www.hivandhepatitis.com

Management Age-related Conditions Is a Key Aspect of Care for Older People with HIV

Elder people with HIV are often diagnosed late, have more advanced immune suppression, and typically have a variety of co-existing chronic age-related conditions, according to a Spanish study of patients age 70 or older reported in the November 2009 issue of Current HIV Research. Older patients respond well to antiretroviral therapy (ART), however, achieving undetectable viral load and good CD4 cell recovery.

Aging with HIV has become an issue of growing importance as the earliest cohort infected with the virus survives to an older age, and as new research suggests that long-term infection may somehow accelerate the aging process.

Beatriz Mothe, Bonaventura Clotet, and colleagues with the Lluita contra la Sida Foundation designed a multicenter cross-sectional study to describe the epidemiological characteristics of the HIV positive population aged 70 years or older in Catalonia, Spain. The analysis included 179 individuals from 8 university hospitals in Barcelona, representing 1.5% of all HIV patients followed during 2008.

Results

• About three-quarters of the study participants were men, and most (87%) became infected through sex.
• 69% were diagnosed as HIV positive after their 60s.
• About half (52%) had advanced immune suppression with CD4 cell counts < 200 cells/mm³ at the time of diagnosis, compared with about one-third of younger patients from the same area.
• Most study patients were on combination ART, and achieved undetectable HIV viral load and a median CD4 count ³350 cells/mm³.
• 154 participants -- 86% -- had at least 1 comorbid condition, the most common of which were:
  • Lipodystrophy (58%);
  • Abnormal blood lipid levels (54%);
  • High blood pressure (36%);
  • Elevate blood glucose or diabetes (30%);
  • Cardiovascular disease (23%);
  • Chronic kidney failure (18%);
  • History of cancer or precancerous changes (17%);
  • Cognitive impairment (11%).
• Rates of abnormal blood lipids, diabetes, and cancer were considerably higher in this group compared with the unselected local population (28%, 17%, and 7%, respectively).
• Study participants were taking an average of 3 drugs (range 1-10) besides antiretroviral agents.

"Elders infected with HIV-1 were frequently affected by comorbidities, polypharmacy [use of multiple drugs] and were likely diagnosed late at low CD4+ counts," the study authors wrote. "Tailored antiretroviral regimens and closer monitoring need to be established for the elderly."

Lluita contra la Sida' Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.

12/4/09

Reference

B Mothe, I Perez, P Domingo, and others. HIV-1 Infection in Subjects Older than 70: A Multicenter Cross-Sectional Assessment in Catalonia, Spain. Current HIV Research 7(6): 597-600. November 2009.