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dc.contributor.authorMeloni, Seema T.en_US
dc.contributor.authorChang, Charlotte A.en_US
dc.contributor.authorEisen, Geoffreyen_US
dc.contributor.authorJolayemi, Toyinen_US
dc.contributor.authorBanigbe, Bolanleen_US
dc.contributor.authorOkonkwo, Prosper I.en_US
dc.contributor.authorKanki, Phyllis J.en_US
dc.date.accessioned2016-11-18T20:47:39Z
dc.date.issued2016en_US
dc.identifier.citationMeloni, Seema T., Charlotte A. Chang, Geoffrey Eisen, Toyin Jolayemi, Bolanle Banigbe, Prosper I. Okonkwo, and Phyllis J. Kanki. 2016. “Long-Term Outcomes on Antiretroviral Therapy in a Large Scale-Up Program in Nigeria.” PLoS ONE 11 (10): e0164030. doi:10.1371/journal.pone.0164030. http://dx.doi.org/10.1371/journal.pone.0164030.en
dc.identifier.issn1932-6203en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:29408346
dc.description.abstractBackground: While there has been a rapid global scale-up of antiretroviral therapy programs over the past decade, there are limited data on long-term outcomes from large cohorts in resource-constrained settings. Our objective in this evaluation was to measure multiple outcomes during first-line antiretroviral therapy in a large treatment program in Nigeria. Methods: We conducted a retrospective multi-site program evaluation of adult patients (age ≥15 years) initiating antiretroviral therapy between June 2004 and February 2012 in Nigeria. The baseline characteristics of patients were described and longitudinal analyses using primary endpoints of immunologic recovery, virologic rebound, treatment failure and long-term adherence patterns were conducted. Results: Of 70,002 patients, 65.2% were female and median age was 35 (IQR: 29–41) years; 54.7% were started on a zidovudine-containing and 40% on a tenofovir-containing first-line regimen. Median CD4+ cell counts for the cohort started at 149 cells/mm3 (IQR: 78–220) and increased over duration of ART. Of the 70,002 patients, 1.8% were reported as having died, 30.1% were lost to follow-up, and 0.1% withdrew from treatment. Overall, of those patients retained and with viral load data, 85.4% achieved viral suppression, with 69.3% achieving suppression by month 6. Of 30,792 patients evaluated for virologic failure, 24.4% met criteria for failure and of 45,130 evaluated for immunologic failure, 34.0% met criteria for immunologic failure, with immunologic criteria poorly predicting virologic failure. In adjusted analyses, older age, ART regimen, lower CD4+ cell count, higher viral load, and inadequate adherence were all predictors of virologic failure. Predictors of immunologic failure differed slightly, with age no longer predictive, but female sex as protective; additionally, higher baseline CD4+ cell count was also predictive of failure. Evaluation of long-term adherence patterns revealed that the majority of patients retained through 84 months maintained ≥95% adherence. Conclusion: While improved access to HIV care and treatment remains a challenge in Nigeria, our study shows that a high quality of care was achieved as evidenced by strong long-term clinical, immunologic and virologic outcomes.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pone.0164030en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072640/pdf/en
dash.licenseLAAen_US
dc.subjectBiology and Life Sciencesen
dc.subjectImmunologyen
dc.subjectVaccination and Immunizationen
dc.subjectAntiviral Therapyen
dc.subjectAntiretroviral Therapyen
dc.subjectMedicine and Health Sciencesen
dc.subjectPublic and Occupational Healthen
dc.subjectPreventive Medicineen
dc.subjectHematologyen
dc.subjectAnemiaen
dc.subjectMicrobiologyen
dc.subjectMedical Microbiologyen
dc.subjectMicrobial Pathogensen
dc.subjectViral Pathogensen
dc.subjectImmunodeficiency Virusesen
dc.subjectHIVen
dc.subjectPathology and Laboratory Medicineen
dc.subjectPathogensen
dc.subjectOrganismsen
dc.subjectVirusesen
dc.subjectBiology and life sciencesen
dc.subjectRNA virusesen
dc.subjectRetrovirusesen
dc.subjectLentivirusen
dc.subjectVirologyen
dc.subjectViral Transmission and Infectionen
dc.subjectViral Loaden
dc.subjectPeople and Placesen
dc.subjectGeographical Locationsen
dc.subjectAfricaen
dc.subjectNigeriaen
dc.subjectGovernment Laboratoriesen
dc.subjectCo-Infectionsen
dc.subjectDiagnostic Medicineen
dc.subjectClinical Laboratory Sciencesen
dc.subjectClinical Laboratoriesen
dc.titleLong-Term Outcomes on Antiretroviral Therapy in a Large Scale-Up Program in Nigeriaen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS ONEen
dash.depositing.authorMeloni, Seema T.en_US
dc.date.available2016-11-18T20:47:39Z
dc.identifier.doi10.1371/journal.pone.0164030*
dash.contributor.affiliatedChang, Charlotte
dash.contributor.affiliatedMeloni, Seema
dash.contributor.affiliatedKanki, Phyllis


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