Age-specific all-cause mortality rates among adolescents and youth living with and without HIV: Evidence from a cohort study in South Africa

IF 4.9 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2025-06-25 DOI:10.1002/jia2.26522

Siyanai Zhou, Elona Toska, Bulelani Gwampi, Leigh F. Johnson, Janke Tolmay, Wylene Saal, Zea Leon, Lucia Knight, Lucie Cluver

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Abstract

Introduction

Mortality among adolescents living with HIV (ALHIV) remains a global health problem. We lack granular (age- and sex-disaggregated) data on mortality among ALHIV, hence, this study aims to assess all-cause mortality among ALHIV in a low-resource setting.

Methods

All adolescents ever initiated on antiretroviral treatment (ART, N = 1107) and their HIV-negative peers (N = 456) aged 10–19 years, recruited as part of the Mzantsi Wakho study cohort, were followed up between 2014 and 2022 (yielding 12,427.7 person-years of follow-up). First, we assessed the proportion of deaths and estimated crude mortality incidence rates per 100 person-years of follow-up and their 95% confidence intervals, stratified by HIV status, sex and mode of HIV acquisition (vertical vs. sexual). We then estimated adjusted incidence rate ratios (IRRs) using Poisson regression adjusted for time-varying age, sex and time on ART. Last, we used the Cox proportional hazards regression model to estimate the risk of death by ART adherence.

Results

A total of 1563 adolescents and young people were included in this analysis, 70.8% ALHIV and 57% female. More deaths occurred in ALHIV compared to their HIV-negative peers (8.3% vs. 0.4%, p<0.001). Among ALHIV, we observed a significantly higher proportion of deaths among males compared to females (10.7% vs. 7.1%, p = 0.036). Overall, mortality increased significantly with age, and males had a higher risk of mortality compared to females. Adolescents and youth living with vertically acquired HIV had a higher risk of mortality than those living with sexually acquired HIV. Comparing mortality rates by mode of HIV acquisition stratified by age and sex, mortality risk was higher among females aged 20+ years with vertically acquired HIV (IRR: 3.61, 95% CI 1.48–8.82) compared to females with sexually acquired HIV of the same age group. In a sub-sample analysis, sustained ART adherence was associated with a lower risk of death (aHR: 0.44, 95% CI 0.23–0.85).

Conclusions

ALHIV experience higher all-cause mortality than their HIV-negative peers, despite having initiated ART. Among ALHIV, mortality risk was higher among males and adolescents who acquired HIV vertically. Strategies to improve survival among ALHIV, including adolescent-tailored care and support for adherence to ART, are urgently needed.

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感染和不感染艾滋病毒的青少年和青年中按年龄划分的全因死亡率：来自南非一项队列研究的证据

感染艾滋病毒的青少年死亡率仍然是一个全球性的健康问题。我们缺乏关于ALHIV死亡率的细粒度（年龄和性别分类）数据，因此，本研究旨在评估低资源环境下ALHIV的全因死亡率。方法在2014年至2022年期间，对Mzantsi Wakho研究队列中招募的所有曾接受抗逆转录病毒治疗的青少年（ART, N = 1107）及其10-19岁的hiv阴性同龄人（N = 456）进行随访（随访12,427.7人年）。首先，我们评估了每100人-年随访的死亡比例和估计的粗死亡率发病率及其95%置信区间，并按艾滋病毒状况、性别和艾滋病毒感染方式（垂直vs性感染）分层。然后，我们使用泊松回归对年龄、性别和ART治疗时间进行校正，估计校正后的发病率比（IRRs）。最后，我们使用Cox比例风险回归模型来估计ART依从性的死亡风险。结果共纳入青少年1563例，其中hiv感染者占70.8%，女性占57%。与hiv阴性的同龄人相比，ALHIV患者的死亡率更高（8.3%对0.4%,p < 0.001）。在ALHIV中，我们观察到男性的死亡比例明显高于女性（10.7%对7.1%,p = 0.036）。总体而言，死亡率随着年龄的增长而显著增加，男性的死亡风险高于女性。青少年和青少年感染垂直获得性艾滋病毒的死亡率高于性获得性艾滋病毒的死亡率。比较按年龄和性别分层的艾滋病毒感染方式的死亡率，20岁以上女性垂直获得性艾滋病毒的死亡率（IRR: 3.61, 95% CI 1.48-8.82）高于同年龄组性获得性艾滋病毒的女性。在亚样本分析中，持续坚持抗逆转录病毒治疗与较低的死亡风险相关（aHR: 0.44, 95% CI 0.23-0.85）。结论：ALHIV患者的全因死亡率高于hiv阴性患者，尽管他们已经开始抗逆转录病毒治疗。在ALHIV中，男性和青少年纵向感染的死亡风险较高。目前迫切需要提高艾滋病毒感染者生存率的战略，包括针对青少年的护理和对坚持抗逆转录病毒治疗的支持。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.