Disengagement From HIV Care and Failure of Second-Line Therapy in Nigeria: A Retrospective Cohort Study, 2005–2017

Abstract

Background: Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). Methods:We conducted a retrospective cohort study of PLHIV aged .15 years who started second-line ART at a tertiary center in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazard models were used to investigate factors associated with: (1) viral failure (HIV-1 RNA .1000 copies/mL), (2) immunologic failure (CD4 count decrease or ,100 cells/mm 3 ), and (3) severe weight loss (.10% of bodyweight), after .6 months of second-line ART.Results: Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (interquartile range 3.7-8.5). Of these, 26% (89/341) subsequently reentered care. Disengagement was associated with male gender, age ,30 years, lower education level, and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared with elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04 to 0.70). Conclusion:Adverse outcomes were common during second-line ART. However, reengagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and reengage those who have disengaged from care.

Current syphilis infection in virally suppressed people living with HIV: a cross-sectional study in eastern China

“…A meta-analysis study found that the overall prevalence of syphilis among HIV-infected patients in China reached 19.9% ( 29 ), 7.3% in sub-Saharan Africa ( 34 ) and 19.9% in France ( 35 ). The 5.6% syphilis infection in our study was lower than the above results, the rationale for this was: our study participants were PLWH with viral suppression, who themselves had higher adherence and lower risk behaviors ( 36 ). Syphilis has emerged as a major public health threat, particularly among MSM in China who have a high incidence of syphilis and HIV/syphilis co-infection ( 33 ).…”

“…The possible reasons were: first the participants in this study are HIV-infected patients who had HIV virally suppressed and had good treatment compliance. People with low levels of education tend to have poor adherence to treatment, resulting in unsuppressed HIV viral load ( 36 ). Therefore, they were not included in this study.…”

Limited emergence of resistance to integrase strand transfer inhibitors (INSTIs) in ART-experienced participants failing dolutegravir-based antiretroviral therapy: a cross-sectional analysis of a Northeast Nigerian cohort

“…Disengagement from care is also a significant problem, although it is possible to re-engage with a substantial proportion of cases, 55 highlighting the benefits that can be gained through outreach and tracing efforts. Given that INSTI-based long-acting injectables are being considered as pre-exposure prophylaxis, 56 it is crucial to conduct further analyses of resistance across SSA over extended periods and to monitor newly diagnosed individuals for INSTI resistance.…”