Abstract
IntroductionThe “greying” of the HIV epidemic necessitates a better understanding of the healthcare needs of older HIV‐positive adults. As these individuals age, it is unclear whether comorbidities and their associated therapies or the ageing process itself alter the response to antiretroviral therapy (ART). In this study, HIV treatment outcomes and corresponding risk factors were compared between older ART initiators and those who were younger using data from the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).Methods HIV‐positive adults (≥18 years) initiating ART at nine sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Patients were classified as older (≥50 years) or younger (<50 years) based on age at ART initiation. ART effectiveness was measured using three outcomes: death, virologic failure and ART treatment modification. Cox regression models for each outcome compared risk between older and younger patients, adjusting for other covariates.ResultsAmong 26,311 patients initiating ART between 1996 and 2016, 3389 (13%) were ≥50 years. The majority of patients in both ≥50 and <50 age groups received a non‐nucleoside reverse transcriptase inhibitor‐based regimen (89% vs. 87%), did not have AIDS at baseline (63% vs. 62%), and were male (59% vs. 58%). Older patients had a higher risk of death (adjusted hazard ratio (aHR) 1.64; 95% confidence intervals (CI): 1.48 to 1.83) and a lower risk of virologic failure (aHR: 0.73; 95% CI: 0.63 to 0.84). There was no difference in risk of ART modification (aHR: 1.00; 95% CI: 0.94 to 1.06). Risk factors for death, virologic failure and treatment modification were similar for each group.ConclusionsOlder age at ART initiation was associated with increased mortality and decreased risk of virologic failure in our cohort of more than 26,000 ART initiators in Latin America and the Caribbean. To the best of our knowledge this is the first study from the region to evaluate ART outcomes in this growing and important population. Given the complexity of issues related to ageing with HIV, a greater understanding is needed in order to properly respond to this shifting epidemic.
Highlights
The “greying” of the HIV epidemic necessitates a better understanding of the healthcare needs of older HIVpositive adults
In adjusted Cox proportional hazard models, older patients had a higher risk of death (adjusted hazard ratio 1.64; 95% confidence intervals (CI): 1.48 to 1.83) and a lower risk of virologic failure, after multiply imputing missing covariate values and adjusting for sex, presence of AIDS-defining illness, intravenous drug use, antiretroviral therapy (ART) regimen, time from HIV diagnosis to ART initiation, ART initiation year, and nadir CD4 count
Given that the relative proportion of ARTinitiating patients over 50 years is increasing across the region, the results from this study provide important insight regarding the impact of ageing on ART outcomes for this growing population in the Latin America and the Caribbean (LAC) region
Summary
Studies from the U.S and Canada have demonstrated that older adults often present with lower CD4 counts and are more likely to have an AIDS-defining condition at the time of HIV diagnosis compared to their younger counterparts [10]. As HIV-positive adults age they have high accumulation of co-morbid conditions, including renal and liver disease, and co-medication use, that may affect their response to ART [14,15]. We analysed data from the Caribbean, Central and South America Network (CCASAnet) cohort to describe risk factors for disparities in outcomes (including death, ART modification and virologic failure) following ART initiation in older relative to younger adults living with HIV in Latin America and the Caribbean (LAC)
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