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Aging and HIV

Aging and HIV

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Aging and HIV

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  1. Aging and HIV David Alain Wohl, MDAssociate Professor of MedicineThe University of North Carolina at Chapel Hill From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

  2. A 35 yo man, non-IDU, diagnosed with HIV starting HIV therapy at CD4>200 can expect to live into his 70’s ART-CC, The Lancet , 2008, 372:293-299

  3. Co-morbidities included: hypertension, diabetes mellitus, hypothyroidism, cardiovascular disease, bone fractures. Poly-pathology is more common in HIV+ patients and increases with age Polypathology (Pp) prevalence among HIV+ cases and HIV-uninfected controls, by age categories. Cases Controls 1% 1% 1% 2% 1% 0.25% 100% 2% 6% 4% 3% 8% 9% 6% 17% 15% 16% 15% 17% 28% 31% 90% 42% 29% 80% 80% 75% 35% 65% 60% 50% 31% 42% 40% 25% 21% 0%  40 yrs  40 yrs 41 to 50 yrs 51 to 60 yrs > 60 yrs 41 to 50 yrs 51 to 60 yrs > 60 yrs n = 542 n = 1,724 n = 452 n = 136 n = 1,626 n = 5,172 n= 1,356 n= 408 Pp prevalence 3.9% 9.0% 20.0% 46.9% 0.5% 1.9% 6.6% 18.7% No age-related diseases 1 co-morbidity 2 co-morbidities 3 co-morbidities 4 co-morbidities Guaraldi G, et al. CID 2011;53:1102-1126.

  4. COHERE Study: Baseline Virologicand Immunologic Profile by Age Baseline CD4 Count Baseline HIV RNA 256 5.1 5.0 5.0 5.0 222 210 4.9 CD4 (cells/mm3) HIV RNA (log10 copies/mL) 4.8 4.8 188 178 178 173 >60 >60 40-49 55-59 40-49 55-59 18-29 30-39 50-54 18-29 30-39 50-54 13-17 13-17 Age at Baseline (years) Age at Baseline (years) COHERE Study Group. AIDS. 2008;22:1463-1113.

  5. COHERE Study:Response by Baseline Age Achieving CD4 Count >200 Cells/mm3 at 12 Months New AIDS Event At 12 Months P<0.0001 for trend P<0.0001 for trend 9.7% 9.6% 9.3% 86.7% 8.5% 85.6% 80.5% 7.0% 76.3% 75.2% Patients (%) Patients (%) 74.7% 73.9% 5.2% 4.8% >60 >60 40-49 55-59 40-49 55-59 18-29 30-39 50-54 18-29 30-39 50-54 13-17 13-17 Age at Baseline (years) Age at Baseline (years) COHERE Study Group. AIDS. 2008;22:1463-1113.

  6. COHERE Study:Continuation of HAART by Baseline Age Discontinuation of All ARTs at 12 Months • Similar rates of discontinuing or switching >1 antiretroviral agent during the first 12 months of HAART • Complete treatment discontinuation was rare • Lower rates were observed among those >40 years of age P<0.0001 for trend 15.3% 14.8% 11.4% Patients (%) 9.2% 7.9% 7.3% 6.9% >60 40-49 55-59 18-29 30-39 50-54 13-17 Age at Baseline (years) COHERE Study Group. AIDS. 2008;22:1463-1113.

  7. Kaiser Permanente Northern California:Immunologic Response and Age • CD4 gains 1 year after HAART initiation were lower in the older group (P=0.046) • 18-39 years of age • +131.8 cells/mm3 • 40-49 years of age • +121.38 cells/mm3 • >50 years of age • +111.8 cells/mm3 • Despite blunted initial immunologic responses in the older group, CD4 counts were similar by year 3 CD4 Cell Count P=0.66 P=0.07 P=0.001 CD4 Count (cells/mm3) Years of Age 18 to 39 (n=2259) 40 to 49 (n=1834) >50 (n=997) 0 1 2 3 4 5 6 Time After HAART Initiation (years) Silverberg MJ, et al. Arch Intern Med. 2007;167:684-691.

  8. DHHS. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

  9. MACS: Frailty Phenotype in HIV-Positive MSMs 50 to 70 Years of Age Prevalence of Frailty Phenotype • Prospective cohort of MSMs (2009-2010) • 2850 person-visits • HIV positive on HAART (n=1451) • HIV negative (n=92) • Ages 50 to 70 years • Frailty phenotype more common in HIV-positive men versus HIV-negative men • May be effect of HIV infection, HAART, or both • Further longitudinal studies are needed HIV-positive on HAART HIV-negative 33% 24% 20% Prevalence (%) 15% 10% 8% 8% 8% 5% 4% <40 40-49 50-59 60-69 >70 Age Group (years) Desquilbet L, et al. 18th CROI. Boston, 2011. Abstract 794.