Factors Associated with Timing of Initiation of Antiretroviral Therapy among HIV-1 Infected Adults in the Niger Delta Region of Nigeria

• Published in: PloS one 2015-05, Vol.10 (5), p.e0125665-e0125665
• Main Authors: Ogoina, Dimie, Finomo, Finomo, Harry, Tubonye, Inatimi, Otonyo, Ebuenyi, Ikenna, Tariladei, Wolo-wolo, Afolayan, Abimbola Anne
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; Adults; AIDS; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; CD4 antigen; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes - immunology; CD4-Positive T-Lymphocytes - pathology; CD4-Positive T-Lymphocytes - virology; Confidence intervals; Demographics; Developing countries; Development and progression; Disease Progression; Female; Females; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - mortality; HIV Infections - pathology; HIV Infections - virology; HIV-1 - immunology; HIV-1 - pathogenicity; Human immunodeficiency virus; Humans; LDCs; Male; Nigeria; Regression analysis; Retrospective Studies; Reviews; Statistical analysis; Survival Analysis; Systematic review; Tertiary Care Centers; Therapy; Time-to-Treatment
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0125665

Based on growing evidence mainly from countries outside Sub-Saharan Africa, the World Health Organisation (WHO) now recommends initiation of antiretroviral therapy (ART) in HIV-infected individuals in developing countries when CD4 cell count (CD4+) is ≤ 500 cells/ul. Nigeria accounts for about 14% of the estimated HIV/AIDS burden in Sub-Saharan Africa. We evaluated the factors associated with timing of initiation of ART among treatment-ineligible HIV-infected adults from Nigeria. We retrospectively reviewed the hospital records of ART ineligible HIV-infected adults who enrolled into HIV care between January 2008 and December 2012 at two major tertiary hospitals in Bayelsa State, South-South Nigeria. Demographic, clinical and laboratories data were obtained at presentation, at each subsequent visit at 6 monthly intervals and at time of initiation of ART. Cox proportional regression and Kaplan-Meier survival analysis were used to evaluate independent predictors of time to initiation of ART. Amongst the 280 study participants, 70.6% were females, 62.6% had CD4+ ≥500 cells/ul, 48.4% had WHO HIV Stage 1 disease and 34.3% were lost to follow up. In a cohort of 180 participants followed up for ≥3 months, participants with CD4+ of 351-500 cells/ul and stage 2 disease were more likely to start ART earlier than those with CD4+ > 500 cells/ul (Hazard ratio [HR]-1.7, 95% confidence interval [CI] of 1.0-2.9) and stage 1 disease (HR-2.3 (95% CI-1.3-4.2) respectively. HIV-infected adults with faster CD4+ decay required earlier ART initiation, especially in the first year of follow up. ART-ineligible HIV-infected adults on follow up in South-South Nigeria are more likely to require earlier initiation of ART if they have stage 2 HIV disease or CD4+ ≤500 cells/ul at presentation. Our findings suggest faster progression of HIV-disease in these groups of individuals and corroborate the growing evidence in support for earlier initiation of ART.