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

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dc.contributor.authorFatti, Geoffreyen_ZA
dc.contributor.authorMothibi, Eulaen_ZA
dc.contributor.authorMeintjes, Graemeen_ZA
dc.contributor.authorGrimwood, Ashrafen_ZA
dc.date.accessioned2015-12-20T16:05:15Z
dc.date.available2015-12-20T16:05:15Z
dc.date.issued2014en_ZA
dc.description.abstractIntroduction 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.identifier.apacitationFatti, 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/11427/15916en_ZA
dc.identifier.chicagocitationFatti, 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/11427/15916en_ZA
dc.identifier.citationFatti, 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.0100273en_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
dc.identifier.urihttp://hdl.handle.net/11427/15916
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0100273
dc.identifier.vancouvercitationFatti 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2014 Fatti et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherElderlyen_ZA
dc.subject.otherAdultsen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherAfricaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherAntiretroviralsen_ZA
dc.subject.otherViral loaden_ZA
dc.titleAntiretroviral treatment outcomes amongst older adults in a large multicentre cohort in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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