Factors Associated with Timing of Initiation of Antiretroviral Therapy among HIV-1 Infected Adults in the Niger Delta Region of Nigeria.
BACKGROUND
Based on growing evidence mainly from countries outside Sub-Saharan Africa, the World Health Organisation (WHO) now recommends initiation of antiretroviral therapy (ART) in HIV-infected individuals in developing countries when CD4 cell count (CD4+) is ≤ 500 cells/ul. Nigeria accounts for about 14% of the estimated HIV/AIDS burden in Sub-Saharan Africa. We evaluated the factors associated with timing of initiation of ART among treatment-ineligible HIV-infected adults from Nigeria.


METHODS
We retrospectively reviewed the hospital records of ART ineligible HIV-infected adults who enrolled into HIV care between January 2008 and December 2012 at two major tertiary hospitals in Bayelsa State, South-South Nigeria. Demographic, clinical and laboratories data were obtained at presentation, at each subsequent visit at 6 monthly intervals and at time of initiation of ART. Cox proportional regression and Kaplan-Meier survival analysis were used to evaluate independent predictors of time to initiation of ART.


RESULTS
Amongst the 280 study participants, 70.6% were females, 62.6% had CD4+ ≥500 cells/ul, 48.4% had WHO HIV Stage 1 disease and 34.3% were lost to follow up. In a cohort of 180 participants followed up for ≥3 months, participants with CD4+ of 351-500 cells/ul and stage 2 disease were more likely to start ART earlier than those with CD4+ > 500 cells/ul (Hazard ratio [HR]-1.7, 95% confidence interval [CI] of 1.0-2.9) and stage 1 disease (HR-2.3 (95% CI-1.3-4.2) respectively. HIV-infected adults with faster CD4+ decay required earlier ART initiation, especially in the first year of follow up.


CONCLUSIONS
ART-ineligible HIV-infected adults on follow up in South-South Nigeria are more likely to require earlier initiation of ART if they have stage 2 HIV disease or CD4+ ≤500 cells/ul at presentation. Our findings suggest faster progression of HIV-disease in these groups of individuals and corroborate the growing evidence in support for earlier initiation of ART.
Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria.
Dimie
D
Ogoina
Department of Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
Finomo
F
Finomo
Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria.
Tubonye
T
Harry
Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria.
Otonyo
O
Inatimi
Department of Internal Medicine, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa state, Nigeria.
Ikenna
I
Ebuenyi
Department of Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
Wolo-wolo
WW
Tariladei
Department of Medicine, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
Abimbola Anne
AA
Afolayan
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology / Q000821:virology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000821:virology*; D015497:HIV-1 / Q000276:immunology / Q000472:pathogenicity; D006801:Humans; D008297:Male; D009549:Nigeria; D012189:Retrospective Studies; D016019:Survival Analysis; D062606:Tertiary Care Centers; D061665:Time-to-Treatment
D019380:Anti-HIV Agents