 |
|
|
| |
First Look at Big 75-and-Older HIV Group--Diagnosed at Age 62.....much higher rates of comorbidities among older HIV+ - 40% with 2 or more, 14% with 4 or more comorbidities
|
| |
| |
First Look at Big 75-and-Older HIV Group--Diagnosed at Age 62.....much higher rates of comorbidities among older HIV+ - 40% with 2 or more, 14% with 4 or more comorbidities
Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston
Mark Mascolini
Compared with HIV patients between 50 and 75 years old, those 75 and older had a similar rate of viral suppression but significantly more age-linked noncommunicable comorbidities [1]. This 15-site French study found that 98% of the 75-and-older group were taking antiretroviral therapy.
Most analyses of "older" people with HIV set 50 years as the threshold of old age. Researchers working with the 43,522-person French DatAIDS cohort exploited the size of this group to compare 12,748 "elderly" HIV-positive people from 50 to 74 with 430 "geriatric" HIV-positives 75 years old or older. The analysis included people with at least one visit since 2004 up to January 9, 2014.
Median ages of the geriatric and elderly groups were 78 (interquartile range [IQR] 76 to 81) and 56 (IQR 52 to 61). About three quarters of both groups were men. The geriatric group had a higher proportion of heterosexuals (56% versus 45.5%) and a lower proportion of men who have sex with men (36.7% versus 39.5%) (P < 0.001). A higher proportion of geriatric than elderly people was underweight by body mass index (22.4% versus 3.9%, P < 0.001). In a clear signal of self-selection, much lower proportions of geriatric than elderly people were current smokers (4.6% versus 37.2%, P < 0.001) or had a drug-injection history (2.1% versus 20.8%, P < 0.001). But similar proportions of both groups (about 13%) abused alcohol.
Median age at HIV diagnosis measured 62.2 in the geriatric group (IQR 56.3 to 67.3) and 39.7 in the elderly group (P < 0.001). Thirty-three people in the geriatric cluster (8%) did not get diagnosed until they were 75 or older. Median CD4 count at the last visit was significantly lower in the geriatric group (494 versus 560, P < 0.001), but exactly the same proportion in each group had a viral load below 50 copies (89.2%). Only 27% in the geriatric group had a CD4/CD8 ratio above 1. The researchers noted that a low CD4/CD8 ratio signals immune senescence; they suggested that the low ratio might be accelerated by the nearly universal prevalence of cytomegalovirus positivity in the geriatric group (95.3% versus 86.7% in the elderly group, P < 0.001).
Rates of nine noncommunicable comorbidities--including osteoporosis, cancer, cardiovascular disease, and renal failure--were significantly higher among geriatric cohort members, but the geriatric and elderly groups had similar rates of depression (15.1% and 16.6%). A much lower proportion of geriatric than elderly people had 0 or 1 noncommunicable comorbidity (45.8% versus 71.1%), while higher proportions had 2 or 3 (40.2% versus 24.7%) or 4 or more (14% versus 4.3%) (P < 0.001).
Almost everyone in the geriatric group, 98%, took antiretroviral therapy, which began at a median age of 64.5 (versus 44.1 in the elderly group, P < 0.001). The geriatric group had taken a median of 6 antiretroviral regimens (compared with 5 in the elderly group, P = 0.016). The most frequently prescribed regimens at the last visit were a nonnucleoside plus two nucleosides (29.3%), a boosted protease inhibitor (PI) plus two nucleosides (22.1%), a nucleoside-sparing boosted PI regimen (17.4%), a nucleoside- and PI-sparing regimen (13%), and an integrase inhibitor plus two nucleosides (10%).
The DatAIDS team called for development of "targeted interventions" for geriatric syndrome risk factors in people with HIV. The size of this geriatric cohort and their late age of HIV diagnosis should remind clinicians that sexual risk counseling should not stop at age 50.
Reference
1. Allavena C, Bernaud C, Lariven S, et al. Ageing with HIV: emerging importance of chronic comorbidities in patients over 75. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 709.
|
| |
|
|
|
|
|
