Older HIV-Infected Patients As Responsive to ART As Younger Individuals

Originally published by Reuters Health, May 15, 2002

NEW YORK (Reuters Health) — Middle-aged and older patients respond as well to antiretroviral therapy (ART) as their younger counterparts, report investigators in Durham, North Carolina. Therefore, age should not be used as a criterion for determining therapy for HIV infection, the authors suggest, and an older patient's failure to respond to ART should not be attributed to age alone.

Dr. Kenneth E. Schmader, of the Durham VA Medical Center, and associates at Duke University identified 101 patients ages 50 and older in 1999 who had initiated treatment at their clinic. These subjects were matched to 202 younger controls by CD4+ cell count and time of entry into treatment. The older group ranged in age from 50 to 79 years of age, while the younger patients were 18 to 39 years old. Average follow-up was 29 months.

The two groups were similar in their use of antiretroviral agents, the authors report in the April issue of the Journal of the American Geriatrics Society. Eighty percent and 82% of the younger adults and older adults, respectively, were taking at least one agent and 51% and 53% were taking three. However, 26% of the younger patients were documented as having interrupted their treatment for more than 1 day, compared with 11% of the older individuals.

Both age groups had a similar immune response, with CD4+ cell counts rising by 3.47 cells per microliter per month in the older subjects versus 4.60 cells per microliter per month in the younger group. However, the older individuals were more likely to achieve an undetectable plasma HIV RNA level, 47% versus 34%.

The authors suggest that treatment interruptions are a marker of adherence. Better adherence could explain the lower viral loads in the older patients.