The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Human immunodeficiency virus infection in the elderly

노인에서 사람면역결핍바이러스 감염증의 특성과 치료

  • Choe, Pyoeng-Gyun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Nam-Joong (Department of Internal Medicine, Seoul National University College of Medicine)
  • 최평균 (서울대학교 의과대학 내과학교실) ;
  • 김남중 (서울대학교 의과대학 내과학교실)
  • Published : 2010.10.01
⟨ Previous Next ⟩

Abstract

The proportion of human immunodeficiency virus (HIV) infected patients aged 50 and older has greatly increased since the beginning of the epidemic, particularly after the introduction of combination antiretroviral therapy. In Korea, 25% of those infected with HIV were older than 50 in 2009. Older untreated patients with HIV demonstrate faster rates of CD4 lymphocyte loss and more rapid progression to acquired immunodeficiency syndrome and death than younger individuals. Most studies have shown that compared with younger patients, patients over 50 generally have a slower immunologic response to antiretroviral therapy, despite a better virological response. Management of HIV infection in older patients is particularly complex, mainly because they are more likely to have co-morbidities necessitating specific medications that may interact with antiretroviral drugs. Patients living longer with HIV are more likely to develop diseases associated with aging, and at an earlier age, than those without HIV. These include dementia, coronary artery disease, dyslipidemia, metabolic syndrome, diabetes, and osteoporosis.

Keywords

References

  1. Centers for Disease Control and Prevention. AIDS among persons aged > or=50 years: United States, 1991-1996. MMWR Morb Mortal Wkly Rep 47:21-27, 1998
  2. Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 41:1-19, 1992
  3. Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372:293-299, 2008 https://doi.org/10.1016/S0140-6736(08)61113-7
  4. Mack KA, Ory MG. AIDS and older Americans at the end of the Twentieth Century. J Acquir Immune Defic Syndr 33(Suppl 2):S68-S75, 2003 https://doi.org/10.1097/00126334-200306012-00003
  5. Centers for Disease Control and Prevention. Epidemiology of HIV/AIDS: United States, 1981-2005. MMWR Morb Mortal Wkly Rep 55:589-592, 2006
  6. Kirk JB, Goetz MB. Human immunodeficiency virus in an aging population, a complication of success. J Am Geriatr Soc 57:2129-2138, 2009 https://doi.org/10.1111/j.1532-5415.2009.02494.x
  7. Grabar S, Weiss L, Costagliola D. HIV infection in older patients in the HAART era. J Antimicrob Chemother 57:4-7, 2006 https://doi.org/10.1093/jac/dki411
  8. Korea Centers for Disease Control. KCDC Public Health Weakly Report. Available at: http://www.cdc.go.kr/phwr. Accessed 1 July, 2010
  9. Chiao EY, Ries KM, Sande MA. AIDS and the elderly. Clin Infect Dis 28:740-745, 1999 https://doi.org/10.1086/515219
  10. El-Sadr W, Gettler J. Unrecognized human immunodeficiency virus infection in the elderly. Arch Intern Med 155:184-186, 1995 https://doi.org/10.1001/archinte.155.2.184
  11. Abel T, Werner M. HIV risk behaviour of older persons. Eur J Public Health 13:350-352, 2003 https://doi.org/10.1093/eurpub/13.4.350
  12. Paul SM, Martin RM, Lu SE, Lin Y. Changing trends in human immunodeficiency virus and acquired immunodeficiency syndrome in the population aged 50 and older. J Am Geriatr Soc 55:1393-1397, 2007 https://doi.org/10.1111/j.1532-5415.2007.01295.x
  13. Skiest DJ, Keiser P. Human immunodeficiency virus infection in patients older than 50 years: a survey of primary care physicians' beliefs, practices, and knowledge. Arch Fam Med 6:289-294, 1997 https://doi.org/10.1001/archfami.6.3.289
  14. Silverberg MJ, Leyden W, Horberg MA, DeLorenze GN, Klein D, Quesenberry CP Jr. Older age and the response to and tolerability of antiretroviral therapy. Arch Intern Med 167:684-691, 2007 https://doi.org/10.1001/archinte.167.7.684
  15. Collaborative Group on AIDS Incubation and HIV Survival including the CASCADE EU Concerted Action. Concerted Action on SeroConversion to AIDS and Death in Europe. Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis. Lancet 355:1131-1137, 2000 https://doi.org/10.1016/S0140-6736(00)02061-4
  16. Phillips A, Pezzotti P. Short-term risk of AIDS according to current CD4 cell count and viral load in antiretroviral drug-naive individuals and those treated in the monotherapy era. AIDS 18:51-58, 2004 https://doi.org/10.1097/00002030-200401020-00006
  17. Fischl MA, Richman DD, Grieco MH, Gottlieb MS, Volberding PA, Laskin OL, Leedom JM, Groopman JE, Mildvan D, Schooley RT. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo- controlled trial. N Engl J Med 317:185-191, 1987 https://doi.org/10.1056/NEJM198707233170401
  18. Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338:853-860, 1998 https://doi.org/10.1056/NEJM199803263381301
  19. Oh MD. Antiretroviral therapy for treatment of human immunodeficiency virus type 1 infection. J Korean Med Assoc 50:316-323, 2007 https://doi.org/10.5124/jkma.2007.50.4.316
  20. Rhee MS, Greenblatt DJ. Pharmacologic consideration for the use of antiretroviral agents in the elderly. J Clin Pharmacol 48:1212-1225, 2008 https://doi.org/10.1177/0091270008322177
  21. Mussini C, Manzardo C, Johnson M, Monforte A, Uberti-Foppa C, Antinori A, Gill MJ, Sighinolfi L, Borghi V, Lazzarin A, Miro JM, Sabin C. Patients presenting with AIDS in the HAART era: a collaborative cohort analysis. AIDS 22:2461-2469, 2008 https://doi.org/10.1097/QAD.0b013e328314b5f1
  22. Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Study Group. Response to combination antiretroviral therapy: variation by age. AIDS 22:1463-1473, 2008 https://doi.org/10.1097/QAD.0b013e3282f88d02
  23. Goetz MB, Boscardin WJ, Wiley D, Alkasspooles S. Decreased recovery of CD4 lymphocytes in older HIV-infected patients beginning highly active antiretroviral therapy. AIDS 15:1576-1579, 2001 https://doi.org/10.1097/00002030-200108170-00017
  24. Kaufmann GR, Furrer H, Ledergerber B, Perrin L, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Rickenbach M, Hirschel B, Battegay M. Characteristics, determinants, and clinical relevance of CD4 T cell recovery to <500 cells/microL in HIV type 1-infected individuals receiving potent antiretroviral therapy. Clin Infect Dis 41:361-372, 2005 https://doi.org/10.1086/431484
  25. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. December 1, 2009; 1-161. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed 1July, 2010
  26. Braithwaite RS, Roberts MS, Chang CC, Goetz MB, Gibert CL, Rodriguez-Barradas MC, Shechter S, Schaefer A, Nucifora K, Koppenhaver R, Justice AC. Influence of alternative thresholds for initiating HIV treatment on quality-adjusted life expectancy: a decision model. Ann Intern Med 148:178-185, 2008 https://doi.org/10.7326/0003-4819-148-3-200802050-00004
  27. Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, Hogg RS, Deeks SG, Eron JJ, Brooks JT, Rourke SB, Gill MJ, Bosch RJ, Martin JN, Klein MB, Jacobson LP, Rodriguez B, Sterling TR, Kirk GD, Napravnik S, Rachlis AR, Calzavara LM, Horberg MA, Silverberg MJ, Gebo KA, Goedert JJ, Benson CA, Collier AC, Van Rompaey SE, Crane HM, McKaig RG, Lau B, Freeman AM, Moore RD. Effect of early versus deferred anti-retroviral therapy for HIV on survival. N Engl J Med 360:1815-1826, 2009 https://doi.org/10.1056/NEJMoa0807252
  28. Nolan L, O'Malley K. Prescribing for the elderly: part I. sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc 36:142-149, 1988 https://doi.org/10.1111/j.1532-5415.1988.tb01785.x
  29. Cuzin L, Delpierre C, Gerard S, Massip P, Marchou B. Immunologic and clinical responses to highly active antiretroviral therapy in patients with HIV infection aged >50 years. Clin Infect Dis 45: 654-657, 2007 https://doi.org/10.1086/520652
  30. Knobel H, Guelar A, Valldecillo G, Carmona A, Gonzalez A, Lopez-Colomes JL, Saballs P, Gimeno JL, Diez A. Response to highly active antiretroviral therapy in HIV-infected patients aged 60 years or older after 24 months follow-up. AIDS 15:1591-1593, 2001 https://doi.org/10.1097/00002030-200108170-00025
  31. Gebo KA. HIV and aging: implications for patient management. Drugs Aging 23:897-913, 2006 https://doi.org/10.2165/00002512-200623110-00005
  32. Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 18(Suppl 1):S19-S25, 2004 https://doi.org/10.1097/00002030-200406002-00003
  33. Tumbarello M, Rabagliati R, De Gaetano Donati K, Bertagnolio S, Tamburrini E, Tacconelli E, Cauda R. Older HIV-positive patients in the era of highly active antiretroviral therapy: changing of a scenario. AIDS 17:128-131, 2003 https://doi.org/10.1097/00002030-200301030-00020
  34. Shah SS, McGowan JP, Smith C, Blum S, Klein RS. Comorbid conditions, treatment, and health maintenance in older persons with human immunodeficiency virus infection in New York City. Clin Infect Dis 35:1238-1243, 2002 https://doi.org/10.1086/343048
  35. Simone MJ, Appelbaum J. HIV in older adults. Geriatrics 63:6-12, 2008
  36. Becker JT, Lopez OL, Dew MA, Aizenstein HJ. Prevalence of cognitive disorders differs as a function of age in HIV virus infection. AIDS 18(Suppl 1):S11-S18, 2004
  37. Cherner M, Ellis RJ, Lazzaretto D, Young C, Mindt MR, Atkinson JH, Grant I, Heaton RK. Effects of HIV-1 infection and aging on neurobehavioral functioning: preliminary findings. AIDS 18 (Suppl 1):S27-S34, 2004
  38. Chiesi A, Vella S, Dally LG, Pedersen C, Danner S, Johnson AM, Schwander S, Goebel FD, Glauser M, Antunes F. Epidemiology of AIDS dementia complex in Europe. AIDS in Europe Study Group. J Acquir Immune Defic Syndr Hum Retrovirol 11:39-44, 1996 https://doi.org/10.1097/00042560-199601010-00005
  39. Valcour V, Paul R. HIV infection and dementia in older adults. Clin Infect Dis 42:1449-1454, 2006 https://doi.org/10.1086/503565
  40. Janssen RS, Nwanyanwu OC, Selik RM, Stehr-Green JK. Epidemiology of human immunodeficiency virus encephalopathy in the United States. Neurology 42:1472-1476, 1992 https://doi.org/10.1212/WNL.42.8.1472
  41. McArthur JC, Hoover DR, Bacellar H, Miller EN, Cohen BA, Becker JT, Graham NM, McArthur JH, Selnes OA, Jacobson LP. Dementia in AIDS patients: incidence and risk factors. Multicenter AIDS Cohort Study. Neurology 43:2245-2252, 1993 https://doi.org/10.1212/WNL.43.11.2245
  42. Valcour V, Shikuma C, Shiramizu B, Watters M, Poff P, Selnes O, Holck P, Grove J, Sacktor N. Higher frequency of dementia in older HIV-1 individuals: the Hawaii Aging with HIV-1 Cohort. Neurology 63:822-827, 2004 https://doi.org/10.1212/01.WNL.0000134665.58343.8D
  43. Larussa D, Lorenzini P, Cingolani A, Bossolasco S, Grisetti S, Bongiovanni M, Moretti F, Uccella I, Zannoni P, Foresti S, Mazzarello G, Arcidiacono MI, Pedale R, Ammassari A, Tozzi V, Perno CF, Monforte AD, Cinque P, Antinori A. Highly active antiretroviral therapy reduces the age-associated risk of dementia in a cohort of older HIV-1-infected patients. AIDS Res Hum Retroviruses 22:386-392, 2006 https://doi.org/10.1089/aid.2006.22.386
  44. Currier JS, Lundgren JD, Carr A, Klein D, Sabin CA, Sax PE, Schouten JT, Smieja M. Epidemiological evidence for cardiovascular disease in HIV-infected patients and relationship to highly active antiretroviral therapy. Circulation 118:e29-e35, 2008 https://doi.org/10.1161/CIRCULATIONAHA.107.189624
  45. Friis-Moller N, Reiss P, Sabin CA, Weber R, Monforte A, El-Sadr W, Thiebaut R, De Wit S, Kirk O, Fontas E, Law MG, Phillips A, Lundgren JD. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med 356:1723-1735, 2007 https://doi.org/10.1056/NEJMoa062744
  46. Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, Dabis F, De Wit S, Law M, D'Arminio Monforte A, Friis-Moller N, Kirk O, Pradier C, Weller I, Phillips AN, Lundgren JD. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 371:1417-1426, 2008 https://doi.org/10.1016/S0140-6736(08)60423-7
  47. Sabin CA, Smith CJ, Delpech V, Anderson J, Bansi L, Gilson R, Schwenk A, Leen C, Gazzard B, Porter K, Mackie N, Fisher M, Orkin C, Johnson M, Easterbrook P, Hill T, Phillips AN. The associations between age and the development of laboratory abnormalities and treatment discontinuation for reasons other than virological failure in the first year of highly active antiretroviral therapy. HIV Med 10:35-43, 2009