Characteristics and Outcome of Patients Diagnosed with HIV at Older Age

To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50.A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013.Patients with new HIV diagnosis ≥50 years of age defined as "older' and <50 defined as "younger.' Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with <2 CD4/viral-load measurements or with <1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤0.43 indicated recent (≤1 year) HIV infection.Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 261cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤1 year) HIV infection.One-fifth of HIV patients are diagnosed at older age (≥50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients.

Below:  CD4 cell counts increments (ΔCD4) of older and younger patients during the study period. Patients were stratified into 4 subgroups according to their initial CD4 cell counts at the time of HIV diagnosis. ΔCD4 was determined as the mean ± SD differences between CD4 cell counts at the end of the study (last visit) and the initial CD4 (at HIV diagnosis) cell counts for each patient. *P not significant.

Full article at:   http://goo.gl/cE25Yt

By:  Asher I1, Guri KM, Elbirt D, Bezalel SR, Maldarelli F, Mor O, Grossman Z, Sthoeger ZM.

• 1From the Unit of Clinical Immunology, Allergy, and Neve -Or AIDS center and the Department of Medicine B, Kaplan Medical Center, Rehovot, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel (IA, KMG, DE, SRB, ZMS); National Cancer Institute, Frederick, Maryland (FM, ZG); Central Virology Laboratory, Ministry of Health, Ramat-Gan (OM); and School of Public Health, Tel-Aviv University, Tel-Aviv, Israel (ZG).
• Medicine (Baltimore). 2016 Jan;95(1):e2327. doi: 10.1097/MD.0000000000002327.

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