Older age does not appear to impact on the effectiveness of HAART, according to research published in the 1 June edition of Clinical Infectious Diseases. Investigations conducted before treatment with HAART became available had found that older patients had higher rates of disease progression and progressed more rapidly to AIDS and death.
Researchers conducted a retrospective analysis of the charts of 52 patients aged 50 or over and 52 patients aged under 50 at the Houston Veteran’s Administration Hospital in the USA, who received care for HIV between 1986 and 1998. Data collected for comparison included first and last CD4 counts, viral load, risk factors for infection, length of time care for HIV infection was received, incidence of opportunistic infections, number of hospitalisations, side effects, death, and whether treatment with HAART had been recommended or received. HAART was defined as a combination of two nucleoside analogues and a protease inhibitor.
It was discovered that the under 50s and over 50s were similar in most respects. There was no significant difference with regard to the development of opportunistic infections or drug related side-effects. The number of hospitalisations was also similar. In the HAART era both groups experienced comparable increases in CD4 count and fall in viral load. The mortality rate was higher in the over 50s (nine deaths against two for the under 50s), but when data was analysed it was found that the majority of these were caused by factors unrelated to HIV and that there was no significant difference in AIDS deaths.
The Texan researchers note that the lack of difference in outcomes was unexpected, and suggest that earlier research on the impact of older age and the rate of HIV disease progression may not be valid in the HAART era.
“These results provide evidence that there should be no difference in the management of older and younger HIV-infected patients. The standard approach to therapy [HAART] seems to produce the same outcomes without causing any additional side-effects”, the investigators conclude, recommending that, “clinicans should judge the effectiveness of therapy for older HIV-infected patients in the same manner that they judge the effectiveness of therapy for younger HIV-infected patients.”
Reference:
Grimes M et al. Clinical experience with human immunodeficiency virus – infected older patients in the era of effective antiretroviral therapy. Clinical Infectious Diseases 34: 1530–1533, 2002