2011. 6 p.
Plos ONE, Volume 6, Issue 4, e19261
Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce. The authors developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (less than or equal to 10 years), adolescents (11-19 years), and adults (greater than or equal to 20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, the authors applied a weighted analysis that assumes 50% of lost patients had died. A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21,982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other factors than age alone predicted mortality. Mortality was higher among males, patients with a low initial CD4 cell count, patients with advanced WHO clinical disease stage, and shorter duration of time receiving cART. The crude mortality rate was lower for children (22.8 per 1000 person-years; 95% CI: 16.1, 29.5) than for adolescents (36.5 per 1000 person-years; 95% CI: 26.3, 46.8) and adults (37.5 per 1000 person-years; 95% CI: 35.9, 39.1).
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