title: Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort.
abstract: The authors conducted a retrospective cohort study of unplanned care interruption (UCI) among adults initiating antiretroviral therapy (ART) from 2009 to 2011 in a Nigerian clinic. The authors used repeated measures regression to model the impact of UCI on CD4 count upon return to care and rate of CD4 change on ART. Among 2496 patients, 83% had 0, 15% had 1, and 2% had ≥2 UCIs. Mean baseline CD4 for those with 0, 1, or ≥2 UCIs was 228/cells/mm3, 355/cells/mm3, and 392/cells/mm3( P < .0001), respectively. The UCI was associated with a 62 CD4 cells/mm3decrease (95% confidence interval [CI]: -78 to -45) at next measurement. In months 1 to 6 on ART, patients with 0 UCI gained 10 cells/µL/mo (95% CI: 7-4). Those with 1 and ≥2 UCIs lost 2 and 5 cells/µL/mo (95% CI: -18 to 13 and -26 to 16). Patients with UCI did not recover from early CD4 losses associated with UCI. Preventing UCI is critical to maximize benefits of ART.
authors.affiliation: 1 Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.|2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.|3 Harvard Medical School, Boston, MA, USA.
authors.forename: Aimalohi A
authors.initials: AA
authors.lastname: Ahonkhai
authors.affiliation: 4 AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
authors.forename: Juliet
authors.initials: J
authors.lastname: Adeola
authors.affiliation: 4 AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Banigbe
authors.affiliation: 4 AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria.
authors.forename: Ifeyinwa
authors.initials: I
authors.lastname: Onwuatuelo
authors.affiliation: 2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Abdulkabir B
authors.initials: AB
authors.lastname: Adegoke
authors.affiliation: 1 Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.|2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.|3 Harvard Medical School, Boston, MA, USA.|5 Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
authors.affiliation: 2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.|3 Harvard Medical School, Boston, MA, USA.|5 Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|6 Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.|7 Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: 1 Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.|2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.|3 Harvard Medical School, Boston, MA, USA.|5 Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|8 Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.|9 Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.|10 Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.affiliation: 3 Harvard Medical School, Boston, MA, USA.
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: 2 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.|5 Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.|8 Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D008297:Male; D009549:Nigeria; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4; HIV infection; adherence; care interruption; immunologic recovery