Abstract

Background:

Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria.

Methods:

This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004–2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU), and determined factors associated with these outcomes at 24 months.

Results:

Out of 8,352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 versus 132 (p=0.0005) at 12 months and 185 versus 151cells/mm3 (p=0.03) at 24 months for younger and older patients respectively. 68.9% versus 71.6% (p=0.13) and 69.6% versus 74.8% (p=0.005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, WHO stage III/IV and having a gap in care, while being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, BMI<18.5kg/m2, and having a gap in care independently predicted LTFU.

Conclusion:

Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.

Author notes

Corresponding author: Patricia A. Agaba Department of Family Medicine University of Jos Nigeria e-mail: agabap@unijos.edu.ng, ellagaba@yahoo.com
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