Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa

Abstract

Objective To determine adherence to and effectiveness of ART in adolescents versus adults in southern Africa Design Observational cohort study Setting Aid for AIDS, a private-sector disease-management program in southern Africa Subjects Adolescents (age 11–19 years; n=154) and adults (n=7,622) initiating ART between 1999 and 2006 and having a viral-load measurement within one year after ART initiation Main Outcome Measures Primary: virologic suppression (HIV viral load ≤400 copies/mL), viral rebound and CD4+ T-cell count at 6, 12, 18, 24 months after ART initiation. Secondary: adherence assessed by pharmacy refills at 6, 12 and 24 months. Multivariate analyses: log-linear regression and Cox proportional hazards. Results A significantly smaller proportion of adolescents achieved 100% adherence at each time point (adolescents: 20.7% at 6 months, 14.3% at 12 months, 6.6% at 24 months; adults: 40.5%, 27.9%, and 20.6% at each time point, respectively; p<0.01). Patients achieving 100% 12-month adherence were significantly more likely to exhibit virologic suppression at 12 months, regardless of age. However, adolescents achieving virologic suppression had significantly shorter time to viral rebound (adjusted hazard ratio 2.03; 95% CI 1.31–3.13; p<0.003). Adolescents were less likely to experience long-term immunologic recovery despite initial CD4+ T-cell counts comparable to adults. Conclusions Compared to adults, adolescents in southern Africa are less adherent to ART and have lower rates of virologic suppression and immunologic recovery and a higher rate of virologic rebound after initial suppression. Studies must determine specific barriers to adherence in this population and develop appropriate interventions.

HIV treatment and care services for adolescents: a situational analysis of 218 facilities in 23 sub‐Saharan African countries

“…This is consistent with literature [17], including a recent global consultation of young people living with HIV [18] that reported significant adherence barriers adolescents face on treatment. Moreover, facilities reported insufficient protocols for determining and managing both non‐adherence and LTFU, as well as limited use of counselling tools to inform their interventions.…”

Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

“…Our observation in this group also contradicts the literature from the region, which shows poor adherence and retention in ART care among adolescents relative to older age groups, which we had hypothesised as also applying to our cohort. [6][7][8] The majority of the unfavourable outcomes observed in our study were due to death. While the vast majority of those who died were HIV-positive, nine in 10 were on life-saving ART and CPT.…”

“…3 Mortality among adolescents with HIV infection, however, has tripled since 2000, and adolescents report poorer retention on antiretroviral therapy (ART) in similar high TB-HIV endemic settings. [4][5][6][7][8] Given the intertwined nature of these two epidemics in Zimbabwe, where seven in 10 TB patients have HIV, it remained to be assessed if poorer retention in HIV care was similar among adolescents receiving TB treatment. Although TB is among the 10 main causes of death among children worldwide, 9 childhood TB remains neglected in resource-limited settings TB treatment among the elderly (defined as persons aged 60 years in this study), has been found to be complicated by the treatment of comorbidities such as diabetes mellitus (DM), leading to increased adverse drug effects, mortality, high rates of recurrent TB and drug resistance.…”

Viral suppression after 12 months of antiretroviral therapy in low- and middle-income countries: a systematic review

“…Details of the cohorts from the papers and conference abstracts are presented in Table 1 and Table 2 (available at: http://www.who.int/bulletin/ volumes/90/5/12-112946), respectively. Two reports 29,52 described outcomes from the same cohort but made use of two different thresholds to define viral suppression. A further seven repo rts 26,27,43,44,47,53,55 described outcomes using two or more thresholds of viral suppression.…”