1. 1 Predictors of Immunological Failure Among Adult Patients Receiving ART at an urban, HIV Clinic in Uganda Dr. Muhumuza Simon (M.D, MPH) Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program [MJAP] 16 th International Conference on AIDS & STIs in Africa (ICASA 2011) Addis Ababa, Ethiopia, December 4-8, 2011

2.  In recent years, there has been a rapid scale up of HAART in resource limited settings  In Uganda, ART coverage is ~ 50% (290,000)  Monitoring patients on ART remains a challenge  Most ART centers use immunological criteria (CD4 cell count) to monitor HIV treatment success 2

3.  Established in November 2004 with funding from CDC-PEPFAR  Supports provision of comprehensive HIV/AIDS services in 2 National Referral Hospitals and 11 HIV clinics  Currently, the program supports > 29,000 patients on ART (~ 10% of the national ART coverage)  ~ 97% of ART patients are on first line treatment 3

4. 4 One of the MJAP supported HIV clinic in Mulago National Referral Hospital

5. 5 To determine factors associated with immunological failure among adult patients receiving HAART

6.  Retrospective cohort analysis of data of 5,306 patients at Mulago ISS clinic between 2009-2011, on 1 st line treatment for 1 year  Immunological failure was defined as having a CD4 cell count < pre-therapy value after 1 year on HAART  This was compared to the patients demographics, pre- therapy CD4 count, WHO stage, HAART regimen, mean adherence levels and incidence of OIs 6

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8. 8  Females 3,508 (66%); Males 1,798 (34%)  Median age was 33 yrs (28-39 IQ Range)  Median pre-therapy CD4 =169 cells/mm3 (87-227 IQ Range)  Immunological failure observed in 336 (6.3%)

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10. VariableAOR (95% CI)P Value 1. Gender Male2.35 (1.89-2.94)0.000 2. Age < 35 years1.84 (1.42-2.37)0.018 3. Regimen category NVP based1.44 (1.14-1.82)0.001 4. Adherence level < 95%1.90 (1.25-2.87)0.001 5. Pre-therapy CD4 count <100 cells/mm32.58 (1.92- 3.45)0.000 10

11. 6. WHO StageCasesControlsOdds95% CI I 569460.050.04 - 0.07 II 10517240.060.05 – 0.07 III 12518500.060.05 – 0.08 IV 504500.110.08 – 0.14  Score test for trend of odds: Pr>Chi2 = 0.005 11

12. Immunological failure is significantly associated with: * Male gender * Age < 35 years * ARV regimen (NVP based) * Adherence level (<95%) * Pre-therapy CD4 count * WHO stage 12

13.  HIV care and treatment programs should emphasize adherence during each patient encounter - Male gender -Young patients  EFV should be preferred against NVP as a 1 st line drug  Early HIV testing and linkage to care before severe immunosuppression develops is critical 13

14.  PEPFAR/CDC  Ministry of Health, Uganda  MJAP Staff  Patients 14