BackgroundPatient retention and positive immuno-virologic outcomes are key goals of any HIV treatment program. Information on predictors of immunovirologic failure and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.
MethodsThe HIV AIDS Care and Anti-Retroviral Therapy (HACART) study was a large multi-center observational clinic-based cohort study of 2585 initially ART-naïve adults who started HAART between April 2008 and February 2009. A total of 628 out of 1780 patients alive and active at 12 months were randomly selected for in-depth analyses.
ResultsVirologic suppression rate (<400 copies/mL) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm3) was 77.4% and Immuno-virologic discordance rate was 33%. In multivariable logistic regression controlling for adherence, risk of virologic failure was significantly associated with age <30 years (OR 1.76; 95% CI: 1.09 to 2.84), anemia (Hemoglobin <10 g/dL) (OR 1.60; 95% CI: 1.04 to 2.48), residential distance 51–100 kilometers (OR 0.41; 0.20–0.87) and post-secondary education (OR 0.53; 95% CI: 0.32 to 0.90). Risk of immunologic failure was associated with male gender (OR 1.65; 95% CI: 0.01 to 2.67), and age <30 years (OR 1.71; 95% CI: 1.19 to 2.63). Risk of immunovirologic discordance was associated with age <30 years (OR 1.64; 95% CI: 1.06 to 2.53) and post-secondary education (OR 0.61; 95% CI: 0.38 to 0.98).
ConclusionAlthough favorable immuno-virologic outcomes can be achieved in this large ART program in Nigeria, immuno-virologic discordance was observed in a third of the patients. Baseline anemia assessment and management (anti-malarials, anti-helminthics, hematinics, etc) may help improve virologic outcomes. Intensifying treatment preparation and nutritional activities, and focusing on young patients, males and persons with less than post-secondary education may help improve favorable immuno-virologic outcomes.
© 2012 Lippincott Williams & Wilkins, Inc.