Effect of Age and HAART Regimen on Clinical Response in an Urban Cohort of HIV-infected Individuals

Overview

Journal AIDS

Specialty Infectious Diseases

Date 2008 Nov 5

PMID 18981772

Citations 42

Authors

Adena H Greenbaum

Lucy E Wilson

Jeanne C Keruly

Richard D Moore

Kelly A Gebo

Affiliations

Soon will be listed here.

Abstract

Objectives: The prevalence of HIV infection in older patients (> or =50 years) is increasing due to HAART, and new HIV infections in older patients. Some earlier studies suggest that older patients respond differently to HAART than younger patients. The objective of this study is to compare the effectiveness of HAART in older and younger HIV patients.

Design: Retrospective analysis of an observational clinical cohort.

Methods: Virologic and immunologic response, progression to AIDS and mortality were compared between 670 younger patients (<40 years) and 149 older patients (> or =50 years) by t-test, Kaplan-Meier methods, and multivariate Cox proportional hazards analysis.

Results: Compared with younger patients, older patients were more likely to be on nonnucleoside reverse transcriptase inhibitors based versus protease inhibitor based regimens (42 vs. 29%, P < 0.01). Time to HIV-1 RNA virologic suppression was less in older than in younger patients (3.2 vs. 4.4 months, P < 0.01). Immunologic response did not differ by age. Older patients had fewer AIDS-defining opportunistic infections (22 vs. 31%, P < 0.01), but higher mortality (36 vs. 27%, P = 0.04) and shorter survival (25th percentile survivor function 36.2 vs. 58.5 months, P = 0.02) than younger patients. Older age was associated with more rapid virologic suppression [adjusted hazard ratio = 1.33 (1.09-1.63)] and earlier mortality [adjusted hazard ratio = 1.56 (1.14-2.14)]. Nonnucleoside reverse transcriptase inhibitors based regimens were associated with more rapid virologic suppression [adjusted hazard ratio = 1.22 (1.03-1.44)].

Conclusion: Time to virologic suppression after HAART initiation was shorter in older patients, although CD4 response did not differ by age. Older patients had fewer opportunistic infections, but survival was shorter. Our data suggest a need to better understand causes of mortality in older patients.

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References

Tumbarello M, Rabagliati R, de Gaetano Donati K, Bertagnolio S, Montuori E, Tamburrini E . Older age does not influence CD4 cell recovery in HIV-1 infected patients receiving highly active antiretroviral therapy. BMC Infect Dis. 2004; 4:46. PMC: 533877. DOI: 10.1186/1471-2334-4-46. View

Lucas G, Chaisson R, Moore R . Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med. 1999; 131(2):81-7. DOI: 10.7326/0003-4819-131-2-199907200-00002. View

Walston J, Hadley E, Ferrucci L, Guralnik J, Newman A, Studenski S . Research agenda for frailty in older adults: toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc. 2006; 54(6):991-1001. DOI: 10.1111/j.1532-5415.2006.00745.x. View

Orlando G, Meraviglia P, Cordier L, Meroni L, Landonio S, Giorgi R . Antiretroviral treatment and age-related comorbidities in a cohort of older HIV-infected patients. HIV Med. 2006; 7(8):549-57. DOI: 10.1111/j.1468-1293.2006.00420.x. View

Gebo K . HIV and aging: implications for patient management. Drugs Aging. 2006; 23(11):897-913. DOI: 10.2165/00002512-200623110-00005. View

Bosch R, Bennett K, Collier A, Zackin R, Benson C . Pretreatment factors associated with 3-year (144-week) virologic and immunologic responses to potent antiretroviral therapy. J Acquir Immune Defic Syndr. 2006; 44(3):268-77. DOI: 10.1097/QAI.0b013e31802c7e20. View

Silverberg M, Leyden W, Horberg M, DeLorenze G, Klein D, Quesenberry Jr C . Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med. 2007; 167(7):684-91. DOI: 10.1001/archinte.167.7.684. View

Patterson K, Napravnik S, Eron J, Keruly J, MOORE R . Effects of age and sex on immunological and virological responses to initial highly active antiretroviral therapy. HIV Med. 2007; 8(6):406-10. DOI: 10.1111/j.1468-1293.2007.00485.x. View

Cuzin L, Delpierre C, Gerard S, Massip P, Marchou B . Immunologic and clinical responses to highly active antiretroviral therapy in patients with HIV infection aged >50 years. Clin Infect Dis. 2007; 45(5):654-7. DOI: 10.1086/520652. View

10.

Nogueras M, Navarro G, Anton E, Sala M, Cervantes M, Amengual M . Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more. BMC Infect Dis. 2006; 6:159. PMC: 1654166. DOI: 10.1186/1471-2334-6-159. View

11.

Paredes R, Mocroft A, Kirk O, Lazzarin A, Barton S, van Lunzen J . Predictors of virological success and ensuing failure in HIV-positive patients starting highly active antiretroviral therapy in Europe: results from the EuroSIDA study. Arch Intern Med. 2000; 160(8):1123-32. DOI: 10.1001/archinte.160.8.1123. View

12.

Douek D, Vescio R, Betts M, Brenchley J, Hill B, Zhang L . Assessment of thymic output in adults after haematopoietic stem-cell transplantation and prediction of T-cell reconstitution. Lancet. 2000; 355(9218):1875-81. DOI: 10.1016/S0140-6736(00)02293-5. View

13.

Manfredi R, Chiodo F . A case-control study of virological and immunological effects of highly active antiretroviral therapy in HIV-infected patients with advanced age. AIDS. 2000; 14(10):1475-7. DOI: 10.1097/00002030-200007070-00034. View

14.

Viard J, Mocroft A, Chiesi A, Kirk O, Roge B, Panos G . Influence of age on CD4 cell recovery in human immunodeficiency virus-infected patients receiving highly active antiretroviral therapy: evidence from the EuroSIDA study. J Infect Dis. 2001; 183(8):1290-4. DOI: 10.1086/319678. View

15.

Yamashita T, Phair J, Munoz A, Margolick J, Detels R, OBrien S . Immunologic and virologic response to highly active antiretroviral therapy in the Multicenter AIDS Cohort Study. AIDS. 2001; 15(6):735-46. DOI: 10.1097/00002030-200104130-00009. View

16.

Goetz M, Boscardin W, Wiley D, Alkasspooles S . Decreased recovery of CD4 lymphocytes in older HIV-infected patients beginning highly active antiretroviral therapy. AIDS. 2001; 15(12):1576-9. DOI: 10.1097/00002030-200108170-00017. View

17.

Knobel H, Guelar A, Valldecillo G, Carmona A, Gonzalez A, Lopez-Colomes J . Response to highly active antiretroviral therapy in HIV-infected patients aged 60 years or older after 24 months follow-up. AIDS. 2001; 15(12):1591-3. DOI: 10.1097/00002030-200108170-00025. View

18.

Moing V, Chene G, Carrieri M, Alioum A, Brun-Vezinet F, Piroth L . Predictors of virological rebound in HIV-1-infected patients initiating a protease inhibitor-containing regimen. AIDS. 2001; 16(1):21-9. DOI: 10.1097/00002030-200201040-00004. View

19.

Mack K, Ory M . AIDS and older Americans at the end of the Twentieth Century. J Acquir Immune Defic Syndr. 2003; 33 Suppl 2:S68-75. DOI: 10.1097/00126334-200306012-00003. View

20.

Hinkin C, Hardy D, Mason K, Castellon S, Durvasula R, Lam M . Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004; 18 Suppl 1:S19-25. PMC: 2886736. DOI: 10.1097/00002030-200418001-00004. View