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

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  • Dimie Ogoina
  • Finomo Finomo
  • Tubonye Harry
  • Otonyo Inatimi
  • Ikenna Ebuenyi
  • Wolo-wolo Tariladei
  • Abimbola Anne Afolayan

Abstract

Introduction: 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 ≤ 500cells/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. Methods: 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. Results: Amongst the 280 study participants, 70.6% were females, 62.6% had CD4+ ≥500cells/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 ≥3months, participants with CD4+ of 351-500cells/ul and stage 2 disease were more likely to start ART earlier than those with CD4+ > 500cells/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. Conclusion: 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+ ≤500cells/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.

Suggested Citation

  • Dimie Ogoina & Finomo Finomo & Tubonye Harry & Otonyo Inatimi & Ikenna Ebuenyi & Wolo-wolo Tariladei & Abimbola Anne Afolayan, 2015. "Factors Associated with Timing of Initiation of Antiretroviral Therapy among HIV-1 Infected Adults in the Niger Delta Region of Nigeria," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-12, May.
  • Handle: RePEc:plo:pone00:0125665
    DOI: 10.1371/journal.pone.0125665
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    1. Amitabh B Suthar & Stephen D Lawn & Julia del Amo & Haileyesus Getahun & Christopher Dye & Delphine Sculier & Timothy R Sterling & Richard E Chaisson & Brian G Williams & Anthony D Harries & Reuben M , 2012. "Antiretroviral Therapy for Prevention of Tuberculosis in Adults with HIV: A Systematic Review and Meta-Analysis," PLOS Medicine, Public Library of Science, vol. 9(7), pages 1-15, July.
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