Fwemba I, Musonda P
University of Zambia, School of Public Health, P.O. Box 5010, Ridgeway Campus, Lusaka, Zambia.
Public Health. 2017 Jun;147:8-14. doi: 10.1016/j.puhe.2017.01.022. Epub 2017 Mar 6.
In resource-limited setting, there is scarce evidence comparing antiretroviral therapy (ART) outcomes among HIV-infected adolescents to that of other age groups.
We analysed data from 25 ART facilities in Lusaka District, comparing treatment-naïve ART-eligible young adolescents (10-14 years), older adolescents (15-19) and young adults (20-24 years) initiating first-line ART to those aged 24 years or older. The adjusted relative risk (RR) of failure to achieve an adequate CD4 response (defined as failure to increase CD4 count by ≥ 50 cells/mm at 6 months or by ≥ 100 cells/mm) at 6 or 12 months after ART initiation was modelled using log-binomial regression. The effect of age group on mortality and loss to follow-up (LTFUP; ≥60 days since scheduled visit date) was estimated using adjusted Cox proportional hazards models, respectively. This was a routine retrospective design using program data.
Of the 94,023 patients initiating ART from May 2004 to February 2011, 1303 (1.4%) were young adolescents, 1440 (1.5%) were older adolescents and 5825 (6.2%) were young adults. 85,455 (90.9%) were 24 years or older at the time of ART initiation. Compared with adults, both young adolescents (RR: 0.88, 95% confidence interval [CI]: 0.76-1.01 at 6 months and RR: 0.80, 95% CI: 0.69-0.93 at 12 months) and older adolescents (RR: 0.82, 95% CI: 0.71-0.95 at 6 months) were less likely to achieve adequate CD4 response. No evidence of a difference in mortality risk was observed among older adolescents (hazard ratio [HR] 1.20, 95% CI: 0.93-1.56) compared with adults; however, there was a reduced risk of mortality in young adolescents compared with adults (HR: 0.61, 95% CI: 0.40-0.92). Young adolescents were less likely to be LTFUP following ART initiation (HR: 0.74, 95% CI: 0.59-0.92), while older adolescents and young adults were reported to be more likely to drop out of care (HR: 1.54 95% CI: 1.33-1.78; HR: 1.51 95% CI: 1.40-1.63 respectively).
Older adolescents and young adults had poorer ART treatment outcomes, including failure to achieve adequate CD4 recovery and failure to remain in long-term care, when compared with adults. Interventions are necessary to help increase outcomes and retention in care.
在资源有限的环境中，将感染艾滋病毒青少年的抗逆转录病毒治疗（ART）结果与其他年龄组进行比较的证据很少。
我们分析了卢萨卡区25个ART机构的数据，将开始接受一线ART治疗的初治合格青少年（10 - 14岁）、年长青少年（15 - 19岁）和青年成年人（20 - 24岁）与24岁及以上的人群进行比较。使用对数二项回归模型对ART开始后6个月或12个月时未能实现足够的CD4反应（定义为6个月时CD4细胞计数增加≥50个细胞/mm³或1个月时增加≥100个细胞/mm³失败）的调整相对风险（RR）进行建模。分别使用调整后的Cox比例风险模型估计年龄组对死亡率和失访（LTFUP；自预定就诊日期起≥60天）的影响。这是一项使用项目数据的常规回顾性设计。
在2004年5月至2011年2月开始接受ART治疗的94,023名患者中，1303名（1.4%）是青少年，1440名（1.5%）是年长青少年，5825名（6.2%）是青年成年人。85,455名（90.9%）在开始ART治疗时年龄为24岁及以上。与成年人相比，青少年（6个月时RR：0.88，95%置信区间[CI]：0.76 - 1.01；12个月时RR：0.80，95%CI：0.69 - 0.93）和年长青少年（6个月时RR：0.82，95%CI：0.71 - 0.95）实现足够CD4反应的可能性较小。与成年人相比，未观察到年长青少年的死亡风险有差异（风险比[HR]1.20，95%CI：0.93 - 1.56）；然而，与成年人相比，青少年的死亡风险降低（HR：0.61，95%CI：0.40 - 0.92）。青少年开始ART治疗后失访的可能性较小（HR：0.74，95%CI：0.59 - 0.92），而据报告年长青少年和青年成年人更有可能退出治疗（HR：1.54，95%CI：1.33 - 1.78；HR：1.51，95%CI：1.40 - 1.63）。
与成年人相比，年长青少年和青年成年人的ART治疗结果较差，包括未能实现足够的CD4恢复以及未能长期坚持治疗。需要采取干预措施来帮助改善治疗结果和提高治疗依从性。
