IDSA: Older HIV Patients Do Well on HAART

SAN DIEGO, Oct. 8 -- Older patients with HIV infection have robust responses to highly active antiretroviral therapy (HAART), with no increased risk of metabolic disorders or other adverse effects, according to two studies.

Patients 50 and older had a shorter time to viral suppression compared with younger patients and had no greater risk of cardiovascular, skeletal, or cognitive problems than did age-matched non-HIV controls, investigators reported here at the Infectious Diseases Society of America meeting.

By 2015, a majority of HIV-positive patients will be 50 or older, said Adena Greenbaum, a medical student at Johns Hopkins. Yet, relatively little data are available on the clinical characteristics or treatment outcomes in older HIV patients.

"There has been some concern that older HIV patients might not respond to or tolerate HAART as well as younger patients, but that concern hasn't been supported by much data," said Greenbaum.

To evaluate older HIV patients' response to HAART, investigators reviewed data on 1,235 patients included in the HIV Research Network. The study group consisted of 270 patients ages 50 and older and 965 younger patients.

The older and younger patients differed significantly in only two respects: The source of infection was more often intravenous drug use and less often male-male sex in older patients, and older patients had been diagnosed more recently.

Patients in both age groups had been on HAART for three to four years. On average, older patients achieved viral suppression (< 400 copies/mL) a month quicker than did younger patients (3.9 months versus 4.9 months, P=0.0025).

Analyses of the time to virologic suppression by type of HAART regimen showed that younger patients responded more quickly to non-nucleoside reverse transcriptase inhibitor regimens than to protease inhibitor-based regimens. In contrast, the type of regimen did not influence time to virologic suppression in older patients.

In an adjusted model of factors that predicted time to virologic suppression, age greater than 50 was one of the predictors (P=0.046).

Kristin Mondy, M.D., of Washington University in St. Louis, and colleagues, examined the potential adverse effects of HIV infection and HAART in older patients (mean age 56). They compared metabolic and other health-related parameters in 70 HIV-positive patients and 70 age-matched controls without HIV infection.

All but two of the HIV patients had exposure to HAART, and duration of HAART averaged 7.4 years. The patients had a median CD4 count of 510 cells/mm³ and a nadir of 191, and Dr. Mondy reported that 27 (38.6%) of the HIV patients had a history of opportunistic infections, and two (2.9%) had a history of AIDS-related malignancy.

Comparison of a variety of clinical parameters showed that HIV patients had higher rates of chronic hepatitis (B or C) and hypertension; higher levels of albumin and triglycerides; and lower levels of hemoglobin, fasting glucose, and fasting LDL-cholesterol. The 10-year Framingham risk score did not differ between groups.

A similar proportion of patients in each group had bone mineral densities consistent with osteopenia, and osteoporosis.

"These HIV patients have been on HAART for a long time, and their impressive rate of virologic suppression indicates that they are also adherent," said Dr. Mondy. "I think the fact that they have remained on HAART as long as they have and maintained virologic suppression probably has played a role in the low rate of complications we observed."