Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Figures & data

Table 1 Baseline and follow-up characteristics of the PLHIV initiating ART by age (N=73,525)

	Age (years)					Total N=73,525
	16–29 N=16,458	30–39 N=29,968	40–49 N=18,561	50–59 N=6,792	≥60 N=1,736
Gender: female (%)	86.3	68.6	51.1	47.8	50.9	65.8
Initial clinical stage (%)
WHO I/II or CDC A	40.6	37.1	33.9	34.8	35.4	36.8
WHO III/IV or AIDS	25.8	28.1	30.2	30.9	34.0	28.5
Missing	33.6	34.8	35.9	34.3	30.6	34.7
Initial hemoglobin levela (g/dL)	10.2 [9.0–11.5]	10.5 [9.0–11.9]	10.7 [9.1–12.0]	10.7 [9.2–12.0]	10.7 [9.3–11.9]	10.5 [9.0–11.9]
Initial CD4 counta (cells/µL)	185 [81–307]	167 [71–278]	160 [68–271]	175 [84–287]	182 [91–300]	170 [74–284]
BMI (kg/m^2) (%)
<18	12.7	10.5	10.2	10.7	10.8	11.0
18–24.9	31.0	32.5	32.0	32.5	29.0	32.0
≥25	7.2	9.5	10.4	10.1	8.9	9.2
Missing	49.0	47.5	47.4	46.7	51.3	47.8
Year of ART initiation (%)
<2007	30.8	30.9	28.3	23.5	20.6	35.4
2007–2010	37.2	35.2	35.0	33.6	32.4	47.0
2011–2015	31.9	33.9	36.7	42.9	47.0	20.6
Follow-up durationa (months)	35.4 [9.8–76.5]	39.5 [11.7–82.1]	38.4 [11.5–81.0]	33.3 [9.7–71.2]	24.8 [10.8–79.1]	37.2 [10.8–79.1]
Death at 36 months (%)	3.7	3.9	4.7	5.9	6.9	4.3
Number of events	613	1,182	872	402	120	3,189
LTFU at 36 months (%)	33.8	28.4	26.6	26.5	31.5	29.0
Number of events	5,563	8,515	4,929	1,802	546	21,355

Note:

a Median [IQR].

Abbreviations: ART, antiretroviral therapy; BMI, body mass index; CDC, Centers for Disease Control and Prevention; IQR, interquartile range; LTFU, lost to follow-up; PLHIV, people living with HIV; WHO, World Health Organization.

Figure 1 Probability of death (Kaplan–Meier estimate) after ART initiation by age groups.

Abbreviations: ART, antiretroviral therapy; M12, 12 months; M24, 24 months; M36, 36 months.

Figure 2 LTFU probability (Kaplan–Meier estimate) after ART initiation by age groups.

Abbreviations: ART, antiretroviral therapy; LTFU, lost to follow-up; M12, 12 months; M24, 24 months; M36, 36 months.

Table 2 Predictors of death in the first 36 months after ART initiation (Cox models)

Variables	Number of deaths	Multivariable model
		HR (95% CI)	P-value
Age at ART initiation (years)			<0.0001
16–29	613	1
30–39	1,182	0.93 (0.84–1.03)
40–49	872	1.02 (0.91–1.13)
50–59	402	1.31 (1.15–1.49)
≥60	120	1.66 (1.36–2.03)
Gender			<0.0001
Female	1,822	1
Male	1,367	1.41 (1.30–1.52)
Year of ART initiation			<0.0001
<2007	1,096	1
2007–2010	1,346	1.37 (1.25–1.51)
2011 and after	747	1.79 (1.61–1.99)
Initial clinical stage			<0.0001
A, B/I, II	643	1
AIDS/III, IV	1,495	1.91 (1.74–2.11)
Missing	1,051	1.63 (1.46–1.81)
Initial CD4 cell count (cells/µL)			<0.0001
≥350	120	1
200–349	400	1.63 (1.33–2.00)
100–199	610	2.37 (1.94–2.89)
50–99	493	3.36 (2.74–4.12)
0–49	1,053	5.02 (4.14–6.09)
Missing	513	2.92 (2.38–3.59)
Initial hemoglobin (g/dL)			<0.0001
≥12	241	1
10–12	559	1.30 (1.12–1.52)
7.5–10	864	2.14 (1.84–2.48)
<7.5	408	3.80 (3.21–4.49)
Missing	1,117	0.76 (0.65–0.88)
First ART regimen			0.0010
AZT+3TC/FTC+NVP/EFV	815	1
D4T+3TC/FTC+NVP/EFV	903	1.20 (1.08–1.33)
TDF+3TC/FTC+NVP/EFV	723	1.16 (1.04–1.29)
Others/unknown	748	1.03 (0.93–1.15)
BMI (kg/m^2)			<0.0001
18–25	767	1
<18	781	2.06(1.86–2.29)
≥25	102	0.64 (0.52–0.79)
Missing	1,539	1.82 (1.64–2.02)
Total number of patients started ART in 2014–2015 and still in care, in the facility			<0.0001
<500	747	1
500–1,000	1,620	1.20 (1.09–1.32)
≥1,000	822	0.86 (0.77–0.97)

Abbreviations: ART, antiretroviral therapy; BMI, body mass index.

Table 3 Predictors of lost to follow-up in the first 36 months after ART initiation (Cox models)

Variables	Number of lost to follow-up	Multivariable model
		HR (95% CI)	P-value
Age at ART initiation (years)			<0.0001
16–29	5,563	1
30–39	8,515	0.83 (0.80–0.85)
40–49	4,929	0.76 (0.73–0.79)
50–59	1,802	0.78 (0.74–0.82)
≥60	546	0.97 (0.88–1.06)
Gender			<0.0001
Female	13,465	1
Male	7,890	1.23 (1.19–1.26)
Year of ART initiation			<0.0001
<2007	6,133	1
2007–2010	7,100	1.01 (0.98–1.05)
2011 and after	8,122	1.63 (1.57–1.69)
Initial clinical stage			<0.0001
A, B/I, II	6,847	1
AIDS/III, IV	5,377	1.12 (1.08–1.17)
Missing	9,131	1.23 (1.19–1.27)
Initial CD4 cell count (cells/µL)			<0.0001
≥350	2,640	1
200–349	3,947	0.91 (0.87–0.96)
100–199	3,810	0.96 (0.91–1.01)
50–99	2,302	1.14 (1.07–1.20)
0–49	3,436	1.30 (1.23–1.37)
Missing	5,220	1.00 (0.95–1.05)
Initial hemoglobin (g/dL)			<0.0001
≥12	1,431	1
10–12	2,691	1.20 (1.12–1.28)
7.5–10	2,528	1.42 (1.33–1.52)
<7.5	707	1.64 (1.50–1.80)
Missing	13,998	1.46 (1.38–1.55)
First ART regimen			<0.0001
AZT+3TC/FTC+NVP/EFV	5,617	1
D4T+3TC/FTC+NVP/EFV	3,889	1.08 (1.04 –1.13)
TDF+3TC/FTC+NVP/EFV	2,833	1.11 (1.06–1.16)
Others/unknown	9,016	1.38 (1.33–1.44)
BMI (kg/m^2)			<0.0001
18–25	4,855	1
<18	1,950	1.19 (1.13–1.26)
≥25	1,255	0.93 (0.87–0.99)
Missing	13,295	2.07 (1.99–2.15)
Total number of patients started ART in 2014–2015 and still in care, in the facility			<0.0001
<500	8,081	1
500–1,000	8,600	1.02 (0.98–1.05)
≥1,000	4,674	0.71 (0.68–0.74)

Abbreviations: ART, antiretroviral therapy; BMI, body mass index.

Figure S1 Flowchart.

Table S1 Effect of other factors (than age), on lost to follow-up in the first 36 months after ART initiation (Cox models), for patients <30 years while starting ART

Variables	Number of lost to follow-up	Univariable models		Multivariable models
		HR (95% CI)	P-value	HR (95% CI)	P-value
Gender			<0.0001		<0.0001
Female	4,719	1		1
Male	844	1.22 (1.14–1.32)		1.17 (1.09–1.26)
Year of ART initiation			<0.0001		<0.0001
<2007	1,568	1		1
2007–2010	2,002	1.09 (1.02–1.16)		1.06 (0.99–1.13)
2011 and after	1,993	1.62 (1.52–1.73)		1.68 (1.56–1.81)
Initial clinical stage			<0.0001		<0.0001
A,B/I,II	1,989	1		1
AIDS/III,IV	1,240	1.03 (0.96–1.11)		1.10 (1.02–1.18)
Missing	2,334	1.55 (1.46–1.64)		1.25 (1.17–1.33)
Initial CD4 cell count (cells/µL)			<0.0001		<0.0001
≥350	968	1		1
200–349	1,129	0.71 (0.65–0.77)		0.87 (0.80–0.95)
100–199	970	0.68 (0.63–0.75)		0.88 (0.80–0.96)
50–99	538	0.84 (0.76–0.93)		1.03 (0.92–1.15)
0–49	809	0.93 (0.84–1.02)		1.13 (1.02–1.24)
Missing	1,149	0.81 (0.75–0.89)		0.83 (0.76–0.91)
Initial hemoglobin (g/dL)			<0.0001		<0.0001
≥12	288	1		1
10–12	668	1.08 (0.94–1.24)		1.07 (0.93–1.23)
7.5–10	575	1.19 (1.03–1.37)		1.15 (0.99–1.33)
<7.5	182	1.61 (1.34–1.94)		1.44 (1.19–1.74)
Missing	3,850	1.48 (1.31–1.67)		1.24 (1.10–1.41)
First ART regimen			<0.0001		<0.0001
AZT+3TC/FTC+NVP/EFV	1,316	1		1
D4T+3TC/FTC+NVP/EFV	863	0.85 (0.78–0.92)		0.98 (0.89–1.07)
TDF+3TC/FTC+NVP/EFV	608	1.28 (1.16–1.40)		1.08 (0.97–1.19)
Others/unknown	2,776	1.57 (1.47–1.68)		1.31 (1.21–1.41)
BMI (kg/m^2)			<0.0001		<0.0001
18–25	1,235	1		1
<18	572	1.24 (1.12–1.37)		1.18 (1.07–1.31)
≥25	261	0.87 (0.76–0.99)		0.88 (0.77–1.01)
Missing	3,495	2.14 (2.01–2.29)		2.04 (1.89–2.20)
Total number of patients started ART in 2014–2015 and still in care, in the facility			<0.0001		<0.0001
<500	2,673	1		1
500–1000	2,038	0.71 (0.67–0.76)		1.09 (1.01–1.17)
≥1000	852	0.77 (0.72–0.84)		0.67 (0.61–0.73)

Abbreviations: ART, antiretroviral therapy; BMI, body mass index.

Table S2 Effect of other factors (than age), on lost to follow-up in the first 36 months after ART initiation (Cox models), for patients 50–59 years while starting ART

Variables	Number of lost to follow-up	Univariable models		Multivariable models
		HR (95% CI)	P-value	HR (95% CI)	P-value
Gender			<0.0001		0.0014
Female	780	1		1
Male	1,022	1.24 (1.13–1.36)		1.17 (1.06–1.29)
Year of ART initiation			<0.0001		<0.0001
<2007	454	1		1
2007–2010	554	0.86 (0.76–0.97)		0.93 (0.82–1.06)
2011 and after	794	1.27 (1.13–1.43)		1.46 (1.28–1.67)
Initial clinical stage			<0.0001		0.01
A,B/I,II	539	1		1
AIDS/III,IV	489	1.08 (0.96–1.23)		1.12 (0.99–1.27)
Missing	774	1.50 (1.34–1.67)		1.20 (1.07–1.35)
Initial CD4 cell count (cells/µL)			<0.0001		<0.0001
≥350	172	1		1
200–349	326	0.94 (0.78–1.13)		1.01 (0.84–1.22)
100–199	334	1.06 (0.88–1.27)		1.16 (0.96–1.40)
50–99	205	1.45 (1.19–1.78)		1.48 (1.20–1.82)
0–49	251	1.54 (1.27–1.87)		1.51 (1.24–1.85)
Missing	514	1.52 (1.28–1.81)		1.28 (1.06–1.54)
Initial hemoglobin (g/dL)			<0.0001		0.0007
≥12	170	1		1
10–12	243	1.03 (0.84–1.25)		1.02 (0.83–1.24)
7.5–10	250	1.56 (1.29–1.90)		1.39 (1.14–1.71)
<7.5	56	1.76 (1.30–2.39)		1.41 (1.03–1.92)
Missing	1,083	1.46 (1.25–1.72)		1.26 (1.05–1.50)
First ART regimen			<0.0001		0.001
AZT+3TC/FTC+NVP/EFV	561	1		1
D4T+3TC/FTC+NVP/EFV	331	0.98 (0.86–1.13)		1.04 (0.90–1.21)
TDF+3TC/FTC+NVP/EFV	299	1.18 (1.03–1.36)		1.02 (0.88–1.18)
Others/unknown	611	1.53 (1.37–1.72)		1.27 (1.12–1.44)
BMI (kg/m^2)			<0.0001		<0.0001
18–25	434	1		1
<18	159	1.28 (1.07–1.54)		1.18 (0.98–1.41)
≥25	113	0.81 (0.66–0.99)		0.87 (0.71–1.07)
Missing	1,096	2.06 (1.85–2.31)		2.07 (1.82–2.36)
Total number of patients started ART in 2014–2015 and still in care, in the facility			<0.0001		<0.0001
<500	485	1		1
500–1000	811	0.76 (0.68–0.85)		0.91 (0.81–1.03)
≥1000	506	0.99 (0.87–1.12)		0.68 (0.59–0.78)

Abbreviations: ART, antiretroviral therapy; BMI, body mass index.

Table S3 Effect of others factor (than age), on lost to follow-up in the first 36 months after ART initiation (Cox models), for patients >60 years while starting ART

Variables	Number of lost to follow-up	Univariable models		Multivariable models
		HR (95% CI)	P-value	HR (95% CI)	P-value
Gender			0.74
Female	273	1
Male	273	1.03 (0.87–1.22)
Year of ART initiation			0.001		<0.0001
<2007	117	1		1
2007–2010	173	0.98 (0.78–1.24)		1.00 (0.78–1.27)
2011 and after	256	1.36 (1.09–1.70)		1.65 (1.30–2.11)
Initial clinical stage			<0.0001		0.0024
A,B/I,II	153	1		1
AIDS/III,IV	184	1.38 (1.11–1.71)		1.41 (1.13–1.76)
Missing	209	1.63 (1.32–2.00)		1.41 (1.13–1.77)
Initial CD4 cell count (cells/µL)			<0.0001		0.0025
≥350	69	1		1
200–349	88	0.75 (0.54–1.02)		0.80 (0.58–1.10)
100–199	110	0.96 (0.71–1.30)		0.94 (0.69–1.29)
50–99	53	1.25 (0.88–1.79)		1.26 (0.87–1.82)
0–49	79	1.57 (1.14–2.17)		1.49 (1.06–2.08)
Missing	147	1.31 (0.99–1.75)		1.05 (0.78–1.43)
Initial hemoglobin (g/dL)			<0.0001		0.0021
≥12	34	1		1
10–12	76	1.48 (0.99–2.22)		1.49 (0.99–2.24)
7.5–10	71	1.80 (1.20–2.71)		1.61 (1.06–2.45)
<7.5	8	1.45 (0.67–3.14)		1.32 (0.61–2.90)
Missing	357	2.33 (1.64–3.32)		2.04 (1.40–2.97)
First ART regimen			<0.0001		0.029
AZT+3TC/FTC + NVP/EFV	159	1		1
D4T+3TC/FTC + NVP/EFV	91	0.95 (0.74–1.23)		1.05 (0.79–1.38)
TDF+3TC/FTC + NVP/EFV	91	1.23 (0.95–1.59)		1.08 (0.83–1.42)
Others/unknown	205	1.71 (1.39–2.11)		1.39 (1.10–1.74)
BMI (kg/m^2)			<0.0001		<0.0001
18–25	119	1		1
<18	56	1.48 (1.08–2.03)		1.30 (0.94–1.80)
≥25	32	0.86 (0.58–1.27)		0.88 (0.59–1.31)
Missing	339	1.89 (1.54–2.34)		1.95 (1.54–2.47)
Total number of patients started ART in 2014–2015 and still in care, in the facility			0.0004		<0.0001
<500	161	1		1
500–1000	264	0.73 (0.60–0.88)		0.96 (0.77–1.19)
≥1000	121	0.64 (0.51–0.82)		0.56 (0.43–0.73)

Abbreviations: ART, antiretroviral therapy; BMI, body mass index.