Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India

S. Nimkar, C. Valvi, D. Kadam, B. B. Rewari, A. Kinikar, N. Gupte, N. Suryavanshi, Andrea Deluca, A. Shankar, J. Golub, R. Bollinger, A. Gupta, I. Marbaniang, V. Mave

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives: India has the highest number of HIV-infected adolescents in Asia, but little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow-up (LTFU) and mortality among Indian adolescents. Methods: The analysis included adolescents (10–19 years old) starting antiretroviral therapy (ART) between 2005 and 2014 at BJ Government Medical College, Pune, India. LTFU was defined as missing more than three consecutive monthly visits. The competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for LTFU, with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. Results: Of 717 adolescents starting ART, 402 with complete data were included in the analysis. Of these, 61% were male and 80% were perinatally infected, and the median baseline CD4 count was 174 cells/μL. LTFU and mortality rates were 4.4 and 4.9/100-person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over 6 years. Age ≥ 15 years [adjusted SHR (aSHR) 2.44; 95% confidence interval (CI) 1.18–5.02] was a risk factor for LTFU. Cumulative mortality increased from 9.5% to 17.9% over 6 years. World Health Organization (WHO) stages III and IV [adjusted hazard ratio (aHR) 2.26; 95% CI: 1.14–4.48] and an increase in CD4 count by 100 cells/μL (aHR: 0.59; 95% CI: 0.43–0.83) were associated with mortality. Conclusions: A third of adolescents had been lost to follow-up or died by follow-up year 6. Older age was a risk factor for LTFU and advanced clinical disease for death. Strategies to improve retention counselling for older adolescents and closer clinical monitoring of all adolescents must be considered.

Original languageEnglish (US)
Pages (from-to)395-402
Number of pages8
JournalHIV Medicine
Issue number6
StatePublished - Jul 2018


  • India
  • adolescents
  • loss to follow-up
  • mortality

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)


Dive into the research topics of 'Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India'. Together they form a unique fingerprint.

Cite this