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Open Access Research article

Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria

Chuka J Anude12*, Emeka Eze3, Henry C Onyegbutulem4, Man Charurat1, Mary-Ann Etiebet1, Samuel Ajayi5, Patrick Dakum16, Oluyemisi Akinwande6, Chris Beyrer2, Alash’le Abimiku1 and William Blattner1

Author Affiliations

1 Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA

2 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

3 University of Benin Teaching Hospital, Benin City, Edo State, Nigeria

4 Asokoro District Hospital, Abuja, Federal Capital Territory, Abuja, Nigeria

5 University of Abuja Teaching Hospital, Abuja, Federal Capital Territory, Abuja, Nigeria

6 Institute of Human Virology Nigeria, Abuja, Nigeria

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BMC Infectious Diseases 2013, 13:113  doi:10.1186/1471-2334-13-113

Published: 1 March 2013

Abstract

Background

Predictors of immuno-virologic outcomes 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 HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic 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 multivariate logistic regression, virologic failure was associated with age <30 years (OR 1.79; 95% CI: 1.17-2.67, p=0.03), anemia (Hemoglobin < 10 g/dl) (OR 1.71; 95% CI: 1.22-2.61, p=0.03), poor adherence (OR 3.82; 95% CI: 2.17-5.97, p=0.001), and post-secondary education (OR 0.60; 95% CI: 0.30-0.86, p=0.02). Immunologic failure was associated with male gender (OR 1.46; 95% CI: 1.04-2.45, p=0.04), and age <30 years (OR 1.50; 95% CI: 1.11-2.39, p=0.03). Virologic failure with immunologic success (VL-/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005).

Conclusions

Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

Keywords:
Immuno-virologic outcomes; Immuno-virologic discordance; Anemia; Treatment failure; Sub-Saharan Africa; Nigeria; PEPFAR; Anti-retroviral therapy; Viral load testing