Virologic failure and mortality in older ART initiators in a multisite Latin American and Caribbean Cohort

Abstract

IntroductionThe “greying” of the HIV epidemic necessitates a better understanding of the healthcare needs of older HIV‐positive adults. As these individuals age, it is unclear whether comorbidities and their associated therapies or the ageing process itself alter the response to antiretroviral therapy (ART). In this study, HIV treatment outcomes and corresponding risk factors were compared between older ART initiators and those who were younger using data from the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).Methods HIV‐positive adults (≥18 years) initiating ART at nine sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Patients were classified as older (≥50 years) or younger (<50 years) based on age at ART initiation. ART effectiveness was measured using three outcomes: death, virologic failure and ART treatment modification. Cox regression models for each outcome compared risk between older and younger patients, adjusting for other covariates.ResultsAmong 26,311 patients initiating ART between 1996 and 2016, 3389 (13%) were ≥50 years. The majority of patients in both ≥50 and <50 age groups received a non‐nucleoside reverse transcriptase inhibitor‐based regimen (89% vs. 87%), did not have AIDS at baseline (63% vs. 62%), and were male (59% vs. 58%). Older patients had a higher risk of death (adjusted hazard ratio (aHR) 1.64; 95% confidence intervals (CI): 1.48 to 1.83) and a lower risk of virologic failure (aHR: 0.73; 95% CI: 0.63 to 0.84). There was no difference in risk of ART modification (aHR: 1.00; 95% CI: 0.94 to 1.06). Risk factors for death, virologic failure and treatment modification were similar for each group.ConclusionsOlder age at ART initiation was associated with increased mortality and decreased risk of virologic failure in our cohort of more than 26,000 ART initiators in Latin America and the Caribbean. To the best of our knowledge this is the first study from the region to evaluate ART outcomes in this growing and important population. Given the complexity of issues related to ageing with HIV, a greater understanding is needed in order to properly respond to this shifting epidemic.

Associations of menopausal age with virological outcomes and engagement in care among women living with HIV in the UK

“…[22][23][24][25] Studies conducted in Latin America/the Caribbean and South Africa have similarly suggested a lower likelihood of experiencing VL rebound amongst older men and women living with HIV. 25,26 Our results may support a greater level of adherence to ART in heterosexual women of a peri-menopausal age in this setting, although given previous published data, our findings should be interpreted cautiously. Although there are currently limited data exploring HIV outcomes amongst older people with HIV in a gender-disaggregated manner, older individuals have generally been reported to have better adherence and tolerability to ART.…”

Impact of age on CD4 recovery and viral suppression over time among adults living with HIV who initiated antiretroviral therapy in the African Cohort Study

“…In contrast, some studies have shown that older ART initiators reach viral suppression at a faster rate and maintain suppression for longer [22,[34][35][36][37]. A large cohort conducted in nine sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru with more than 26,000 participants found better viral suppression among adults 50 years and older as compared to those less than 50 years [38], which is likely due to differences in adherence rather than physiological reasons. Findings from an analysis of the USbased cohorts found that HIV-infected ART-naïve adults initiated on ART achieved virologic suppression faster than younger PLWH [13,22,27].…”

The impact of data quality and source data verification on epidemiologic inference: a practical application using HIV observational data

“…The analysis of observational HIV data allows for a robust evaluation of the antiretroviral treatment [ART] experience over time. For example, we have pooled data from multiple HIV clinical care sites to better understand outcomes of key populations (e.g., late ART initiators [10], older patients [11], and patients with 10+ years of follow-up [12]) as well as assess site-level progress in clinical retention, ART use, and viral suppression over time [13]. Other HIV cohorts have investigated a myriad of topics, including (but not limited to) efficacy and tolerability of ART regimens [14], comorbidities [15] and patient outcomes [16].…”