Virological and Immunologic Outcome of HIV Infected Drug Experienced Adults in North Central Nigeria

Background: Antiretroviral therapy (ART) has decreased the mortality and morbidity among people living with HIV and AIDS (PLWH). Viral load (VL) has been used by clinicians as primary tool recommended by WHO to monitor patients progress on High Antiretroviral active therapy (HAART). There is a paucity of information on Virological and immunological outcomes of HIV infected drug experience adults’ patients in north central Nigeria. We conducted a tertiary hospital based cross-sectional study at federal medical centre in Nasarawa state between December 2019 to march 2020. Method: A total of 474 HIV positive adult were enrolled using a Systematic random technique. Blood specimen for CD+4 T cells count and viral load determination were obtained and PCR-Real time and Flow-cytometry were used to estimate plasma viral load and CD4+ T cell count respectively. Frequency was used to determine percentage and logistic regression was used to determine the associated factors with Virological suppression and immunology outcome in patients on HAART 95% CI and odd ratio (OR) was used to measure strength of association. Results: From the 474 cohort that were enrolled 34.6% were on WHO baseline clinical stage IIV and 57.8% of cohort were on HAART, started treatment regimen in less than a year with 42.2% diagnosed and confirmed with HIV infection between 1-5years. 57.8% were transferred into the centre as a major reason for enrolment. 57.8% has history of TB treatment in the past while 42.2% of the study participants who were eligible for treatment initiation were determine by CD4+ counts with a median interquartile range of 180 (92-300) cells/mm3. virological suppression (VL level < 1000 copies/ml) was found in 85% (95% CI 77.7, 86.1) of study participants, and it has been associated with CD4 cell count between 250 and 400 cells/mm3 (adjusted odds ratio (AOR) = 2.56; 95% CI 1.14, 5.75) and > 499 cells/mm3 (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 40 years old (AOR = 5.40; 95% CI 2.3, 10.01). Similarly, favourable immunological status (≥250 cells/mm3 for male and ≥ 600 cells/mm3 for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm3, age at enrolment of 26 through 40 years old, and urban residency were significantly associated with favourable immunological outcome. Conclusion: Low Immunological recovery among study cohort was observed although viral suppression was shown in majority of the HIV infected adult who are on HAART. Early initiation on HAART should be encouraged in other to achieve immunological recovery and viral suppression in order to achieve the USAIDS- 90-90-90 to end HIV pandemic by 2030.