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

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 wit...

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Main Authors: India Butler, William MacLeod, Pappie P. Majuba, Brent Tipping
Format: Article
Language:English
Published: AOSIS 2018-11-01
Series:Southern African Journal of HIV Medicine
Subjects:
ART
Online Access:https://sajhivmed.org.za/index.php/hivmed/article/view/838
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spelling doaj-17faec0d2e03421e92de68706686c8122020-11-24T21:13:28ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512018-11-01191e1e810.4102/sajhivmed.v19i1.838604Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South AfricaIndia Butler0William MacLeod1Pappie P. Majuba2Brent Tipping3Division of Geriatric Medicine, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandHealth Economics and Epidemiology Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandRight to Care, Helen Joseph HospitalDivision of Geriatric Medicine, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the WitwatersrandIntroduction: 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.https://sajhivmed.org.za/index.php/hivmed/article/view/838gaeriatricseniorAIDSARTantiretrovirals
collection DOAJ
language English
format Article
sources DOAJ
author India Butler
William MacLeod
Pappie P. Majuba
Brent Tipping
spellingShingle India Butler
William MacLeod
Pappie P. Majuba
Brent Tipping
Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
Southern African Journal of HIV Medicine
gaeriatric
senior
AIDS
ART
antiretrovirals
author_facet India Butler
William MacLeod
Pappie P. Majuba
Brent Tipping
author_sort India Butler
title Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
title_short Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
title_full Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
title_fullStr Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
title_full_unstemmed Human immunodeficiency virus infection and older adults: A retrospective single-site cohort study from Johannesburg, South Africa
title_sort human immunodeficiency virus infection and older adults: a retrospective single-site cohort study from johannesburg, south africa
publisher AOSIS
series Southern African Journal of HIV Medicine
issn 1608-9693
2078-6751
publishDate 2018-11-01
description 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.
topic gaeriatric
senior
AIDS
ART
antiretrovirals
url https://sajhivmed.org.za/index.php/hivmed/article/view/838
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