Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background.</div>Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria.<div class="boxTitle">Methods.</div>This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months.<div class="boxTitle">Results.</div>Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (<span style="font-style:italic;">P</span> = .0005) at 12 months and 185 vs 151 cells/mm³ (<span style="font-style:italic;">P</span> = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (<span style="font-style:italic;">P</span> = .13) and 69.6% vs 74.8% (<span style="font-style:italic;">P</span> = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m², and having a gap in care independently predicted LTFU.<div class="boxTitle">Conclusions.</div>Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.</span>

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