title: Aging with HIV: an overview of an urban cohort in Rio de Janeiro (Brazil) across decades of life.
abstract: The introduction of highly active antiretroviral therapy during the 1990s was crucial to the decline in the rates of morbidity and death related to the acquired immunodeficiency syndrome (AIDS) and turned human immunodeficiency virus (HIV) infection into a chronic condition. Consequently, the HIV/AIDS population is becoming older. The aim of this study was to describe the immunological, clinical and comorbidity profile of an urban cohort of patients with HIV/AIDS followed up at Instituto de Pesquisa Clinica Evandro Chagas, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Retrospective data from 2307 patients during January 1st, 2008 and December 31st, 2008 were collected. For continuous variables, Cuzick's non-parametric test was used. For categorical variables, the Cochran-Armitage non-parametric test for tendency was used. For all tests, the threshold for statistical significance was set at 5%. In 2008, 1023 (44.3%), 823 (35.7%), 352 (15.3%) and 109 (4.7%) were aged 18-39, 40-49, 50-59 and ≥60 years-old, respectively. Older and elderly patients (≥40 years) were more likely to have viral suppression than younger patients (18-39 years) (p<0.001). No significant difference in the latest CD4(+) T lymphocyte count in the different age strata was observed, although elderly patients (≥ 50 years) had lower CD4(+) T lymphocyte nadir (p<0.02). The number of comorbidities increased with age and the same pattern was observed for the majority of the comorbidities, including diabetes mellitus, dyslipidemia, hypertension, cardiovascular diseases, erectile dysfunction, HCV, renal dysfunction and also for non-AIDS-related cancers (p<0.001). With the survival increase associated to successful antiretroviral therapy and with the increasing new infections among elderly group, the burden associated to the diagnosis and treatment of the non-AIDS related HIV comorbidities will grow. Longitudinal studies on the impact of aging on the HIV/AIDS population are still necessary, especially in resource-limited countries.
authors.affiliation: Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, HIV/AIDS Clinical Research Center, Rio de Janeiro, RJ, Brazil.
authors.forename: Thiago Silva
authors.initials: TS
authors.lastname: Torres
authors.forename: Sandra Wagner
authors.initials: SW
authors.lastname: Cardoso
authors.forename: Luciane de Souza
authors.initials: Lde S
authors.lastname: Velasque
authors.forename: Luana Monteiro Spindola
authors.initials: LM
authors.lastname: Marins
authors.forename: Marília Santini de
authors.initials: MS
authors.lastname: Oliveira
authors.forename: Valdilea Gonçalves
authors.initials: VG
authors.lastname: Veloso
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014505:Urban Population; D019562:Viral Load; D055815:Young Adult