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

Simple item page
dc.contributor.authorNglazi, Mweeteen_ZA
dc.contributor.authorKranzer, Katharinaen_ZA
dc.contributor.authorHolele, Pearlen_ZA
dc.contributor.authorKaplan, Richarden_ZA
dc.contributor.authorMark, Daniellaen_ZA
dc.contributor.authorJaspan, Heatheren_ZA
dc.contributor.authorLawn, Stephenen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.date.accessioned2015-11-18T03:54:16Z
dc.date.available2015-11-18T03:54:16Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: 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 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. METHODS: Treatment 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. RESULTS: 883 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/muL; 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/muL; 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. CONCLUSIONS: Despite 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.en_ZA
dc.identifier.apacitationNglazi, M., Kranzer, K., Holele, P., Kaplan, R., Mark, D., Jaspan, H., ... Bekker, L. (2012). Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/15059en_ZA
dc.identifier.chicagocitationNglazi, Mweete, Katharina Kranzer, Pearl Holele, Richard Kaplan, Daniella Mark, Heather Jaspan, Stephen Lawn, Robin Wood, and Linda-Gail Bekker "Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa." <i>BMC Infectious Diseases</i> (2012) http://hdl.handle.net/11427/15059en_ZA
dc.identifier.citationNglazi, M. D., Kranzer, K., Holele, P., Kaplan, R., Mark, D., Jaspan, H., ... & Bekker, L. G. (2012). Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa. BMC infectious diseases, 12(1), 21.en_ZA
dc.identifier.ris TY - Journal Article AU - Nglazi, Mweete AU - Kranzer, Katharina AU - Holele, Pearl AU - Kaplan, Richard AU - Mark, Daniella AU - Jaspan, Heather AU - Lawn, Stephen AU - Wood, Robin AU - Bekker, Linda-Gail AB - BACKGROUND: 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 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. METHODS: Treatment 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. RESULTS: 883 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/muL; 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/muL; 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. CONCLUSIONS: Despite 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. DA - 2012 DB - OpenUCT DO - 10.1186/1471-2334-12-21 DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa TI - Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa UR - http://hdl.handle.net/11427/15059 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15059
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2334-12-21
dc.identifier.vancouvercitationNglazi M, Kranzer K, Holele P, Kaplan R, Mark D, Jaspan H, et al. Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa. BMC Infectious Diseases. 2012; http://hdl.handle.net/11427/15059.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDesmond Tutu HIV Centreen_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 Licenseen_ZA
dc.rights.holder2012 Nglazi et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Infectious Diseasesen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcinfectdis/en_ZA
dc.subject.otherantiretroviralen_ZA
dc.subject.otheradolescentsen_ZA
dc.subject.otheroutcomesen_ZA
dc.subject.othermortalityen_ZA
dc.subject.othervirological failureen_ZA
dc.subject.otherAfricaen_ZA
dc.titleTreatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Nglazi_Treatment_outcomes_2012.pdf
Size:
211.11 KB
Format:
Adobe Portable Document Format
Description:
Download
Collections
Journal Articles