title: Complications of HIV infection in an ageing population: challenges in managing older patients on long-term combination antiretroviral therapy.
abstract: With the use of combination antiretroviral therapy, the proportion of HIV-infected patients over age 50 has greatly increased. The rate of progression of untreated HIV disease, response to therapy and complicating effects of co-morbidities differ in older versus younger patients. Compared with younger individuals, older untreated HIV patients demonstrate faster rates of CD4+ cell loss and more rapid progression to AIDS and death. With treatment, older patients have a better virological response, but a less robust immunological response. The treatment of older HIV-infected patients is further complicated by pre-existing co-morbid conditions including cardiovascular, hepatic and metabolic complications that may be exacerbated by the effects of HIV infection per se, modest immunodeficiency (i.e. at CD4+ counts >350 cells/mm³), and the metabolic and other adverse effects of combination antiretroviral therapy. Based on these considerations guidelines for the treatment of HIV-infected patients state that increased age is a consideration in initiating antiretroviral therapy in persons with >350-500 CD4+ cells/mm³.
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000150:complications; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008107:Liver Diseases / Q000150:complications; D008875:Middle Aged
chemical_list: D019380:Anti-HIV Agents