Nigeria has made significant gains in scaling-up access to HIV prevention, treatment and support services and by the end of 2014, provided antiretroviral therapy (ART) to over 747,382 individuals and care and support to almost 1.5 million people. The main objective of this study was to determine predictors of immunologic failure in the absence of routine viral load monitoring.
This was a retrospective cohort study of 12,456 HIV-infected patients enrolled into HIV care at the University of Abuja Teaching Hospital (UATH) between February, 2005 and December, 2014.To identify predictors of immunologic failure, univariate and multivariate analyses were performed using log binomial models to estimate relative risks (RR) and confidence intervals. All available plausible predictors were included in the multivariate models if they were significant at a P
value of <0.20.
Among 2,602 patients with immunologic failure, 868 (33.3%) had VL measurements and 381 (43.9%) of these had a detectable VL. Fifty six samples (56/198; 28%) had no resistance; 160 (80%) harbored NRTI resistance; 151 (76.3%) M184I/V; 29 (14.6%) had ≥3 TAMs, and 37 (18.7%) had K65R, of which all were on TDF. One hundred and sixty-two samples (81.8%) harbored NNRTI resistance; 72 (36.4%) Y181C and 68 (34.3%) K103N with 53% having ≥ 2 etravirine associated mutations. Service entry point [RR (95%CI): 0.79 (0.64 to 0.91); P
< 0.001]; being on NVP containing regimen [RR (95%CI): 1.21 (0.99 to 1.45); P
= 0.023]; WHO stage III or IV [0.76 (0.60– 0.96); P
= 0.013]; baseline CD4 cell count <200 cells/μL [0.19 (0.16 to 0.22); P
< 0.001]; and male gender [1 (1.07 to 1.40); P
= 0.005] were associated with immunologic failure.
Immunological criteria for failure erroneously classified patients without virological replication as failing therapy in our program. Patients with both virologic and immunologic failures had extensive accumulations of drug resistance mutations.