Effect of age and HAART regimen on clinical response in an urban cohort of HIV-infected individuals
Effect of age and HAART regimen on clinical response in an urban cohort of HIV-infected individuals
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DOI：
10.1097/qad.0b013e32831883f9
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发表时间：
2008-11-12
期刊：
影响因子：
3.8
通讯作者：
Gebo, Kelly A.
中科院分区：
文献类型：
--
作者：
Greenbaum, Adena H.;Wilson, Lucy E.;Gebo, Kelly A.
目的：由于高效抗逆转录病毒治疗，老年患者（>= 50岁）的艾滋病毒感染率正在增加，老年患者中新发艾滋病毒感染。一些早期的研究表明，老年患者对HAART的反应与年轻患者不同。本研究的目的是比较HAART在老年和年轻HIV患者中的有效性。设计：对一个观察性临床队列的回顾性分析。方法：比较670名年轻患者的病毒学和免疫学应答、艾滋病进展和死亡率t检验、Kaplan-Meier法和多变量考克斯比例风险分析。与年轻患者相比，老年患者更可能接受非核苷类逆转录酶抑制剂与蛋白酶抑制剂为主的治疗方案（42% vs.29%，P < 0.01）。老年患者达到HIV-1 RNA病毒学抑制的时间短于年轻患者（3.2个月对4.4个月，P < 0.01）。免疫应答没有年龄差异。与年轻患者相比，老年患者的艾滋病定义的机会性感染较少（22 vs. 31%，P < 0.01），但死亡率较高（36 vs. 27%，P = 0.04），生存期较短（第25百分位生存功能36.2 vs. 58.5个月，P = 0.02）。年龄越大，病毒学抑制越快[校正风险比= 1.33（1.09-1.63）]和死亡率越早[校正风险比= 1.56（1.14-2.14）]。基于非核苷类逆转录酶抑制剂的治疗方案与更快速的病毒学抑制相关[校正风险比= 1.22（1.03-1.44）]。结论：老年患者HAART开始后病毒学抑制的时间较短，尽管CD 4应答并不因年龄而异。老年患者机会性感染较少，但生存期较短。我们的数据表明，需要更好地了解老年患者的死亡原因。(C)2008年威科健康|利平科特威廉姆斯&威尔金斯
Objectives: The prevalence of HIV infection in older patients (>= 50 years) is increasing due to HAART, and new HIV infections in older patients. Some earlier studies suggest that older patients respond differently to HAART than younger patients. The objective of this study is to compare the effectiveness of HAART in older and younger HIV patients.Design: Retrospective analysis of an observational clinical cohort.Methods: Virologic and immunologic response, progression to AIDS and mortality were compared between 670 younger patients (= 50 years) by t-test, Kaplan-Meier methods, and multivariate Cox proportional hazards analysis.Results: Compared with younger patients, older patients were more likely to be on nonnucleoside reverse transcriptase inhibitors based versus protease inhibitor based regimens (42 vs. 29%, P < 0.01). Time to HIV-1 RNA virologic suppression was less in older than in younger patients (3.2 vs. 4.4 months, P < 0.01). Immunologic response did not differ by age. Older patients had fewer AIDS-defining opportunistic infections (22 vs. 31 %, P < 0.01), but higher mortality (36 vs. 27%, P = 0.04) and shorter survival (25th percentile survivor function 36.2 vs. 58.5 months, P = 0.02) than younger patients. Older age was associated with more rapid virologic suppression [adjusted hazard ratio = 1.33 (1.09-1.63)] and earlier mortality [adjusted hazard ratio = 1.56 (1.14-2.14)]. Nonnucleoside reverse transcriptase inhibitors based regimens were associated with more rapid virologic suppression [adjusted hazard ratio = 1.22 (1.03-1.44)].Conclusion: Time to virologic suppression after HAART initiation was shorter in older patients, although CD4 response did not differ by age. Older patients had fewer opportunistic infections, but survival was shorter. Our data suggest a need to better understand causes of mortality in older patients. (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins