title: Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults.
abstract: BACKGROUND
  the number and proportion of adults diagnosed with HIV infection aged 50 years and older has risen. This study compares the effect of CD4 counts and anti-retroviral therapy (ART) on mortality rates among adults diagnosed aged ≥50 with those diagnosed at a younger age.
  
  
  METHODS
  retrospective cohort analysis of national surveillance reports of HIV-diagnosed adults (15 years and older) in England, Wales and Northern Ireland. The relative impacts of age, CD4 count at diagnosis and ART on mortality were determined in Cox proportional hazards models.
  
  
  RESULTS
  among 63,805 adults diagnosed with HIV between 2000 and 2009, 9% (5,683) were aged ≥50 years; older persons were more likely to be white, heterosexual and present with a CD4 count <200 cells/mm(3) (48 versus 32% P < 0.01) and AIDS at diagnosis (19 versus 9%, P < 0.01). One-year mortality was higher in older adults (10 versus 3%, P < 0.01) and especially in those diagnosed with a CD4 <200 cells/mm(3) left untreated (46 versus 15%, P < 0.01). While the relative mortality risk reduction from ART initiation at CD <200 cells/mm(3) was similar in both age groups, the absolute risk difference was higher among older adults (40 versus 12% fewer deaths) such that the number needed to treat older adults to prevent one death was two compared with eight among younger adults.
  
  
  CONCLUSIONS
  the magnitude of benefit from ART is greater in older adults than younger adults. Older persons should be considered as a target for HIV testing. Coupled with prompt treatment, earlier diagnosis is likely to reduce substantially deaths in this group.
authors.affiliation: Public Health and Primary Care, Institute of Public Health, Forvie Site Robinson Way, Cambridge, UK.
authors.forename: Daniel H J
authors.initials: DH
authors.lastname: Davis
authors.forename: Ruth
authors.initials: R
authors.lastname: Smith
authors.forename: Alison
authors.initials: A
authors.lastname: Brown
authors.forename: Brian
authors.initials: B
authors.lastname: Rice
authors.forename: Zheng
authors.initials: Z
authors.lastname: Yin
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000375:Aging; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; antiretroviral therapy; epidemiology; older people; surveillance