TORONTO — With age comes enhanced adherence to HIV therapy, according to results of a study presented at the 16th International AIDS Conference.
Michael J. Silverberg, Ph.D., of Kaiser Permanente's Division of Research, Oakland, Calif., and his associates took a prospective look at approximately 5,000 patients in their registry from 1995 to 2004. Of those, 1,000 were aged 50 years or older. All patients were in the Kaiser Permanente Northern California health plan for the 6 months prior to antiretroviral therapy.
The investigators found that subjects over the age of 50 were more adherent to highly active antiretroviral therapy (HAART)—a cocktail of a protease inhibitor plus two reverse transcriptase inhibitors—than were younger individuals.
As a result, they were 15% more likely to reach undetectable levels of HIV infection and had higher CD4 counts after 3 years of HAART therapy than did their younger counterparts, Dr. Silverberg said. These good results were entirely due to their excellent adherence, he added.
Patients older than 50 years were more likely to achieve HIV RNA levels of less than 500 copies/mL; and, like patients aged 40–49 years, they had a blunted immune response in the first year of therapy. That response was compensated for, however, by faster subsequent increases in CD4 cell counts compared with those of patients aged 18–39, Dr. Silverberg reported.
Older patients were more likely to have more comorbidities such as metabolic syndrome, abnormal blood lipids, and heart disease, which was linked to a higher first-year incidence of laboratory abnormalities, he said. In addition, antiretroviral therapy was associated with reduced tolerability of the drugs.
Laboratory abnormalities frequently seen after initiation of HAART in older individuals included hyperglycemia, abnormal bilirubin, neutrophil, ALT and AST levels, and raised creatinine.
“Because of these abnormalities, we feel that older patients need particularly close monitoring, especially at the beginning of their therapy,” Dr. Silverberg said. “However, they do quite well. Some of the patients were quite a bit older than 50, and the oldest was in his 70s. I guess with age, people become more disciplined with their treatment,” he added.
Older patients were also 15% more likely to reach undetectable levels of HIV infection and had higher CD4 counts. DR. SILVERBERG