Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more

BMC Infectious Diseases BioMed Central Research article Open Access Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more MaMercedes Nogueras*1, Gemma Navarro1, Esperança Antón1, Montserrat Sala1, Manel Cervantes1, MaJosé Amengual2 and Ferran Segura1 Address: 1Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain and 2UDIAT Diagnosis Centre, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain Email: MaMercedes Nogueras* - ; Gemma Navarro - ; Esperança Antón - ; Montserrat Sala - ; Manel Cervantes - ; MaJosé Amengual - ; Ferran Segura - * Corresponding author Published: 06 November 2006 BMC Infectious Diseases 2006, 6:159 doi:10.1186/1471-2334-6-159 Received: 28 July 2006 Accepted: 06 November 2006 This article is available from: http://www.biomedcentral.com/1471-2334/6/159 © 2006 Nogueras et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIVinfected patients with regard to younger HIV-infected patients. Methods: A prospective cohort study (1998–2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13–40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chisquared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and TwoWay ANOVA from random factors. Results: G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). Conclusion: Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed. Page 1 of 9 (page number not for citation purposes) BMC Infectious Diseases 2006, 6:159 http://www.biomedcentral.com/1471-2334/6/159 Background Methods Over the last years, the proportion of old individuals infected with HIV is increasing. For instance, patients older than 50 years were more than 10 % of AIDS notifications made in the last ten years in USA [1]. More than 90 500 individuals over 50 years are living with AIDS in this country [2]. In Europe, 12.6 % of AIDS patients were older than 50 years in 1998, whereas 14.5 % of them had more than 50 years in 2002 [3]. Since the beginning of the HIV pandemic to 2005, 71 039 cases of AIDS have been reported in Spain. Mean age at time of diagnosis was 40.3 years [4]. Study setting Subjects were enrolled at the Sabadell Hospital. This is a 765-bed general teaching hospital located in Barcelona, Spain. It provides primary and specialty care for HIV infection to 850 patients, approximately. The progressive increase of mean age of subjects with HIV infection and AIDS could be explained by different factors. Since 1996, when highly active antiretroviral therapy (HAART) was available, the history of HIV infection has evolved from acute or subacute disease to a chronic and controllable infection. Thus, HIV-infected people grow older and live longer. Antimicrobial therapy and chemoprophylaxis have also allowed the increase survival of people living with HIV infection. Moreover, some epidemiological features have changed. The importance of sexual transmission as mode of HIV spread is increasing [1]. Therefore, there are a number of patients who are not aware of their infection, delaying the diagnosis. There are epidemiological differences between younger and older HIV-infected individuals. Older people have a higher prevalence of sexual HIV transmission, a reduction of transmission due to intravenous use, and a higher proportion of men [5,6]. On the other hand, there are controversial data about the virological and immunological responses to HAART as well as survival in older patients. Some studies indicates that the duration of survival is significantly shorter for elderly people due to deficiencies in the immune system related to age [7,8]. However, others studies seem to show older people have the same response to HAART than younger patients [9,10]. In the past, there was little attention to older people with HIV infection due to the little number of them. Nevertheless, the importance of knowledge about the HIV infection in this population is increasing. The aim of the present study is to characterize the ways in which older HIV infected people differ from younger, in a Spanish cohort. Our previously hypothesis are: firstly, older patients have different epidemiological and clinical features; secondly, they response to HAART in the same way that younger patients. The survey takes into account epidemiological and clinical features, virological and immunological responses, prognostic, and survival. Design A prospective cohort study (1998–2003) Database Eligible patients were enrolled at the PISCIS project. The latter is a multicenter cohort (10 hospitals of Catalonia and one from Balearic Islands) of HIV-infected people whose features are entered into a computerized database [11]. Inclusion criteria are: to be more than 16 years old, to have confirmed positive serology against HIV, and to be attended at first time from January 1, 1998 in one hospital of the study. All patients with these conditions are included in PISCIS cohort inde (...truncated)