Mortality and losses to follow‐up among adolescents living with HIV in the Ie DEA global cohort collaboration

• Published in: Journal of the International AIDS Society Vol. 21; no. 12
• Main Authors: Kariminia, Azar, Law, Matthew, Davies, Mary‐Ann, Vinikoor, Michael, Wools‐Kaloustian, Kara, Leroy, Valeriane, Edmonds, Andrew, McGowan, Catherine, Vreeman, Rachel, Fairlie, Lee, Ayaya, Samuel, Yotebieng, Marcel, Takassi, Elom, Pinto, Jorge, Adedimeji, Adebola, Malateste, Karen, Machado, Daisy M, Penazzato, Martina, Hazra, Rohan, Sohn, Annette H
• Format: Journal Article
• Language: English
• Published: Geneva John Wiley & Sons, Inc 01.12.2018
• Subjects: Acquired immune deficiency syndrome; Age; AIDS; Child development; Collaboration; Health care; HIV; Hospitals; Human immunodeficiency virus; Mortality; Preventive medicine; Teenagers; Malawi; United States > US; Southern Africa; South Africa; Zimbabwe; Zambia; Ivory Coast; France
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25215

Abstract Introduction We assessed mortality and losses to follow‐up ( LTFU ) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (Ie DEA ) consortium. Methods Cohorts in the Asia‐Pacific, the Caribbean, Central, and South America, and sub‐Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV ( ALHIV ) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow‐up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple‐drug antiretroviral therapy (triple‐ ART ). Results Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four‐year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p  <   0.001). Overall, there were higher hazards of death for females (adjusted sub‐hazard ratio (as HR ) 1.19, 95% confidence interval ( CI ) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest as HR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (as HR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (as HR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (as HR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest as HR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (as HR 1.27, 95% CI 1.18 to 1.37) or in rural settings (as HR 1.21, 95% CI 1.13 to 1.29), and starting triple‐ ART after 2006 (highest as HR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). Conclusions Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population‐specific reasons for death and LTFU .