Treatment Responses and Complications among HIV-infected Patients who Initiated Antiretroviral at
the Age of ≥ 50 Years and those who are < 50 years at Chiang Mai University Hospital
1560
Romanee Chaiwarith, MD, Thanapat Kittipanyaworakun MD
Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Introduction
Prevalence of HIV in patients aged ≥ 50 years is increasing. Responses to combination
antiretroviral therapy (cART) in this population are variable. Comorbidities and side effects are
Results
Variables
also common.
This study aimed to evaluate responses to cART and adverse effects after cART in HIVinfected elderly patients.
Age (years,
median, IQR)
Male (%)
Objectives
Primary objective was to compare virologic and immunologic responses after cART initiation
between patients who initiated cART at aged ≥ 50 years and aged < 50 years.
Secondary objective was to compare demographic data, adverse events and metabolic
complications between groups
Materials and Methods
Age < 50 years
(209 patients)
34 (28.9, 40.3)
Age ≥ 50 years
(103 patients)
54.5 (51.8, 58.4)
113 (54.1)
63 (61.2)
Occupation (190, 98)
25 (13.2)
42 (42.9)
Employee
102 (53.7)
23 (23.5)
Route of transmission
Heterosexual
168 (80.4)
100 (97.1)
Homosexual
38 (18.2)
2 (1.9)
Number of underlying diseases (207, 103)
98 (47.3)
34 (33.0)
Study population: HIV-infected adults who were aged ≥ 18 years and initiated cART
40 (38.8)
2 diseases
312 patients were randomly selected from 1073 patients, 209 patients aged < 50 years and 103
patients aged ≥ 50 years.
0.275
29 (14.0)
15 (14.6)
≥ 3 diseases
5 (2.5)
14 (13.6)
Hypertension
13 (6.3)
27 (26.2)
<0.001
Diabetes mellitus
4 (1.9)
9 (8.7)
0.012
Dyslipidemia
6 (2.9)
9 (8.7)
0.045
HBV co-infection
35/188 (18.6)
6/ 95 (6.3)
0.007
HCV co-infection
18/189 (9.5)
6/97 (6.2)
0.337
CD4 cells responses after cART initiation were not different between 2 groups as shown in
40 (20.7)
13 (13.1)
0.148
Tuberculosis
32 (16.6)
19 (19.2)
0.626
Cryptococcosis
12 (6.2)
0(0)
0.010
Penicilliosis marneffei
19 (9.8)
12 (12.1)
0.552
Median time to reach CD4 cells of 350
cells/mm3
after cART were 30 months (IQR 18, 48) and
30 months (IQR 18, 60) in patients aged <50 and ≥50 years, respectively as shown in Figure 2.
Adverse effects and metabolic complications between 2 groups are shown in Table 3
p-values
0.134
First cART regimen
0.023
AZT, d4T/3TC/NVP
113 (54.1)
52 (50.5)
AZT, d4T/3TC/EFV
42 (20.1)
15 (14.6)
TDF/3TC, FTC/EFV
34 (16.3)
33 (32.0)
0.457
35 (38.0)
81 (44.8)
35 (38.0)
200-350
25 (13.8)
19 (20.6)
≥ 350
5 (2.8)
3 (3.3)
HIV-1 RNA (log
N=56
N=36
5 (4.7, 5.3)
5 (4.8, 5.5)
0.539
Figure 1 CD4 cells after cART initiation
cART initiation between groups
Age < 50 years
Age ≥ 50 years
(209 patients)
(103 patients)
P-value
Lipodystrophy
48 (23.0)
29 (28.2)
0.331
Rash
12 (5.7)
8 (7.8)
0.473
Hepatitis
7 (3.4)
3 (2.9)
1.000
Bone marrow
4 (1.9)
6 (5.8)
0.087
Adverse events
Pneumocystis pneumonia
Proportions of patients achieving undetectable HIV-1 RNA at 6 months were 93.5% (101/108)
70 (38.7)
50-199
Variables
Opportunistic infections (193, 99)
and 95.3% (61/64) in patients aged <50 and ≥50 years, respectively.
Age ≥ 50 years
(103 patients)
90 (32.5, 193.5)
Table 3 Adverse events and metabolic complications after
Characteristics of patients in 2 groups are shown in Table 1 and 2
Figure 1.
Age < 50 years
(209 patients)
75 (23, 156)
CD4 cells category (cells/mm3)
< 50
copies/ml)
0.001
75 (36.2)
Results
<0.001
CD4 cells at cART
< 0.001
1 disease
between patients who initiated cART at aged ≥ 50 years and aged < 50 years were compared
Variables
<0.001
Government officer
None
Demographic characteristics, responses to cART, and adverse effects after cART initiation
P-value
Median CD4 cells (cells/mm3) at each visit
initiation (cells/mm3)
Study design: A retrospective cohort study.
between January 2005 and December 2012 at Chiang Mai University Hospital
Results
Table 2 Laboratory findings of patients between groups
Table 1 Characteristics of patients between groups
Email: [email protected]
Mailing address: 110 Intavaroros,
Sribhoom, Muang, Chiang Mai,
Thailand.
Tel +66-5394-6457
Fax +66-5389-4231
Table 4: Treatment outcome of patients
Table 5: Factors associated with death
suppression
Renal complication
1 (0.5)
6 (5.8)
0.006
41 (19.6)
38 (36.9)
0.001
Dyslipidemia
28 (13.4)
29 (28.2)
0.003
Hypertension
19 (9.1)
12 (11.6)
0.547
Diabetes mellitus
1 (0.5)
5 (4.8)
0.016
0.8 (0.7, 1.0)
1.0 (0.8, 1.2)
<0.001
97.5 (91, 107.5)
102 (98, 117)
0.003
Metabolic
complications
FBS (mg/dl)
LDL (mg/dl)
Conclusions
We identified distinct differences in risk of transmission and
underlying diseases between groups.
However, immunologic and virologic responses to cART were not
Laboratory findings
Creatinine (mg/dl)
Figure 2 Probability of achieving CD4 cells of 350 cells/mm3
after cART initiation
121 (95, 144)
135 (109, 160)
0.006
different.
Blood cholesterol and sugar were higher among older patients
after cART, although no relevant clinically significance.