Table 2.
Proportions With an Elevated Viral Load (>400 Copies/mL) and Baseline Predictors of an Elevated Viral Load After Starting Antiretroviral Therapy
| Elevated VL | Months 3–12 of ART | Elevated VL | Months 18–30 of ART | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Crude Analysis | Multivariable Analysisa | Crude Analysis | Multivariable Analysisa | |||||||||||
| Characteristic | No. (%) | RR | (95% CI) | P Value | Adjusted RR | (95% CI) | P Value | No. (%) | RR | (95% CI) | P Value | Adjusted RR | (95% CI) | P Value |
| CD4 category, cells/μL | <.0001 | <.0001 | <.0001 | <.0001 | ||||||||||
| <200 | 98 (16.1) | 2.73 | (2.03–3.70) | <.0001 | 2.21 | (1.60–3.07) | <.0001 | 43 (23.4) | 2.56 | (1.66–3.93) | <.0001 | 2.40 | (1.52–3.79) | <.0001 |
| 200–499 | 78 (5.9) | Ref | … | Ref | … | 39 (9.2) | Ref | … | Ref | … | ||||
| ≥500 | 27 (5.2) | 0.89 | (.56–1.39) | .61 | 0.96 | (.62–1.48) | .84 | 5 (3.3) | 0.27 | (.10–.70) | .007 | 0.30 | (.12–0.74) | .010 |
| Age, y | .090 | .077 | .97 | .66 | ||||||||||
| 18–24 | 29 (8.3) | 0.82 | (.54–1.24) | 0.99 | (.66–1.48) | 13 (10.7) | 0.92 | (.49–1.71) | 1.13 | (.61–2.08) | ||||
| 25–34 | 103 (8.9) | Ref | … | Ref | … | 40 (11.2) | Ref | … | Ref | … | ||||
| 35–49 | 65 (9.1) | 1.02 | (.73–1.41) | 0.82 | (.58–1.13) | 29 (12.2) | 1.04 | (.62–1.72) | 0.78 | (.47–1.31) | ||||
| ≥50 | 6 (3.3) | 0.37 | (.16–.86) | 0.36 | (.16–.82) | 5 (10.9) | 0.87 | (.31–2.37) | 1.14 | (.42–3.08) | ||||
| Sex | ||||||||||||||
| Female | 123 (7.3) | Ref | … | Ref | … | 58 (10.8) | Ref | … | Ref | … | ||||
| Male | 80 (10.6) | 1.46 | (1.40–1.52) | <.0001 | 1.13 | (.84–1.53) | .41 | 29 (13.0) | 1.22 | (.77–1.91) | .40 | 0.30 | (.55–1.46) | .67 |
| WHO stage | <.0001 | .0001 | .020 | .80 | ||||||||||
| I/II | 132 (6.5) | Ref | … | Ref | … | 58 (9.4) | Ref | … | Ref | … | ||||
| III | 58 (17.5) | 2.71 | (2.48–2.97) | 2.39 | (1.60–3.56) | 23 (19.7) | 2.15 | (1.49–3.11) | 1.18 | (.61–2.30) | ||||
| IV | 11 (20.4) | 3.14 | (1.44–6.84) | 2.01 | (1.06–4.10) | 6 (27.3) | 2.60 | (1.13–5.97) | 1.20 | (.48–3.02) | ||||
| Pregnancy in women | ||||||||||||||
| No | 119 (7.6) | Ref | … | … | Ref | 57 (11.4) | Ref | … | Ref | … | ||||
| Yes | 4 (3.2) | 0.42 | (.13–1.37) | .15 | 0.48 | (.17–1.32) | .156 | 1 (2.7) | 0.18 | (.01–1.34) | .095 | 0.31 | (.03–2.35) | .26 |
| Concurrent TB | ||||||||||||||
| No | 172 (7.8) | Ref | … | … | Ref | 69 (10.1) | Ref | … | Ref | … | ||||
| Yes | 31 (13.3) | 1.72 | (1.17–2.51) | .005 | 0.68 | (.42–1.12) | .13 | 18 (22.0) | 2.29 | (1.30–3.81) | .001 | 1.18 | (.61–2.26) | .61 |
| First NRTI | .013 | .52 | <.0001 | .0037 | ||||||||||
| Tenofovir | 194 (8.1) | Ref | … | Ref | … | 78 (10.6) | Ref | … | Ref | … | ||||
| Zidovudine | 3 (18.8) | 2.18 | (.55–8.70) | 1.51 | (.66–3.41) | 6 (54.6) | 4.90 | (2.45–9.79) | 3.60 | (1.43–9.09) | ||||
| Stavudine | 5 (25.0) | 3.12 | (2.30–4.23) | 1.31 | (.57–3.05) | 3 (42.9) | 4.54 | (1.21–16.92) | 2.49 | (.84–7.38) | ||||
| NNRTI | ||||||||||||||
| Efavirenz | 199 (8.3) | Ref | … | Ref | … | 84 (11.2) | Ref | … | Ref | … | ||||
| Nevirapine | 2 (6.5) | 0.76 | (.41–1.37) | .36 | 0.64 | (.20–2.11) | .47 | 3 (60.0) | 6.40 | (3.41– 12.01) | <.0001 | 1.88 | (.64–5.48) | .25 |
| Prior ART exposure | ||||||||||||||
| No | 194 (8.1) | … | … | … | 82 (11.0) | … | … | … | ||||||
| Yes | 9 (19.2) | 2.36 | (.98–5.72) | .056 | 1.43 | (.67–3.05) | .34 | 5 (27.8) | 4.00 | (1.92–8.40) | < .0001 | 2.85 | (1.41–5.73) | .003 |
| Year starting ART | ||||||||||||||
| 2014 | 70 (8.8) | Ref | … | … | … | 64 (13.5) | Ref | … | … | … | ||||
| 2015 | 133 (8.0) | 0.86 | (.60–1.24) | .42 | … | … | 23 (8.0) | 0.79 | (.39–1.52) | .49 | … | … | ||
Modified Poisson regression with generalized estimating equations to account for clustering was used, including 10 multiple imputed datasets for missing covariate values. Models were controlled for time on ART and healthcare facility.
Abbreviations: ART, antiretroviral therapy; CI, confidence interval; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; RR, risk ratio; TB, tuberculosis; VL, viral load; WHO, World Health Organization.
aMultivariable models included baseline CD4 cell count category, age, sex, baseline WHO stage, pregnancy, concurrent TB, first NRTI in ART regimen, NNRTI in ART regimen, and prior ART exposure.