Long-term outcomes of antiretroviral therapy in an adult HIV program: a 10-year retrospective cohort study in Kano, Nigeria.
BACKGROUND
Treatment outcomes from HIV/AIDS programs in resource-limited settings mostly describe short-term follow-up. We report 10-year treatment outcomes in an HIV clinic in Kano, Nigeria.


METHODS
Using paper medical charts, the authors conducted a retrospective cohort study of patients that initiated ART from June 1, 2004 to December 31, 2007, and were followed up until June 30, 2014. The authors abstracted data from patient case files and did a time-to-event analysis on ART failure and loss to follow-up, and determined immunologic trends.


RESULTS
The authors studied 345 patient records (29,860 person months of follow-up); 82 records (23.7%) indicated that patients failed their first-line ART regimen at the rate of 2.75 failures per 1000 person-months. The estimates of durability on first-line ART regimen were 99.1% at 1 year and 59.0% at 10 years. Of the studied patients, 83.0% were still in care at the end of the 10-year period. Only being on abacavir (hazard ratio: 8.0) was a positive predictor of ART failure. CD4 increment at 4 years (hazard ratio: 0.9) and 5 years (hazard ratio: 0.9) were negative predictors.


CONCLUSIONS
A high rate of long-term ART durability and modest long-term retention in care were achieved among our cohort. Improved availability of low-cost virologic and immunologic monitoring tools and provision of resistance testing technology will go a long way in improving early detection of treatment failure in the developing world.
Baba Maiyaki Musa, MD, Department of Medicine,, Bayero University, PMB 3011,, Kano 0234, Nigeria, T: +2348033472311, babamaiyaki2000@yahoo.co.uk.
Baba Maiyaki
BM
Musa
Modupe
M
Coker
Scottie
S
Bussell
Muktar
M
Aliyu
Musa
M
Babashani
Hamza
H
Muhammad
Ibrahim
I
Nashabaru
Musa
M
Garbati
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015704:CD4 Antigens / Q000097:blood; D015224:Dideoxynucleosides / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D020276:HIV Long-Term Survivors / Q000706:statistics & numerical data*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult; D000099227:Abacavir
D044966:Anti-Retroviral Agents; D015704:CD4 Antigens; D015224:Dideoxynucleosides; D000099227:Abacavir