title: Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria.
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.
authors: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA. canude@jhsph.edu
authors: Chuka J
authors: CJ
authors: Anude
authors: Emeka
authors: E
authors: Eze
authors: Henry C
authors: HC
authors: Onyegbutulem
authors: Man
authors: M
authors: Charurat
authors: Mary-Ann
authors: MA
authors: Etiebet
authors: Samuel
authors: S
authors: Ajayi
authors: Patrick
authors: P
authors: Dakum
authors: Oluyemisi
authors: O
authors: Akinwande
authors: Chris
authors: C
authors: Beyrer
authors: Alash'le
authors: A
authors: Abimiku
authors: William
authors: W
authors: Blattner
mesh_terms: D000328:Adult; D000740:Anemia / Q000821:virology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents