| Abstrakt: |
Background: Little is known about advanced HIV disease (AHD) at antiretroviral therapy (ART) initiation among children and adolescents living with HIV (CALHIV) and related age disparities in the Democratic Republic of the Congo (DRC). Methods: We conducted a retrospective cohort analysis of routine program data collected among adults, adolescents, and children living with HIV in 6 health zones in Kinshasa, DRC from 2005 to 2020. Results: Thirty-two percent of those who initiated ART had AHD. Compared to adults, adolescents had a 15% higher risk of AHD (RR: 1.15; 95% CI: 1.08-1.21; P <.001). Despite their higher risk of AHD, adolescents had a lower risk of mortality (aSHR: 0.72; 95% CI: 0.52-0.99; P =.047) and lower cumulative death events versus adults (aSHR: 0.44; 95% CI: 0.34-0.59; P <.001). Conclusions: ADH at ART initiation is highly prevalent in Kinshasa, DRC, and adolescents are disproportionally impacted. There is a need to scale up high-impact HIV interventions targeting CALHIV. Plain language summary : A study to understand advanced HIV disease (AHD) among people living with HIV (PLHIVs) when they start antiretroviral treatment in Kinshasa, Democratic Republic of Congo, including how common it is, how it affects PLHIVs, and how AHD and its consequences differ between children, adolescent, and adult PLHIVs. Why was the study done? Some PLHIVs discover their HIV status later after being infected, and others delay starting treatment once a diagnosis is made. These situations could lead to AHD at the start of antiretroviral treatment. AHD is a severe form of HIV disease, and people who start antiretrovirals with AHD could be at risk of several complications, including death, opportunistic infections, and higher cost of treatment. There is limited evidence about AHD among PLHIV who start antiretrovirals in the DRC and related disparities between children, adolescents, and adults in the country. What did the researchers do? We analyzed data from an HIV program implemented in Kinshasa, DRC, from 2005 to 2020. The analysis examined how common AHD is among PLHIVs, how it affects them, and how AHD and its consequences differ between children, adolescents, and adult PLHIVs. What did the researchers find? The study found that a third of all PLHIVs who started antiretrovirals had AHD. Adolescents were more affected by AHD than adults, and there were no differences between adults and children. Despite their higher risk of AHD than adults, adolescents had lower chances of dying than adults. What do the findings mean? These findings have significant implications for HIV interventions in the DRC. The study highlights the need for more effective HIV interventions targeting PLHIVs, with a focus on early diagnosis and treatment initiation. The results also suggest that interventions tailored explicitly for adolescents may be necessary to address the disproportionate impact of AHD on this population. Overall, the study provides important information on the burden of HIV in the DRC and highlights the need for continued efforts to address this public health challenge. [ABSTRACT FROM AUTHOR] |
