Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults 英文参考文献.docVIP

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Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults 英文参考文献.doc

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Association of Age with Mortality and Virological and Immunological Response to Antiretroviral Therapy in Rural South African Adults 英文参考文献

AssociationofAgewithMortalityandVirologicaland ImmunologicalResponsetoAntiretroviralTherapyin RuralSouthAfricanAdults PortiaC.Mutevedzi1,2*,RichardJ.Lessells1,3,AlisonJ.Rodger2,Marie-LouiseNewell1,4 1Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa, 2Department of Infection and Population Health, University CollegeLondon,London,United Kingdom,3FacultyofInfectious andTropicalDiseases, London SchoolofHygieneandTropicalMedicine,London,United Kingdom, 4InstituteofChildHealth,UniversityCollegeLondon,London,UnitedKingdom Abstract Objective:Toassesswhethertreatmentoutcomesvarywithageforadultsreceivingantiretroviraltherapy(ART)inalarge ruralHIVtreatmentcohort. Design:RetrospectivecohortanalysisusingdatafromapublicHIVTreatmentCareProgramme. Methods:AdultsinitiatingART1stAugust2004-31stOctober2009werestratifiedbyageatinitiation:youngadults(16–24 years) mid-age adults (25–49 years) and older ($50 years) adults. Kaplan-Meier survival analysis was used to estimate mortalityratesandageandperson-timestratifiedCoxregressiontodeterminefactorsassociatedwithmortality.Changesin CD4 cell counts were quantified using a piecewise linear model based on follow-up CD4 cell counts measured at six- monthlytimepoints. Results:8846adultswereincluded,808(9.1%)youngadults;7119(80.5%)mid-ageadultsand919(10.4%)olderadults,with 997 deaths over 14,778 person-years of follow-up. Adjusting for baseline characteristics, older adults had 32% excess mortality(p=0.004)comparedtothoseaged25–49years.Overallmortalityrates(MR)per100person-yearswere6.18(95% CI4.90–7.78);6.55(95%CI6.11–7.02)and8.69(95%CI7.34–10.28)foryoung,mid-ageandolderadultsrespectively.Inthe first year on ART, for older compared to both young and mid-aged adults, MR per 100 person-years were significantly higher; 0–3 months (MR: 27.1 vs 17.17 and 21.36) and 3–12 months (MR: 9.5 vs 4.02 and 6.02) respectively. CD4 count reconstitutionwaslower,despitebettervirologicalresponseintheolde