. 2020 Nov 12;17(1):66.

doi: 10.1186/s12981-020-00323-x.

Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

Emmanuel Bahemana^{1

2}, Allahna Esber^{3

4}, Nicole Dear^{5

6}, Kavitha Ganesan^{5

6}, Ajay Parikh^{5

6}, Domonique Reed^{5

6}, Lucas Maganga⁷, Samoel Khamadi^{8

5}, Mucho Mizinduko⁹, Anange Lwilla⁸, Dorothy Mkondoo^{8

5}, Gwamaka Mwaisanga^{8

5}, Nancy Somi^{8

5}, John Owouth^{5

10}, Jonah Maswai^{5

11}, Francis Kiweewa¹², Michael Iroezindu^{5

13}, Julie A Ake⁵, Trevor A Crowell^{5

6}, Victor G Valcour¹⁴, Christina S Polyak^{5

6}; AFRICOS Study Group

Collaborators, Affiliations

Collaborators

AFRICOS Study Group:
J Hern, E Duff, A Reynolds, D Bartolanzo, K Song, M Milazzo, L Francisco, S Schech, A Golway, T Mebrahtu, E Lee, K Bohince, T Hamm, K Lombardi, M Imbach, L Eller, S Peel, J Malia, A Kroidl, I Kroidl, C Geldmacher, C Kafeero, A Nambuya, J Tegamanyi, H Birungi, O Mugagga, G Nassali, P Wangiri, M Nantabo, P Nambulondo, B Atwijuka, A Asiimwe, C T Nabanoba, M Semwogerere, R Mwesigwa, S Jjuuko, R Namagembe, E Bagyendagye, A Tindikahwa, I Rwomushana, F Ssentongo, H Kibuuka, M Millard, J Kapkiai, S Wangare, R Mangesoi, P Chepkwony, L Bor, E Maera, A Kasembeli, J Rotich, C Kipkoech, W Chepkemoi, A Rono, Zeddy Kesi, Janet Ngeno, Edwin Langat, Keneddy Labosso, Ken Langat, Robert Kirui, L Rotich, M Mabwai, E Chelangat, J Agutu, C Tonui, E Changwony, M Bii, E Chumba, J Korir, J Sugut, D Gitonga, R Ngetich, S Kiprotich, W Rehema, C Ogari, I Ouma, O Adimo, S Ogai, C Okwaro, E Maranga, J Ochola, K Obambo, V Sing'oei, L Otieno, O Nyapiedho, N Sande, E Odemba, F Wanjiru, E Chiweka, P Kiliba, M Mwaipopo, J Muhumuza, N Mkingule, O Mwasulama, A Sanagare, P Kishimbo, G David, F Mbwayu, J Mwamwaja, J Likiliwike, J Muhumuza, R Mcharo, N Mkingule, O Mwasulama, B Mtafya, C Lueer, A Kisinda, T Mbena, H Mfumbulwa, L Mwandumbya, P Edwin, W Olomi, Y Adamu, A Akintunde, A B Tiamiyu, K Afoke, S Mohammed, N E Harrison, U C Agbaim, O A Adegbite, Z Parker, G A Adelakun, F O Oni, R O Ndbuisi, J Elemere, N Azuakola, T T Williams, M Ayogu, O Enas, O Enameguono, A F Odo, I C Ukaegbu, O Ugwuezumba, S O Odeyemi, N C Okeke, L Umeji, A Rose, H Daniel, H Nwando, E I Nicholas, T Iyanda, C Okolo, V Y Mene, B Dogonyaro, O Olabulo, O Akinseli, F Onukun, G Knopp

Affiliations

¹ HJF Medical Research International, Inc., Mbeya, Tanzania. ebahemana@wrp-t.org.
² U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. ebahemana@wrp-t.org.
³ U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. aesber@hivresearch.org.
⁴ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. aesber@hivresearch.org.
⁵ U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
⁶ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
⁷ National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania.
⁸ HJF Medical Research International, Inc., Mbeya, Tanzania.
⁹ Muhimbili University of Health and Allied Science-Dar-Es-Salaam, Dar-Es-Salaam, Tanzania.
¹⁰ HJF Medical Research International, Kisumu, Kenya.
¹¹ HJF Medical Research International, Kericho, Kenya.
¹² Makerere University Walter Reed Project, Kampala, Uganda.
¹³ HJF Medical Research International, Abuja, Nigeria.
¹⁴ Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.

PMID: 33183355
PMCID: PMC7664082
DOI: 10.1186/s12981-020-00323-x

Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

Emmanuel Bahemana et al. AIDS Res Ther. 2020.

. 2020 Nov 12;17(1):66.

doi: 10.1186/s12981-020-00323-x.

Authors

Collaborators

AFRICOS Study Group:
J Hern, E Duff, A Reynolds, D Bartolanzo, K Song, M Milazzo, L Francisco, S Schech, A Golway, T Mebrahtu, E Lee, K Bohince, T Hamm, K Lombardi, M Imbach, L Eller, S Peel, J Malia, A Kroidl, I Kroidl, C Geldmacher, C Kafeero, A Nambuya, J Tegamanyi, H Birungi, O Mugagga, G Nassali, P Wangiri, M Nantabo, P Nambulondo, B Atwijuka, A Asiimwe, C T Nabanoba, M Semwogerere, R Mwesigwa, S Jjuuko, R Namagembe, E Bagyendagye, A Tindikahwa, I Rwomushana, F Ssentongo, H Kibuuka, M Millard, J Kapkiai, S Wangare, R Mangesoi, P Chepkwony, L Bor, E Maera, A Kasembeli, J Rotich, C Kipkoech, W Chepkemoi, A Rono, Zeddy Kesi, Janet Ngeno, Edwin Langat, Keneddy Labosso, Ken Langat, Robert Kirui, L Rotich, M Mabwai, E Chelangat, J Agutu, C Tonui, E Changwony, M Bii, E Chumba, J Korir, J Sugut, D Gitonga, R Ngetich, S Kiprotich, W Rehema, C Ogari, I Ouma, O Adimo, S Ogai, C Okwaro, E Maranga, J Ochola, K Obambo, V Sing'oei, L Otieno, O Nyapiedho, N Sande, E Odemba, F Wanjiru, E Chiweka, P Kiliba, M Mwaipopo, J Muhumuza, N Mkingule, O Mwasulama, A Sanagare, P Kishimbo, G David, F Mbwayu, J Mwamwaja, J Likiliwike, J Muhumuza, R Mcharo, N Mkingule, O Mwasulama, B Mtafya, C Lueer, A Kisinda, T Mbena, H Mfumbulwa, L Mwandumbya, P Edwin, W Olomi, Y Adamu, A Akintunde, A B Tiamiyu, K Afoke, S Mohammed, N E Harrison, U C Agbaim, O A Adegbite, Z Parker, G A Adelakun, F O Oni, R O Ndbuisi, J Elemere, N Azuakola, T T Williams, M Ayogu, O Enas, O Enameguono, A F Odo, I C Ukaegbu, O Ugwuezumba, S O Odeyemi, N C Okeke, L Umeji, A Rose, H Daniel, H Nwando, E I Nicholas, T Iyanda, C Okolo, V Y Mene, B Dogonyaro, O Olabulo, O Akinseli, F Onukun, G Knopp

Affiliations

¹ HJF Medical Research International, Inc., Mbeya, Tanzania. ebahemana@wrp-t.org.
² U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. ebahemana@wrp-t.org.
³ U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. aesber@hivresearch.org.
⁴ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. aesber@hivresearch.org.
⁵ U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
⁶ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
⁷ National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania.
⁸ HJF Medical Research International, Inc., Mbeya, Tanzania.
⁹ Muhimbili University of Health and Allied Science-Dar-Es-Salaam, Dar-Es-Salaam, Tanzania.
¹⁰ HJF Medical Research International, Kisumu, Kenya.
¹¹ HJF Medical Research International, Kericho, Kenya.
¹² Makerere University Walter Reed Project, Kampala, Uganda.
¹³ HJF Medical Research International, Abuja, Nigeria.
¹⁴ Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.

PMID: 33183355
PMCID: PMC7664082
DOI: 10.1186/s12981-020-00323-x

Abstract

Introduction: With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS).

Methods: Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age.

Results: Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm³, IQR:130-547 vs. 277cells/mm³, IQR: 132-437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old).

Conclusion: This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

Keywords: Elders on antiretroviral drugs; HIV and aging; HIV treatment outcomes; Sub-saharan Africa.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Odds ratios for achieving select CD4 cut-offs by time since ART initiation

**Fig. 2**
Proportion of participants virally suppressed over time, by age group

See this image and copyright information in PMC

References

1. United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS report on the global AIDS epidemic. 2010.
1. United Nations Programme on HIV/AIDS (UNAIDS). UNAIDS data 2019. 2020. - PubMed
1. UNAIDS . UNAIDS report shows that 19 million of the 35 million people living with HIV today do not know that they have the virus | UNAIDS. UNAIDS: Press Release. Geneva; 2014.
1. Mahy M, Autenrieth CS, Stanecki K, Wynd S. Increasing trends in HIV prevalence among people aged 50 years and older: Evidence from estimates and survey data. AIDS. 2014 doi: 10.1097/QAD.0000000000000479. - DOI - PMC - PubMed
1. Hontelez JAC, de Vlas SJ, Baltussen R, Newell M-L, Bakker R, Tanser F, et al. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS. 2012;26(Suppl 1):S19–30. doi: 10.1097/QAD.0b013e3283558526. - DOI - PMC - PubMed

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Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

Collaborators

Affiliations

Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials