Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

Abstract

Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm3, IQR:130–547 vs. 277cells/mm3, IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

The HIV care cascade in sub‐Saharan Africa: systematic review of published criteria and definitions

“…Thirty‐nine studies reported on initiation of ART [2,21,23,28,33,34,37,40‐42,44‐47,49‐54,23,55‐62,64,66,67‐75], with 25 (64%) defining numerators and denominators. Thirty‐two were longitudinal, four of mixed design and three were cross‐sectional.…”

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,20‐32,34,36,40‐43,46,56,58,65,68,69,72‐74,76‐93,95‐99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

“…Thirty‐nine studies reported on initiation of ART [ 2 , 21 , 23 , 28 , 33 , 34 , 37 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ], with 25 (64%) defining numerators and denominators. Thirty‐two were longitudinal, four of mixed design and three were cross‐sectional.…”

“…A total of 52 studies reported numbers or percentages of patients retained at this step [ 8 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 36 , 40 , 41 , 42 , 43 , 46 , 56 , 58 , 65 , 68 , 69 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 95 , 96 , 97 , 98 , 99 ]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”

“…A total of 52 studies reported numbers or percentages of patients retained at this step [8,[20][21][22][23][24][25][26][27][28][29][30][31][32]34,36,[40][41][42][43]46,56,58,65,68,69,[72][73][74][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][95][96][97][98][99]. The majority of studies (32 studies, 62%) covering this step were longitudinal studies.…”