Objective: To investigate the malaria parasitemia, CD4(+) cell counts and some haematological indices among HIV-malaria co-infected adult patients with highly active antiretroviral therapy (HAART). Methods: A total of 342 adult HIV positive subjects were recruited at the consultant outpatient HIV/AIDS clinic, University of Benin Teaching Hospital, Benin City, Nigeria between June 2011 to November 2011. Blood samples were taken for malaria parasite count, CD4(+) cell count and other haematological counts. Results: Out of the 342 adult HIV positive subjects a total of 254 patients (74.3%) were found to have malaria parasitemia. The incidence of malaria parasitemia increased with advancing clinical stage of HIV infection and this was statistically significant (P=0.002). There was no statistical significance when gender was compared with the HIV malaria status (P >0.05). Of the 254 co-infected patients, 134 (52.8%) had high parasitemia (>1.25x10(9)/L). Sixty patients were found to be hyperparasitemic (>2.5 parasites/L). There was a significant association between CD4(+) cell count and having significant parasitemia (P < 0.000 1). About half (50.8%) of co-infected patients had CD4(+) cell count <= 200/ mu L. and majority (44.9%) of this population also had significant parasitemia. Anaemia and thrombocytopenia were not significantly associated with HIV-malaria co-infection (P > 0.05). Conclusions: The prevalence of parasitemia is high among the HIV/AIDS infected patients.

Background Predictors of immuno-virologic outcomes and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs. Methods The HACART study was a multi-center observational clinic-based cohort study of 2585 adults who started HAART between April 2008 and February 2009. A total of 628 patients were randomly selected at 12 months for immuno-virologic analyses. Results Virologic suppression rate (<400 copies/ml) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm 3 ) was 77.4% and immuno-virologic discordance rate was 33%. In multivariate logistic regression, virologic failure was associated with age <30 years (OR 1.79; 95% CI: 1.17-2.67, p = 0 . 03 ), anemia (Hemoglobin < 10 g/dl) (OR 1.71; 95% CI: 1.22-2.61, p = 0 . 03 ), poor adherence (OR 3.82; 95% CI: 2.17-5.97, p = 0 . 001 ), and post-secondary education (OR 0.60; 95% CI: 0.30-0.86, p = 0 . 02 ). Immunologic failure was associated with male gender (OR 1.46; 95% CI: 1.04-2.45, p = 0 . 04 ), and age <30 years (OR 1.50; 95% CI: 1.11-2.39, p = 0 . 03 ). Virologic failure with immunologic success (VL - /CD4 + ) was associated with anemia (OR 1.80; 95% CI: 1.13-2.88, p = 0 . 03 ), poor adherence (OR 3.90; 95% CI: 1.92-8.24, p = 0 . 001 ), and post-secondary education (OR 0.40; 95% CI: 0.22-0.68, p = 0 . 005 ). Conclusions Although favorable immuno-virologic outcomes could be achieved in this large ART program, immuno-virologic discordance was observed in a third of the patients. Focusing on intensified treatment preparation and adherence, young patients, males, persons with low educational status and most importantly baseline anemia assessment and management may help address predictors of poor immuno-virologic outcomes, and improve overall HIV program impact. Viral load testing in addition to the CD4 testing should be considered to identify, characterize and address negative immuno-virologic outcomes and discordance.

Background Patient retention and positive immuno-virologic outcomes are key goals of any HIV treatment program. Information on predictors of immunovirologic failure and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs. Methods The HIV AIDS Care and Anti-Retroviral Therapy (HACART) study was a large multi-center observational clinic-based cohort study of 2585 initially ART-naïve adults who started HAART between April 2008 and February 2009. A total of 628 out of 1780 patients alive and active at 12 months were randomly selected for in-depth analyses. Results Virologic suppression rate (<400 copies/mL) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm3) was 77.4% and Immuno-virologic discordance rate was 33%. In multivariable logistic regression controlling for adherence, risk of virologic failure was significantly associated with age <30 years (OR 1.76; 95% CI: 1.09 to 2.84), anemia (Hemoglobin <10 g/dL) (OR 1.60; 95% CI: 1.04 to 2.48), residential distance 51–100 kilometers (OR 0.41; 0.20–0.87) and post-secondary education (OR 0.53; 95% CI: 0.32 to 0.90). Risk of immunologic failure was associated with male gender (OR 1.65; 95% CI: 0.01 to 2.67), and age <30 years (OR 1.71; 95% CI: 1.19 to 2.63). Risk of immunovirologic discordance was associated with age <30 years (OR 1.64; 95% CI: 1.06 to 2.53) and post-secondary education (OR 0.61; 95% CI: 0.38 to 0.98). Conclusion Although favorable immuno-virologic outcomes can be achieved in this large ART program in Nigeria, immuno-virologic discordance was observed in a third of the patients. Baseline anemia assessment and management (anti-malarials, anti-helminthics, hematinics, etc) may help improve virologic outcomes. Intensifying treatment preparation and nutritional activities, and focusing on young patients, males and persons with less than post-secondary education may help improve favorable immuno-virologic outcomes.

Background Patient retention and positive immuno-virologic outcomes are key goals of any HIV treatment program. Information on predictors of immunovirologic failure and discordance and their associations with clinical, demographic, socio-economic and behavioral risk factors are not well described in Nigeria since HIV viral load testing is not routinely offered in public HIV treatment programs. Methods The HIV AIDS Care and Anti-Retroviral Therapy (HACART) study was a large multi-center observational clinic-based cohort study of 2585 initially ART-naïve adults who started HAART between April 2008 and February 2009. A total of 628 out of 1780 patients alive and active at 12 months were randomly selected for in-depth analyses. Results Virologic suppression rate (<400 copies/mL) was 76.7%, immunologic recovery rate (CD4 change from baseline ≥50 cells/mm3) was 77.4% and Immuno-virologic discordance rate was 33%. In multivariable logistic regression controlling for adherence, risk of virologic failure was significantly associated with age <30 years (OR 1.76; 95% CI: 1.09 to 2.84), anemia (Hemoglobin <10 g/dL) (OR 1.60; 95% CI: 1.04 to 2.48), residential distance 51–100 kilometers (OR 0.41; 0.20–0.87) and post-secondary education (OR 0.53; 95% CI: 0.32 to 0.90). Risk of immunologic failure was associated with male gender (OR 1.65; 95% CI: 0.01 to 2.67), and age <30 years (OR 1.71; 95% CI: 1.19 to 2.63). Risk of immunovirologic discordance was associated with age <30 years (OR 1.64; 95% CI: 1.06 to 2.53) and post-secondary education (OR 0.61; 95% CI: 0.38 to 0.98). Conclusion Although favorable immuno-virologic outcomes can be achieved in this large ART program in Nigeria, immuno-virologic discordance was observed in a third of the patients. Baseline anemia assessment and management (anti-malarials, anti-helminthics, hematinics, etc) may help improve virologic outcomes. Intensifying treatment preparation and nutritional activities, and focusing on young patients, males and persons with less than post-secondary education may help improve favorable immuno-virologic outcomes.

Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria.We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent.These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.