Multimorbidity in Elderly Persons According to the Year of Diagnosis of Human Immunodeficiency Virus Infection: A Cross-sectional Dat’AIDS Cohort Study

Abstract

Background We assessed prevalence of multimorbidity (MM) according to year of human immunodeficiency virus (HIV) diagnosis in elderly people living with HIV (PLWH). Methods This was a cross-sectional study of MM in PLWH aged ≥70 years from the Dat’AIDS French multicenter cohort. MM was defined as at least 3 coexistent morbidities of high blood pressure, diabetes mellitus, osteoporosis, non-AIDS cancer, chronic renal failure, cardiovascular and cerebrovascular disease, obesity, undernutrition, or hypercholesterolemia. Logistic regression models evaluated the association between MM and calendar periods of HIV diagnosis (1983–1996, 1997–2006, and 2007–2018). The secondary analysis evaluated MM as a continuous outcome, and a sensitivity analysis excluded PLWH with nadir CD4 count <200 cells/μL. Results Between January 2017 and September 2018, 2476 PLWH were included. Median age was 73 years, 75% were men, median CD4 count was 578 cells/μL, and 94% had controlled viremia. MM prevalence was 71%. HBP and hypercholesterolemia were the most prevalent comorbidities. After adjustment for age, gender, smoking status, hepatitis C and hepatitis B virus coinfection, group of exposure, nadir CD4 count, CD4:CD8 ratio, and last CD4 level, calendar period of diagnosis was not associated with MM (P = .169). MM was associated with older age, CD4/CD8 ratio <0.8, and nadir CD4 count <200 cells/μL. Similar results were found with secondary and sensitivity analyses. Conclusions MM prevalence was high and increased with age, low CD4/CD8 ratio, and nadir CD4 count <200 cells/μL but was not associated with calendar periods of HIV diagnosis. Known duration of HIV diagnosis does not seem to be a criterion for selecting elderly PLWH at risk of MM.

Switching to a Bictegravir Single Tablet Regimen in Elderly People Living with HIV-1: Data Analysis from the BICTEL Cohort

“…Significant changes in the immune profile were detected, with a remarkable improvement of CD4 + T cells count, CD8 + T cells count and CD4 + /CD8 + ratio among both the overall population and over 55 PLWH. Our observations that confirm a positive effect of BIC/FTC/TAF among elderly PLWH is reassuring, considering that aging is known to be accompanied by immune senescence, with the CD4 + /CD8 + ratio being a strong indicator of frailty and multi-morbidity [ 16 , 17 ].…”

Immune restoration in HIV-1-infected patients after 12 years of antiretroviral therapy: a real-world observational study

“…Several studies confirmed that achieving CD4 counts ≥500 cells/µL was associated with a lower mortality [29,35]. Although few studies investigated the association between CD4/CD8 ratio restoration ≥0.8 and mortality, Demontès M, et al [36] reported multimorbidity was associated with CD4/CD8 ratio < 0.8, and Marianna M, et al [37] found CD4/CD8 ratio < 0.8 could be used as a predictor for cardiovascular diseases. This new system could have several important implications in clinical practice: (1)it could guide physicians, healthcare providers, and social workers to accurately assess the immune status upon ART, and retarget those patients who were considered to have achieved immune restoration based on normalized CD4 counts alone, (2) in the era of "treat all", using CD4 cell counts as the only immune evaluation parameter may lead to the overestimation of successful immune restoration and neglection of the risk of death in patients with HIV, (3) the high probability of incomplete immune reconstitution after long-term treatment implies that only ART might not be sufficient to achieve complete immune restoration.…”

Comorbidades em Idosos Vivendo com HIV/Aids

“…O HIV, junto à imunodefi ciência crônica e ativação imune, está envolvido no envelhecimento acelerado. Ainda, as primeiras gerações de terapia antirretroviral também estão associadas à incidência de algumas comorbidades, principalmente às síndromes metabólicas e cardiovasculares 18 . Há também uma alta prevalência de riscos comportamentais nas PVHIV, como o tabagismo e uso recreativo de drogas, os quais estão associados a muitas comorbidades 19, 20 .…”