title: Survival of HIV-infected adolescents on antiretroviral therapy in Uganda: findings from a nationally representative cohort in Uganda.
abstract: BACKGROUND
  Adolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes for adolescents on cART in resource-limited settings remain scarce.
  
  
  METHODS
  We developed an observational study of patients who started cART at The AIDS Service Organization (TASO) in Uganda between 2004 and 2009. Age was stratified into three groups: children (≤10 years), adolescents (11-19 years), and adults (≥20 years). Kaplan-Meier survival curves were generated to describe time to mortality and loss to follow-up, and Cox regression used to model associations between age and mortality and loss to follow-up. To address loss to follow up, we applied a weighted analysis that assumes 50% of lost patients had died.
  
  
  RESULTS
  A total of 23,367 patients were included in this analysis, including 810 (3.5%) children, 575 (2.5%) adolescents, and 21 982 (94.0%) adults. A lower percentage of children (5.4%) died during their cART treatment compared to adolescents (8.5%) and adults (10%). After adjusting for confounding, other features predicted mortality than age alone. Mortality was higher among males (p<0.001), patients with a low initial CD4 cell count (p<0.001), patients with advanced WHO clinical disease stage (p<0.001), and shorter duration of time receiving cART (p<0.001). The crude mortality rate was lower for children (22.8 per 1000 person-years; 95% CI: 16.1, 29.5), than adolescents (36.5 per 1000 person-years; 95% CI: 26.3, 46.8) and adults (37.5 per 1000 person-years; 95% CI: 35.9, 39.1).
  
  
  CONCLUSIONS
  This study is the largest assessment of adolescents receiving cART in Africa. Adolescents did not have cART mortality outcomes different from adults or children.
authors.affiliation: The AIDS Support Organization, Kampala, Uganda.
authors.forename: Celestin
authors.initials: C
authors.lastname: Bakanda
authors.forename: Josephine
authors.initials: J
authors.lastname: Birungi
authors.forename: Robert
authors.initials: R
authors.lastname: Mwesigwa
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
authors.forename: Keith
authors.initials: K
authors.lastname: Chan
authors.forename: Alexis
authors.initials: A
authors.lastname: Palmer
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000821:virology; D002648:Child; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents