Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa.
PLoS One
; 9(6): e100273, 2014.
Article
in En
| MEDLINE
| ID: mdl-24949879
ABSTRACT
INTRODUCTION:
Increasing numbers of patients are starting antiretroviral treatment (ART) at advanced age or reaching advanced age while on ART. We compared baseline characteristics and ART outcomes of older adults (aged ≥55 years) vs. younger adults (aged 25-54 years) in routine care settings in South Africa.METHODS:
A multicentre cohort study of ART-naïve adults starting ART at 89 public sector facilities was conducted. Mortality, loss to follow-up (LTFU), immunological and virological outcomes until five years of ART were compared using competing-risks regression, generalised estimating equations and mixed-effects models.RESULTS:
4065 older adults and 86,006 younger adults were included. There were more men amongst older adults; 44.7% vs. 33.4%; RRâ=â1.34 (95% CI 1.29-1.39). Mortality after starting ART was substantially higher amongst older adults, adjusted sub-hazard ratio (asHR)â=â1.44 over 5 years (95% CI 1.26-1.64), particularly for the period 7-60 months of treatment, asHRâ=â1.73 (95% CI 1.44-2.10). LTFU was lower in older adults, asHRâ=â0.87 (95% CI 0.78-0.97). Achievement of virological suppression was greater in older adults, adjusted odds ratioâ=â1.42 (95% CI 1.23-1.64). The probabilities of viral rebound and confirmed virological failure were both lower in older adults, adjusted hazard ratiosâ=â0.69 (95% CI 0.56-0.85) and 0.64 (95% CI 0.47-0.89), respectively. The rate of CD4 cell recovery (amongst patients with continuous viral suppression) was 25 cells/6 months of ART (95% CI 17.3-33.2) lower in older adults.CONCLUSIONS:
Although older adults had better virological outcomes and reduced LTFU, their higher mortality and slower immunological recovery warrant consideration of age-specific ART initiation criteria and management strategies.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
HIV Infections
/
Anti-HIV Agents
Type of study:
Clinical_trials
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Africa
Language:
En
Journal:
PLoS One
Journal subject:
CIENCIA
/
MEDICINA
Year:
2014
Document type:
Article
Affiliation country:
Sudáfrica