Determinants of survival of adolescents receiving antiretroviral therapy in the Centre Region of Cameroon: a multi-centered cohort-analysis.

Autor: Tendongfor N; Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon., Fokam J; Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon. josephfokam@gmail.com.; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon. josephfokam@gmail.com.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. josephfokam@gmail.com., Chenwi CA; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon. collinschen@yahoo.co.uk.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. collinschen@yahoo.co.uk., Nwabo FLT; Faculty of Health Sciences, University of Buea, P.O. Box 63, Buea, Cameroon.; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon., Nangmo A; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon., Debimeh N; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon., Moyo STN; Pediatric Department, National Social Welfare Centre, Essos Health Centre, Yaoundé, Cameroon., Halle MP; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.; Faculty of Medicine and Pharmaceutical Science, University of Douala, Douala, Cameroon., Njom-Nlend AE; Pediatric Department, National Social Welfare Centre, Essos Health Centre, Yaoundé, Cameroon.; Higher Institute of Medical Technology, University of Douala, Yaoundé, Cameroon., Ndombo PK; Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon., Ndjolo A; Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), PO Box 3077, Yaoundé, Cameroon.; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Jazyk: angličtina
Zdroj: AIDS research and therapy [AIDS Res Ther] 2023 Dec 15; Vol. 20 (1), pp. 88. Date of Electronic Publication: 2023 Dec 15.
DOI: 10.1186/s12981-023-00584-2
Abstrakt: Background: In spite of the global decreasing mortality associated with HIV, adolescents living with HIV (ADLHIV) in sub-Saharan Africa still experience about 50% mortality rate. We sought to evaluate survival rates and determinants of mortality amongst ADLHIV receiving antiretroviral therapy (ART) in urban and rural settings.
Methods: A multi-centered, 10-year retrospective, cohort-study including ADLHIV on ART ≥ 6 months in the urban and rural settings of the Centre Region of Cameroon. Socio-demographic, clinical, biological, and therapeutic data were collected from files of ADLHIV. The Kaplan-Meier method was used to estimate survival probability after ART initiation; the log rank test used to compare survival curves between groups of variables; and the Cox proportional hazard model was used to identify the determinants of mortality.
Results: A total of 403 adolescents' records were retained; 340 (84%) were from the urban and 63 (16%) from the rural settings. The female to male ratio was 7:5; mean age (Standard deviation) was 14.1 (2.6) years; at baseline, 64.4% were at WHO clinical stages I/II, 34.9% had ≥ 500 CD4 cells/mm 3 , 91.1% were anemic, and the median [Inter Quartile Range] duration on ART was5.3 [0.5-16] years. The survival rate at 1, 5 and 10 years on ART was respectively 97.0%, 55.9% and 8.7%; with mean survival time of 5.8 years (95% CI 5.5-6.1). In bivariate analysis, living in the rural setting, non-disclosed HIV status, baseline CD4 count < 500 cells/mm 3 , not being exposed to nevirapine prophylaxis at birth and being horizontally infected were found to be the determinants of higher mortality with poor retention in care slightly associated with mortality. In multivariate analysis, living in rural settings, poor retention in care and anemia were independent predictors of mortality (p < 0.05).
Conclusion: Although ADLHIV have good survival rate on ART after 1 year, we observe poor survival rates after 5 years and especially 10 years of treatment experience. Mitigating measures against poor survival should target those living in rural settings, anemic at baseline, or experiencing poor retention in care.
(© 2023. The Author(s).)
Databáze: MEDLINE
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