Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy

Bakanda, Celestin; Birungi, Josephine; Mwesigwa, Robert; Ford, Nathan; Cooper, Curtis; Au-Yeung, Christopher; Chan, Keith; Nachega, Jean B.; Wood, Evan; Hogg, Robert S.; Dybul, Mark; Mills, Edward J.

doi:10.1097/qad.0b013e3283437ed7

Cited by 55 publications

(45 citation statements)

References 26 publications

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“…For instance, the proportion of males compared to females was higher among the older adults. This has been noted previously 19,20,22 and the explanation this is probably a result of older men having younger women as intimate partners. Partially, this could be supported by the higher proportion of females (almost two-thirds) among younger patients.…”

Section: Discussionsupporting

confidence: 71%

“…Recently, there are some studies from SSA 19-23 . These studies have reported on various aspects, mainly mortality 19,20,22 , with some reporting on immunological response 20 .…”

Section: Introductionmentioning

confidence: 99%

“…These studies have reported on various aspects, mainly mortality 19,20,22 , with some reporting on immunological response 20 . Studies reporting on immunological recovery among both older and younger adults used different definitions for suboptimal immunological response 24-26 .…”

Section: Introductionmentioning

confidence: 99%

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Mortality and Immunological Recovery Among Older Adults on Antiretroviral Therapy at a Large Urban HIV Clinic in Kampala, Uganda

Semeere¹,

Lwanga²,

Sempa³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background We describe older (> 50 years) HIV-infected adults after ART initiation, evaluating immunological recovery by age category, considering individual trajectories based on the pre-treatment CD4. We also describe mortality on ART and its risk factors by age category including the contribution of poor immunological recovery at a large urban clinic in Kampala, Uganda. Methods We performed a cohort analysis of adult (>18 years) HIV-infected patients who initiated ART between January 1, 2004 and January 3, 2012. Immunological response was evaluated using mixed-effects linear regression. We described mortality using Kaplan Meier survival methods analyzing for risk factors of mortality using multivariate Weibull survival regression stratified by age category. Results Among 9,806 individuals who initiated ART, mean age was 37 years (S.D 8.8), average follow-up 5.7 years (S.D 1.7) and median baseline CD4 was 115 cells/mm3 (IQR; 42-184). Adults <50 years had on average a higher CD4 increase of 45 cells/mm3 (95% CI; 17, 72, p=0.001) compared to counterparts aged ≥ 60 years. Mortality was highest among older adults compared to younger counterparts. Only CD4 count <100 cells/mm3 after 1 year on ART and a CD4 count less than baseline were associated with a statistically significant higher rate of death among older adults. Conclusion Older adults had a slower immunological response which was associated with mortality, but this mortality was not typically associated with opportunistic infections. Future steps would require more evaluation of possible causes of death among these older individuals if survival on ART is to be further improved.

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Section: Discussionsupporting

confidence: 71%

“…Recently, there are some studies from SSA 19-23 . These studies have reported on various aspects, mainly mortality 19,20,22 , with some reporting on immunological response 20 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality and Immunological Recovery Among Older Adults on Antiretroviral Therapy at a Large Urban HIV Clinic in Kampala, Uganda

Semeere¹,

Lwanga²,

Sempa³

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

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“…Home-based counseling and testing (HBCT) is a potential strategy for early identification of patients prior to the severe depletion of their CD4 T cells. This strategy is necessary to link up at-risk populations such as adolescents, men, and the elderly who usually have poor health seeking behaviors with treatment programs, [44,45] thereby ensuring better health outcomes. It is also important for early identification of discordant couples and linking them up with treatment, care, and support to prevent further viral spread.…”

Section: Discussionmentioning

confidence: 99%

Human immunodeficiency virus screening in rural communities of Rivers State, Nigeria: Challenges and potential solutions

Tobin-West

Onyekwere

2014

Ann Afr Med

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“…Selain itu, kematian lebih cepat terjadi dalam empat tahun pertama semenjak terapi antiretroviral dimulai. 3 Belum diketahui pasti penyebabnya, namun diperkirakan perhatian yang kurang terhadap kepatuhan berobat, interaksi obat dan toksisitas, serta komorbid multipel memiliki pengaruh. Dengan demikian, dibutuhkan pendekatan tersendiri dalam menangani pasien HIVusia lanjut.…”

Section: Pendahuluanunclassified

HIV pada Geriatri HIV in Geriatrics

Ainun¹,

Yunihastuti²,

Roosheroe³

2017

JPDI

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ABSTRAKJumlah pasien HIV yang berusia lanjut semakin bertambah dikarenakan angka kesintasan pasien yang meningkat dan infeksi HIV pada pasien usia lanjut. Populasi pasien tersebut membutuhkan penatalaksaan tersendiri dikarenakan terdapat sejumlah komorbid baik yang berhubungan dengan HIV maupun tidak, polifarmasi, penurunan kapasitas fungsional dan isu sosial. PENDAHULUANJumlah pasien HIV berusia tua meningkat dari tahun ke tahun. Hal ini selain disebabkan oleh angka kejadian yang meningkat, juga disebabkan oleh terapi antiretroviral yang efektif sehingga angka harapan hidup bertambah. Sejak highly active anti-retroviral therapy (HAART) diperkenalkan pada tahun 1996 dan dimulai terapi anti retroviral kombinasi, pasien HIV yang terdiagnosis awal dan mendapat terapi antiretroviral dapat hidup seperti orang normal pada umumnya. 1 Pada penelitian yang dilakukan oleh Greene, dkk. 2 ditemukan rentang waktu terpanjang dari pasien terdiagnosis HIV hingga saat penelitian dilakukan mencapai 21 tahun. 2 Terapi antiretroviral menurunkan efek HIV dan peradangan kronik, namun tidak halnya dengan fungsi imunologis normal. Angka kesintasan pada pasien HIVusia lanjut yang mendapat terapi antiretroviral 30% lebih rendah dibanding populasi muda. Selain itu, kematian lebih cepat terjadi dalam empat tahun pertama semenjak terapi antiretroviral dimulai. 3 Belum diketahui pasti penyebabnya, namun diperkirakan perhatian yang kurang terhadap kepatuhan berobat, interaksi obat dan toksisitas, serta komorbid multipel memiliki pengaruh. Dengan demikian, dibutuhkan pendekatan tersendiri dalam menangani pasien HIVusia lanjut.

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Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy

Abstract: As antiretroviral treatment cohorts mature, the proportion of patients who are elderly will inevitably increase. Elderly patients may require focused clinical care that extends beyond HIV treatment.

Cited by 55 publications

References 26 publications

Mortality and Immunological Recovery Among Older Adults on Antiretroviral Therapy at a Large Urban HIV Clinic in Kampala, Uganda

Mortality and Immunological Recovery Among Older Adults on Antiretroviral Therapy at a Large Urban HIV Clinic in Kampala, Uganda

Human immunodeficiency virus screening in rural communities of Rivers State, Nigeria: Challenges and potential solutions

HIV pada Geriatri HIV in Geriatrics

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