Aging, Antiretrovirals, and Adherence: A Meta Analysis of Adherence among Older HIV-Infected Individuals

Abstract

Introduction Older adults are generally considered to be at greater risk for medication non-adherence due to factors such as medication complexity, side effects, cost, and cognitive decline. However, this generalization may not apply to older adults with human immunodeficiency virus (HIV). Regardless of age, suboptimal adherence to antiretroviral therapy (ART) can lead to increased viral load, immunosuppression, drug-resistant viral strains, co-morbidities, and opportunistic infections. Understanding trends of adherence to ART among older adults is critical, especially as the population of people living with HIV grows older. Objectives The purpose of this systematic review and meta-analysis is to determine if older individuals with HIV are less likely to be non-adherent to antiretroviral therapy than younger individuals with HIV. Design A systematic search in PubMed, Embase, and PsycINFO was conducted to identify peer-reviewed articles evaluating adherence to ART in older adults. Two independent reviewers screened abstracts, applied inclusion criteria, and appraised study quality. The bibliographies of qualifying studies were searched. Data were abstracted from studies by two independent authors. Meta-analyses were conducted, and adherence levels were reported as the relative risk of non-adherence in older individuals compared to younger individuals. Results The systematic search yielded 1,848 abstracts. Twelve studies met full inclusion criteria. The overall meta-analysis found that older age reduced risk for non-adherence by 27% (Relative Risk (RR) 0.72, 95% Confidence Interval (CI) 0.64–0.82). Studies assessing both short-term and long-term adherence demonstrated a significant reduction in non-adherence among older patients (RR 0.75, 95% CI 0.64–0.87 and RR 0.65, 95% CI 0.50–0.85, respectively). Conclusions Older adults with HIV have a reduced risk for non-adherence to ART than their younger counterparts. Future studies should seek to elucidate contributing factors of adherence among older individuals with HIV.

Impact of Age on Retention in Care and Viral Suppression

“…24 Similarly, a recent systematic review and meta-analysis noted that older age reduced the risk of ART non-adherence by 27% (relative risk 0.72, [0.64, 0.82]). 25 These studies suggest that differences in ART adherence between older and younger adults exist and may mediate the relationships with viral suppression. Unfortunately, ART adherence data was unavailable and thus was not included in our analyses.…”

Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort

“…Studies from high‐income countries and resource‐limited settings have also shown higher rates of virologic suppression among older patients as a result of better treatment adherence compared to younger patients 12, 33, 36, 37, 38. Possible explanations for a higher mortality risk in older patients include multi‐morbidities, polypharmacy, chronic infection with viral pathogens (e.g.…”

Immunosenescence and hurdles in the clinical management of older HIV-patients

“…[71][72][73][74][75][76][77] Interestingly, this finding is not explained by differences in virological response, as older HIV-infected patients tend to have a superior virological outcome when compared with younger patients. [78][79][80][81][82][83] Some suggests that these finding may be linked with higher adherence in older patients, 78,[84][85] but other authors reported a higher risk of inadequate adherence in HIV patients who have other comorbidities and take other medications besides HAART. [86][87] While virological response seems not to be influenced by age, at least biologically, older patients have lower CD4C T-cell gain compared with younger persons, [88][89][90][91][92][93][94][95] even when adjusted for antiretroviral therapy regimens.…”