Treatment Outcomes in Patients Receiving Combination Antiretroviral Therapy in Central Hospital, Benin City, Nigeria

Purpose: This study investigated mortality rate, early CD4 responses, pattern of ARVs substitutions and medication adherence of HIV-infected patients on first-line triple combination antiretroviral therapy (ART) in Central Hospital, Benin City, Nigeria.
Methods: A retrospective assessment of 196 HIV-infected patients on first-line combination ART regimens was performed following 18 months of therapy. Medication adherence assessment of a 69-patient follow-up target group 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 was used to assess survival functions while log-rank test was applied to assess statistical difference at 95 % confidence interval (CI). Mean age of participants was 33.6 years (95 % CI, 32.1 - 35.2; 67.9 % were females.
Results: At ART initiation, 27.0 % were at WHO clinical stage II, 47.0 % at stage III. Mortality rate (N = 196) was 20.3 deaths per 100 patient-months; 31.6 % occurred in < 30 days while 52.6 % occurred post-120 days of treatment. The mean CD4-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. The level of adherence reported after 18 months on ART was 73.8 %.
Conclusion: In this setting, patients receiving ART showed significant improvements in CD4-cell status but adherence level was relatively poor. Patients were more stable on zidovudine-based or nevirapine-based regimens than on stavudine-based or efavirenz-based regimens. Early mortality rate was high, indicating a need for early interventions.