1
|
Fan L, Li P, Yu A, Liu D, Wang Z, Wu Y, Zhang D, Zou M, Ma P. Prevalence of and prognosis for poor immunological recovery by virally suppressed and aged HIV-infected patients. Front Med (Lausanne) 2023; 10:1259871. [PMID: 37928477 PMCID: PMC10625403 DOI: 10.3389/fmed.2023.1259871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Background Antiretroviral therapy (ART) prolongs lifespan and decreases mortality of HIV infected patients. However, many patients do not achieve optimal immune reconstitution. The influence of non-optimal immune recovery on non-AIDS related diseases is not well defined in aged HIV-infected patients receiving ART. Methods A retrospective study was conducted at Tianjin Second People's Hospital, China to evaluate the association of an inadequate immunological response and non-AIDS diseases in HIV infected patients ≥60 years of age and virally suppressed for at least 2 years by ART. Results The study included patients (n = 666) who initiated ART between August 2009 and December 2020. The prevalence of patients with an inadequate immunological response was 29.6%. The percentage of non-AIDS diseases such as hypertension, cardiovascular disease (CVD), diabetes, tumor, and chronic kidney disease (CKD) was 32.9, 9.9, 31, 4.1, and 13%, respectively. In addition to baseline CD4+ T cell counts, CVD and tumor were associated with poor immune reconstitution in aged Chinese HIV-1 infected patients. The adjusted odds ratios (95% confidence interval) were AOR 2.45 (95% CI: 1.22-4.93) and 3.06 (95% CI: 1.09-8.56, p = 0.03). Inadequate immunological response was associated with greater mortality (AOR: 2.83, 95% CI: 1.42-5.67, p = 0.003) in this cohort. Conclusion These results tend to demonstrate appropriate drug selection at ART initiation and prevention of non-AIDS complications during ART decreased mortality of and an inadequate immunological response in aged HIV infected patients.
Collapse
Affiliation(s)
- Lina Fan
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Penghui Li
- Department of Surgery, Tianjin Second People's Hospital, Tianjin, China
| | - Aiping Yu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Dan Liu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Ziyu Wang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
| | - Yue Wu
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Out-patient Department, Tianjin Second People's Hospital, Tianjin, China
| | - Defa Zhang
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Out-patient Department, Tianjin Second People's Hospital, Tianjin, China
| | - Meiyin Zou
- Affiliated Infectious Disease Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ping Ma
- Department of Infectious Diseases, Tianjin Second People's Hospital, Tianjin, China
- Tianjin Association of STD/AIDS Prevention and Control, Tianjin, China
| |
Collapse
|
2
|
Serrão R, Piñero C, Velez J, Coutinho D, Maltez F, Lino S, Sarmento E Castro R, Tavares AP, Pacheco P, Lopes MJ, Mansinho K, Miranda AC, Neves I, Correia de Abreu R, Almeida J, Pássaro L. Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study. Int J Infect Dis 2018; 79:94-100. [PMID: 30529370 DOI: 10.1016/j.ijid.2018.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC. METHODS This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC. RESULTS Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005). CONCLUSIONS A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.
Collapse
Affiliation(s)
- Rosário Serrão
- Department of Infectious Diseases, Centro Hospitalar de São João, Porto, Portugal.
| | - Carmela Piñero
- Department of Infectious Diseases, Centro Hospitalar de São João, Porto, Portugal.
| | - Jorge Velez
- Department of Infectious Diseases, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
| | - Daniel Coutinho
- Department of Infectious Diseases, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
| | - Fernando Maltez
- Department of Infectious Diseases, Centro Hospitalar Lisboa Central, Hospital Curry Cabral, Lisboa, Portugal.
| | - Sara Lino
- Department of Infectious Diseases, Centro Hospitalar Lisboa Central, Hospital Curry Cabral, Lisboa, Portugal.
| | | | - Ana Paula Tavares
- Department of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal.
| | - Patrícia Pacheco
- Department of Infectious Diseases, Hospital Prof. Doutor Fernando Fonseca EPE, Amadora, Portugal.
| | - Maria João Lopes
- Department of Infectious Diseases, Hospital Prof. Doutor Fernando Fonseca EPE, Amadora, Portugal.
| | - Kamal Mansinho
- Department of Infectious Diseases, Centro Hospitalar Lisboa Ocidental, Hospital Egas Moniz, Lisboa, Portugal.
| | - Ana Cláudia Miranda
- Department of Infectious Diseases, Centro Hospitalar Lisboa Ocidental, Hospital Egas Moniz, Lisboa, Portugal.
| | - Isabel Neves
- Department of Infectious Diseases, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
| | | | | | | |
Collapse
|
3
|
Mortality and immunological recovery among older adults on antiretroviral therapy at a large urban HIV clinic in Kampala, Uganda. J Acquir Immune Defic Syndr 2015; 67:382-9. [PMID: 25171733 DOI: 10.1097/qai.0000000000000330] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe older (>50 years) HIV-infected adults after antiretroviral therapy (ART) initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pretreatment CD4. We also describe mortality on ART and its risk factors by age category including the contribution of poor immunological recovery at a large urban clinic in Kampala, Uganda. METHODS We performed a cohort analysis of adult (>18 years) HIV-infected patients who initiated ART between January 1, 2004 and January 3, 2012. Immunological response was evaluated using mixed-effects linear regression. We described mortality using Kaplan-Meier survival methods analyzing for risk factors of mortality using multivariate Weibull survival regression stratified by age category. RESULTS Among 9806 individuals who initiated ART, mean age was 37 years (SD: 8.8), average follow-up 5.7 years (SD: 1.7), and median baseline CD4 was 115 cells per cubic millimeter (interquartile range: 42-184). Adults younger than 50 years had on average a higher CD4 increase of 45 cells per cubic millimeter (95% confidence interval: 17 to 72; P = 0.001) compared with counterparts aged 60 years and older. Mortality was highest among older adults compared with younger counterparts. Only CD4 count <100 cells per cubic millimeter after 1 year on ART and a CD4 count less than baseline were associated with a statistically significant higher rate of death among older adults. CONCLUSIONS Older adults had a slower immunological response, which was associated with mortality, but this mortality was not typically associated with opportunistic infections. Future steps would require more evaluation of possible causes of death among these older individuals if survival on ART is to be further improved.
Collapse
|
4
|
Comorbidities among the HIV-infected patients aged 40 years or older in Taiwan. PLoS One 2014; 9:e104945. [PMID: 25119532 PMCID: PMC4132082 DOI: 10.1371/journal.pone.0104945] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/11/2014] [Indexed: 12/25/2022] Open
Abstract
Background With the widespread use of combination antiretroviral therapy (cART), life expectancy of HIV-infected patients has significantly prolonged. An increasing number of HIV-infected patients are aging and concurrent use of medications are not uncommon for management of metabolic complications and cardiovascular diseases related to aging and prolonged exposure to cART. Methods We reviewed medical records of all HIV-infected patients aged 40 years or older who had been followed at a university hospital for HIV care in Taiwan between January and December 2013. A standardized case record form was used to collect information on demographics and clinical characteristics, comorbidity, cART, and concurrent medications. Results During the study period, 610 patients aged 40 to 49 years (mean, 44.1) and 310 aged 50 years or older (mean, 58.8) sought HIV care at this hospital. Compared with patients aged 40 to 49 years, those aged 50 years or older were significantly more likely to be female (15.9% vs 3.8%); to have received cART (97.7% vs 94.8%) and a lower plasma HIV RNA load (1.6 vs 1.7 log10 copies/ml); and to have diabetes mellitus (18.4% vs 4.6%), hypertension (31.0% vs 10.8%), hyperlipidemia (29.4% vs 11.6%), coronary artery disease (6.8% vs 0.5%), and an estimated glomerular filtration rate <60 ml/min/1.73 m2 (11.5% vs 2.7%); and were significantly less likely to have syphilis. Other than HIV infection, patients aged 50 years or older were more likely to have been receiving two or more concurrent medications than those aged 40 to 49 years (22.9% vs 6.4%). Conclusions Our findings show a significant proportion of the HIV-infected patients aged 50 years or older have multiple comorbidities that may increase the risk for cardiovascular and renal complications. Issues of poly-pharmacy among the HIV-infected patients who are aging should be addressed to ensure adherence and minimize drug-drug interactions.
Collapse
|
5
|
Eduardo E, Lamb MR, Kandula S, Howard A, Mugisha V, Kimanga D, Kilama B, El-Sadr W, Elul B. Characteristics and outcomes among older HIV-positive adults enrolled in HIV programs in four sub-Saharan African countries. PLoS One 2014; 9:e103864. [PMID: 25075743 PMCID: PMC4116238 DOI: 10.1371/journal.pone.0103864] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/03/2014] [Indexed: 12/04/2022] Open
Abstract
Background Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa. Methodology Using routinely-collected longitudinal patient-level data among 391,111 adults ≥15 years enrolling in HIV care from January 2005–December 2010 and 184,689 initiating ART, we compared characteristics and outcomes between older (≥50 years) and younger adults at 199 clinics in Kenya, Mozambique, Rwanda, and Tanzania. We calculated proportions over time of newly enrolled and active adults receiving HIV care and initiating ART who were ≥50 years; cumulative incidence of loss to follow-up (LTF) and recorded death one year after enrollment and ART initiation, and CD4+ response following ART initiation. Findings From 2005–2010, the percentage of adults ≥50 years newly enrolled in HIV care remained stable at 10%, while the percentage of adults ≥50 years newly initiating ART (10% [2005]-12% [2010]), active in follow-up (10% [2005]-14% (2010]), and active on ART (10% [2005]-16% [2010]) significantly increased. One year after enrollment, older patients had significantly lower incidence of LTF (33.1% vs. 32.6%[40–49 years], 40.5%[25–39 years], and 56.3%[15–24 years]; p-value<0.0001), but significantly higher incidence of recorded death (6.0% vs. 5.0% [40–49 years], 4.1% [25–39 years], and 2.8% [15–24 years]; p-valve<0.0001). LTF was lower after vs. before ART initiation for all ages, with older adults experiencing less LTF than younger adults. Among 85,763 ART patients with baseline and follow-up CD4+ counts, adjusted average 12-month CD4+ response for older adults was 20.6 cells/mm3 lower than for adults 25–39 years of age (95% CI: 17.1–24.1). Conclusions The proportion of patients who are ≥50 years has increased over time and been driven by aging of the existing patient population. Older patients experienced less LTF, higher recorded mortality and less robust CD4+ response after ART initiation. Increased programmatic attention on older adults receiving HIV care in sub-Saharan Africa is warranted.
Collapse
Affiliation(s)
- Eduard Eduardo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Matthew R Lamb
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Sasi Kandula
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Andrea Howard
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Veronicah Mugisha
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Davies Kimanga
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Bonita Kilama
- National AIDS Control Program, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Wafaa El-Sadr
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America; ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| |
Collapse
|
6
|
Coelho AV, Silva SP, de Alencar LC, Stocco G, Crovella S, Brandão LA, Guimarães RL. ABCB1andABCC1variants associated with virological failure of first-line protease inhibitors antiretroviral regimens in Northeast Brazil patients. J Clin Pharmacol 2013; 53:1286-93. [DOI: 10.1002/jcph.165] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 08/13/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Antonio V.C. Coelho
- Department of Genetics; Federal University of Pernambuco; Recife PE Brazil
- Laboratory of Immunopatology Keizo Asami (LIKA); Federal University of Pernambuco; Recife PE Brazil
| | - Suedja P.S. Silva
- Laboratory of Immunopatology Keizo Asami (LIKA); Federal University of Pernambuco; Recife PE Brazil
- Post-graduation Program of Therapeutic Innovation (PPGIT); Federal University of Pernambuco; Recife PE Brazil
| | | | - Gabriele Stocco
- Department of Life Sciences; University of Trieste; Trieste Italy
| | - Sergio Crovella
- Department of Genetics; Federal University of Pernambuco; Recife PE Brazil
- Laboratory of Immunopatology Keizo Asami (LIKA); Federal University of Pernambuco; Recife PE Brazil
| | - Lucas A.C. Brandão
- Department of Genetics; Federal University of Pernambuco; Recife PE Brazil
- Departament of Pathology; Federal University of Pernambuco; Recife PE Brazil
| | | |
Collapse
|
7
|
Torres TS, Cardoso SW, Velasque LDS, Marins LMS, Oliveira MSD, Veloso VG, Grinsztejn B. Aging with HIV: an overview of an urban cohort in Rio de Janeiro (Brazil) across decades of life. Braz J Infect Dis 2013; 17:324-31. [PMID: 23602466 PMCID: PMC9427395 DOI: 10.1016/j.bjid.2012.10.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 12/21/2022] Open
Abstract
The introduction of highly active antiretroviral therapy during the 1990s was crucial to the decline in the rates of morbidity and death related to the acquired immunodeficiency syndrome (AIDS) and turned human immunodeficiency virus (HIV) infection into a chronic condition. Consequently, the HIV/AIDS population is becoming older. The aim of this study was to describe the immunological, clinical and comorbidity profile of an urban cohort of patients with HIV/AIDS followed up at Instituto de Pesquisa Clinica Evandro Chagas, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Retrospective data from 2307 patients during January 1st, 2008 and December 31st, 2008 were collected. For continuous variables, Cuzick's non-parametric test was used. For categorical variables, the Cochran–Armitage non-parametric test for tendency was used. For all tests, the threshold for statistical significance was set at 5%. In 2008, 1023 (44.3%), 823 (35.7%), 352 (15.3%) and 109 (4.7%) were aged 18–39, 40–49, 50–59 and ≥60 years-old, respectively. Older and elderly patients (≥40 years) were more likely to have viral suppression than younger patients (18–39 years) (p < 0.001). No significant difference in the latest CD4+ T lymphocyte count in the different age strata was observed, although elderly patients (≥ 50 years) had lower CD4+ T lymphocyte nadir (p < 0.02). The number of comorbidities increased with age and the same pattern was observed for the majority of the comorbidities, including diabetes mellitus, dyslipidemia, hypertension, cardiovascular diseases, erectile dysfunction, HCV, renal dysfunction and also for non-AIDS-related cancers (p < 0.001). With the survival increase associated to successful antiretroviral therapy and with the increasing new infections among elderly group, the burden associated to the diagnosis and treatment of the non-AIDS related HIV comorbidities will grow. Longitudinal studies on the impact of aging on the HIV/AIDS population are still necessary, especially in resource-limited countries.
Collapse
Affiliation(s)
- Thiago Silva Torres
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas, HIV/AIDS Clinical Research Center, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | |
Collapse
|
8
|
Kumarasamy N, Patel A, Pujari S. Antiretroviral therapy in Indian setting: when & what to start with, when & what to switch to? Indian J Med Res 2012; 134:787-800. [PMID: 22310814 PMCID: PMC3284090 DOI: 10.4103/0971-5916.92626] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
With the rapid scale up of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Several new safe antiretroviral, and newer class of drugs and monitoring assays are developed recently. As a result the treatment guideline for the management of HIV disease continue to change. This review focuses on evolving science on Indian policy - antiretroviral therapy initiation, which drugs to start with, when to change the initial regimen and what to change.
Collapse
Affiliation(s)
- N Kumarasamy
- YRG CARE Medical Centre, Voluntary Health Services, Chennai, India.
| | | | | |
Collapse
|