Association of aging and survival in a large HIV-infected cohort on antiretroviral therapy

The AIDS Support Organization Headquarters, Kampala, Uganda.
AIDS (London, England) (Impact Factor: 5.55). 02/2011; 25(5):701-5. DOI: 10.1097/QAD.0b013e3283437ed7
Source: PubMed


To examine if there is a significant difference in survival between elderly (>50 years) and nonelderly adult patients receiving combination antiretroviral therapy in Uganda between 2004 and 2010.
Prospective observational study.
Patients 18-49 years of age (nonelderly) and 50 years of age and older enrolled in the AIDS Support Organization Uganda HIV/AIDS national programme were assessed for time to all-cause mortality. We applied a Weibull multivariable regression.
Among the 22 087 patients eligible for analyses, 19 657 (89.0%) were aged between 18 and 49 years and 2430 (11.0%) were aged 50 years or older. These populations differed in terms of the distributions of sex, baseline CD4 cell count and death. The age group 40-44 displayed the lowest crude mortality rate [31.4 deaths per 1000 person-years; 95% confidence interval (CI) 28.1, 34.7) and the age group 60-64 displayed the highest crude mortality rate (58.9 deaths per 1000 person-years; 95% CI 42.2, 75.5). Kaplan-Meier survival estimates indicated that nonelderly patients had better survival than elderly patients (P < 0.001). Adjusted Weibull analysis indicated that elderly age status was importantly associated (adjusted hazard ratio 1.23, 95% CI 1.08-1.42) with mortality, when controlling for sex, baseline CD4 cell count and year of therapy initiation.
As antiretroviral treatment cohorts mature, the proportion of patients who are elderly will inevitably increase. Elderly patients may require focused clinical care that extends beyond HIV treatment.

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    • "the survival gains tend to be smaller than at younger ages (Bakanda et al., 2011; Negin et al., 2011). Longer survival implies that HIV infection will be increasingly common among older people, as was shown in a projection for a rural population in South Africa (Hontelez et al., 2011). "
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