TreatmentUpdate
214

March/April 2016 

Emerging issues in older HIV-positive people

As people age they become at heightened risk for many health issues. As HIV-positive people survive longer, preventing and treating age-related health issues will become more important.

Researchers at major medical centres in France compared health-related information from more than 13,000 HIV-positive people, some of whom were more than 75 years old. They found that some older people had a statistically significant increase in many age-related complications, in some cases, multiple complications. Consequently, the researchers called for programs to screen HIV-positive people for these conditions so they can be prevented and treated in their early stages. They also recommended collaboration among specialists caring for this population.

Study details

Researchers extracted information from a database called Dat’AIDS, which has enrolled nearly 44,000 HIV-positive participants, and selected two groups that they described as follows:

  • “elderly” (aged 50 to 75 years) – 12,748 participants
  • “geriatric” (aged 75 years and older) – 654 participants

The average profile of the elderly participants upon entering Dat’AIDS was as follows:

  • age – 56 years
  • 75% men, 25% women
  • co-infected with hepatitis C virus – 25%
  • co-infected with cytomegalovirus (CMV) – 87%
  • current smoker – 37%
  • engaged in alcohol abuse – 13%
  • current or past injection of street drugs – 21%
  • current CD4+ count – 560 cells/mm3
  • 89% had a viral load less than 50 copies/mL
  • age at ART initiation – 44 years

The average profile of the geriatric participants upon entering the study was as follows:

  • age – 78 years
  • 72% men, 28% women
  • co-infected with hepatitis C virus – 9%
  • co-infected with cytomegalovirus (CMV) – 95%
  • current smoker – 5%
  • alcohol abuse – 13%
  • current or past injection of street drugs – 2%
  • current CD4+ count – 494 cells/mm3
  • 89% had a viral load less than 50 copies/mL
  • age at ART initiation – 65 years

Results

The distribution of age-associated illnesses between the two groups of participants was as follows:

Type 2 diabetes

  • elderly – 11%
  • geriatric – 22%

Higher-than-normal blood pressure

  • elderly – 21%
  • geriatric – 42%

Cardiovascular disease (except stroke)

  • elderly – 9%
  • geriatric – 21%

Stroke

  • elderly – 3%
  • geriatric – 6%

Cancer (unrelated to HIV infection)

  • elderly – 12%
  • geriatric – 23%

Severe kidney dysfunction

  • elderly – 5%
  • geriatric – 14%

Liver injury arising from hepatitis

  • elderly – 5%
  • geriatric – 2%

Depression

  • elderly – 17%
  • geriatric – 15%

Readers can see that nearly all conditions were more common in geriatric people, with the exception of depression and liver injury.

The proportion of participants having two or more age-related complications was increased among the geriatric participants as follows:

One age-related condition

  • elderly – 71%
  • geriatric – 46%

Two or three age-related conditions

  • elderly – 25%
  • geriatric – 40%

Four or more age-related conditions

  • elderly – 4%
  • geriatric – 15%

Bear in mind

In both groups of participants, there were high rates of what researchers call “virological success”—having a viral load less than 50 copies/mL because of ART. Furthermore, CD4+ cell counts were around 500 cells/mm3 in both sets of participants.

However, people aged 76 and older were more likely to have age-related health issues.

The researchers recommended that clinics prioritize screening for and treatment of age-related conditions, especially those that affect the following organ-systems:

  • heart and circulatory system
  • liver
  • kidneys
  • bones
  • brain

The researchers also cautioned doctors to be aware of the potential for older patients taking multiple medicines, as this may cause unexpected interactions.

The researchers encouraged doctors and nurses to incorporate assessments of geriatric conditions and, when necessary, interventions for those conditions into regular care.

They also would like to see more collaboration among HIV specialists, family doctors and geriatric specialists to help deal with the issue of age-related conditions among aging HIV-positive patients.

—Sean R. Hosein

REFERENCE

Allavena C, Bernaud C, Lariven S, et al. Aging with HIV: emerging importance of chronic comorbidities in patients over 75. Conference on Retroviruses and Opportunistic Infections, 22-25 February 2016, Boston, MA. Abstract 709.