title: Presentation and outcome amongst older Singaporeans living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS): does age alone drive excess mortality?
abstract: BACKGROUND
  There is little detailed information on human immunodeficiency virus (HIV) amongst older adults in Singapore.
  
  
  METHODS
  A retrospective study of 121 consecutive referrals of patients presenting for HIV care was conducted. Demographic, clinical and laboratory variables were collected. A prognostic model derived from the North American Veterans' Affairs Cohort Study (VACS) was used to estimate prognosis.
  
  
  RESULTS
  The median age at presentation was 43 (range, 18 to 76). Thirty-eight patients (31%) were aged 50 or older and 106 patients (88%) were male. Older patients were more likely to be of Chinese ethnicity (P = 0.035), married (P = 0.0001), unemployed or retired (P = 0.0001), and to have acquired their infection heterosexually (P = 0.0002). The majority of patients in both groups were symptomatic at presentation. Eighty-one (67%) had CD4 counts less than 200 at baseline with no observable differences in HIV ribonucleic acid (RNA) or clinical stage based on age. Non-Acquired Immunodeficiency Syndrome (AIDS) morbidity was observed more frequently amongst older patients. The estimated prognosis of patients differed significantly based on age. Using the VACS Index and comparing younger patients with those aged 50 and above, mean 5 year mortality estimates were 25% and 50% respectively (P <0.001). A trend towards earlier antiretroviral therapy was noted amongst older patients (P = 0.067) driven mainly by fewer financial difficulties reported as barriers to treatment.
  
  
  CONCLUSIONS
  Older patients form a high proportion of newly diagnosed HIV/AIDS cases and present with more non-AIDS morbidity. This confers a poor prognosis despite comparable findings with younger patients in terms of clinical stage, AIDS-defining illness, CD4 count and HIV viral load.
authors.affiliation: Department of Medicine, National University Hospital, Singapore. Paul_john_huggan@nuhs.edu.sg
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Huggan
authors.forename: Rui Min
authors.initials: RM
authors.lastname: Foo
authors.forename: Dariusz
authors.initials: D
authors.lastname: Olszyna
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Chew
authors.forename: Nares
authors.initials: N
authors.lastname: Smitasen
authors.forename: Amartya
authors.initials: A
authors.lastname: Mukhopadhyay
authors.forename: Sophia
authors.initials: S
authors.lastname: Archuleta
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D020276:HIV Long-Term Survivors; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009026:Mortality / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D012923:Social Class; D055815:Young Adult