Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Abstract

BackgroundReporting 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.SettingSeventeen adult HIV/AIDS clinics spread over nine countries in West Africa.MethodsData 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.ResultsAt 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.ConclusionThe 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.

Disobedience in Medication and Opportunistic Infection as Lead Factors to HIV/AIDS Mortality at Kencong Public Health Center, Jember

“…It is because of HIV-1 RNA virus which detected, the amount of CD4 and ARV regimens. The same result was found in research conducted by (Bernard et al, 2018) that stated poor clinical condition at initiation of antiretroviral therapy, CD4, Hb level, dan Body Mass Index (BMI) were associated as a predictor of mortality unrelated to age grouping.…”

Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis

“…[33][34][35][36][37][38][39][40][41] Studies have shown that undernutrition (ie, BMI <18.5 kg/m 2 ) is one of the main factors that significantly increases the risk of LTFU among adults living with HIV. [42][43][44][45][46][47] This finding may reflect that undernourished patients are more likely to develop OIs and later died but were under-reported to the HIV clinics due to a passive reporting system. 48 For example, a meta-analysis in SSA conducted by our team found that the risk of developing TB in undernourished adults living with HIV is twice that of well-nourished counterparts.…”

“…Some studies showed that undernutrition significantly increases the risk of LTUF among adults living with HIV. [42][43][44][45][46][47] Conversely, a few studies found that undernutrition and LTFU among adults living with HIV have no significant association. 47 Estimating the pooled effect of undernutrition on LTFU among adults living with HIV is important to provide evidence for healthcare workers and policymakers in designing specific interventions to minimise undernutrition-related LTFU among adults living with HIV.…”

“…There have been extensive primary studies on the relationship between undernutrition and LTFU among adults living with HIV in SSA. 42 45–48 50–57 However, these individual studies have reported inconsistent findings. Some studies showed that undernutrition significantly increases the risk of LTUF among adults living with HIV.…”

Getting local: focusing on communities to achieve greater impact in the next phase of the HIV response

“…The rapid scaling up of treatment has led to over 20 million people receiving life‐saving HIV medication; however, the quality of services has been inconsistent across different settings. In some places, a staggering two‐fifths (40%) of people on therapy are lost to follow‐up . Additionally, due to variable levels of viral suppression (caused by a shortened duration of anti‐retro‐viral therapy (ART) access and poor ART adherence at the individual level), the number of persons acquiring primary HIV‐resistant virus is increasing .…”