Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India.
HIV Med
; 19(6): 395-402, 2018 07.
Article
em En
| MEDLINE
| ID: mdl-29573312
ABSTRACT
OBJECTIVES:
India has the highest number of HIV-infected adolescents in Asia, but little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents.METHODS:
The analysis included adolescents (10-19 years old) starting antiretroviral therapy (ART) between 2005 and 2014 at BJ Government Medical College, Pune, India. LTFU was defined as missing more than three consecutive monthly visits. The competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality.RESULTS:
Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male and 80% were perinatally infected, and the median baseline CD4 count was 174 cells/µL. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over 6 years. Age ≥ 15 years [adjusted SHR (aSHR) 2.44; 95% confidence interval (CI) 1.18-5.02] was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over 6 years. World Health Organization (WHO) stages III and IV [adjusted hazard ratio (aHR) 2.26; 95% CI 1.14-4.48] and an increase in CD4 count by 100 cells/µL (aHR 0.59; 95% CI 0.43-0.83) were associated with mortality.CONCLUSIONS:
A third of adolescents had been lost to follow-up or died by follow-up year 6. Older age was a risk factor for LTFU and advanced clinical disease for death. Strategies to improve retention counselling for older adolescents and closer clinical monitoring of all adolescents must be considered.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
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Serviços de Saúde do Adolescente
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Fármacos Anti-HIV
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Saúde do Adolescente
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Perda de Seguimento
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Child
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Female
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Humans
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Male
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article