Objective: To assess whether treatment outcomes vary with age for adults receiving antiretroviral therapy (ART) in a large
rural HIV treatment cohort.
Design: Retrospective cohort analysis using data from a public HIV Treatment & Care Programme.
Methods: Adults initiating ART 1st August 2004 - 31st October 2009 were stratified by age at initiation: young adults (16?24
years) mid-age adults (25?49 years) and older ($50 years) adults. Kaplan-Meier survival analysis was used to estimate
mortality rates and age and person-time stratified Cox regression to determine factors associated with mortality. Changes in
CD4 cell counts were quantified using a piecewise linear model based on follow-up CD4 cell counts measured at sixmonthly
Results: 8846 adults were included, 808 (9.1%) young adults; 7119 (80.5%) mid-age adults and 919 (10.4%) older adults, with
997 deaths over 14,778 person-years of follow-up. Adjusting for baseline characteristics, older adults had 32% excess
mortality (p = 0.004) compared to those aged 25?49 years. Overall mortality rates (MR) per 100 person-years were 6.18 (95%
CI 4.90?7.78); 6.55 (95% CI 6.11?7.02) and 8.69 (95% CI 7.34?10.28) for young, mid-age and older adults respectively. In the
first year on ART, for older compared to both young and mid-aged adults, MR per 100 person-years were significantly
higher; 0?3 months (MR: 27.1 vs 17.17 and 21.36) and 3?12 months (MR: 9.5 vs 4.02 and 6.02) respectively. CD4 count
reconstitution was lower, despite better virological response in the older adults. There were no significant differences in MR
after 1year of ART. Baseline markers of advanced disease were independently associated with very early mortality (0?3
months) whilst immunological and virological responses were associated with mortality after 12months.
Conclusions: Early ART initiation and improving clinical care of older adults are required to reduce high early mortality and
enhance immunologic recovery, particularly in the initial phases of ART.