HIV infection: treatment outcomes in older and younger adults.
HIV infection: treatment outcomes in older and younger adults.
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HIV 感染：老年人和年轻人的治疗结果。
DOI：
10.1046/j.1532-5415.2002.50152.x
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发表时间：
2002
影响因子：
6.3
通讯作者：
Schmader,KennethE
中科院分区：
文献类型：
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作者：
Wellons,MelissaFair;Sanders,Linda;Edwards,LloydJ;Bartlett,JohnA;Heald,AlisonE;Schmader,KennethE
目的：确定抗逆转录病毒治疗（ART）对老年人免疫缺陷病毒（HIV）感染患者与年轻人HIV感染患者的免疫学和病毒学结果的影响。方法：采用1：2回顾性病例对照研究（1993 - 1999）。地点：杜克大学传染病诊所。参与者：101例老年患者，平均年龄56.7岁（范围50 - 79岁）; 202例年轻患者，平均年龄32.8岁（范围21 - 39岁）。患者在基线CD4+细胞计数和临床entry.MEASUREMENTSThe病毒学和免疫学结果匹配病毒抑制（HIV核糖核酸（RNA）水平≤ 400拷贝/ml）和CD4+细胞计数的变化。为了估计抗逆转录病毒药物暴露的差异，比较了总体和药物类别的ART患者百分比。为了进一步评估抗逆转录病毒药物暴露，比较了ART中断患者的百分比。（332 vs 306个细胞/mm3; P =.31）和CD4+细胞计数的相似增加（+3.47 vs +4.60个细胞/mm3/月; P = 0.37），平均值±标准差为2.4 ± 1.7年随访。老年组中，目前血浆HIV RNA水平低于400的患者比例较高（46% vs 34%; P = 0.05）。两组的非核苷逆转录酶、核苷逆转录酶和蛋白酶抑制剂使用率相似。年龄较大的组有较少的中断在ART比年轻组（11%比26%; P = 0.01）。结论艾滋病毒感染的患者对ART反应良好，与一个显着更大的百分比达到目前的血浆HIV RNA低于检测限。老年患者的CD 4+细胞计数增加与年轻匹配对照相似。年龄较大的患者不太可能中断ART，这表明更好的依从性和/或耐受性，并且可以解释HIV RNA抑制率较高的原因。J Am Geriatr Soc 50：603 - 607，2002。
OBJECTIVESTo determine the effect of antiretroviral therapy (ART) on the immunological and virological outcomes of older human immunodeficiency virus (HIV)‐infected patients compared with younger HIV‐infected patients.DESIGNMatched (1:2) retrospective case‐control study (1993–1999).SETTINGDuke University Infectious Diseases Clinic.PARTICIPANTSOne hundred one older patients, mean age 56.7 (range 50–79) and 202 younger patients, mean age 32.8 (range 21–39). Patients were matched on baseline CD4+ cell count and date of clinic entry.MEASUREMENTSThe virological and immunological outcomes were viral suppression (HIV ribonucleic acid (RNA) level ≤400 copies/ml) and change in CD4+ cell count. To estimate differences in antiretroviral drug exposure, the percentage of patients on ART overall and by drug class was compared. To assess antiretroviral drug exposure further, the percentage of patients having interruptions in ART was compared.RESULTSThe older and younger groups had similar baseline CD4+ cell counts (332 vs 306 cells/mm3;P= .31) and similar increases in CD4+ cell counts (+3.47 vs +4.60 cells/mm3/month;P= .37) over a mean ± standard deviation of 2.4 ± 1.7 years of follow‐up. The older group had a higher percentage of patients with current plasma HIV RNA levels less than 400 (46% vs 34%;P= .05). The groups had similar rates of non‐nucleoside reverse transcriptase, nucleoside reverse transcriptase, and protease inhibitor use. The older group had fewer interruptions in ART than the younger group (11% vs 26%;P= .01).CONCLUSIONSOlder HIV‐infected patients responded well to ART, with a significantly greater percentage achieving a current plasma HIV RNA below detectable limits. Older patients experienced similar increases in CD4+ cell count as younger matched controls. Older patients were less likely to interrupt ART, which suggests better adherence and/or tolerance and may explain the higher rate of HIV RNA suppression.J Am Geriatr Soc 50:603–607, 2002.