According to a recent study published and presented at the American Society for Microbiology conference in Denver, Colorado on Sunday, May 19, by Thomas Nahass of ID Care in Hillsborough, successful treatment of HIV and AIDS has resulted in an elderly population now living successfully with the disease.
Advancement in treatments has resulted HIV patients who, in years past did not survive to become senior citizens, are now living well into their seventies and eighties.
ID Care, an infectious disease practice, has been treating HIV patients since the early 1990s. For his study, Nahass selected twenty-two patients diagnosed with HIV, age 70 or older, living at a good functional level. These patients, all on highly active antiretroviral therapy (HAART), were compared to the practice’s younger patients.
Approaching the third decade of HAART (highly active anti-retroviral treatment) for the treatment of HIV, the increasing age of the affected population makes it important to understand how elderly patients respond. HIV had once been a mysterious disease, attacking the immune system and stealing lives. Subsequent awareness and developments in treatments in the 1980s have allowed HIV to be treated as a chronic illness. This work provides further evidence that with adherence to proper treatment, HIV can be successfully managed for a long lifetime.
Results showed that there were no significant differences between the older cohort and the entire population with regard to effectiveness of treatment. The study also indicated that additional health conditions did not negatively impact lifestyle of the over 70 population and the few causes of death included lung cancer, drug overdose, and heart failure.
Excellent compliance in the 70 and over age group most likely contributes to a good HIV outcome just as it does in younger patients. It was therefore concluded that HIV in the elderly should be considered a chronic illness and with proper treatment will not alter their life span.
The study was conducted using a retrospective chart review of office visits between September 2011 and September 2012 and found 814 unique patients with a diagnosis of either HIV or AIDS. Of these patients, there were 22 (2.7% of the total) who were 70 to 86 years old.
The electronic and paper records for these patients were reviewed to determine the onset of the illness and when therapy was first recorded. HIV infection had been present for more than 20 years in 6 patients (27.3%), 10-20 years in 12 patients (54.5%), and less than 10 years in 4 patients (18.2%). The average duration of HIV infection was 14.7 years and all patients were on HAART. Therapy had been given for more than 20 years in 2 patients (9.1%), 10-20 years in 15 patients (68.2%), and less than 10 years in 5 patients (2.7%). The average time on antiviral therapy was 13.2 years. The average number of co-morbid conditions was 2.3, the most common of which were diabetes, hypertension, hypercholesterolemia, and various types of cancer. 19 patients are still alive, while 3 had died at a mean age of 77.3. The causes of death included lung cancer, drug overdose, and heart failure. All patients have a good functional level except one who has residual deficits from vacuolar myelopathy, an HIV related health condition rarely seen in the current era with good treatment.
The results of the comparison of laboratory values for the total population compared to the over 70 population was remarkable for their similarity. A patient is considered under control with a viral load (measure of virus in the blood) less than 1000 copies/mL and suppressed when it is 200 copies or less. For the total HIV population, 778 patients had a recorded HIV viral load and 656 of these (84.3%) had less than 200 copies/mL. The 19 patients who are still alive from the elderly cohort all also have a viral load of less than 200 copies/mL. CD4 count is a measure of the immune system and a value greater than 200 cells/mL indicates a healthy response to outside pathogens. For the total HIV population the average CD4 (measure of immune system) count was 585 cells/mL ranging from 14-2076 cells/mL and our elderly patients averaged 523 cells/mL, the difference was not statistically significant. These results suggest that the elderly respond to treatment in a similar manner to younger patients and can successfully manage HIV regardless of age.