Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda

• Published in: PloS one 2011-04, Vol.6 (4), p.e19261-e19261
• Main Authors: Bakanda, Celestin, Birungi, Josephine, Mwesigwa, Robert, Nachega, Jean B, Chan, Keith, Palmer, Alexis, Ford, Nathan, Mills, Edward J
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adolescents; Adult; Adults; Age; Age Factors; AIDS; Analysis; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology; CD4 antigen; CD4-Positive T-Lymphocytes - cytology; CD4-Positive T-Lymphocytes - virology; Child; Children; Cohort Studies; Drug Therapy, Combination; Female; Health aspects; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - mortality; HIV patients; Human immunodeficiency virus; Humans; Male; Males; Medical research; Medicine; Mortality; Patient compliance; Patients; Proportional Hazards Models; Regression analysis; Regression models; Risk groups; Social and Behavioral Sciences; Survival; Teenagers; Therapy; Treatment Outcome; Uganda; Youth
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0019261

Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce. We developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (≤10 years), adolescents (11-19 years), and adults (≥20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we applied a weighted analysis that assumes 50% of lost patients had died. A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was higher among males (p