CCRT was feasible with our study population and improved maze learning and attention on a detection task. This supports previous findings by our group with cerebral malaria survivors (Bangirana, Giordani, et al., 2009).

Background We describe older (> 50 years) HIV-infected adults after ART initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pre-treatment 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 9,806 individuals who initiated ART, mean age was 37 years (S.D 8.8), average follow-up 5.7 years (S.D 1.7) and median baseline CD4 was 115 cells/mm3 (IQR; 42-184). Adults <50 years had on average a higher CD4 increase of 45 cells/mm3 (95% CI; 17, 72, p=0.001) compared to counterparts aged ≥ 60 years. Mortality was highest among older adults compared to younger counterparts. Only CD4 count <100 cells/mm3 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. Conclusion 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.

ObjectiveClinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low–income African countries.Methods Setting: HIV clinics in Uganda and Zimbabwe. Design: Secondary exploratory cross-sectional analysis of the DART randomized controlled trial. Outcome Measures: Clinical and laboratory characteristics were compared between adults aged 18-49 years (younger) and ≥ 50 years (older), using two exploratory multivariable logistic regression models, one with HIV viral load (measured in a subset pre-ART) and one without.ResultsA total of 3316 eligible participants enrolled in DART were available for analysis; 219 (7%) were ≥ 50 years and 1160 (35%) were male. Across the two adjusted regression models, older adults had significantly higher systolic blood pressure, lower creatinine clearance and were consistently less likely to be females compared to younger adults with HIV. Paradoxically, the models separately suggested that older adults had statistically significant (but not clinically important) higher CD4+ cell counts and higher plasma HIV–1 viral copies at initiation. Crude associations between older age and higher baseline hemoglobin, body mass index, diastolic blood pressure and lower WHO clinical stage were not sustained in the adjusted analysis.ConclusionsOur study found clinical and immunological differences between younger and older adults, in a cohort of Africans starting antiretroviral therapy. Further investigations should explore how these differences could be used to ensure equity in service delivery and affect outcomes of antiretroviral therapy.

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