Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients

• Published in: PloS one Vol. 13; no. 9; p. e0203895
• Main Authors: Allavena, Clotilde, Hanf, Matthieu, Rey, David, Duvivier, Claudine, BaniSadr, Firouze, Poizot-Martin, Isabelle, Jacomet, Christine, Pugliese, Pascal, Delobel, Pierre, Katlama, Christine, Joly, Véronique, Chidiac, Christian, Dournon, Nathalie, Merrien, Dominique, May, Thierry, Reynes, Jacques, Gagneux-Brunon, Amandine, Chirouze, Catherine, Huleux, Thomas, Cabié, André, Raffi, François
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.09.2018; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adults; Age; Aging; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; CD4 antigen; Comorbidity; Dosage and administration; Drug therapy; Dyslipidemia; Elderly patients; Geriatrics; Health aspects; HIV; HIV infections; Hospitals; Human immunodeficiency virus; Infections; Infectious diseases; Life expectancy; Life Sciences; Medical diagnosis; Medicine and Health Sciences; Mortality; Older people; People and Places; Population; Protease inhibitors; Proteinase inhibitors; Therapy; Thymidine; France; HIV infections; HIV; Geriatric depression; Geriatric psychiatry; Elderly; Antiretroviral therapy; HIV diagnosis and management; Geriatrics
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0203895

As HIV-infected adults on successful antiretroviral therapy (ART) are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. The objective of this cross-sectional study was to compare in the French Dat'AIDS cohort, the HIV geriatric population, aged 75 years and over, to the elderly one, aged from 50 to 74 years. As of Dec 2015, 16,436 subjects (43.8% of the French Dat'AIDS cohort) were aged from 50 to 74 (elderly group) and 572 subjects (1.5%) were aged 75 and over (geriatric group). Durations of HIV infection and of ART were slightly but significantly different, median at 19 and 18 years, and 15 and 16 years in the elderly and geriatric group, respectively. The geriatric group was more frequently at CDC stage C and had a lower nadir CD4. This group had been more exposed to first generation protease inhibitors and thymidine analogues. Despite similar virologic suppression, type of ART at the last visit significantly differed between the 2 groups: triple ART in 74% versus 68.2%, ART ≥ 4 drugs in 4.7% versus 2.7%; dual therapy in 11.6% versus 16.4% in the elderly group and the geriatric group, respectively. In the geriatric group all co-morbidities were significantly more frequent, except dyslipidemia, 4.3% of the elderly group had ≥4 co-morbidities versus18.4% in the geriatric group. Despite more co-morbidities and more advanced HIV infection the geriatric population achieve similar high rate of virologic suppression than the elderly population. A multidisciplinary approach should be developed to face the incoming challenge of aging HIV population.