title: [Aging and HIV infection: 4 years follow-up of 149 HIV infected patients older than 60 years in West Paris agglomeration (COREVIH Île-de-France Ouest)].
abstract: In France, patients over 50 years represent more than 23.6% of all registered cases in the French Hospital Database for HIV (FHDH), and 18% of newly HIV-diagnosed patients.
  
  
  OBJECTIVE
  To describe the long-term evolution after 4 years of a cohort of HIV infected patients older than 60 years recruited in COREVIH Île-de-France Ouest.
  
  
  RESULTS
  One hundred and forty-nine participants, 115 men (77%) and 34 women (23%), were included in the cohort analysis in 2004, and baseline characteristics were: median age 65.4 years (60.3-86.3), CDC stage C: 36%, HBV and HCV co-infections: four (2.7%) and eight (5.4%) patients, median time from first HIV infection diagnosis: 8.5 years (0.25-19.5), ongoing HAART regimen: 88%, median duration of ARV treatment: 7.5 years (0.2-15.5), baseline CD4 cells count: 372/mm(3) (18-1860), HIV viral load less than 200 c/ml: 104 (70%). After a 4-year follow-up, 111 patients were alive, all but one treated with HAART, 17/149 (11.5%) were lost for follow-up, and 21/149 were deceased (14%). Causes of death were acute cardiovascular disease (4/21), neoplasia (11/21), neurological disease 1/21, end stage liver disease 3/21, unknown 2/21. The prevalence of co-morbidities after 4 years of follow-up were: arterial hypertension 40/111 (36%), hypercholesterolemia 48/111 (43%), diabetes 23/111 (21%), kidney disease with renal insufficiency (creatinine clairance<60 ml/min): 36/111 (32%). At the end of follow-up, median CD4 cells count was 494/mm(3), and viral load was undetectable less than 200 c/ml in 107/111 patients (96%). No new opportunistic infection occurred during the 4-year follow-up, but 24 patients had a new diagnosis of neoplasia (incidence 40/1000 person-year). Cancer was the cause of death in 11/24.
  
  
  CONCLUSIONS
  Clinical and immunological improvement was continuous under HAART in these aged HIV infected patients, but co-morbidities are frequently observed in this population, with high incidence of cardiovascular disease and neoplasia, and related mortality. A multidisciplinary approach, with preventive consultations, oncology and cardiovascular screening, as done in geriatrics, is warranted in the aging HIV population.
authors: AP-HP, hôpital Raymond-Poincaré, 92380 Garches, France.
authors: Gabriella
authors: G
authors: Flexor
authors: David
authors: D
authors: Zucman
authors: Huguette
authors: H
authors: Berthé
authors: Françoise
authors: F
authors: Meier
authors: Gilles
authors: G
authors: Force
authors: Alix
authors: A
authors: Greder-Belan
authors: Christophe
authors: C
authors: Billy
authors: Caroline
authors: C
authors: Dupont
authors: Emmanuel
authors: E
authors: Mortier
authors: Antoine
authors: A
authors: Bizard
authors: Elisabeth
authors: E
authors: Rouveix
authors: Pierre
authors: P
authors: de Truchis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000276:immunology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D015897:Comorbidity; D018450:Disease Progression; D004198:Disease Susceptibility; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000378:metabolism; D006525:Hepatitis, Viral, Human / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D010297:Paris / Q000453:epidemiology; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents