Abstract
As HIV-infected adults on successful antiretroviral therapy (ART) are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. The objective of this cross-sectional study was to compare in the French Dat’AIDS cohort, the HIV geriatric population, aged 75 years and over, to the elderly one, aged from 50 to 74 years. As of Dec 2015, 16,436 subjects (43.8% of the French Dat’AIDS cohort) were aged from 50 to 74 (elderly group) and 572 subjects (1.5%) were aged 75 and over (geriatric group). Durations of HIV infection and of ART were slightly but significantly different, median at 19 and 18 years, and 15 and 16 years in the elderly and geriatric group, respectively. The geriatric group was more frequently at CDC stage C and had a lower nadir CD4. This group had been more exposed to first generation protease inhibitors and thymidine analogues. Despite similar virologic suppression, type of ART at the last visit significantly differed between the 2 groups: triple ART in 74% versus 68.2%, ART ≥ 4 drugs in 4.7% versus 2.7%; dual therapy in 11.6% versus 16.4% in the elderly group and the geriatric group, respectively. In the geriatric group all co-morbidities were significantly more frequent, except dyslipidemia, 4.3% of the elderly group had ≥4 co-morbidities versus18.4% in the geriatric group. Despite more co-morbidities and more advanced HIV infection the geriatric population achieve similar high rate of virologic suppression than the elderly population. A multidisciplinary approach should be developed to face the incoming challenge of aging HIV population.
Highlights
As a benefit of long term suppressive antiretroviral therapy with improved tolerability, the number of aging HIV infected individuals is increasing with about half of them above 50 years of age or over in high-income countries [1, 2]
There was no difference in the proportion of HIV-1 infected subjects on antiretroviral therapy (ART), 97.3% and 97.2% in the geriatric and the elderly group, respectively, with a duration of known HIV infection slightly shorter in the geriatric group than in the elderly group (18.0 vs 19.0 years, p = 0.029) and a median duration of ART significantly longer in the geriatric group than in the elderly group, (16.0 vs 15.0 years, p = 0.003)
Plasma HIV RNA was below 50 copies/mL in 90.6% and 90.9% of the subjects on ART in the elderly and geriatric group, respectively (p = 0.932)
Summary
As a benefit of long term suppressive antiretroviral therapy with improved tolerability, the number of aging HIV infected individuals is increasing with about half of them above 50 years of age or over in high-income countries [1, 2]. Large differences in life expectancy persist between certain sub-groups of patients according to sex, race, HIV transmission risk group, lifestyle and CD4 cell counts at ART initiation[3, 5, 6]. It is well-established that multimorbidity increases with age, comorbidities, including cardiovascular diseases, diabetes, cancer, cognitive dysfunction, depression and osteopenia are more frequent in the HIV population[7,8,9,10,11]. The concept of premature aging of HIV-infected persons appears to be controversial, when considering the investigation of the effects of age on non–AIDS-defining malignancies[13]
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