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dc.contributor.authorO'Brien, D
dc.contributor.authorSpelman, T
dc.contributor.authorGreig, J
dc.contributor.authorMcMahon, J
dc.contributor.authorSsonko, C
dc.contributor.authorCasas, E
dc.contributor.authorMesic, A
dc.contributor.authorDu Cros, P
dc.contributor.authorFord, N
dc.date.accessioned2020-12-22T04:33:16Z
dc.date.available2020-12-22T04:33:16Z
dc.date.issued2016-01-14
dc.identifierpii: 20665
dc.identifier.citationO'Brien, D., Spelman, T., Greig, J., McMahon, J., Ssonko, C., Casas, E., Mesic, A., Du Cros, P. & Ford, N. (2016). Risk factors for mortality during antiretroviral therapy in older populations in resource-limited settings. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 19 (1), https://doi.org/10.7448/IAS.19.1.20665.
dc.identifier.issn1758-2652
dc.identifier.urihttp://hdl.handle.net/11343/258089
dc.description.abstractINTRODUCTION: An increasing proportion of adult patients initiating antiretroviral therapy (ART) in resource-limited settings are aged > 50 years. Older populations on ART appear to have heightened risk of death, but little is known about factors influencing mortality in this population. METHODS: We performed a retrospective observational multisite cohort study including all adult patients (≥ 15 years) initiating ART between 2003 and 2013 in programmes supported by Médecins Sans Frontières across 12 countries in Asia, Africa and Europe. Patients were stratified into two age groups, > 50 years and 15 to 50 years. A Cox proportional hazards model was used to explore factors associated with mortality. RESULTS: The study included 41,088 patients: 2591 (6.3%) were aged > 50 years and 38,497 (93.7%) were aged 15 to 50 years. The mortality rate was significantly higher in the age group > 50 years [367 (14.2%) deaths; mortality rate 7.67 deaths per 100 person-years (95% confidence interval, CI: 6.93 to 8.50)] compared to the age group 15 to 50 years [3788 (9.8%) deaths; mortality rate 4.18 deaths per 100 person-years (95% CI: 4.05 to 4.31)], p < 0.0001. Higher CD4 levels at baseline were associated with significantly reduced mortality rates in the 15 to 50 age group but this association was not seen in the > 50 age group. WHO Stage 4 conditions were more strongly associated with increased mortality rates in the 15 to 50 age group compared to populations > 50 years. WHO Stage 3 conditions were associated with an increased mortality rate in the 15 to 50 age group but not in the > 50 age group. Programme region did not affect mortality rates in the > 50 age group; however being in an Asian programme was associated with a 36% reduced mortality rate in populations aged 15 to 50 years compared to being in an African programme. There was a higher overall incidence of Stage 3 WHO conditions in people > 50 years (12.8/100 person-years) compared to those 15 to 50 years (8.1/100 person-years) (p < 0.01). The rate of Stage 4 WHO conditions was similar (5.8/100 versus 6.1/100 respectively, p = 0.52). Mortality rates on ART associated with the majority of specific WHO conditions were similar between the 15 to 50 and > 50 age groups. CONCLUSIONS: Older patients on ART in resource-limited settings have increased mortality rates, but compared to younger populations this appears to be less influenced by baseline CD4 count and WHO clinical stage. HIV treatment programmes in resource-limited settings need to consider risk factors associated with mortality on ART in older populations, which may differ to those related to younger adults.
dc.languageEnglish
dc.publisherJOHN WILEY & SONS LTD
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.titleRisk factors for mortality during antiretroviral therapy in older populations in resource-limited settings
dc.typeJournal Article
dc.identifier.doi10.7448/IAS.19.1.20665
melbourne.affiliation.departmentMedicine (RMH)
melbourne.affiliation.departmentSurgery (St Vincent's)
melbourne.affiliation.facultyMedicine, Dentistry & Health Sciences
melbourne.source.titleJournal of the International AIDS Society
melbourne.source.volume19
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid1030265
melbourne.contributor.authorO'Brien, Daniel
melbourne.contributor.authorSpelman, Timothy
dc.identifier.eissn1758-2652
melbourne.accessrightsOpen Access


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