Background: Patient 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.
Methods: The HIV AIDS Care and Anti-Retroviral Therapy (HACART) study was a large multi-center observational clinic-based cohort study of 2585 initially ART-naive 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.
Results: Virologic 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).
Conclusion: Although 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.
(C) 2012 Lippincott Williams & Wilkins, Inc.