Poorer ART Outcomes with Increasing Age at a Large Public Sector HIV Clinic in Johannesburg, South Africa

Abstract

Background: As the current HIV-positive population ages, the absolute number of patients >50 years on treatment is increasing. Methods: We analyze the differences in treatment outcomes by age category (18-29, 30-39, 40-49, 50-59, and ≥60) among 9139 HIV-positive adults initiating ART in South Africa. Results: The adjusted hazard ratios (HRs) for all-cause mortality increased with increasing age, with the strongest association in the first 12 months of follow-up among patients 50 to 59 years (HR 1.67; 95% confidence interval [CI]: 1.24-2.23) versus those <30 years. However, patients 50 to 59 years were less likely to be lost during 24 months on antiretroviral therapy ([ART] HR 0.75; 95% CI: 0.59-0.94) versus patients <30 years. By 6 and 12 months on treatment, older patients were less likely to increase their CD4 count by ≥50 cells/mm3. Conclusion: Although older patients are at higher risk of mortality and have poorer immunological responses than their younger counterparts, they are more likely to adhere to care and treatment in the first 24 months on ART.