Cohort Profile: The Nigerian HIV Geriatric Cohort Study

Abstract Background: An estimated 280,000 adults aged 50 years and above live with HIV in Nigeria, a population set to increase with ART efficacy and expanding coverage. To learn how elderly people living with HIV (EPLHIV) in Nigeria fare, despite not being prioritized by the national treatment program, and to deepen knowledge for their differentiated care and achieve better outcomes, the Nigerian HIV Geriatric Cohort (NHGC) was setup. Methods: Patient-level data spanning the period 2004 to 2018, obtained from comprehensive HIV treatment hospitals, that are supported by four major PEPFAR-implementing partners in Nigeria was used. These 4 entities collaborated as member organizations of the Nigeria Implementation Science Alliance. We defined geriatric/elderly as those aged 50 years and above. From de-identified treatment records, demographic and clinical data of EPLHIV ≥50-year-old at ART initiation during the review period was extracted, merged into a single REDcap® database, and described using STATA 13. Results: A total of 101,652 unique EPLHIV entries were analysed. This cohort’s data was of 53,608 (52.7%) women, 51,037 (71.4%) of EPLHIV identified as married and 33,446 (51.1%) unemployed. Mean age was 57.1 years (SD=6.9) with average duration on ART as 4.6 years (SD=3.5). ART profile showed that 88,792 (95.7%) were on 1st-line and 55,905 (64.9%) were on TDF-based regimens. Mean-body mass index (BMI) was 23.0 kg/m2 (SD=5.4 kg/m2) with 56,010(55.1%), 19,619(19.3%) and 8844 (8.7%) showing normal (18.5kg/m2–24.9kg/m2), overweight (BMI 25- <30kg/m2) and obese (BMI ≥30kg/m2) ranges respectively. Hypertensive readings (systolic-BP >140mmHg or diastolic-BP >90mmHg) was found in 21,550 (21.2%) ELHIV records. Mean CD4 count was 420cells/µL (SD=285cells/µL) and 83,660(82.3%) had a viral load result showing <1000copies/ml. As for treatment outcomes, available records showed that 54.1% were active-in-treatment, 28.4% were lost-to-follow-up and 6.8% died. Poor population death records and aversion to autopsies makes it almost impossible to estimate AIDS-related deaths. Conclusions: The study described the clinical and non-clinical profile of EPLHIV in Nigeria. This study provides vital information for stakeholders in HIV prevention, care and treatment to understand the characteristics of EPLHIV. Findings from further analysis of this cohort will be applied to improve the quality of health of EPLHIV.