title: The associations between age and the development of laboratory abnormalities and treatment discontinuation for reasons other than virological failure in the first year of highly active antiretroviral therapy.
abstract: OBJECTIVE
  The aim of this study was to describe the relationship between age and the time to treatment discontinuation in the absence of virological failure as well as the development of specific laboratory abnormalities, in patients starting highly active antiretroviral therapy (HAART) for the first time.
  
  
  METHODS
  Analyses included 8708 antiretroviral-naïve patients from the UK Collaborative HIV Cohort (CHIC) study who started HAART from 1998 onwards. We considered time to the first discontinuation of any drug in the initial HAART regimen for reasons other than virological failure; the association between this and age at the start of HAART was determined using proportional hazards regression after adjustment for potential confounders. The incidence of specific laboratory abnormalities in the first year after starting HAART was compared in those of different ages using multiple logistic regression.
  
  
  RESULTS
  A total of 2650 patients discontinued at least one drug in their HAART regimen in the first year for reasons other than virological failure; after controlling for confounders, those aged < 30 years at the time of starting HAART were more likely to discontinue than those aged 30-39 years [relative hazard (RH) 1.12; 95% confidence interval (CI) 1.01, 1.24] as were those aged > or = 50 years (RH 1.14; 95% CI 1.00, 1.31). There were strong associations between greater age and raised total cholesterol, decreased haemoglobin and raised triglycerides over the first year, although the latter disappeared after adjustment for pre-HAART levels, suggesting that this finding reflected higher pre-HAART triglyceride levels in older individuals.
  
  
  CONCLUSIONS
  Continued attempts to improve the tolerability of HAART regimens may help to sustain the good outcomes in all age groups over the longer term.
authors.affiliation: Department of Primary Care and Population Science, Royal Free and UC Medical School, London, UK. c.sabin@pcps.ucl.ac.uk
authors.forename: C A
authors.initials: CA
authors.lastname: Sabin
authors.forename: C J
authors.initials: CJ
authors.lastname: Smith
authors.forename: V
authors.initials: V
authors.lastname: Delpech
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.forename: L
authors.initials: L
authors.lastname: Bansi
authors.forename: R
authors.initials: R
authors.lastname: Gilson
authors.forename: A
authors.initials: A
authors.lastname: Schwenk
authors.forename: C
authors.initials: C
authors.lastname: Leen
authors.forename: B
authors.initials: B
authors.lastname: Gazzard
authors.forename: K
authors.initials: K
authors.lastname: Porter
authors.forename: N
authors.initials: N
authors.lastname: Mackie
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.forename: C
authors.initials: C
authors.lastname: Orkin
authors.forename: M
authors.initials: M
authors.lastname: Johnson
authors.forename: P
authors.initials: P
authors.lastname: Easterbrook
authors.forename: T
authors.initials: T
authors.lastname: Hill
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D013997:Time Factors; D019562:Viral Load