Zhou Siyanai, Toska Elona, Gwampi Bulelani, Johnson Leigh F, Tolmay Janke, Saal Wylene, Leon Zea, Knight Lucia, Cluver Lucie
Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
J Int AIDS Soc. 2025 Jun;28(6):e26522. doi: 10.1002/jia2.26522.
Mortality among adolescents living with HIV (ALHIV) remains a global health problem. We lack granular (age- and sex-disaggregated) data on mortality among ALHIV, hence, this study aims to assess all-cause mortality among ALHIV in a low-resource setting.
All adolescents ever initiated on antiretroviral treatment (ART, N = 1107) and their HIV-negative peers (N = 456) aged 10-19 years, recruited as part of the Mzantsi Wakho study cohort, were followed up between 2014 and 2022 (yielding 12,427.7 person-years of follow-up). First, we assessed the proportion of deaths and estimated crude mortality incidence rates per 100 person-years of follow-up and their 95% confidence intervals, stratified by HIV status, sex and mode of HIV acquisition (vertical vs. sexual). We then estimated adjusted incidence rate ratios (IRRs) using Poisson regression adjusted for time-varying age, sex and time on ART. Last, we used the Cox proportional hazards regression model to estimate the risk of death by ART adherence.
A total of 1563 adolescents and young people were included in this analysis, 70.8% ALHIV and 57% female. More deaths occurred in ALHIV compared to their HIV-negative peers (8.3% vs. 0.4%, p<0.001). Among ALHIV, we observed a significantly higher proportion of deaths among males compared to females (10.7% vs. 7.1%, p = 0.036). Overall, mortality increased significantly with age, and males had a higher risk of mortality compared to females. Adolescents and youth living with vertically acquired HIV had a higher risk of mortality than those living with sexually acquired HIV. Comparing mortality rates by mode of HIV acquisition stratified by age and sex, mortality risk was higher among females aged 20+ years with vertically acquired HIV (IRR: 3.61, 95% CI 1.48-8.82) compared to females with sexually acquired HIV of the same age group. In a sub-sample analysis, sustained ART adherence was associated with a lower risk of death (aHR: 0.44, 95% CI 0.23-0.85).
ALHIV experience higher all-cause mortality than their HIV-negative peers, despite having initiated ART. Among ALHIV, mortality risk was higher among males and adolescents who acquired HIV vertically. Strategies to improve survival among ALHIV, including adolescent-tailored care and support for adherence to ART, are urgently needed.
感染艾滋病毒的青少年（ALHIV）的死亡率仍然是一个全球健康问题。我们缺乏关于ALHIV死亡率的详细（按年龄和性别分类）数据，因此，本研究旨在评估资源匮乏地区ALHIV的全因死亡率。
作为Mzantsi Wakho研究队列的一部分，招募了所有开始接受抗逆转录病毒治疗（ART，N = 1107）的10至19岁青少年及其艾滋病毒阴性同龄人（N = 456），并在2014年至2022年期间进行随访（随访时间为12427.7人年）。首先，我们评估了死亡比例，并估计了每100人年随访的粗死亡率发病率及其95%置信区间，按艾滋病毒状态、性别和艾滋病毒感染方式（垂直感染与性传播感染）分层。然后，我们使用泊松回归估计调整后的发病率比（IRR），并对随时间变化的年龄、性别和接受ART的时间进行了调整。最后，我们使用Cox比例风险回归模型来估计ART依从性导致的死亡风险。
本分析共纳入1563名青少年和年轻人，其中70.8%为ALHIV，57%为女性。与艾滋病毒阴性同龄人相比，ALHIV的死亡人数更多（8.3%对0.4%，p<0.001）。在ALHIV中，我们观察到男性的死亡比例明显高于女性（10.7%对7.1%，p = 0.036）。总体而言，死亡率随年龄显著增加，男性的死亡风险高于女性。垂直感染艾滋病毒的青少年和年轻人比性传播感染艾滋病毒的人有更高的死亡风险。按年龄和性别分层比较艾滋病毒感染方式的死亡率，20岁及以上垂直感染艾滋病毒的女性的死亡风险高于同年龄组性传播感染艾滋病毒的女性（IRR：3.61，95%CI 1.48 - 8.82）。在子样本分析中，持续的ART依从性与较低的死亡风险相关（aHR：0.44，95%CI 0.23 - 0.85）。
尽管开始接受ART治疗，但ALHIV的全因死亡率高于其艾滋病毒阴性同龄人。在ALHIV中，男性和垂直感染艾滋病毒的青少年的死亡风险更高。迫切需要制定提高ALHIV生存率的策略，包括针对青少年的护理和对ART依从性的支持。
