Complications of HIV infection in an ageing population: challenges in managing older patients on long-term combination antiretroviral therapy

J Antimicrob Chemother. 2011 Jun;66(6):1210-4. doi: 10.1093/jac/dkr058. Epub 2011 Mar 18.

Abstract

With the use of combination antiretroviral therapy, the proportion of HIV-infected patients over age 50 has greatly increased. The rate of progression of untreated HIV disease, response to therapy and complicating effects of co-morbidities differ in older versus younger patients. Compared with younger individuals, older untreated HIV patients demonstrate faster rates of CD4+ cell loss and more rapid progression to AIDS and death. With treatment, older patients have a better virological response, but a less robust immunological response. The treatment of older HIV-infected patients is further complicated by pre-existing co-morbid conditions including cardiovascular, hepatic and metabolic complications that may be exacerbated by the effects of HIV infection per se, modest immunodeficiency (i.e. at CD4+ counts >350 cells/mm³), and the metabolic and other adverse effects of combination antiretroviral therapy. Based on these considerations guidelines for the treatment of HIV-infected patients state that increased age is a consideration in initiating antiretroviral therapy in persons with >350-500 CD4+ cells/mm³.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / adverse effects
  • Antiretroviral Therapy, Highly Active / adverse effects
  • CD4 Lymphocyte Count
  • Cardiovascular Diseases / complications
  • Disease Progression
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV Infections / immunology
  • Humans
  • Liver Diseases / complications
  • Middle Aged

Substances

  • Anti-HIV Agents