title: Predictors of raised viral load during antiretroviral therapy in patients with and without prior antiretroviral use: a cross-sectional study.
abstract: OBJECTIVE
  In Lagos, Nigeria, Médecins Sans Frontières (MSF) and the Ministry of Health (MoH) commenced free antiretroviral treatment (ART) in a hospital-based clinic. We performed a cross-sectional study to compare factors associated with raised viral load between patients with ("experienced") and without ("naïve") prior antiretroviral (ARV) exposure at commencement of ART at the clinic. We also examined factors influencing ARV adherence in experienced patients prior to clinic entry.
  
  
  METHODS
  We included adult patients receiving ART from MSF who answered a questionnaire about previous antiretroviral use. Multivariate logistic regression was used to estimate odds ratios (OR) for raised viral load (≥1000 copies/mL).
  
  
  RESULTS
  1246 (96%) patients answered: 1075 (86%) reported no, and 171 (14%) some, prior ARV exposure. ARV-naïve patients were more immunosuppressed at baseline: 65% vs 37% (p<0.001) had CD4<200; 17% vs 9% (p = 0.013) were WHO stage 4. Proportionately more experienced than naïve patients had raised viral loads (20% vs 9%, p<0.001) on ART in the MSF/MoH clinic. Raised viral load was associated with prior ARV experience (adjusted OR = 3.74, 95%CI 2.09-6.70, p<0.001) and complete interruption of current ART (adjusted OR = 3.71, 95%CI 2.06-6.68, p<0.001). Higher CD4 at time of VL and a higher self-rated score of recent adherence were associated with lower OR of a raised viral load. Among experienced patients who missed pills before joining MSF/MoH, most common reasons were because ARVS were not affordable (58%) or available (33%), with raised viral load associated with being unsure how to take them (OR = 3.16, 95%CI 1.10-9.12, p = 0.033).
  
  
  CONCLUSIONS
  Patients previously exposed to ARVs had increased OR of raised viral load. The cost and availability of ARVs were common reasons for missing ARVs before joining the MSF/MoH clinic, and inadequate patient knowledge was associated with raised viral load.
authors: Manson Unit, Médecins Sans Frontières, London, United Kingdom. jane.greig@london.msf.org
authors: Jane E
authors: JE
authors: Greig
authors: Philipp A
authors: PA
authors: du Cros
authors: Clair
authors: C
authors: Mills
authors: Wilfred
authors: W
authors: Ugwoeruchukwu
authors: Andrew
authors: A
authors: Etsetowaghan
authors: Adetola
authors: A
authors: Grillo
authors: Adetoro
authors: A
authors: Tayo-Adetoro
authors: Kunle
authors: K
authors: Omiyale
authors: Tim
authors: T
authors: Spelman
authors: Daniel P
authors: DP
authors: O'Brien
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data; D019562:Viral Load / Q000187:drug effects*
chemical_list: D019380:Anti-HIV Agents
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