Upload
amice-butler
View
213
Download
1
Embed Size (px)
Citation preview
Slide 1 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA. IAS–USA
David Alain Wohl, MDAssociate Professor of MedicineThe University of North Carolina
at Chapel Hill
Aging and HIV
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
Slide 2 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
A 35 yo man, non-IDU, diagnosed with HIV starting HIV therapy at CD4>200 can expect to live into his 70’s
ART-CC, The Lancet , 2008, 372:293-299
Slide 5 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
4%6%
Poly-pathology is more common in HIV+ patients and increases with age
• Co-morbidities included: hypertension, diabetes mellitus, hypothyroidism, cardiovascular disease, bone fractures.
Cases Controls
100%
41 to 50 yrs 51 to 60 yrs > 60 yrs 40 yrs 41 to 50 yrs 51 to 60 yrs > 60 yrs 40 yrsn = 542 n = 1,724 n = 452 n = 136
No age-related diseases 2 co-morbidities1 co-morbidity 3 co-morbidities 4 co-morbidities
n = 1,626 n = 5,172 n= 1,356 n= 408
0%
75%
50%
25%
90%
9%
80%
17%
65%
28%
6%
40%
42%
15%
80%
16%
3%
60%
31%
8%
42%
35%
17%
21%
31%
29%
15%
1% 1% 1% 2% 1%2%
0.25%
Polypathology (Pp) prevalence among HIV+ cases and HIV-uninfected controls, by age categories.
Pp prevalence 3.9% 9.0% 20.0% 46.9% 0.5% 1.9% 6.6% 18.7%
Guaraldi G, et al. CID 2011;53:1102-1126.
Slide 6 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
COHERE Study: Baseline Virologicand Immunologic Profile by Age
Baseline HIV RNA
HIV
RN
A (
log
10 c
op
ies/
mL
)
13-17
4.8
18-29 30-39 40-49 50-54 55-59 >60
4.8
5.0 5.0 5.0
5.1
4.9
COHERE Study Group. AIDS. 2008;22:1463-1113.
Age at Baseline (years)
CD
4 (c
ells
/mm
3 )
13-17
222
18-29 30-39 40-49 50-54 55-59 >60
256
188
178 178173
210
Age at Baseline (years)
Baseline CD4 Count
Slide 7 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
COHERE Study:Response by Baseline Age
Achieving CD4 Count>200 Cells/mm3 at 12 Months
Pat
ien
ts (
%)
13-17
85.6%
18-29 30-39 40-49 50-54 55-59 >60
86.7%
76.3% 75.2% 73.9% 74.7%
80.5%
COHERE Study Group. AIDS. 2008;22:1463-1113.
Age at Baseline (years)
Pat
ien
ts (
%)
13-17 18-29 30-39 40-49 50-54 55-59 >60
Age at Baseline (years)
New AIDS EventAt 12 Months
P<0.0001 for trend
4.8%5.2%
8.5%
9.6% 9.3%
7.0%
9.7%
P<0.0001 for trend
Slide 8 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
COHERE Study:Continuation of HAART by Baseline Age
COHERE Study Group. AIDS. 2008;22:1463-1113.
Pat
ien
ts (
%)
13-17 18-29 30-39 40-49 50-54 55-59 >60
Age at Baseline (years)
Discontinuation ofAll ARTs at 12 Months
15.3% 14.8%
9.2%
6.9%7.9%
11.4%
7.3%
P<0.0001 for trend
● Similar rates of discontinuing or switching >1 antiretroviral agent during the first 12 months of HAART
● Complete treatment discontinuation was rare
- Lower rates were observed among those >40 years of age
Slide 9 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
Kaiser Permanente Northern California:Immunologic Response and Age
0 1 2 3 4 5 6 Time After HAART Initiation (years)
CD4 Cell Count
CD
4 C
ou
nt
(cel
ls/m
m3 )
Years of Age 18 to 39 (n=2259)
40 to 49 (n=1834)
>50 (n=997)
Silverberg MJ, et al. Arch Intern Med. 2007;167:684-691.
P=0.001
P=0.07
P=0.66
● CD4 gains 1 year after HAART initiation were lower in the older group (P=0.046)- 18-39 years of age
• +131.8 cells/mm3
- 40-49 years of age• +121.38 cells/mm3
- >50 years of age• +111.8 cells/mm3
● Despite blunted initial immunologic responses in the older group, CD4 counts were similar by year 3
Slide 10 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
DHHS. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Slide 11 of 11
From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.
MACS: Frailty Phenotype in HIV-Positive MSMs 50 to 70 Years of Age
• Prospective cohort of MSMs (2009-2010)– 2850 person-visits– HIV positive on HAART
(n=1451)– HIV negative (n=92)
• Ages 50 to 70 years – Frailty phenotype more
common in HIV-positive men versus HIV-negative men
• May be effect of HIV infection, HAART, or both
• Further longitudinal studies are needed Age Group (years)
Pre
vale
nce
(%
)5%
Prevalence of Frailty Phenotype
<40 40-49 50-59 60-69 >70
Desquilbet L, et al. 18th CROI. Boston, 2011. Abstract 794.
HIV-positive on HAARTHIV-negative
4%
8% 8%
15%
8%
20%
10%
33%
24%