Aging and hiv
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Aging and HIV. David Alain Wohl , MD Associate Professor of Medicine The University of North Carolina at Chapel Hill. From DA Wohl , MD, at New York, NY: May 03, 2012, IAS-USA. . A 35 yo man, non-IDU, diagnosed with HIV starting HIV therapy at CD4>200 can expect to live into his 70 ’ s.

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Aging and hiv

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.


Aging and hiv

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


Poly pathology is more common in hiv patients and increases with age

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.


Cohere study baseline virologic and immunologic profile by age

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.


Cohere study response by baseline age

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.


Cohere study continuation of haart by baseline age

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.


Kaiser permanente northern california immunologic response and age

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.


Aging and hiv

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


Macs frailty phenotype in hiv positive msms 50 to 70 years of age

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.


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