Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa

BMC Infectious Diseases

Linda-Gail Bekker³  Robin Wood³  Stephen D Lawn⁵  Heather Jaspan¹  Daniella Mark³  Richard Kaplan³  Pearl Holele⁴  Katharina Kranzer⁵  Mweete D Nglazi² 

[1]Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA

[2]International Union against Tuberculosis and Lung Disease, Paris, France

[3]The Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, and the Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa

[4]Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa

[5]Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

关键词: Africa;    virological failure;    mortality;    outcomes;    adolescents;    antiretroviral;   

Others  :  1175469
DOI  :  10.1186/1471-2334-12-21

 received in 2011-05-28, accepted in 2012-01-25,  发布年份 2012

【 摘 要 】

Background

Very few data are available on treatment outcomes of adolescents living with HIV infection (whether perinatally acquired or sexually acquired) in sub-Saharan Africa. The present study therefore compared the treatment outcomes in adolescents with those of young adults at a public sector community-based ART programme in Cape Town, South Africa.

Methods

Treatment outcomes of adolescents (9-19 years) were compared with those of young adults (20-28 years), enrolled in a prospective cohort between September 2002 and June 2009. Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders. The treatment outcomes were mortality, loss to follow-up (LTFU), immunological response, virological suppression and virological failure.

Results

883 patients, including 65 adolescents (47 perinatally infected and 17 sexually infected) and 818 young adults, received ART. There was no difference in median baseline CD4 cell count between adolescents and young adults (133.5 vs 116 cells/μL; p = 0.31). Overall mortality rates in adolescents and young adults were 1.2 (0.3-4.8) and 3.1 (2.4-3.9) deaths per 100 person-years, respectively. Adolescents had lower rates of virological suppression (< 400 copies/mL) at 48 weeks (27.3% vs 63.1%; p < 0.001). Despite this, however, the median change in CD4 count from baseline at 48 weeks of ART was significantly greater for adolescents than young adults (373 vs 187 cells/μL; p = 0.0001). Treatment failure rates were 8.2 (4.6-14.4) and 5.0 (4.1-6.1) per 100 person-years in the two groups. In multivariate analyses, there was no significant difference in LTFU and mortality between age groups but increased risk in virological failure [AHR 2.06 (95% CI 1.11-3.81; p = 0.002)] in adolescents.

Conclusions

Despite lower virological suppression rates and higher rates of virological failure, immunological responses were nevertheless greater in adolescents than young adults whereas rates of mortality and LTFU were similar. Further studies to determine the reasons for poorer virological outcomes are needed.

【 授权许可】

   
2012 Nglazi et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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