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Antiretroviral Therapy in Older HIV-Infected Patients
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Am Fam Physician. 2002 Sep 15;66(6):1072.
Numerous studies have demonstrated a more rapid progression of human immunodeficiency virus (HIV) infection to acquired immunodeficiency syndrome (AIDS) and earlier death in older HIV-positive persons. Treatment trials done before the era of highly active antiretroviral therapy (HAART) also suggested lesser efficacy in older patients. Grimes and colleagues performed a retrospective chart review of patients treated with HAART at a Veteran’s Administration medical center to determine if HIV-positive persons who were at least 50 years of age experienced slower progression of HIV disease since the advent of these effective treatments.
After identifying 52 HIV-infected patients who were at least 50 years of age, the authors randomly selected 52 other HIV-infected subjects younger than 50 years of age to serve as a control group. Because of higher death rates among the older patients, the average length of treatment that could be followed was shorter for the older subjects than for their younger counterparts (4.3 years versus 5.4 years). Approximately 50 percent of the study subjects were from minority ethnic groups. There were no significant differences in initial CD4+ T lymphocyte counts or viral loads between the older and younger groups.
Chart reviews over the years of treatment revealed no significant differences in the incidence of medication-related side effects between the age groups. The only opportunistic infection that was significantly different between the cohorts was a higher incidence of Candida infection (thrush) among the younger patients. The amount of improvement in CD4+ counts and viral loads during treatment was not clinically or statistically different between older and younger subjects. The higher mortality rate among older patients was not because of AIDS-related diseases; causes of death included cardiac tamponade, cardiac arrhythmia, lung cancer, and gastric cancer.
The authors concluded that HIV-infected patients more than 50 years of age had similar benefits from HAART as younger counterparts and no greater risk for treatment-related side effects.
Grimes RM, et al. Clinical experience with human immunodeficiency virus-infected older patients in the era of effective antiretroviral therapy. Clin Infect Dis. June 1, 2002;34:1530–3.
Copyright © 2002 by the American Academy of Family Physicians.
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