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

Nglazi MD, Kranzer K, Holele P, Kaplan R, Mark D, Jaspan H, Lawn SD, Wood R, Bekker LG - BMC Infect. Dis. (2012)

Bottom Line: Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: 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. Mweete.Nglazi@hiv-research.org.za

ABSTRACT

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.

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Adjusted Cox proportional hazard regression model for virological failure among adolescents and young adults. Virological failure was defined as 2 consecutive viral loads above 1000 copies/mL and adjustment was made for age, baseline CD4 count and viral load.
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Figure 1: Adjusted Cox proportional hazard regression model for virological failure among adolescents and young adults. Virological failure was defined as 2 consecutive viral loads above 1000 copies/mL and adjustment was made for age, baseline CD4 count and viral load.

Mentions: The rate of virological failure among all patients was 5.2 (95% CI 4.3-6.3) per 100 person-years. The rate of virological failure in adolescents and young adults were 8.2 (95% CI 4.6-14.4) and 5.0 (95% CI 4.1-6.1) per 100 person-years, respectively. There was a significantly higher rate of virological failure in adolescents compared to young adults [AHR 2.06 (95% CI 1.11-3.81; p = 0.02)] (Figure 1). However, this association was weakened [AHR 1.51 (95% CI 0.68-3.33); p = 0.31] in a sub-analysis comparing perinatally infected adolescents and young adults.


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

Nglazi MD, Kranzer K, Holele P, Kaplan R, Mark D, Jaspan H, Lawn SD, Wood R, Bekker LG - BMC Infect. Dis. (2012)

Adjusted Cox proportional hazard regression model for virological failure among adolescents and young adults. Virological failure was defined as 2 consecutive viral loads above 1000 copies/mL and adjustment was made for age, baseline CD4 count and viral load.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295677&req=5

Figure 1: Adjusted Cox proportional hazard regression model for virological failure among adolescents and young adults. Virological failure was defined as 2 consecutive viral loads above 1000 copies/mL and adjustment was made for age, baseline CD4 count and viral load.
Mentions: The rate of virological failure among all patients was 5.2 (95% CI 4.3-6.3) per 100 person-years. The rate of virological failure in adolescents and young adults were 8.2 (95% CI 4.6-14.4) and 5.0 (95% CI 4.1-6.1) per 100 person-years, respectively. There was a significantly higher rate of virological failure in adolescents compared to young adults [AHR 2.06 (95% CI 1.11-3.81; p = 0.02)] (Figure 1). However, this association was weakened [AHR 1.51 (95% CI 0.68-3.33); p = 0.31] in a sub-analysis comparing perinatally infected adolescents and young adults.

Bottom Line: Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: 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. Mweete.Nglazi@hiv-research.org.za

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus