Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration.

Abstract

BackgroundReporting mortality and lost to follow-up (LTFU) by age is essential as older HIV-positive patients might be at risk of long-term effects of living with HIV and/or taking antiretroviral therapy (ART). As age effects might not be linear and might impact HIV outcomes in the oldest more severely, people living with HIV (PLHIV) aged 50–59 years and PLHIV aged >60 years were considered separately.SettingSeventeen adult HIV/AIDS clinics spread over nine countries in West Africa.MethodsData were collected within the International Epidemiological Databases to Evaluate AIDS West Africa Collaboration. ART-naïve PLHIV-1 adults aged >16 years initiating ART and attending ≥2 clinic visits were included (N=73,525). Age was divided into five groups: 16–29/30–39/40–49/50–59/≥60 years. The age effect on mortality and LTFU was evaluated with Kaplan–Meier curves and multivariable Cox proportional hazard regressions.ResultsAt month 36, 5.9% of the patients had died and 47.3% were LTFU. Patients aged ≥60 (N=1,736) and between 50–59 years old (N=6,792) had an increased risk of death in the first 36 months on ART (adjusted hazard ratio=1.66; 95% CI: 1.36–2.03 and adjusted hazard ratio=1.31; 95% CI: 1.15–1.49, respectively; reference: <30 years old). Patients ≥60 years old tend to be more often LTFU.ConclusionThe oldest PLHIV presented the poorest outcomes, suggesting that the PLHIV aged >50 years old should not be considered as a unique group irrespective of their age. Tailored programs focusing on improving the care services for older PLHIV in Sub-Saharan Africa are clearly needed to improve basic program outcomes.