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HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study.

Shroufi, Amir; Gunguwo, Hilary; Dixon, Mark; Nyathi, Mary; Ndebele, Wedu; Saint-Sauveur, Jean-François; Taziwa, Fabian; Ferreyra, Cecilia; Viñoles, Mari-Carmen; Ferrand, Rashida A.
AIDS; 27(12): 1971-8, 2013 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-23525033

OBJECTIVES:

In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults.

DESIGN:

We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe.

METHODS:

Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months).

RESULTS:

One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001).

CONCLUSION:

With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized.
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