title: Virological failure reduced with HIV-serostatus disclosure, extra baseline weight and rising CD4 cells among HIV-positive adults in Northwestern Uganda.
abstract: BACKGROUND
  Little is known about the incidence of virological failure among Human Immunodeficiency virus (HIV) infected adults after Uganda transitioned from Zidovidine/Lamivudine/ Nevirapine (AZT/3TC/NVP) to Tenofovir/Lamivudine/Efavirenze (TDF/3 T/EFV) as a first-line anti-retroviral therapy (ART) in 2013. This was the first study in Uganda to investigate the incidence and predictors of virological failure among HIV-positive adults in Northwestern Uganda.
  
  
  METHODS
  A retrospective cohort of 383 HIV-positive adults at Arua Teaching and Regional Referral Hospital HIV Clinic with at least six months of ART duration and five consecutive good adherence levels was used. Socio-demographic and clinical variables were analyzed with STATA version 12 at 5 % significance level. The Chi-squared, Fisher's exact and Student's t-tests were used for bivariate analysis. Cox Proportional Hazard Regression analysis was used for univariable and multivariate analysis, Kaplan-Meier for comparison of survival probability and the log-rank for testing survivorship probability. Hazard ratios (HR), 95 % confidence intervals (CI) and probability values were stated.
  
  
  RESULTS
  The average age of the cohort was 34.0 ± 11 years (Median: 32 years, Interquartile range (IQR): 25-31 years). 28 (7.3 %; 95 % Confidence Interval [CI]: 4.9-10.6) incident cases of virological failures and an incidence rate of 58 per 1000 person-years over risk time of 483 years was recorded. One-kilogram baseline body weight difference (41-kg and above) at ART initiation (Adjusted Hazard Ratio [aHR] = 0.86, 95 % CI:0.76-0.96, P = 0.008), one-CD4 cell increase (35 cells/ul and above) after ART initiation (aHR = 0.99, 95 % CI: 0.98-0.99, P < 0.001) and HIV-serostatus disclosure (aHR = 0.15, 95 % CI: 0.06-033, P < 0.001) reduced the hazard of virological failure.
  
  
  CONCLUSIONS
  Virological failure is common among HIV-positive adults in Northwestern Uganda. It reduced with extra baseline weight, rising CD4 cell counts and HIV-serostatus disclosure.
authors: Institute of Public Health and Management, International Health Sciences University, P.O. Box 7782, Kampala, Uganda. jonahzd@gmail.com.|Department of Anatomy, Uganda Society for Health Scientists, Makerere University College of Health Sciences, P.O. Box, 7072, Kampala, Uganda. jonahzd@gmail.com.
authors: Jonathan
authors: J
authors: Izudi
authors: Arua District Local Government, Kampala, Uganda.
authors: Sunday
authors: S
authors: Alioni
authors: Baylor College of Medicine Children's Foundation-Uganda, Box 72052, Kampala, Uganda.
authors: Emmanuel
authors: E
authors: Kerukadho
authors: Bugema University, School of Graduate Studies, P.O Box 6529, Kampala, Uganda.
authors: David
authors: D
authors: Ndungutse
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D048588:Benzoxazines / Q000627:therapeutic use; D001835:Body Weight; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects; D015331:Cohort Studies; D003521:Cyclopropanes; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000627:therapeutic use; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D012189:Retrospective Studies; D000068698:Tenofovir / Q000627:therapeutic use; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D019829:Nevirapine; D000068698:Tenofovir; C098320:efavirenz
keywords: ART; CD4 cells; HIV-serostatus disclosure; Northwestern Uganda; Virological failure