Aging and HIV infection: 4 years follow-up of 149 HIV infected patients older than 60 years in West Paris agglomeration (COREVIH Île-de-France Ouest)

• Published in: La Presse médicale (1983) Vol. 42; no. 5; pp. e145 - e152
• Main Authors: Flexor, Gabriella, Zucman, David, Berthé, Huguette, Meier, Françoise, Force, Gilles, Greder-Belan, Alix, Billy, Christophe, Dupont, Caroline, Mortier, Emmanuel, Bizard, Antoine, Rouveix, Elisabeth, de Truchis, Pierre
• Format: Journal Article
• Language: French
• Published: France 01-05-2013
• Subjects: Aged; Aged, 80 and over; Aging - immunology; Anti-HIV Agents - therapeutic use; Cardiovascular Diseases - epidemiology; Cause of Death; CD4 Lymphocyte Count; Comorbidity; Disease Progression; Disease Susceptibility; Female; Follow-Up Studies; Hepatitis, Viral, Human - epidemiology; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - metabolism; Humans; Immunocompromised Host; Male; Metabolic Diseases - epidemiology; Middle Aged; Neoplasms - epidemiology; Paris - epidemiology; Viral Load; Paris
• ISSN: 2213-0276
• DOI: 10.1016/j.lpm.2012.11.005

In France, patients over 50 years represent more than 23.6% of all registered cases in the French Hospital Database for HIV (FHDH), and 18% of newly HIV-diagnosed patients.
To describe the long-term evolution after 4 years of a cohort of HIV infected patients older than 60 years recruited in COREVIH Île-de-France Ouest.
One hundred and forty-nine participants, 115 men (77%) and 34 women (23%), were included in the cohort analysis in 2004, and baseline characteristics were: median age 65.4 years (60.3-86.3), CDC stage C: 36%, HBV and HCV co-infections: four (2.7%) and eight (5.4%) patients, median time from first HIV infection diagnosis: 8.5 years (0.25-19.5), ongoing HAART regimen: 88%, median duration of ARV treatment: 7.5 years (0.2-15.5), baseline CD4 cells count: 372/mm(3) (18-1860), HIV viral load less than 200 c/ml: 104 (70%). After a 4-year follow-up, 111 patients were alive, all but one treated with HAART, 17/149 (11.5%) were lost for follow-up, and 21/149 were deceased (14%). Causes of death were acute cardiovascular disease (4/21), neoplasia (11/21), neurological disease 1/21, end stage liver disease 3/21, unknown 2/21. The prevalence of co-morbidities after 4 years of follow-up were: arterial hypertension 40/111 (36%), hypercholesterolemia 48/111 (43%), diabetes 23/111 (21%), kidney disease with renal insufficiency (creatinine clairance<60 ml/min): 36/111 (32%). At the end of follow-up, median CD4 cells count was 494/mm(3), and viral load was undetectable less than 200 c/ml in 107/111 patients (96%). No new opportunistic infection occurred during the 4-year follow-up, but 24 patients had a new diagnosis of neoplasia (incidence 40/1000 person-year). Cancer was the cause of death in 11/24.
Clinical and immunological improvement was continuous under HAART in these aged HIV infected patients, but co-morbidities are frequently observed in this population, with high incidence of cardiovascular disease and neoplasia, and related mortality. A multidisciplinary approach, with preventive consultations, oncology and cardiovascular screening, as done in geriatrics, is warranted in the aging HIV population.