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HIV More Advanced at Diagnosis in
Older People, ART Response Slower
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IDWeek 2018, October 3-7, 2018, San Francisco
Mark Mascolini
People 50 or older had a 150-cell lower CD4 count when diagnosed with HIV, according to a 2010-2015 analysis by Yale University clinicians [1]. Compared with younger people, the older group proved twice as likely to have AIDS at diagnosis, and their initial response to antiretroviral therapy (ART) seemed slower.
Yale researchers who conducted this study noted that people 50 or older now account for about half of the US HIV population and represent 1 in 6 people newly diagnosed with HIV. Across the country, about 35% of this older group has AIDS at HIV diagnosis. They conducted this single-center retrospective study to get a better idea of HIV disease characteristics, staging, and response to treatment in people diagnosed at age 50 or older.
The analysis involved everyone newly diagnosed with HIV at Yale's HIV ambulatory clinic from January 2010 through December 2015. The research team used medical records to establish relevant data, including age, HIV staging, and virologic and CD4-cell response to ART. Virologic suppression meant a viral load below 50 copies 12 weeks after treatment began.
Of the 130 study participants, 28 (21.5%) were 50 or older at HIV diagnosis. Whites and nonwhites made up 57.1% and 42.9% of the older group, compared with 34.3% and 65.7% of the younger group (P = 0.03). Average CD4 count at diagnosis lay about 150 cells lower in the older group (227.8 versus 376.4, P = 0.004). Two thirds of people 50 or older had AIDS at diagnosis, compared with under one third of younger people (67.9% versus 30.4%, P = 0.0006). Average viral load at diagnosis did not differ substantially between groups. Nor did proportion of women (21.4% older, 25.5% younger) or prevalence of HIV transmission route.
Older people started a protease inhibitor regimen more often than younger people (25% versus 5.9%, P = 0.01), while marginally lower proportions of the older group started an integrase inhibitor (35.7% versus 42.2%) or a nonnucleoside (35.7% versus 40.2%).
A nonsignificantly lower proportion of older people reached a viral load below 50 copies in the first 12 weeks of therapy (53.6% versus 65.6%, P = 0.30), and average CD4 gain through 12 weeks was nonsignificantly lower among older people (100 versus 124.5 cells, P = 0.41). People without viral suppression at 12 weeks were more likely to have AIDS at diagnosis. All women with a detectable viral load at 12 weeks were nonwhite, whereas men with a detectable load at 12 weeks tended to be white.
The Yale researchers believe their findings that older people with HIV enter care with more advanced infection and respond to ART more slowly "are alarming and require emphasis on HIV diagnosis at early stages."
Reference
1. Rizk C, Taylor B, Yasin F, Barakat L. Older HIV-infected adults are twice more likely to present late to care. IDWeek 2018, October 3-7, 2018, San Francisco. Abstract 575.
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