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Women 65 or Older Have Worse Virologic Control Than Men in Italian Cohort
  16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Women 65 or older in the Italian GEPPO cohort had a lower virologic suppression rate than elderly men, but they had a better CD4/CD8 ratio than men [1]. The researchers suggested differences in regimens, adverse events, comorbidities, or drug-drug interactions could explain the worse virologic control in women.
Prospective cohort studies in Europe (AGEhIV, POPPY) and the United States (VACS) aim to evaluate health changes in older adults with versus without HIV. But these cohort include relatively few women and none are designed to compare outcomes in elderly women and elderly men. GEPPO, Geriatric Patients Living With HIV/AIDS, is a prospective cohort of HIV-positive people 65 or older in 10 outpatient clinics in Italy [2]. Participants are tracked for major comorbidities and for polypharmacy, defined as use of 5 or more drugs other than antiretrovirals.
This cross-sectional analysis compared 210 GEPPO women 65 or older with 1027 GEPPO men the same age. Women did not differ significantly from men in age (average 71.8 and 71.0), proportion of Caucasians (97.1% and 98.5%), HIV duration (15.8 and 16 years), HCV antibody positivity (11.8% and 11.3%), or hepatitis B surface antigen positivity (8% and 8.8%).
A significantly lower proportion of women than men had a viral load below 50 copies (74.3% versus 81.8%, P = 0.002). Women had a lower nadir CD4 count than men (153 versus 189, P = 0.012) but a higher (better) current CD4/CD8 ratio (1.01 versus 0.9, P = 0.016). Current CD4 count was similar in women and men (635 and 641).
Similar proportions of women and men were taking a single antiretroviral or two antiretrovirals (28.6% and 29.1%). A lower proportion of women were taking a protease inhibitor (39.5% versus 46.8%, P = 0.05), and a nonsignificantly higher proportion of women were taking an integrase inhibitor (35.7% versus 29.7%). Women with bone disease took protease inhibitors significantly less often than men with bone disease (38% versus 53.7%, P = 0.026) and took boosted regimens significantly less often (30.4% versus 44%, P = 0.048).
Average number of comorbidities was similar in women and men (2.19 and 2.37), but women had a significantly lower prevalence of cardiovascular disease (about 10% versus 20%, P < 0.001) and significantly higher prevalence of bone disease (about 50% versus 20%, P < 0.001). Polypharmacy rates were similar in women and men (20% and 22.8%). A significantly higher proportion of women than men used antilipid drugs (20.5% versus 14.8%, P = 0.04), but a significantly lower proportion of women received antithrombotic agents (18.6% versus 26.3%, P = 0.019), even when the medical record indicated cardiovascular disease (P = 0.018).
GEPPO investigators believe this is the largest analysis of HIV-positive women 65 or older. They surmised that the lower CD4 nadir in women than men reflects late diagnosis, perhaps because women get targeted in HIV screening programs less often than men. Several factors could explain the worse virologic response in women than men, the researchers noted, including differing antiretroviral choices in women and more adverse events or drug-drug interactions.
1. Foca E, Magro P, Guaraldi G, et al. Elderly HIV-positive women in the GEPPO cohort: a gender-based analysis of viro-immunological, clinical and therapeutical features. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PS5/1.
2. Nozza S, Malagoli A, Maia L, et al. Antiretroviral therapy in geriatric HIV patients: the GEPPO cohort study. J Antimicrob Chemother. 2017 Jun 10. doi: 10.1093/jac/dkx169. Epub ahead of print.