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HAART in HIV+ naive elderly patients: immuno-virological response and clinical outcome

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Journal of the International AIDS Society200811 (Suppl 1) :P17

https://doi.org/10.1186/1758-2652-11-S1-P17

  • Published:

Keywords

  • Virological Response
  • Drug Addict
  • Naive Patient
  • Infectious Disease Unit
  • Therapeutic Switch

Purpose of the study

Elderly patients (≥50 years) are increasing in the HIV population; HAART-related prolonged survival and late diagnosis of new HIV infections are possible reasons of this findings. It is debated whether older patients have a different response to HAART. The aim of this retrospective study was to evaluate efficacy of HAART and clinical outcome in a group of patients ≥50 year in comparison to a control group (<50 years-old).

Methods

All naïve patients starting HAART since November 1996 in two different Infectious Diseases units in Catania (Sicily) were included. The following parameters were evaluated: epidemiological (sex, age, risk factors, year of HAART beginning), viro-immunological (CD4 cell count, HIV-RNA viral load), and clinical (CDC, first treatment, number and causes of therapeutic switch, new AIDS diseases and death). The follow-up was performed until the last available visit.

Summary of results

We enrolled 276 HIV-1-infected patients; 215 (78%) male, median age 38 years; 122 (44%) heterosexuals, 103 (38%) homo-bisexuals, 43 (16%) drug addicts; 139 (50.4%) CDC A, 31 (11.2%) CDC B, 106 (38.4%) CDC C; median CD4 cell count was 155 (IQ range 48–301), median HIV-RNA viral load 5.0 log10 (IQ range 4.3–5.4). Fifty-one patients (18.5%) were ≥50 years old, 82.4% male, most of them infected by sexual intercourse (p = 0.002). At baseline, elderly patients were more frequently symptomatic (p = 0.002) with a trend to lower CD4 cell count (98 vs. 169 cells/μl); no differences were seen on HIV-RNA copies/ml. Twelve months after beginning of HAART, median absolute increase (146 vs. 165 cells/μl) of the CD4 cell count and percentage of patients with HIV-RNA <400 copies/ml (87.2% vs. 85.7%) were comparable in elderly and younger patients, respectively 82.1% and 82.8% achieved an immuno-virological response (defined as VL <400 copies/ml and more than 100 CD4 cells/μl increase). At last, 65% and 16% of elderly patients achieved, respectively, more than 200 and more than 500 CD4 cell/μl with no significant difference with younger patients. Discontinuation of HAART (any causes) was less frequent in older subjects (p = 0.04). After a median follow-up of 68 months, the percentage of deaths was 15.7% and 5.8% (p = 0.034) in the elderly and younger group, respectively.

Conclusion

In our experience, elderly and younger naive patients on HAART have similar immunological and virological response while hard clinical end-points tend to be more frequent in older subjects. Prospective studies are necessary to further investigate our findings.

Authors’ Affiliations

(1)
Unit of Infectious diseases University of Catania ARNAS Garibaldi, Catania, Italy
(2)
Unit of Infectious diseases Ferrarotto Hospital AO Vittorio Emanuele, Catania, Italy

Copyright

© Celesia et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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