Advertisement

International Journal of Clinical Pharmacy

, Volume 36, Issue 6, pp 1190–1195 | Cite as

Clinical characteristics and antiretroviral treatment of older HIV-infected patients

  • Mercedes Gimeno-Gracia
  • María José Crusells-Canales
  • María José Rabanaque-Hernández
Research Article

Abstract

Background The number of Human Immunodeficiency Virus (HIV) patients aged 50 years or over is growing year on year, due to both late diagnoses and the chronicity of the illness. This increase is a new phenomenon. Objective To describe the clinical and epidemiological characteristics of the older HIV infected population and determine if there are differences in antiretroviral treatment between younger and older patients. Setting This study was conducted in the outpatient hospital pharmacy service of a University Hospital in Spain. Method A descriptive study involving HIV infected patients aged 50 years or older who received ambulatory antiretroviral therapy between January and December 2011. Variables related to HIV and to antiretroviral therapy were collected. A comparison of antiretroviral drugs used was made with the populations older and younger than 50 years. Main outcome measure Antiretroviral therapy differences between older and younger HIV-patients. Results 130 patients (20 % of the antiretroviral treated patients) were 50 or over and 77 % of these was aged between 50 and 59. At the time of diagnosis, 50 % suffered an advanced state of disease. At the end of the study period, 58 % had CD4 lymphocyte levels of over 500 cells/mm3 and 90 % had an undetectable viral load. The antiretroviral therapy of the older group that was based on protease inhibitors was used in the 51.5 % of the patients compared with 54.4 % in the younger group. The figures for nonnucleoside reverse transcriptase inhibitors based therapy were 43.8 and 39.8 %, respectively. The older population used treatments that included tenofovir (56.9 vs. 64.8 %, p = 0.105) less frequently and used more treatments that included abacavir (26.9 vs. 19.1 %, p = 0.054) than the under 50′s. Conclusion Half the older HIV-infected patients were diagnosed with an advanced disease and the majority showed a positive response to antiretroviral therapy. There are no statistically significant differences between the frequency of antiretroviral therapy use in older and younger HIV-patients, although older HIV-patients has less often used treatments with tenofovir and more often used treatments with abacavir.

Keywords

AIDS Antiretroviral therapy ART Elderly Spain 

Notes

Acknowledgments

We thank Elena Rivero for the final manuscript.

Funding

There has not been any funding for this study.

Conflicts of interest

On behalf of all authors, the corresponding author states there is no conflict of interest.

References

  1. 1.
    Blanco JR, Caro AM, Pérez-Cachafeiro S, Gutierrez F, Iribarren JA, Gonzalez- Garcia J, et al. HIV infection and aging. AIDS Rev. 2010;12:218–30.PubMedGoogle Scholar
  2. 2.
    Montaner JSG, Hogg R, Wood E, Kerr T, Tyndal M, Levy A, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of HIV epidemic. Lancet. 2006;368:531–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;2(382):1525–33.CrossRefGoogle Scholar
  4. 4.
    The Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-Infected patients treated with antiretroviral therapy, 1996–2006: Collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50:1387–96.PubMedCentralCrossRefGoogle Scholar
  5. 5.
    The Antiretroviral Therapy Cohort Collaboration. Life expectancy of individual son combination antiretroviral therapy in high-income countries: A collaborative analysis of 14 cohort studies. Lancet. 2008;372:293–9.PubMedCentralCrossRefGoogle Scholar
  6. 6.
    Work Group for the HIV and Aging Consensus Project. Summary report from the human immunodeficiency virus and aging consensus project: Treatment strategies for clinicians managing older individuals with the human immunodeficiency virus. J Am Geriatr Soc. 2012;60:974–9.CrossRefGoogle Scholar
  7. 7.
    Hasse B, Ledergerber B, Furrer H, Battegay M, Hirschel B, Cavassini M, et al. Morbidity and aging in HIV-infected persons: The Swiss HIV cohort study. Clin Infect Dis. 2011;53:1130–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Blanco JR, Jarrín I, Vallejo M, Berenguer J, Solera C, Rubio R, et al. Definition of advance age in HIV infection: Looking for an age cut-off. AIDS Res Hum Retroviruses. 2012;28:1000–6.PubMedGoogle Scholar
  9. 9.
    Panel de expertos de GeSIDA y Plan Nacional del Sida. [Consensus Statement by GeSIDA/National AIDS Plan Secretariat on antiretroviral treatment in adults infected by the human immunodeficiency virus (Updated January 2013)]. Enferm Infecc Microbiol Clin. 2013;31:602–613.Google Scholar
  10. 10.
    Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011;53:1120–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Önen NF, Overton ET, Seyfried W, Stumm ER, Snell M, Mondy K, et al. Aging and HIV infection: A comparison between older HIV-infected persons and the general population. HIV Clin Trials. 2010;11:100–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Panel de expertos de Secretaría del Plan Nacional sobre el Sida (SPNS), Sociedad Española de Farmacia Hospitalaria (SEFH), Grupo Estudio del SIDA (GESIDA). [Improving adhesion to antiretroviral treatment]. Farm Hosp. 2008;32:349–357.Google Scholar
  13. 13.
    Plan Nacional Sobre el Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III. Encuesta Hospitalaria de pacientes con VIH/SIDA [internet]. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad; [updated 2011, cited 2012 April]. http://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeEncuestaHospitalaria2011.pdf. Spanish.
  14. 14.
    Marzolini C, Back D, Weber R, Furrer H, Cavassini M, Calmy A, et al. Ageing with HIV: Medication use and risk for potential drug-drug interactions. J Antimicrob Chemother. 2011;66:2107–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Navarro G, Nogueras MM, Segura F, Casabona J, Miro JM, Murillas J, et al. HIV-1 infected patients older than 50 years. PISCIS cohort study. J Infect. 2008;57:64–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Oliva J, Galindo S, Vives N, Arrillaga A, Izquierdo A, Nicolau A, et al. Delayed diagnosis of HIV infection in Spain. Enferm Infecc Microbiol Clin. 2010;28:583–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Díez M, Oliva J, Sánchez J, Vives N, Cevallos C. Izquierdo A [Incidence of new HIV diagnoses in Spain, 2004–2009]. Gac Sanit. 2012;26:107–15.PubMedCrossRefGoogle Scholar
  18. 18.
    Lima VD, Harrigan R, Bangsberg DR, Hogg RS, Gross R, Yip B, et al. The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009;50:529–36.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Ortego C, Huedo-Medina TB, Vejo J, Llorca FJ. Adherence to highly active antiretroviral therapy in Spain. A meta-analysis. Gac Sanit. 2011;25:282–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Ibarra O, Ortega L. Survey of the pharmaceutical care situation of the HIV patient in Spain. Farm Hosp. 2008;32:170–7.CrossRefGoogle Scholar
  21. 21.
    Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, et al. Medication adherence in HIV- infected adults: Effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18:S19–25.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Mercedes Gimeno-Gracia
    • 1
  • María José Crusells-Canales
    • 2
  • María José Rabanaque-Hernández
    • 3
  1. 1.Pharmacy Department“Lozano Blesa” University Clinical HospitalSaragossaSpain
  2. 2.Infectious Disease Department“Lozano Blesa” University Clinical HospitalSaragossaSpain
  3. 3.Public Health DepartmentUniversity of ZaragozaSaragossaSpain

Personalised recommendations