Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients

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.

The challenge of HIV treatment in an era of polypharmacy

“…As expected, the number of comorbidities in PLWH has been shown to increase with age: 18.4% of PLWH aged ≥75 years from the French Dat'AIDS cohort had ≥4 comorbidities versus 4.3% of those aged 50 to 74 years [32]. A similar picture is observed in the Swiss HIV Cohort Study (SHCS) as the number of age-associated comorbidities is significantly higher in PLWH aged 65 years compared to those aged 50 to 64 years [35].…”

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

“…With universal access to effective and tolerable antiretroviral therapy, people living with HIV are living longer [1][2][3]. They are also presenting with new clinical and social challenges associated with aging [4]. In high income countries, the proportion of people living with HIV who are 50 years of age or older increased from 15% in 2000 to 33% in 2016, with a similar trend in low and middle income countries [5,6].…”

Risk and Cost Associated With Drug–Drug Interactions Among Aging HIV Patients Receiving Combined Antiretroviral Therapy in France

“…Therapeutic progress in the area of combined antiretroviral therapy (cART) during the past 2 decades has dramatically decreased HIV morbidity and mortality [1, 2]. In the Dat’AIDS French cohort of people living with HIV (PLWH), 45.3% and 1.5% were older than age 50 and 75 years, respectively, on December 2015 [3]. Currently, HIV patients aged >65 years account for 6% of PLWH in the United States [4].…”