Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration
Received 25 April 2018
Accepted for publication 19 September 2018
Published 16 November 2018 Volume 2018:10 Pages 239—252
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Bassel Sawaya
Charlotte Bernard,1,2 Eric Balestre,1,2 Patrick A Coffie,3–5 Serge Paul Eholie,3,4 Eugène Messou,3–6 Viviane Kwaghe,7 Benson Okwara,8 Adrien Sawadogo,9 Yao Abo,10 François Dabis,1,2 Nathalie de Rekeneire1,2
On behalf of the International Epidemiological Database to evaluate Aids (IeDEA) West Africa Collaboration
1INSERM, Centre INSERM U1219-Epidémiologie-Biostatistique, Bordeaux, France; 2University of Bordeaux, School of Public Health (ISPED), Bordeaux, France; 3Département de Dermatologie et d’Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire; 4Unit of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d’Ivoire; 5Programme PAC-CI, Treichville University Teaching Hospital, Abidjan, Ivory Coast; 6Center of Care, Research and Training (CePReF), Yopougon-Attié Hospital, Abidjan, Ivory Coast; 7University of Abuja Teaching Hospital, Abuja, Nigeria; 8University of Benin City Teaching Hospital, Benin City, Nigeria; 9Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso Polytechnic University, Bobo-Dioulasso, Burkina Faso; 10National Blood Transfusion Center (CNTS), Abidjan, Ivory Coast
Background: Reporting mortality and lost to follow-up (LTFU) by age is essential as older HIV-positive patients might be at risk of long-term effects of living with HIV and/or taking antiretroviral therapy (ART). As age effects might not be linear and might impact HIV outcomes in the oldest more severely, people living with HIV (PLHIV) aged 50–59 years and PLHIV aged >60 years were considered separately.
Setting: Seventeen adult HIV/AIDS clinics spread over nine countries in West Africa.
Methods: Data were collected within the International Epidemiological Databases to Evaluate AIDS West Africa Collaboration. ART-naïve PLHIV-1 adults aged >16 years initiating ART and attending ≥2 clinic visits were included (N=73,525). Age was divided into five groups: 16–29/30–39/40–49/50–59/≥60 years. The age effect on mortality and LTFU was evaluated with Kaplan–Meier curves and multivariable Cox proportional hazard regressions.
Results: At month 36, 5.9% of the patients had died and 47.3% were LTFU. Patients aged ≥60 (N=1,736) and between 50–59 years old (N=6,792) had an increased risk of death in the first 36 months on ART (adjusted hazard ratio=1.66; 95% CI: 1.36–2.03 and adjusted hazard ratio=1.31; 95% CI: 1.15–1.49, respectively; reference: <30 years old). Patients ≥60 years old tend to be more often LTFU.
Conclusion: The oldest PLHIV presented the poorest outcomes, suggesting that the PLHIV aged >50 years old should not be considered as a unique group irrespective of their age. Tailored programs focusing on improving the care services for older PLHIV in Sub-Saharan Africa are clearly needed to improve basic program outcomes.
Keywords: HIV, aging, ART, mortality, lost to follow-up, Sub-Saharan Africa
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