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Loss to follow‐up and mortality among HIV ‐infected adolescents receiving antiretroviral therapy in Pune, India
Author(s) -
Nimkar S,
Valvi C,
Kadam D,
Rewari BB,
Kinikar A,
Gupte N,
Suryavanshi N,
Deluca A,
Shankar A,
Golub J,
Bollinger R,
Gupta A,
Marbaniang I,
Mave V
Publication year - 2018
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12605
Subject(s) - medicine , hazard ratio , cumulative incidence , confidence interval , proportional hazards model , antiretroviral therapy , incidence (geometry) , demography , human immunodeficiency virus (hiv) , survival analysis , pediatrics , viral load , immunology , cohort , physics , sociology , optics
Objectives India has the highest number of HIV ‐infected adolescents in Asia, but little is known about their treatment outcomes. We assessed rates and factors associated with loss to follow‐up ( LTFU ) and mortality among Indian adolescents. Methods The analysis included adolescents (10–19 years old) starting antiretroviral therapy ( ART ) between 2005 and 2014 at BJ Government Medical College, Pune, India. LTFU was defined as missing more than three consecutive monthly visits. The competing‐risks method was used to calculate subdistribution hazard ratios ( SHR s) of predictors for LTFU , with death as the competing risk. Cox proportional hazard models were used to identify predictors of mortality. Results Of 717 adolescents starting ART , 402 with complete data were included in the analysis. Of these, 61% were male and 80% were perinatally infected, and the median baseline CD 4 count was 174 cells/μL. LTFU and mortality rates were 4.4 and 4.9/100‐person years, respectively. Cumulative LTFU incidence increased from 6% to 15% over 6 years. Age ≥ 15 years [adjusted SHR ( aSHR ) 2.44; 95% confidence interval ( CI ) 1.18–5.02] was a risk factor for LTFU . Cumulative mortality increased from 9.5% to 17.9% over 6 years. World Health Organization ( WHO ) stages III and IV [adjusted hazard ratio ( aHR ) 2.26; 95% CI: 1.14–4.48] and an increase in CD 4 count by 100 cells/μL (aHR: 0.59; 95% CI: 0.43–0.83) were associated with mortality. Conclusions A third of adolescents had been lost to follow‐up or died by follow‐up year 6. Older age was a risk factor for LTFU and advanced clinical disease for death. Strategies to improve retention counselling for older adolescents and closer clinical monitoring of all adolescents must be considered.