Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa.

IF 1.6 4区医学 Q4 INFECTIOUS DISEASES

Southern African Journal of Hiv Medicine Pub Date : 2018-11-29 eCollection Date: 2018-01-01 DOI:10.4102/sajhivmed.v19i1.838

India Butler, William MacLeod, Pappie P Majuba, Brent Tipping

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引用次数: 5

Abstract

Introduction: HIV-infected adults aged over 50 years in South Africa are increasing. This study explored differences between baseline characteristics and 12-month outcomes of younger and older HIV-infected adults initiated on antiretroviral therapy (ART). Additionally, associations with outcomes within the older group were sought.

Methods: We retrospectively reviewed treatment-naive HIV-infected adult patients at ART initiation. Patients aged 18.0-39.9 years were compared to patients aged over 50 years using log-binomial regression for baseline characteristics and 12-month outcomes. Within the older group, outcome associations were found using multivariate regression.

Results: The older cohort (n = 1635) compared to the younger cohort (n = 10726) comprised more males (47.2% vs. 35.4%, PR 1.52, p < 0.05), smokers (12.9% vs. 9.7%, PR 1.32, p < 0.05) and overweight patients (26.0% vs. 20.0%, PR 1.32, p < 0.05). Fewer older patients had tuberculosis (10.2% vs. 15.3%, PR 0.67, p < 0.05), other opportunistic infections (16.9% vs. 23.3%, PR 0.70, p < 0.05), World Health Organization stage 3/4 disease (39.9% vs. 43.2%, PR 0.89, p < 0.05), anaemia (22.8% vs. 28.4%, PR 0.77, p < 0.05), liver dysfunction (17.1% vs. 21.3%, PR 0.83, p < 0.05) or low CD4+ count < 100 cells/mm³ (56.3% vs. 59.9%, PR 0.71, p < 0.05).Mortality was higher in the older cohort (11.3% vs. 7.5%, PR 1.48, p < 0.05). Virological suppression was greater in the older cohort (89.5% vs. 86.5%, PR 1.28, p < 0.05) but CD4+ restitution was lower (62.8% vs. 75.0%, PR 0.61, p < 0.05). There was no difference in treatment complications between the groups.Within the older cohort, associations with death were as follows: age > 55 years (PR 1.47, p < 0.05), an AIDS-defining condition (PR 2.28, p < 0.05), raised ALT (PR 1.53, p < 0.05) and CD4+ < 100 cells/mm³ (PR 2.15, p < 0.05). Associations with favourable treatment response at 12 months were unemployment (PR 1.18, p < 0.05) and raised ALT (PR 1.19, p < 0.05). Associations with a treatment complication at 12 months were unemployment (PR 1.12, p < 0.05), smoking (PR 1.20, p < 0.05) and nevirapine use (PR 1.36, p < 0.05) but secondary education was protective (PR 0.87, p < 0.05).

Conclusion: HIV-infected South African adults aged over 50 years differ in characteristics and outcomes compared to their younger counterparts and justify specialised management within HIV treatment facilities.

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人类免疫缺陷病毒感染与老年人:来自南非约翰内斯堡的回顾性单点队列研究。

导言:南非50岁以上感染艾滋病毒的成年人正在增加。本研究探讨了开始抗逆转录病毒治疗(ART)的年轻和老年艾滋病毒感染者的基线特征和12个月结局之间的差异。此外，研究人员还寻找了与老年组结果的关联。方法:我们回顾性地回顾了在抗逆转录病毒治疗开始时未接受治疗的hiv感染成年患者。年龄为18.0-39.9岁的患者与年龄超过50岁的患者进行对比，采用对数二项回归分析基线特征和12个月预后。在老年组中，使用多变量回归发现结果相关。结果:老年队列(n = 1635)与年轻队列(n = 10726)相比，男性(47.2%比35.4%，PR为1.52,p < 0.05)、吸烟者(12.9%比9.7%，PR为1.32,p < 0.05)和超重患者(26.0%比20.0%，PR为1.32,p < 0.05)较多。老年患者较少发生结核病(10.2%比15.3%，PR 0.67, p < 0.05)、其他机会性感染(16.9%比23.3%，PR 0.70, p < 0.05)、世界卫生组织3/4期疾病(39.9%比43.2%，PR 0.89, p < 0.05)、贫血(22.8%比28.4%，PR 0.77, p < 0.05)、肝功能障碍(17.1%比21.3%，PR 0.83, p < 0.05)或CD4+计数低< 100细胞/mm3(56.3%比59.9%，PR 0.71, p < 0.05)。老年组死亡率较高(11.3% vs. 7.5%， PR 1.48, p < 0.05)。老年组的病毒学抑制更大(89.5%比86.5%，PR 1.28, p < 0.05)，但CD4+恢复较低(62.8%比75.0%，PR 0.61, p < 0.05)。两组间治疗并发症无差异。在老年队列中，与死亡相关的因素如下:年龄> 55岁(PR为1.47,p < 0.05)，艾滋病定义条件(PR为2.28,p < 0.05)， ALT升高(PR为1.53,p < 0.05)和CD4+ < 100细胞/mm3 (PR为2.15,p < 0.05)。与12个月时良好治疗反应相关的是失业(PR为1.18,p < 0.05)和ALT升高(PR为1.19,p < 0.05)。12个月时与治疗并发症相关的是失业(PR为1.12,p < 0.05)、吸烟(PR为1.20,p < 0.05)和奈韦拉平使用(PR为1.36,p < 0.05)，但中等教育程度具有保护作用(PR为0.87,p < 0.05)。结论:50岁以上感染艾滋病毒的南非成年人在特征和结果上与年轻人不同，因此有理由在艾滋病毒治疗机构内进行专门管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern African Journal of Hiv Medicine 医学-病毒学

CiteScore

2.80

自引率

11.80%

发文量

审稿时长

>12 weeks

期刊介绍： The Southern African Journal of HIV Medicine is focused on HIV/AIDS treatment, prevention and related topics relevant to clinical and public health practice. The purpose of the journal is to disseminate original research results and to support high-level learning related to HIV Medicine. It publishes original research articles, editorials, case reports/case series, reviews of state-of-the-art clinical practice, and correspondence.