MEDIAN TIME TO ACHIEVE UNDETECTABLE VIRAL LOAD AFTER INITIATION OF ANTIRETROVIRAL TREATMENT AMONG HIV-INFECTED ADULTS IN SOUTH-EAST NIGERIA

Abstract

The burden of high HIV prevalence and poor to access to treatment and care at the beginning of the last decade had necessitated APIN-Plus/Harvard PEPFAR intervention in Nigeria in 2004. So far, no published local study as documented the probability of survival in Nigeria for patients on HIV treatment by way of their time to achieve undetectable viral load after initiation of antiretroviral treatment, let alone determine patient factors that may influence or predict the time to undetectable viral load while on antiretrovira treatment. This study therefore assessed the median time to achieve undetectable viral load after initiation of antiretroviral therapy among HIV-infected adults in South-east Nigeria as well as those patient characteristics that influence or predict that outcome. It involved a retrospective review of records of 800 antiretroviral treatment-eligible but antiretroviral drug-naive patients receiving treatment at the UNTH Enugu between June 2008 and May 2010. Categorical variables were presented using proportions, frequency tables and graphs while means, medians,standard deviation and range were used in presenting quantitative variables. Kaplan-Meier analysis was used to estimate the cohort survival probability in terms of time to undetectable viral load while Cox's regression analysis was used to model the predictors of the main study outcome. All tests of hypothesis were based on 5% significance. The meanage of the 800 patients was 37.6 ±9.8 years with 72% aged between 25 - 44 years. About 45% of the cohort was married and 64.8% were females. Traders were in the majority with 34.3% while 51% attained secondary education or higer. Mean systolic blood pressure (BP) was 114.5mmHg± 13.5 while mean diastolic BP was 73.4mmHg±10.1 and12.1% were hypertensive. Median CD4 count was 150.5 cells/ml with 71% of the cohort having CD4 count less than 200 cells/ml while the median RNA viral load was 153,007 copies/ml. The cohort's median time to achieve undetectable viral load was 125 weeks with 78.6% of them achieving it within one year. Prevalence of tuberculosis co-infection among the patients was 8.1% with male preponderance. Being a civil was the only patient characteristic that significantly influenced or predicted the time to undetectable viral load among the cohort. At a median time of 12.5 weekly the study showed a very good survivorship as it takes a shorter time for those on treatment from the UNTH Enugu programme to achieve undetectable viral load than those from previous studies. The cohort performance also show that nearly nearly every patient that achieved viral load undetectability at the Enugu programme did within one year of starting the drug treatment. Prevalence of HIV/TB co-infection at the study site was relatively low at 8% compared to results obtained from other parts of the country and only occupation appeared to improve the speed of achieving undetectable viral load among patients receiving treatment fun the Enugu programme. Further studies will be required to determine the sustainability of patents' undetectability status by assessing the proportion of RNA viral load rebound among the cohort.