Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa

 

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dc.contributor.author Fatti, Geoffrey en_ZA
dc.contributor.author Mothibi, Eula en_ZA
dc.contributor.author Meintjes, Graeme en_ZA
dc.contributor.author Grimwood, Ashraf en_ZA
dc.date.accessioned 2015-12-20T16:05:15Z
dc.date.available 2015-12-20T16:05:15Z
dc.date.issued 2014 en_ZA
dc.identifier.citation Fatti, G., Mothibi, E., Meintjes, G., & Grimwood, A. (2013). Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa. PloS one, 9(6), e100273. doi:10.1371/journal.pone.0100273 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/15916
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0100273
dc.description.abstract Introduction Increasing numbers of patients are starting antiretroviral treatment (ART) at advanced age or reaching advanced age while on ART. We compared baseline characteristics and ART outcomes of older adults (aged ≥55 years) vs. younger adults (aged 25-54 years) in routine care settings in South Africa. METHODS: A multicentre cohort study of ART-naïve adults starting ART at 89 public sector facilities was conducted. Mortality, loss to follow-up (LTFU), immunological and virological outcomes until five years of ART were compared using competing-risks regression, generalised estimating equations and mixed-effects models. RESULTS: 4065 older adults and 86,006 younger adults were included. There were more men amongst older adults; 44.7% vs. 33.4%; RR = 1.34 (95% CI: 1.29-1.39). Mortality after starting ART was substantially higher amongst older adults, adjusted sub-hazard ratio (asHR) = 1.44 over 5 years (95% CI: 1.26-1.64), particularly for the period 7-60 months of treatment, asHR = 1.73 (95% CI: 1.44-2.10). LTFU was lower in older adults, asHR = 0.87 (95% CI: 0.78-0.97). Achievement of virological suppression was greater in older adults, adjusted odds ratio = 1.42 (95% CI: 1.23-1.64). The probabilities of viral rebound and confirmed virological failure were both lower in older adults, adjusted hazard ratios = 0.69 (95% CI: 0.56-0.85) and 0.64 (95% CI: 0.47-0.89), respectively. The rate of CD4 cell recovery (amongst patients with continuous viral suppression) was 25 cells/6 months of ART (95% CI: 17.3-33.2) lower in older adults. CONCLUSIONS: Although older adults had better virological outcomes and reduced LTFU, their higher mortality and slower immunological recovery warrant consideration of age-specific ART initiation criteria and management strategies. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Elderly en_ZA
dc.subject.other Adults en_ZA
dc.subject.other Death rates en_ZA
dc.subject.other Africa en_ZA
dc.subject.other HIV en_ZA
dc.subject.other Antiretrovirals en_ZA
dc.subject.other Viral load en_ZA
dc.title Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2014 Fatti et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Fatti, G., Mothibi, E., Meintjes, G., & Grimwood, A. (2014). Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/15916 en_ZA
dc.identifier.chicagocitation Fatti, Geoffrey, Eula Mothibi, Graeme Meintjes, and Ashraf Grimwood "Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/15916 en_ZA
dc.identifier.vancouvercitation Fatti G, Mothibi E, Meintjes G, Grimwood A. Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa. PLoS One. 2014; http://hdl.handle.net/11427/15916. en_ZA
dc.identifier.ris TY - Journal Article AU - Fatti, Geoffrey AU - Mothibi, Eula AU - Meintjes, Graeme AU - Grimwood, Ashraf AB - Introduction Increasing numbers of patients are starting antiretroviral treatment (ART) at advanced age or reaching advanced age while on ART. We compared baseline characteristics and ART outcomes of older adults (aged ≥55 years) vs. younger adults (aged 25-54 years) in routine care settings in South Africa. METHODS: A multicentre cohort study of ART-naïve adults starting ART at 89 public sector facilities was conducted. Mortality, loss to follow-up (LTFU), immunological and virological outcomes until five years of ART were compared using competing-risks regression, generalised estimating equations and mixed-effects models. RESULTS: 4065 older adults and 86,006 younger adults were included. There were more men amongst older adults; 44.7% vs. 33.4%; RR = 1.34 (95% CI: 1.29-1.39). Mortality after starting ART was substantially higher amongst older adults, adjusted sub-hazard ratio (asHR) = 1.44 over 5 years (95% CI: 1.26-1.64), particularly for the period 7-60 months of treatment, asHR = 1.73 (95% CI: 1.44-2.10). LTFU was lower in older adults, asHR = 0.87 (95% CI: 0.78-0.97). Achievement of virological suppression was greater in older adults, adjusted odds ratio = 1.42 (95% CI: 1.23-1.64). The probabilities of viral rebound and confirmed virological failure were both lower in older adults, adjusted hazard ratios = 0.69 (95% CI: 0.56-0.85) and 0.64 (95% CI: 0.47-0.89), respectively. The rate of CD4 cell recovery (amongst patients with continuous viral suppression) was 25 cells/6 months of ART (95% CI: 17.3-33.2) lower in older adults. CONCLUSIONS: Although older adults had better virological outcomes and reduced LTFU, their higher mortality and slower immunological recovery warrant consideration of age-specific ART initiation criteria and management strategies. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0100273 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa TI - Antiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africa UR - http://hdl.handle.net/11427/15916 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.