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Background: The availability of HAART has had a profound positive effect on HIV morbidity and mortality. However, the occurrence of primary treatment failure is a drawback to this success resulting in higher cost of treatment and poor outcomes. It is therefore important to establish the factors that are associated with primary HIV treatment failure. These factors can be used to identify patients at high risk of early treatment failure, and to screen for
treatment failure resulting in earlier diagnosis.

Objectives: To determine the factors associated with HIV treatment failure.

Design: Nested case control study

Subjects: Adult HIV patients in 18 HIV clinics run by AMPATH in Western Kenya.

Methods: All previously, treatment naïve patients started on HAART and subsequently diagnosed to have treatment failure between Feb 2006 and August 2008, formed the study cases. The control group was made up of; previously treatment naïve patients started on HAART at similar time to the cases and who had sustained immunologic response. Data on demographic, clinical characteristics and laboratory parameters was extracted from the AMPATH
medical records database. The data was then analyzed.

Results: Data on 12027 patients was analyzed, with 5709 in the cases and 6314 in the controls. Factors that were associated with increased risk of immunologic failure were age above 45 (O.R 1.21), male gender (O.R 1.22) and urban residence (O.R 1.09).Perfect adherence and first line effavirenz based regimen were protective

Conclusion: Poor adherence, male gender, age above 45yrs and living in an urban area, are risk factors for immunologic treatment failure