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

Mweete D Nglazi,Stephen D Lawn,Pearl Holele,Heather Jaspan,Robin Wood,Linda-Gail Bekker,Katharina Kranzer,Daniella Mark,Richard Kaplan

doi:10.1186/1471-2334-12-21

Abstract

BackgroundVery 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.MethodsTreatment 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.Results883 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.ConclusionsDespite 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.

Highlights

Very few data are available on treatment outcomes of adolescents living with HIV infection in sub-Saharan Africa
Adolescents had a median age of 11.5 years [interquartile range (IQR) 10.0-17.3] with 44 (67.7%) in early (9-14 years), 8 (12.3%) in middle (15-17 years) and 13 (20.0%) in late (18-19 years) adolescence
There was no difference in duration of follow-up in the ART cohort in adolescents compared with young adults [median 34.6 months; IQR of 17.8-48.1 vs. 31.1 months (IQR: 15.3-49.2); p = 0.59]

Summary

Introduction

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 burden of HIV in the Adolescence is a complex development phase of marked psychosocial, behavioural, physiological and cognitive changes [1,4] that exacerbate the challenges of an HIV-positive status and the requirement to adhere to a structured treatment regimen. It is a time when there is hyperawareness of physical appearance [5,6,7] and a time of experimentation, risk-taking and significant peer influence with a need to assert an individual identity that is distinct from caregivers [8,9]. Low levels of virological suppression [12,14,15,16,17], increased risk of virological failure [17], loss to follow-up (LTFU) [15,16] and death have all been described [17]

Methods

Results

Discussion

Conclusion