Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia

Michael J. Vinikoor, Jessica Joseph, Jonas Mwale, Melissa A. Marx, Fastone M. Goma, Lloyd B. Mulenga, Jeffrey S.A. Stringer, Joseph J. Eron, Benjamin H. Chi

Research output: Contribution to journalArticlepeer-review

Abstract

We analyzed the association of age at antiretroviral therapy (ART) initiation with CD4+ T cell count recovery, death, and loss to follow-up (LTFU) among HIV-infected adults in Zambia. We compared baseline characteristics of patients by sex and age at ART initiation [categorized as 16-29 years, 30-39 years, 40-49 years, 50-59 years, and 60 years and older]. We used the medication possession ratio to assess adherence and analysis of covariance to measure the adjusted change in CD4+ T cell count during ART. Using Cox proportional hazard regression, we examined the association of age with death and LTFU. In a secondary analysis, we repeated models with age as a continuous variable. Among 92,130 HIV-infected adults who initiated ART, the median age was 34 years and 6,281 (6.8%) were aged ≥50 years. Compared with 16-29 year olds, 40-49 year olds (-46 cells/mm3), 50-59 year olds (-53 cells/mm3), and 60+ year olds (-60 cells/mm3) had reduced CD4+ T cell gains during ART. The adjusted hazard ratio (AHR) for death was increased for individuals aged ≥40 years (AHR 1.25 for 40-49 year olds, 1.56 for 50-59 year olds, and 2.97 for 60+ year olds). Adherence and retention in care were poorest among 16-29 year olds but similar in other groups. As a continuous variable, a 5-year increase in age predicted reduced CD4+ T cell count recovery and increased risk of death. Increased age at ART initiation was associated with poorer clinical outcomes, while age <30 years was associated with a higher likelihood of being lost to follow-up. HIV treatment guidelines should consider age-specific recommendations.

Original languageEnglish (US)
Pages (from-to)949-955
Number of pages7
JournalAIDS research and human retroviruses
Volume30
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Immunology
  • Virology
  • Infectious Diseases

Fingerprint Dive into the research topics of 'Age at antiretroviral therapy initiation predicts immune recovery, death, and loss to follow-up among HIV-infected adults in urban Zambia'. Together they form a unique fingerprint.

Cite this