Baseline characteristics, loss to follow-up and mortality, by age at ART initiation between 2006 and 2015 at Lighthouse and Martin Preuss clinics, Malawi.

<p>Baseline characteristics, loss to follow-up and mortality, by age at ART initiation between 2006 and 2015 at Lighthouse and Martin Preuss clinics, Malawi.</p

Characteristics and outcomes of older HIV-infected patients receiving antiretroviral therapy in Malawi: A retrospective observation cohort study

<div><p>Objective</p><p>To estimate patients enrolling on antiretroviral therapy (ART) over time; describe trends in baseline characteristics; and compare immunological response, loss to follow-up (LTFU), and mortality by three age groups (25–39, 40–49 and ≥50 years).</p><p>Design</p><p>A retrospective observation cohort study.</p><p>Methods</p><p>This study used routine ART data from two public clinics in Lilongwe, Malawi. All HIV-infected individuals, except pregnant or breastfeeding women, aged ≥ 25 years at ART initiation between 2006 and 2015 were included. Poisson regression models estimated risk of mortality, stratified by age groups.</p><p>Results</p><p>Of 37,378 ART patients, 3,406 were ≥ 50 years old. Patients aged ≥ 50 years initiated ART with more advanced WHO clinical stage and lower CD4 cell count than their younger counterparts. Older patients had a significantly slower immunological response to ART in the first 18 months on ART compared to patients aged 25–39 years (p = 0.04). Overall mortality rates were 2.3 (95% confidence Interval (CI) 2.2–2.4), 2.9 (95% CI 2.7–3.2) and 4.6 (95% CI 4.2–5.1) per 100 person-years in patients aged 25–39 years, 40–49 years and 50 years and older, respectively. Overall LTFU rates were 6.3 (95% CI 6.1–6.5), 4.5 (95% CI 4.2–4.7), and 5.6 (95% CI 5.1–6.1) per 100 person years among increasing age cohorts. The proportion of patients aged ≥ 50 years and newly enrolling into ART care remained stable at 9% while the proportion of active ART patients aged ≥50 years increased from 10% in 2006 to 15% in 2015.</p><p>Conclusion</p><p>Older people had slower immunological response and higher mortality. Malawi appears to be undergoing a demographic shift in people living with HIV. Increased consideration of long-term ART-related problems, drug-drug interactions and age-related non-communicable diseases is warranted.</p></div

Median CD4 count by age at antiretroviral therapy (ART) and duration on ART.

<p>Median CD4 count by age at antiretroviral therapy (ART) and duration on ART.</p

Proportion of older patients (50+years) receiving antiretroviral therapy (ART) at Martin Preuss and Lighthouse clinics between 2006 and 2015.

<p>Proportion of older patients (50+years) receiving antiretroviral therapy (ART) at Martin Preuss and Lighthouse clinics between 2006 and 2015.</p

Univariable and multivariable model of characteristics associated with mortality among adult ART patients aged 25–49 years and those aged ≥ 50 years.

<p>Univariable and multivariable model of characteristics associated with mortality among adult ART patients aged 25–49 years and those aged ≥ 50 years.</p

Baseline characteristics of adult patients (aged ≥50) starting ART, by year of ART initiation.

<p>Baseline characteristics of adult patients (aged ≥50) starting ART, by year of ART initiation.</p