Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria

Chuka J. Anude, Emeka Eze, Henry C. Onyegbutulem, Man Charurat, Mary Ann Etiebet, Samuel Ajayi, Patrick Dakum, Oluyemisi Akinwande, Christopher Beyrer, Alash'le Abimiku, William Blattner

Research output: Contribution to journalArticle

Abstract

Background: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.Methods: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses.Results: Virologic suppression rate (3) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age -/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005).Conclusions: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

Original languageEnglish (US)
Article number113
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
StatePublished - Mar 1 2013

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Nigeria
HIV
Viral Load
Anemia
Educational Status
Highly Active Antiretroviral Therapy
Patient Compliance
Cohort Studies
Therapeutics
Logistic Models
Economics
Demography
Education

Keywords

  • Anemia
  • Anti-retroviral therapy
  • Immuno-virologic discordance
  • Immuno-virologic outcomes
  • Nigeria
  • PEPFAR
  • Sub-Saharan Africa
  • Treatment failure
  • Viral load testing

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria. / Anude, Chuka J.; Eze, Emeka; Onyegbutulem, Henry C.; Charurat, Man; Etiebet, Mary Ann; Ajayi, Samuel; Dakum, Patrick; Akinwande, Oluyemisi; Beyrer, Christopher; Abimiku, Alash'le; Blattner, William.

In: BMC Infectious Diseases, Vol. 13, No. 1, 113, 01.03.2013.

Research output: Contribution to journalArticle

Anude, CJ, Eze, E, Onyegbutulem, HC, Charurat, M, Etiebet, MA, Ajayi, S, Dakum, P, Akinwande, O, Beyrer, C, Abimiku, A & Blattner, W 2013, 'Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria', BMC Infectious Diseases, vol. 13, no. 1, 113. https://doi.org/10.1186/1471-2334-13-113
Anude, Chuka J. ; Eze, Emeka ; Onyegbutulem, Henry C. ; Charurat, Man ; Etiebet, Mary Ann ; Ajayi, Samuel ; Dakum, Patrick ; Akinwande, Oluyemisi ; Beyrer, Christopher ; Abimiku, Alash'le ; Blattner, William. / Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria. In: BMC Infectious Diseases. 2013 ; Vol. 13, No. 1.
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abstract = "Background: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.Methods: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses.Results: Virologic suppression rate (3) was 77.4{\%} and immuno-virologic discordance rate was 33{\%}. In multivariate logistic regression, virologic failure was associated with age -/CD4+) was associated with anemia (OR 1.80; 95{\%} CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95{\%} CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95{\%} CI: 0.22-0.68, p=0.005).Conclusions: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.",
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AU - Anude, Chuka J.

AU - Eze, Emeka

AU - Onyegbutulem, Henry C.

AU - Charurat, Man

AU - Etiebet, Mary Ann

AU - Ajayi, Samuel

AU - Dakum, Patrick

AU - Akinwande, Oluyemisi

AU - Beyrer, Christopher

AU - Abimiku, Alash'le

AU - Blattner, William

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N2 - Background: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.Methods: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses.Results: Virologic suppression rate (3) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age -/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005).Conclusions: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

AB - Background: Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs.Methods: The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses.Results: Virologic suppression rate (3) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age -/CD4+) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p=0.03), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p=0.001), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p=0.005).Conclusions: Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

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KW - PEPFAR

KW - Sub-Saharan Africa

KW - Treatment failure

KW - Viral load testing

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