Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria

作者：Ahonkhai Aimalohi A^*; Banigbe Bolanle; Adeola Juliet; Adegoke Abdulkabir B; Regan Susan; Bassett Ingrid V; Idigbe Ifeoma; Losina Elena; Okonkwo Prosper; Freedberg Kenneth A

来源：Journal of Adolescent Health, 2016, 59(3): 298-304.

DOI：10.1016/j.jadohealth.2016.05.002

• Adolescents
• HIV
• Young adults
• Older adults
• Inconsistent care
• Retention
• Viremia
• ART
• Resource-limited setting

Purpose: Interruptions in HIV care are a major cause of morbidity and mortality, particularly in resource-limited settings. We compared engagement in care and virologic outcomes between HIV-infected adolescents and young adults (AYA) and older adults (OA) one year after starting anti-retroviral therapy (ART) in Nigeria.
Methods: We conducted a retrospective cohort study of AYA (15-24 years) and OA (>24 years) who initiated ART from 2009-2011. We used negative binomial regression to model the risk of inconsistent care and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first year on ART. Regular care included monthly ART pickup and 3-monthly clinical visits. Patients with <= 3 months between consecutive visits were considered in care. Those with inconsistent care had >3 months between consecutive visits.
Results: The cohort included 354 AYA and 2,140 OA. More AYA than OA were female (89% vs. 65%, p < .001). Median baseline CD4 was 252/mu L in AYA and 204/mu L in OA (p = .002). More AYA had inconsistent care than OA (55% vs. 47%, p = .001). Adjusting for sex, baseline CD4, and education, AYA had a greater risk of inconsistent care than OA (Relative Risk [RR]: 1.15, p = .008). Among those in care after one year on ART, viremia was more common in AYA than OA (40% vs. 26% p = .003, RR: 1.53, p = .002).
Conclusions: In a Nigerian cohort, AYA were at increased risk for inconsistent HIV care. Of patients remaining in care, youth was the only independent predictor of viremia at 1 year. Youth-friendly models of HIV care are needed to optimize health outcomes.

• 出版日期2016-9
• 单位河北医科大学