidence of antiretroviral therapy (ART) failure in Conakry, largely attributed to advanced immunosuppression, co-infections, and limited health literacy. To enhance treatment outcomes, the authors recommend strategies including early HIV diagnosis, timely initiation of ART, patient-centered health education, community-based support systems, and integrated, tailored TB/HIV services. Future research should investigate antiretroviral resistance patterns and additional risk factors to better inform national HIV response strategies.