Impact of Unplanned Care Interruption on CD4 Response Early After ART Initiation in a Nigerian Cohort

Abstract

The authors conducted a retrospective cohort study of unplanned care interruption (UCI) among adults initiating antiretroviral therapy (ART) from 2009 to 2011 in a Nigerian clinic. The authors used repeated measures regression to model the impact of UCI on CD4 count upon return to care and rate of CD4 change on ART. Among 2496 patients, 83% had 0, 15% had 1, and 2% had ≥2 UCIs. Mean baseline CD4 for those with 0, 1, or ≥2 UCIs was 228/cells/mm3, 355/cells/mm3, and 392/cells/mm3 (P < .0001), respectively. The UCI was associated with a 62 CD4 cells/mm3 decrease (95% confidence interval [CI]: −78 to −45) at next measurement. In months 1 to 6 on ART, patients with 0 UCI gained 10 cells/μL/mo (95% CI: 7–4). Those with 1 and ≥2 UCIs lost 2and 5 cells/μL/mo (95% CI: −18 to 13 and −26 to 16). Patients with UCI did not recover from early CD4 losses associated with UCI. Preventing UCI is critical to maximize benefits of ART.