jules levin, NATAP: HIV in 70-year-olds — comorbid conditions (0103)

IAS: HIV-1 INFECTION IN SUBJECTS OLDER THAN 70:
A MULTICENTER CROSS-SECTIONAL ASSESSMENT IN CATALONIA, SPAIN – (11/29/09)
Reported by Jules Levin
Presented at IAS Capetown July 2009

Management of HIV-1 infection in older patients can be complicated by geriatric syndromes, high comorbidity and polipharmacy….We designed a multicenter cross-sectional study to describe the epidemiological characteristics of the HIV-1-infected population aged 70 years or more in our setting….69% had been diagnosed with HIV-1 after their sixties….179 HIV-infected individuals aged 70 years or more were included….154 subjects had at least one comorbid condition, including dyslipidemia (54%), hypertension (36%), hyperglicaemia or diabetes (30%), cardiovascular disease (23%), chronic renal failure (18%), history of neoplasia (17%), and cognitive impairment (11%)…..Lipodystrophy was reported in 58% of individuals…..Elders infected with HIV-1 were frequently affected by comorbidities, polypharmacy and were likely diagnosed late at low CD4+ counts. Tailored antiretroviral regimens and closer monitoring need to be established for the elderly.

AUTHORS: Mothe B.1,2, Perez I.3, Domingo P4., Podzamczer D5., Ribera E.6, Viladés C.7, Vidal F.7, Dalmau D.8, Pedrol E.9, Negredo E1., Molto J1., Paredes R.2, Perez-Alvarez N1, 10, Gatell JM3, Clotet B. Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona. 2 Retrovirology Laboratory irsiCaixa, Hospital Universitari Germans Trias i Pujol, Badalona. 3 Hospital Clínic, Barcelona. 4HIV Unit, Hospital de la Santa Creu i Sant Pau, Barcelona. 5HIV Unit, Hospital Universitari de Bellvitge, Barcelona. 6Infectious Diseases Division, Hospital de la Vall d’Hebron, Barcelona. 7 HIV Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona. 8 HIV Unit, Hospital Universitari Mutua de Terrassa, Terrassa. 9 HIV Unit, Hospital de Granollers, Granollers. 10 Statistics and Operations Research Department,Technical University of Catalonia, Spain.

BACKGROUND: Improvements in antiretroviral therapy and new HIV infections in the elderly have led to an increasing prevalence of HIV-infected subjects over 70 in industrialized countries. In the US, it has been estimated that 50% of HIV-1-infected people would be older than 50 years by the year 2015. Management of HIV-1 infection in older patients can be complicated by geriatric syndromes, high comorbidity and polipharmacy.

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METHODS: We designed a multicenter cross-sectional study to describe the epidemiological characteristics of the HIV-1-infected population aged 70 years or more in our setting. Eight university hospitals of the Barcelona metropolitan area participated in the study. Information about epidemiology, comorbidity, lipodistrophy, antiretroviral history and concomitant treatments was recorded. Descriptive statistics were used to characterize the cohort and contrasted with a historical cohort of HIV-infected adults from the same setting. (PISCIS Multicenter Cohort, Navarro, J Infect 2008

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RESULTS: 179 HIV-infected individuals aged 70 years or more were included (1.5% among 11,815 HIV-1 infected subjects followed during 2007) Most subjects were male (76%), had acquired HIV infection through sexual intercourse (87%), 69% had been diagnosed with HIV-1 after their sixties. The CD4 cell counts at HIV-1 diagnosis (median: 190 cells/mm3 (IQR 64; 325 cells/mm3) were lower than in the PISCIS Multicenter Cohort (median: 277 cells/mm3 (IQR 264; 288)). 154 subjects had at least one comorbid condition, including dyslipidemia (54%), hypertension (36%), hyperglicaemia or diabetes (30%), cardiovascular disease (23%), chronic renal failure (18%), history of neoplasia (17%), and cognitive impairment (11%).

Lipodystrophy was reported in 58% of individuals. Fifty-one percent of subjects were on a NNRTI-based regimen; receiving either nevirapine or efavirenz (1:1 ratio). Atazanavir (17%) was more used over other protease inhibitors (lopinavir 7%). Elders were taking an average of 2.97 drugs (range 1-10) other than antiretrovirals.

CONCLUSIONS: Elders infected with HIV-1 were frequently affected by comorbidities, polypharmacy and were likely diagnosed late at low CD4+ counts. Tailored antiretroviral regimens and closer monitoring need to be established for the elderly. Preventive campaigns and promotion for HIV testing addressed to this growing population should be reinforced.


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