HIV infection: treatment outcomes in older and younger adults.
OBJECTIVE
To determine the effect of antiretroviral therapy (ART) on the immunological and virological outcomes of older human immunodeficiency virus (HIV)-infected patients compared with younger HIV-infected patients.


METHODS
Matched (1:2) retrospective case-control study (1993-1999).


METHODS
Duke University Infectious Diseases Clinic.


METHODS
One hundred one older patients, mean age 56.7 (range 50-79) and 202 younger patients, mean age 32.8 (range 21-39). Patients were matched on baseline CD4+ cell count and date of clinic entry.


METHODS
The virological and immunological outcomes were viral suppression (HIV ribonucleic acid (RNA) level < or =400 copies/ml) and change in CD4+ cell count. To estimate differences in antiretroviral drug exposure, the percentage of patients on ART overall and by drug class was compared. To assess antiretroviral drug exposure further, the percentage of patients having interruptions in ART was compared.


RESULTS
The older and younger groups had similar baseline CD4+ cell counts (332 vs 306 cells/mm3; P =.31) and similar increases in CD4+ cell counts (+3.47 vs +4.60 cells/mm3/month; P =.37) over a mean +/- standard deviation of 2.4 +/- 1.7 years of follow-up. The older group had a higher percentage of patients with current plasma HIV RNA levels less than 400 (46% vs 34%; P =.05). The groups had similar rates of non-nucleoside reverse transcriptase, nucleoside reverse transcriptase, and protease inhibitor use. The older group had fewer interruptions in ART than the younger group (11% vs 26%; P =.01).


CONCLUSIONS
Older HIV-infected patients responded well to ART, with a significantly greater percentage achieving a current plasma HIV RNA below detectable limits. Older patients experienced similar increases in CD4+ cell count as younger matched controls. Older patients were less likely to interrupt ART, which suggests better adherence and/or tolerance and may explain the higher rate of HIV RNA suppression.
Wellons
Melissa Fair
MF
School of Medicine, Department of Medicine, Center for Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina 27705, USA.
Sanders
Linda
L
Edwards
Lloyd J
LJ
Bartlett
John A
JA
Heald
Alison E
AE
Schmader
Kenneth E
KE
D000328:Adult; D017677:Age Distribution; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors