Baseline characteristics, immunological and virological markers and current ART adherence.

<p>ART = antiretroviral therapy. ARV = antiretroviral. IQR = interquartile range. VL = viral load. NNRTI = non-nucleoside reverse transcriptase inhibitor. PI = protease inhibitor. MSF/MoH = Médecins Sans Frontières/Ministry of Health.</p

Logistic regression model for raised viral load any time after ≥6 months on MSF/MoH-ART (n = 1027).

<p>ART = antiretroviral therapy. OR = odds ratio. CI = confidence interval. ARV = antiretroviral. VL = viral load. MSF/MoH = Médecins Sans Frontières/Ministry of Health.</p

Logistic regression model for raised viral load after ≥6 months on MSF/MoH-ART in ARV-experienced patients (n = 154).

<p>VL = viral load. ART = antiretroviral therapy. ARV = antiretroviral. OR = odds ratio. NNRTI = non-nucleoside reverse transcriptase inhibitor. MSF/MoH = Médecins Sans Frontières/Ministry of Health. WHO = World Health Organisation. Number of patients with raised viral load included in model = 32 (21%).</p

Reasons for missing ARVs before joining the MSF/MoH clinic and association with raised viral load in ARV-experienced patients after ≥6 months on MSF/MoH-ART (n = 158).

<p>ART = antiretroviral therapy. OR = odds ratio. VL = viral load. CI = confidence interval. MSF/MoH = Médecins Sans Frontières/Ministry of Health.</p

Predictors of Raised Viral Load during Antiretroviral Therapy in Patients with and without Prior Antiretroviral Use: A Cross-Sectional Study

OBJECTIVES: In Lagos, Nigeria, Médecins Sans Frontières (MSF) and the Ministry of Health (MoH) commenced free antiretroviral treatment (ART) in a hospital-based clinic. We performed a cross-sectional study to compare factors associated with raised viral load between patients with (“experienced”) and without (“naïve”) prior antiretroviral (ARV) exposure at commencement of ART at the clinic. We also examined factors influencing ARV adherence in experienced patients prior to clinic entry. METHODS: We included adult patients receiving ART from MSF who answered a questionnaire about previous antiretroviral use. Multivariate logistic regression was used to estimate odds ratios (OR) for raised viral load (≥1000 copies/mL). RESULTS: 1246 (96%) patients answered: 1075 (86%) reported no, and 171 (14%) some, prior ARV exposure. ARV-naïve patients were more immunosuppressed at baseline: 65% vs 37% (p<0.001) had CD4<200; 17% vs 9% (p = 0.013) were WHO stage 4. Proportionately more experienced than naïve patients had raised viral loads (20% vs 9%, p<0.001) on ART in the MSF/MoH clinic. Raised viral load was associated with prior ARV experience (adjusted OR = 3.74, 95%CI 2.09–6.70, p<0.001) and complete interruption of current ART (adjusted OR = 3.71, 95%CI 2.06–6.68, p<0.001). Higher CD4 at time of VL and a higher self-rated score of recent adherence were associated with lower OR of a raised viral load. Among experienced patients who missed pills before joining MSF/MoH, most common reasons were because ARVS were not affordable (58%) or available (33%), with raised viral load associated with being unsure how to take them (OR = 3.16, 95%CI 1.10–9.12, p = 0.033). CONCLUSIONS: Patients previously exposed to ARVs had increased OR of raised viral load. The cost and availability of ARVs were common reasons for missing ARVs before joining the MSF/MoH clinic, and inadequate patient knowledge was associated with raised viral load