Median time to achieve undetectable viral load following initiation of anti-retroviral therapy at an HIV/AIDS treatment center in Nigeria
HIV-1 plasma viral load (VL) has been documented as a strong predictor of progression to AIDS and death in HIV-infected patients just as the attainment of undetectable viral load (UVL) remains a major goal of antiretroviral therapy (ART). An important measure of treatment success in HIV/AIDS patients is the time to achieve UVL. This study examined how long it took a cohort of patients to achieve UVL as well as its key determinants following initiation of ART in a PEPFAR-supported ART site in Nigeria.
METHODS:
This is a retrospective review of two-year treatment records of ART-naïve adult patients attending the University of Nigeria Teaching Hospital Enugu ART site. Data were summarised using descriptive statistics. Median time to achieve UVL was determined using Kaplan-Meier analysis based on viral load lower limit of detection (LLD) of 400 copies/mL. Determinants of the time to event were modelled using Cox’s regression analysis.
RESULTS:
A total of 813 records of patients with a mean age of 37.6 ± 9.8 years were reviewed. Of these, 65.0% were females, 71.0% were of ages 25 – 44 years and about half (51%) attained secondary education or higher. Median baseline viral load was 148,575 (134,690 – 177,522) copies/mL. About 8.2% of them were found to have co-infection with tuberculosis. Median time to achieve UVL was 12.0 (11.88 – 12.12) weeks with 79% (642) of them achieving it within the two-year study period. Subjects with pre-treatment normal blood pressure (BP) [≥90/60≤139/89] showed 40% faster rate of achieving UVL compared to those with baseline low or elevated BP.
CONCLUSIONS:
Our study patients demonstrated a relatively faster response to ART than those in previous studies conducted elsewhere. However, further studies may be required in order to examine the factors that may be responsible for the high level of censoring observed among the patients.