Immunologic and virological response to ART among HIV infected individuals at a tertiary hospital in Ghana ¹Obiri-Yeboah Dorcas, School of Medical Sciences, University of Cape Coast 2Ibrahim Baidoo, Public Health Unit, Cape Coast Teaching Hospital 3Arthur Francis, Cape Coast Teaching Hospital 4Hayfron-Benjamin Anna, School of Nursing, University of Cape Coast, Ghana 5Ayisi-Addo Stephen, National AIDS/STI Control Program, Ghana

Outline Background Aim and objectives Methods Results Discussion and Conclusion

Background- WHO “90 90 90” policy 90% of infected people should know their status 90% of infected people should be on ART 90% on ART should achieve virological suppression by 12 months

Treatment failure Viral loads persistently more than 1000 copies of HIV RNAs/ml of blood plasma after 12 months on ART and/or Immunologically when CD4 counts are persistently at or below 250 cells/mm3 (ART Guideline, 2016)

Study aim To analyze the determinants of immunological and virological response to ART among HIV infected individuals in a tertiary facility in Ghana.

Methods Design: analytical cross sectional study with a retrospective component Location: Cape Coast Teaching Hospital (CCTH) ART Centre Participants: Clients aged ≥18 years on ART for ≥6 months Sampling strategy: systematic (1: 3) sampling Total participants: 440 Data collection: client records, questionnaire and laboratory tests

Results Variable Mean (SD)/n (%) Age (yrs.) Mean 45.5 (±11.6) 18-30 38 (8.6) 31-60 367 (83.4) >60 35 (8.0) Gender   Male 94 (21.4) Female 346 (78.6) HIV type 1 432 (98.1) 1 & 2 8 (1.8) tuberculosis Yes 13 (2.9) No 427 (97.1)

Virological response

Immunological response

Associated factors Variable CD4 <350, {n (%)} OR (95%CI) P value *aOR (95%CI) Employment   Unemployed 34 (19.7) - Unskilled employment 129 (74.6) 0.6 (0.3-0.9) 0.04 0.6 (0.3-1.2) 0.16 Skilled employment 10 (5.8) 0.4 (0.2-1.2) 0.09 0.2 (0.1-0.7) 0.01 Tuberculosis Diagnosis No 165 (95.4) Yes 8 (4.6) 2.4 (0.7-8.2) 0.15 8.5 (1.1-73.0) 0.05 Plasma viral load after 6 mths on ART (N=139) ≤1000 copies/ml 53 (38.1) >1000 copies/ml 86 (61.9) 2.2 (1.4 – 3.6) 0.001 2.0 (1.2-3.2)

Discussion/Recommendations 6 months and 12 months on ART, participants who had viral copies <1000/ml rose from 149 (47.0%) to 368 (89.5%) respectively. Mean CD4 count rose from 215.1 cells/mm3, 386.6 cells/mm3, and 579.6 cells/mm3 “Treat All” policy and early ART initiation recommended to improve outcome (WHO, 2017) Quality monitoring and routine VL testing is essential at all levels

Associated factors Poor response associated with TB- screening and treatment will improve ART response (Soeters et al. 2014) Other factors which affect adherence to ART needs to be explored to improve outcome (Elul et al. 2013) Employment situation Gender Disclosure to sexual partners (Obiri-Yeboah et al. 2016) Age etc

Conclusion Strict adherence to the national policy on HIV testing, management of positive clients and full implementation of the “Treat All” policy in Ghana could achieve, if nothing at all, the third “90, 90, 90” target by 2020.

References Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. WHO (2017). Geneva Guidelines for Antiretroviral Therapy in Ghana. (2016). National AIDS Control Programme, Accra Ghana, Soeters, H. M., S. Napravnik, M. R. Patel, J. J. J. Eron and A. Van Rie (2014). "The effect of tuberculosis treatment on virologic and CD4+ cell count response to combination antiretroviral therapy: a systematic review." AIDS 28(2): 245-255.

Obiri-Yeboah. D, Amoako-Sakyi. D, Baidoo. I, Adu-Oppong. A and R Obiri-Yeboah. D, Amoako-Sakyi. D, Baidoo. I, Adu-Oppong. A and R. T (2016). "The ‘Fears’ of Disclosing HIV Status to Sexual Partners: A Mixed Methods Study in a Counseling Setting in Ghana." AIDS and Behavior. Elul, B., P. Basinga, H. Nuwagaba-Biribonwoha, S. Saito, D. Horowitz, D. Nash, J. Mugabo, V. Mugisha, E. Rugigana, R. Nkunda and A. Asiimwe (2013). "High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda." PLoS One 8(1): e53586.

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