Antiretroviral Therapy Adherence, Virologic and Immunologic Outcomes in Adolescents Compared With Adults in Southern Africa

Datos Bibliográficos

ID23376794
AutoresJean B Nachega (0000-0002-2862-4443, Johns Hopkins University, autor de correspondencia), Michael Hislop, Hoang Nguyen (0009-0009-4941-4486), Hoàng Dũng Nguyễn (0000-0002-3338-3816, Johns Hopkins University, autor de correspondencia), David Dowdy (0000-0003-0481-7475, Johns Hopkins University), David W Dowdy, Richard E Chaisson (0000-0003-4710-925X, Johns Hopkins University, autor de correspondencia), Leon Regensberg, Mark F Cotton (0000-0003-2559-6034, Stellenbosch University), Mark Cotton, Gary Maartens (0000-0003-3080-6606, University of Cape Town)
Año2009
Volumen51
Número1
Páginas65-71
Fecha de publicación2009-05-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaJAIDS Journal of Acquired Immune Deficiency Syndromes (JOURNAL)
Identificadores de la revistaISSN: 1525-4135 • E-ISSN: 1944-7884
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/qai.0b013e318199072e
PMID19282780
PMCIDPMC2674125
OpenAlexW1974951626
IdiomaEN
Citas recibidas83
Referencias citadas34

OBJECTIVE: To determine adherence to and effectiveness of antiretroviral therapy (ART) in adolescents vs. adults in southern Africa. DESIGN: Observational cohort study. SETTING: Aid for AIDS, a private sector disease management program in southern Africa. SUBJECTS: Adolescents (age 11-19 years; n = 154) and adults (n = 7622) initiating ART between 1999 and 2006 and having a viral load measurement within 1 year after ART initiation. MAIN OUTCOME MEASURES: Primary: virologic suppression (HIV viral load < or = 400 copies/mL), viral rebound, and CD4 T-cell count at 6, 12, 18, and 24 months after ART initiation. Secondary: adherence assessed by pharmacy refills at 6, 12, and 24 months. Multivariate analyses: loglinear regression and Cox proportional hazards. RESULTS: A significantly smaller proportion of adolescents achieved 100% adherence at each time point (adolescents: 20.7% at 6 months, 14.3% at 12 months, and 6.6% at 24 months; adults: 40.5%, 27.9%, and 20.6% at each time point, respectively; P < 0.01). Patients achieving 100% 12-month adherence were significantly more likely to exhibit virologic suppression at 12 months, regardless of age. However, adolescents achieving virologic suppression had significantly shorter time to viral rebound (adjusted hazard ratio 2.03; 95% confidence interval: 1.31 to 3.13; P < 0.003). Adolescents were less likely to experience long-term immunologic recovery despite initial CD4 T-cell counts comparable to adults. CONCLUSIONS: Compared with adults, adolescents in southern Africa are less adherent to ART and have lower rates of virologic suppression and immunologic recovery and a higher rate of virologic rebound after initial suppression. Studies must determine specific barriers to adherence in this population and develop appropriate interventions.

Antiretroviral therapy · Cohort · Cohort study · Confidence interval · Hazard ratio · Human immunodeficiency virus (HIV) · Multivariate analysis · Observational study · Proportional hazards model · Retrospective cohort study · Viral load · Young adult · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Immunology · Internal Medicine · Medicine · Pediatrics