HAART outcomes in older HIV-infected patients in Lima, Peru
Objectives: Outcomes and additional issues related to care of older HIV-infected patients have deserved relatively low attention. We designed this study to analyse HAART-related outcomes in HIV-infected patients older than 60 years in comparison to younger individuals in a limited-resource setting.
Methods: Retrospective review of HAART-associated outcomes in >60-year old patients that completed at least 6 months of treatment and entered the HIV treatment program between 2004 and 2006. Cases were identified in 5 different sites in Lima, Peru, and were compared to 2 controls identified as the previous and the following patient entering the treatment program at the corresponding clinic.
Results: Cases represented 3.8% of the patients receiving HAART at these 5 sites. Thirty cases (Group 1) and 60 controls (Group 2) were identified. Average ages were 64.5 ± 4.0 yrs and 38.9 ± 8.9 yrs, respectively. Both groups were comparable in terms of gender composition, and baseline Karnofsky score, CD4 cell count and HIV viral load. Median follow up time was 26 months for both groups. At the time of data collection, the rate of virological success (HIV-1 viral load <400 copies/mL) was 88% in Group 1, and 81% in Group 2. Median CD4 increase was also similar in younger (156 cells/uL) and older patients (167 cell/uL). Severe treatment-related complications leading to a change in antiretroviral regimen, milder complications, and HIV-associated deaths, were also of similar frequency. Cardiovascular diseases, such as heart failure (n=3), hypertension (n=3), and ischemic stroke (n=1) were seen in 6 patients in Group 1 (20%), no such case was seen in Group 2.
Conclusions: Treatment of older HIV-infected patients can be done with comparable rates of success to younger patients in a limited-resource setting. Special needs of these patients need to be identified, such as treatment of age-related comorbidities.
Hidalgo J.1, Benites C.2, Nunura J.3, Dedios M.4, Martinez L.2
Asociacion Via Libre/Guillermo Almenara Hospital