Morbidity and Mortality Weekly Report
Antiretroviral agents, AIDS (Disease) -- Epidemiology, AIDS (Disease) -- Treatment -- Statistics, AIDS (Disease) -- Sub-Saharan Africa -- Longitudinal studies
Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to a decline of about 30% in the global annual number of human immunodeficiency (HIV)–related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50%, and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15–24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited.
Age-related differences in enrollment characteristics and outcomes were analyzed among 16,421 patients aged ≥15 years starting ART in seven African countries (Côte d’Ivoire, Nigeria, Swaziland, Mozambique, Zambia, Uganda, and Tanzania) during 2004–2012. Patient characteristics and outcomes were compared across three age groups: adolescents and young adults (15–24 years), middle-aged adults (25–49 years), and older adults (≥50 years). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries (Côte d’Ivoire, Mozambique, and Tanzania) in both crude and multivariable analyses.
The higher risk for LTFU among adolescent and young adult ART enrollees, compared with older adults, increases their risk for death and increases the risk they will transmit HIV to seronegative sex partners. Effective interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and lower HIV incidence in this age group.
Centers for Disease Control and Prevention (CDC)
Auld AF, Agolory SG, Shiraishi RW, Wabwire-Mangen F, Kwesigabo G, Mulenga M, Hachizovu S, Asadu E, Tuho MZ, Ettiegne-Traore V, Mbofana F, Okello V, Azih C, Denison JA, Tsui S, Koole O, Kamiru H, Nuwagaba-Biribonwoha H, Alfredo C, Jobarteh K, Odafe S, Onotu D, Ekra KA, Kouakou JS, Ehrenkranz P, Bicego G, Torpey K, Mukadi YD, Praag Ev, Menten J, Mastro T, Hamilton CD, Swaminathan M, Dokubo EK, Baughman AL, Spira T, Colebunders R, Bangsberg D, Marlink R, Zee A, Kaplan J, Ellerbrock TV. Antiretroviral Therapy Enrollment Characteristics and Outcomes Among HIV-Infected Adolescents and Young Adults Compared with Older Adults -Seven African Countries, 2004-2013. MMWR Morb Mortal Wkly Rep. 2014 Nov 28;63(47):1097-1103. PubMed PMID: 25426651