title: HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study.
abstract: OBJECTIVE
  In this study we examine whether adolescents treated for HIV/AIDS in southern Africa can achieve similar treatment outcomes to adults.
  
  
  METHODS
  We have used a retrospective cohort study design to compare outcomes for adolescents and adults commencing antiretroviral therapy (ART) between 2004 and 2010 in a public sector hospital clinic in Bulawayo, Zimbabwe.
  
  
  METHODS
  Cox proportional hazards modelling was used to investigate risk factors for death and loss to follow-up (LTFU) (defined as missing a scheduled appointment by ≥3months).
  
  
  RESULTS
  One thousand, seven hundred and seventy-six adolescents commenced ART, 94% having had no previous history of ART. The median age at ART initiation was 13.3 years. HIV diagnosis in 97% of adolescents occurred after presentation with clinical disease and a higher proportion had advanced HIV disease at presentation compared with adults [WHO Stage 3/4 disease (79.3 versus 65.2%, P < 0.001)]. Despite this, adolescents had no worse mortality than adults, assuming 50% mortality among those LTFU (6.4 versus 7.3 per 100 person-years, P = 0.75) with rates of loss to follow-up significantly lower than in adults (4.8 versus 9.2 per 100 person-years, P < 0.001). Among those who were followed for 5 years or more, 5.8% of adolescents switched to a second-line regimen as a result of treatment failure, compared with 2.1% of adults (P < 0.001).
  
  
  CONCLUSIONS
  With adolescent-focused services, it is feasible to achieve good outcomes for adolescents in large-scale ART programs in sub-Saharan Africa. However, adolescents are at high risk of treatment failure, which compromises future drug options. Interventions to address poor adherence in adolescence should be prioritized.
authors.forename: Amir
authors.initials: A
authors.lastname: Shroufi
authors.forename: Hilary
authors.initials: H
authors.lastname: Gunguwo
authors.forename: Mark
authors.initials: M
authors.lastname: Dixon
authors.forename: Mary
authors.initials: M
authors.lastname: Nyathi
authors.forename: Wedu
authors.initials: W
authors.lastname: Ndebele
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Saint-Sauveur
authors.forename: Fabian
authors.initials: F
authors.lastname: Taziwa
authors.forename: Cecilia
authors.initials: C
authors.lastname: Ferreyra
authors.forename: Mari-Carmen
authors.initials: MC
authors.lastname: Viñoles
authors.forename: Rashida A
authors.initials: RA
authors.lastname: Ferrand
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents