ART initiation in late adolescence linked to decreased continuation of therapy

Children who began ART in late adolescence were less likely to continue therapy than children who began ART in early adolescence, according to research presented at the AIDS 2014 meeting.

Lucy Nganga, MD, of Futures Group International in Nairobi, Kenya, and colleagues compared attrition among pre-adolescents, early and late adolescents who were receiving ART at 29 faith-based facilities from 2004 to 2012. Attrition was defined as lost to follow-up or known death. Pre-adolescents were aged 5 to 9 years; early adolescents were aged 10 to 13 years; and late adolescents were aged 14 to 19 years. The study cohort consisted of 2,792 pre-adolescents, 1,448 early adolescents and 1,210 late adolescents.

Late adolescents had a lower median baseline CD4 count compared with pre- and early adolescents. Late adolescents had a count of 232 cells/mcL vs. 270 cells/mcL and 384 cells/mcL among early and pre-adolescents, respectively.

The 12-month probability of attrition was significantly higher among late adolescents compared with pre- and early adolescents. Attrition at 12 months was not significantly different among children who began ART as pre- and early adolescents. However, attrition significantly increased from age 15 years and peaked at 18 years.

At 60 months, late adolescents were three times more likely to be lost to the program compared with younger children.

“While pediatric patients starting ART in this program had relatively low cumulative attrition, loss to program rates increased more dramatically among children starting ART in late adolescence compared to those starting in pre- or early adolescence. Strategies to support pediatric HIV services need to take into account impact of age at treatment initiation,” the researchers concluded.

For more information:

Nganga L. Abstract #TUAB0205. Presented at: 20th International AIDS Conference; July 20-25, 2014; Melbourne, Australia.