Older age does not influence CD4 cell recovery in HIV-1 infected patients receiving Highly Active Anti Retroviral Therapy

Abstract

Background: Diagnosis of HIV infection is recently occurring with increasing frequency in middleaged and in older individuals. As HAART became available, a minimal beneficial effect on immunological outcome in older in respect of younger subjects has been reported. In fact, both the intensity and the rapidity of the immunological response appeared to be reduced in elderly subjects. On the contrary, only few reports have indicated a similar immunological outcome both in older and younger HIV-positive subjects. Interestingly, older age did not seem to significantly affect the long-term virological outcome of HAART treated subjects.

Definition of Advanced Age in HIV Infection: Looking for an Age Cut-Off

“…47 The difference may be explained by the more recent initiation of our cohort, which included patients who started therapy after 2004. Mortality is higher among older patients, 16,18,19,30,46,48,49 which has also been observed in patients between 50 and 59 years in our study. This association is not seen in those aged more than 60 years probably due to the small sample size of this group.…”

“…16,18,19,[27][28][29][30][31][32][33] Perhaps the higher prevalence of delayed HIV described in older patients may contribute to their poorer immune response. 30,32,[34][35][36][37][38] In this sense, we found a late diagnosis of HIV infection in 53.3% of the patients > 50 years vs. 21.5% in those < 30 years ( p < 0.001). 39 Similar findings were reported by Smith et al, with almost half of patients ‡ 50 years being late presenters compared to 33% of younger adults ( p < 0.001).…”

“…Many authors have found no differences in virological control according to age, 7,10,12,[27][28][29][30][31][32]40 and, moreover, some have found a better virological response in older patients. 5,8,9,[15][16][17][18][19] In our case the virological response was similar across all age groups but improved significantly in patients over 60 years.…”

VIH y edad: una relación en evolución

“…¿Cómo responden estos pacientes al TARGA? Este aspecto también es objeto de discusión dado que, mientras que algunos estudios han demostrado una menor respuesta inmunoló-gica entre los pacientes de mayor edad (2, 4, 9-12), para otros autores no hay diferencias (13)(14)(15)(16). Quizá esa peor respuesta al tratamiento se deba a esa mayor demora diagnóstica y, por la tanto, a ese mayor deterioro inmunoló-gico de los pacientes de mayor edad: de ahí la necesidad de realizar diagnóstico precoz.…”

“…Si bien el inicio precoz puede retrasar el deterioro inmunológico y mejorar su pronóstico, no iniciarlo en fases precoces minimiza los efectos adversos del tratamiento. No debemos olvidar que los pacientes mayores infectados por el VIH tienen una mayor presencia de comorbilidades (hipertensión arterial, EPOC, diabetes mellitus,...) (6,13,14,17,18) que los obliga al uso de otras terapias específicas no relacionadas con la infección por el VIH (AINEs, inhibidores de la bomba de protones,…) con el consiguiente riesgo de interacciones (18), algunas de ellas graves.…”