HIV/AIDS in Puerto Rican Patients 50 Years or Older

1. HIV/AIDS in Puerto Rican Patients 50 Years or Older Alejandro Amill, MPH; María Gómez, Ph.D.; Doris Báez, MSc; Miriam Velásquez, MSc; Diana M Fernandez, MSc; Eddy Ríos, Ph.D., MPH; and Robert F. Hunter, MD, FACP. Universidad Central del Caribe, Bayamón, Puerto Rico Retrovirus Research Center

2. Background • 11% (86,875) of the AIDS cases reported in the United States and 12% (3513) of the cases in Puerto Rico are from individuals 50 years or older. (CDC, 2002 & PR Health Department, 2003) • Elders are usually perceived as not being at risk for HIV infection and usually excluded from targeted prevention programs. (Chiao, Ries & Sande, 1999) • Health care providers are slow to diagnose HIV in older people. (Kasper & Cavalieri, 1999)

3. Objectives • To characterize and describe HIV/AIDS infected patients 50 years or older of age in terms of their socio-demographic, risk and clinical profile , and compare them with a younger sample counterpart.

4. Research Design • Prospective cohorts (IRB approved): HIV Central Registry (HCR), Adult Spectrum of Disease (ASD). • Data collection started on May 1992. • Setting: Hospital Universitario Ramón Ruiz Arnau and Immunology Clinic. • Data sources: Interview, medical records abstraction and laboratory blood samples. • Participants: Age ≥ 18 years, HIV/AIDS.

5. Research Design Puerto Rico’s Health Regions. Source: Department of Health in Puerto Rico.

6. Methods • Study design: Cross-sectional study from a longitudinal cohort. Data from 3151 study participants was collected between May 1992 and December 2002. • Study Sample: 288 (9.1% of the total study population) HIV/AIDS with age ≥ 50 years. • Bivariate analysis: Mantel-Haenszel Chi-Square (M-H X2) and Wilcoxon Rank Sum test . Significance level set at p< 0.05. • Variables were evaluated at year of patient enrollment. • Packages: SAS Windows V8, SPSS 11.0 Windows

7. Results Proportion of confirmed AIDS cases 50 years or older, in Puerto Rico. *PR Health Department (2004).

8. Results Table 1. Socio-demographic parameters, n=288

9. Results Table 2. Other socio-demographic parameters.

10. Results High school diploma or higher degree between the groups of age, n=2802 Age distribution by categories, n=288. ^ OR=0.489 C.I. (0.357, 0.671) P value < 0.0001 Median= 54 years

11. Results Table 3. Reported risky practices. ^

12. Results Aids diagnosis at study entry, N=3151. ^ OR=1.48, C.I. (1.15, 1.89), p= 0.0017

13. Results Type of Aids diagnosis at study entry, n=1582. ^ OR=0.694, C.I. (0.423, 0.965), p= 0.048

14. Results Table 4. Other clinical parameters. ^

15. Results Table 5. Immunology markers in patients without AIDS diagnosis.

16. Results Table 6. Immunology markers in patients with AIDS diagnosis.

17. Results Survival function for patients with AIDS diagnosis at last follow up, n= 2168. Median of survival:18-49 (2.16 years), >=50 (1.85 years) P >0.05

18. Conclusions • Elderly patients are less likely to have completed a high school education that their younger counterparts. • Elderly adults are more likely to exposed to heterosexual contact, specifically with a person with AIDS or HIV infection documented. • Elderly patients are seeking health care with a later stage of the disease and with several co-morbid chronic conditions.

19. Limitations and Recommendations • Non probabilistic sample of all 50 years or older patients with HIV/AIDS in Puerto Rico. • More research from population base prospective data is needed in order to generate models for risky behaviors prediction and clinical outcomes. • HIV/AIDS health interventions and programs for prevention base on this data could result in reduction of risk exposures and morbidity outcomes among elders in Puerto Rico.

20. Acknowledgements • RCMI/NIH grant # G12RR03035 • CDC/ASD grant # U62/CCU206209 • Consultants: Dr. St. Lawrence, Dr. Bandigwala, Dr. Thomas • System Specialist: Magaly Torres • Data Abstractors: Gisela I. Cestero, Glenda L. Ortiz, Heidy Ortiz. • Data Entry: Wanda Marín.