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Effect of age on response to and tolerability of highly active antiretroviral therapy: a case-control study

Purpose of the study

Patients who develop HIV infection in their older years represent a special issue for health care providers. We sought to determine the characteristics of HIV infection in older individuals, including co-morbid conditions, response and tolerability to highly active antiretroviral therapy (HAART), and to compare these aspects with those diagnosed among younger subjects.


All outpatients medical records of HIV-infected patients, newly diagnosed between 1 Jan. 2000 and 30 April 2008 at the Infectious Diseases Clinic of Perugia University Hospital, were reviewed. All patients were selected, and divided in two groups, according to age (<50 years>). Demographic data, HIV risk behaviours, stage of HIV disease (including CD4 cell count, HIV viral load), use of HAART, co-morbid conditions and tolerability of therapy were collected. When available, 6- and 12-month data on CD4 cell count, HIV-RNA undetectability, side-effects and modification of treatments were collected as well. Data were analysed with t-test for continuous variables and chi-square for categorical variables; logistic regression was used for multivariate analysis.

Summary of results

During the study period 328 consecutive adult patients had been diagnosed as HIV positive; 51 were older than 50 years. Compared to younger patients, older patients were more frequently male (p = 0.015) and Italian (p < 0.001); drug addiction was less frequent among older patients, although this result was marginally significant (p = 0.054). Older patients had significantly more co-morbidities (diabetes, hypertension, dyslipidemia) (p < 0.001). We did not find significant differences for HIV-RNA undetectability and for CD4 cell count at 6 and 12 months. However, older patients had more side-effects (p = 0.001) and changed treatment more frequently (p < 0.001).


The main problem with older patients is treatment tolerability, which causes a more frequent change of antiretroviral drugs. However, viro-immunological results do not differ between the two age groups. Clinical trials admitting older HIV patients are needed.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Francisci, D., Masini, G., Papili, R. et al. Effect of age on response to and tolerability of highly active antiretroviral therapy: a case-control study. JIAS 11 (Suppl 1), P84 (2008).

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