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Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults

Mutevedzi, PC; Lessells, RJ; Rodger, AJ; Newell, ML; (2011) Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults. PLOS ONE , 6 (7) , Article e21795. 10.1371/journal.pone.0021795. Green open access

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Abstract

Objective: To assess whether treatment outcomes vary with age for adults receiving antiretroviral therapy (ART) in a large rural HIV treatment cohort.Design: Retrospective cohort analysis using data from a public HIV Treatment & Care Programme.Methods: Adults initiating ART 1(st) August 2004 - 31(st) October 2009 were stratified by age at initiation: young adults (16-24 years) mid-age adults (25-49 years) and older (>= 50 years) adults. Kaplan-Meier survival analysis was used to estimate mortality rates and age and person-time stratified Cox regression to determine factors associated with mortality. Changes in CD4 cell counts were quantified using a piecewise linear model based on follow-up CD4 cell counts measured at six-monthly time points.Results: 8846 adults were included, 808 (9.1%) young adults; 7119 (80.5%) mid-age adults and 919 (10.4%) older adults, with 997 deaths over 14,778 person-years of follow-up. Adjusting for baseline characteristics, older adults had 32% excess mortality (p = 0.004) compared to those aged 25-49 years. Overall mortality rates (MR) per 100 person-years were 6.18 (95% CI 4.90-7.78); 6.55 (95% CI 6.11-7.02) and 8.69 (95% CI 7.34-10.28) for young, mid-age and older adults respectively. In the first year on ART, for older compared to both young and mid-aged adults, MR per 100 person-years were significantly higher; 0-3 months (MR: 27.1 vs 17.17 and 21.36) and 3-12 months (MR: 9.5 vs 4.02 and 6.02) respectively. CD4 count reconstitution was lower, despite better virological response in the older adults. There were no significant differences in MR after 1year of ART. Baseline markers of advanced disease were independently associated with very early mortality (0-3 months) whilst immunological and virological responses were associated with mortality after 12months.Conclusions: Early ART initiation and improving clinical care of older adults are required to reduce high early mortality and enhance immunologic recovery, particularly in the initial phases of ART.

Type: Article
Title: Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults
Open access status: An open access version is available from UCL Discovery
DOI: 10.1371/journal.pone.0021795
Publisher version: http://dx.doi.org/10.1371/journal.pone.0021795
Language: English
Additional information: © 2011 Mutevedzi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The Africa Centre for Health and Population Studies is funded by a core grant from the Wellcome Trust (Grant number 082384/Z/07/Z) [www.wellcome.ac.uk]. The Hlabisa HIV Treatment and Care Programme receives support through the United States Agency for International Development (USAID) and the President's Emergency Plan (PEPFAR) under the terms of Award No. 674-A-00-08-00001-00. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the USAID or the United States Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Keywords: RECONSTITUTION INFLAMMATORY SYNDROME, HIV-INFECTION, INCOME COUNTRIES, FOLLOW-UP, OLDER-ADULTS, HIGH-RATES, SCALE-UP, PROGRAM, COHORT, OUTCOMES
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1356692
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