Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries.
Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries.
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DOI：
10.1371/journal.pone.0103864
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Elul B
中科院分区：
文献类型：
--
作者：
Eduardo E;Lamb MR;Kandula S;Howard A;Mugisha V;Kimanga D;Kilama B;El-Sadr W;Elul B
关于撒哈拉以南非洲50岁以上成年人接受艾滋病毒护理的信息有限。我们使用从2005年1月至2010年12月登记接受HIV护理的391，111名≥15岁成人和184，689名开始ART的患者纵向数据，比较了肯尼亚，莫桑比克，卢旺达和坦桑尼亚199家诊所的老年人（≥50岁）和年轻人之间的特征和结果。我们计算了年龄≥50岁的新入组和活跃的接受HIV护理和开始ART的成年人随时间推移的比例;失访（LTF）的累积发生率，并记录了入组和ART开始后一年的死亡，以及ART开始后的CD 4+应答。从2005年至2010年，新登记接受艾滋病毒护理的50岁以上成年人的百分比稳定在10%，而新开始抗逆转录病毒治疗的50岁以上成年人的百分比（10% [2005]-12% [2010]），随访中的积极性（10% [2005]-14%（2010]）和ART中的积极性（10% [2005]-16%（2010]）显著增加。入组一年后，老年患者的LTF发生率显著降低（33.1% vs. 32.6%[40-49岁]、40.5%[25-39岁]和56.3%[15-24岁]; p值<0.0001），但记录的死亡发生率显著更高（6.0% vs. 5.0% [40-49岁]、4.1% [25-39岁]和2.8% [15-24岁]; p值<0.0001）。所有年龄段的LTF在ART开始后比开始前低，老年人的LTF比年轻人少。在85，763例具有基线和随访CD 4+计数的ART患者中，老年人的校正平均12个月CD 4+应答比25-39岁的成年人低20.6个细胞/mm 3（95% CI：17.1-24.1）。年龄≥50岁的患者比例随时间推移而增加，并受现有患者人群老龄化的影响。老年患者在ART开始后LTF较低，记录的死亡率较高，CD 4+应答较低。在撒哈拉以南非洲，有必要加强对接受艾滋病毒护理的老年人的方案关注。
Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa. Using routinely-collected longitudinal patient-level data among 391,111 adults ≥15 years enrolling in HIV care from January 2005–December 2010 and 184,689 initiating ART, we compared characteristics and outcomes between older (≥50 years) and younger adults at 199 clinics in Kenya, Mozambique, Rwanda, and Tanzania. We calculated proportions over time of newly enrolled and active adults receiving HIV care and initiating ART who were ≥50 years; cumulative incidence of loss to follow-up (LTF) and recorded death one year after enrollment and ART initiation, and CD4+ response following ART initiation. From 2005–2010, the percentage of adults ≥50 years newly enrolled in HIV care remained stable at 10%, while the percentage of adults ≥50 years newly initiating ART (10% [2005]-12% [2010]), active in follow-up (10% [2005]-14% (2010]), and active on ART (10% [2005]-16% [2010]) significantly increased. One year after enrollment, older patients had significantly lower incidence of LTF (33.1% vs. 32.6%[40–49 years], 40.5%[25–39 years], and 56.3%[15–24 years]; p-value<0.0001), but significantly higher incidence of recorded death (6.0% vs. 5.0% [40–49 years], 4.1% [25–39 years], and 2.8% [15–24 years]; p-valve<0.0001). LTF was lower after vs. before ART initiation for all ages, with older adults experiencing less LTF than younger adults. Among 85,763 ART patients with baseline and follow-up CD4+ counts, adjusted average 12-month CD4+ response for older adults was 20.6 cells/mm3 lower than for adults 25–39 years of age (95% CI: 17.1–24.1). The proportion of patients who are ≥50 years has increased over time and been driven by aging of the existing patient population. Older patients experienced less LTF, higher recorded mortality and less robust CD4+ response after ART initiation. Increased programmatic attention on older adults receiving HIV care in sub-Saharan Africa is warranted.
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DOI：
10.1097/00126334-200306012-00015
发表时间：
2003-06-01
影响因子：
3.6
作者：
Goodkin, K;Heckman, T;Eisdorfer, C
通讯作者：
Eisdorfer, C
影响因子：
3
作者：
Orlando, G.;Meraviglia, P.;Cargnel, A.
通讯作者：
Cargnel, A.
影响因子：
2
作者：
Muga, Geoffrey O.;Onyango-Ouma, Washington
通讯作者：
Onyango-Ouma, Washington
影响因子：
3.5
作者：
Braitstein, Paula;Boulle, Andrew;Low, Nicola
通讯作者：
Low, Nicola
影响因子：
3.7
作者：
Negin J;van Lettow M;Semba M;Martiniuk A;Chan A;Cumming RG
通讯作者：
Cumming RG