Long-term HIV treatment outcomes and associated factors in sub-Saharan Africa: multicountry longitudinal cohort analysis

Seth C. Inzaule, Stefanie Kroeze, Cissy M. Kityo, Margaret Siwale, Sulaimon Akanmu, Maureen Wellington, Marleen de Jager, Prudence Ive, Kishor Mandaliya, Wendy Stevens, Kim Steegen, Immaculate Nankya, T. Sonia Boender, Pascale Ondoa, Kim C. E. Sigaloff, Tobias F. Rinke de Wit, Raph L. Hamers

Research output: Contribution to journalArticleAcademicpeer-review


Objective:In a multicountry prospective cohort of persons with HIV from six countries between 2007 and 2015, we evaluated long-term outcomes of first-line non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART), and risk factors for loss-to-follow-up, mortality, virological failure, and incomplete CD4 +T-cell recovery.Methods:We calculated cumulative incidence of lost-to-follow-up, death, virological failure (VL ≥ 1000 cps/ml) and incomplete CD4 +T-cell recovery (<500 cells/μl) at successive years, using Kaplan-Meier and Cox regression.Results:Of 2735 participants, 58.0% were female, median age was 37 (interquartile range [IQR] 32-43) years, and median pre-ART CD4 +T-cell count was 135 (IQR 63-205)/μl. Total follow-up time was 7208 person-years (median 24.3 months, IQR 18.7-58.3). Deaths by any cause and loss to follow-up occurred mostly during the first year of ART (84%, 201/240 and 56%, 199/353, respectively). During their first 6 years of ART, 71% (95% confidence interval [CI] 69.0-73.7) were retained on first-line, and among those 90-93% sustained viral suppression (<1000 cps/ml); CD4 +T-cell recovery was incomplete in 60% (220/363) of participants. The risk factors associated with poor outcomes during long-term ART were: for loss-to-follow-up, recent VL ≥1000 cps/ml, recent CD4 +T-cell count ≤50 cells/μl, age <30 years, being underweight; for mortality, recent CD4 +T-cell count ≤50 cells/μl; and, for virological failure, age <40 years, recent CD4 +T-cell count ≤200 cells/μl, poor adherence, male sex, and low-level viremia.Conclusion:To achieve long-term ART success towards the UNAIDS targets, early ART initiation is crucial, coupled with careful monitoring and retention support, particularly in the first year of ART. Male and youth-centred care delivery models are needed to improve outcomes for those vulnerable groups.

Original languageEnglish
Pages (from-to)1437-1447
Number of pages11
JournalAIDS (London, England)
Issue number10
Publication statusPublished - 1 Aug 2022

Cite this