Antiretroviral
Therapy and its Complications in Older Patients with HIV
 Due
to the benefits of effective HAART, more people with HIV are living longer than
ever before. However, there is insufficient research on HIV and its treatment
in patients older than 50 years of age -- a group that may experience more rapid
disease progression and a higher rate of adverse side effects from antiretroviral
therapy.
As reported in the November 2006 issue of HIV Medicine,
Italian researchers conducted a study of the immunological, virological, and metabolic
effects of 48 weeks of antiretroviral therapy in older patients followed at 3
infectious diseases units in Milan since 1994. Results were compared with those
from younger control subjects aged 25-35 years.
Results 
The study included 159 older patients (age 50 or more) and 118 younger control
subjects.
Subjects in both groups were comparable in terms of HIV stage, baseline CD4 cell
count, and viral load, but differed with regard to mode of HIV transmission, co-morbid
conditions, and related chronic treatments.
After 48 weeks of treatment, viral load decreased by a mean 2.6 log copies/mL
and CD4 count increased by a mean 137.5 cells/mm3 in the older patients -- similar
to values observed in younger individuals.
The relative risks of abnormal test result in the older patients were:
-
Blood glucose: 7.33 (95% CI 4.36-12.36);
- Total cholesterol: 1.73 (95% CI
1.45-2.07);
- High-density lipoprotein (HDL, or "good") cholesterol:
1.56 (95% CI 1.22-2.0);
- Triglycerides: 1.26 (95% CI 1.02-1.56);
- Serum
creatinine: 6.48 (95% CI 4.36-9.66);
- Alanine aminotransferase (ALT): 0.45
(95% CI 0.35-0.58).
Moderate to severe liver and kidney toxicities were observed in the older patients
but not in the younger control subjects.
39 new cases of cardiovascular, endocrine/metabolic, and neurological disorders
were diagnosed in the older patients, compared with 4 in the younger group (24.52
vs 3.39 per 100 person-years; P < 0.0001).
Conclusion
"Diseases
induced by, or related to, the toxic effects of antiretrovirals interact with
age-specific health profiles, raising new questions and challenges," the
authors wrote in conclusion. "Comparative epidemiological studies, research
studies addressing specific questions and surveillance are needed to answer the
questions that arise in clinical monitoring."
12/05/06
Reference
P
Meraviglia, L Cordier, and others. Antiretroviral treatment and age-related comorbidities
in a cohort of older HIV-infected patients. HIV Medicine 7(8): 549-557.
November 2006. | |
