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

IntroductionMortality 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.MethodsAll 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.ResultsA 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