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Treatment outcomes in patients receiving combination antiretroviral therapy

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Background

This study investigated mortality rate, early CD4 responses, pattern of ARVs substitutions and medication adherence of HIV-infected patients on first-line triple combination ART.

Methods

Assessment of 196 HIV-infected patients on combination ART regimens was performed after 18 months of therapy. Medication adherence assessment of 69 follow-up target groups was based on a study-specific questionnaire. Paired sample t-test and simple linear correlation were used to test the association of the CD4-cell Counts at different time intervals. Kaplan-Meier model used to assess survival functions and the log-rank test was used to assess statistical difference at 95% CI.

Results

Mean age of participants was 33.6 years (95%CI, 32.05-35.15); 67.9% were females. At ART initiation, 27.0% were at WHO stage II, 47.0% at stage III. Mortality rate (N = 196) was 20.32 deaths per 100 patient-months; 31.6% occurred in <30 days while 52.6% occurred post 120 days of treatment. The meanCD4-cell count (cells/mm3) at ART initiation was 179.2 which increased to 328.5 at 3 months, 325.6 at 6 months, 357.4 at 12 months, and 366.7 at 18 months, (p < 0.01). Patients started on Stavudine-based or Efavirenz-based regimens were considerably more likely to have that drug substituted, compared to patients started on Zidovudine-based or Nevirapine-based regimens. 73.8% level of adherence was reported after 18 months on ART.

Discussion

In this setting, patients receiving ART showed significant improvements in CD4-cell status but adherence level was relatively poor. A large proportion of the patients presented very late for treatment with very poor baseline parameters. This finding supports the need for a rapid scale-up of counselling and testing for early detection of asymptomatic cases in developing countries. Patients were more stable on Zidovudine-based or Nevirapine-based regimens compared to Stavudine-based or Efavirenz-based regimens. Early mortality rate was high probably due to poor baseline parameters or late presentation for treatment, indicating need for early interventions. The follow-up CD4-cells measurements were not done every 6 months for all patients eligible for repeat CD4-cell Count in accordance to the Nigerian national ART guidelines, hence the need for improvement in the adherence to the national treatment guideline.

Author information

Correspondence to Kenneth Agu.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Agu, K., Ochei, U., Oparah, A. et al. Treatment outcomes in patients receiving combination antiretroviral therapy. Retrovirology 7, P54 (2010) doi:10.1186/1742-4690-7-S1-P54

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Keywords

  • Medication Adherence
  • Adherence Assessment
  • National Treatment Guideline
  • Simple Linear Correlation
  • Medication Adherence Assessment