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*280. Outcomes after Initiating HAART in Older and Younger HIV-Infected Adults
J Maruenda, University of Oklahoma Health Science Center; HN Yarandi, College of Nursing, University of Florida; JW Sleasman, College of Medicine, University of Florida; BS Bender, GRECC, VA Medical Center - Gainesville; College of Medicine, University of Florida
Objectives: The overall objective was to determine whether older HIV-infected patients had similar outcomes after initiating highly active antiretroviral therapy (HAART)as younger HIV-infected patients. Specifically, we investigated whether older patients as compared to younger patients had the same virologic and immunologic responses to HAART. We also explored the differences between older and younger HIV-infected patients in mortality, the incidence of opportunistic infectious, and adverse drug reactions after initiating HAART.
Methods: Medical records of HIV-infected patients who attended the Gainesville VA infectious disease clinic and who were initiated on their first HAART regimen during the period of May 1996 to April 1998 were screened. From this screening we selected the records of all patients who met the following inclusion criteria: (1)taking HAART regimen for at least 6 weeks or more; (2) had detectable virus in their blood by RT-PCR or bDNA techniques prior to therapy; (3) age of 40 years and younger or 50 years and older. After successful completion of training, two postdoctoral fellows reviewed the records.
Results: The rates of change in CD4+ T cell counts and viral loads (VL) following HAART were similar in both older (n = 19) and younger (n = 18) HIV-infected patients, and the maximal effect was observed early in therapy. Only one older patient died -- of a myocardial infarction -- in the study period. One younger patient developed esophageal candidiasis and one older patient developed recurrent pneumonia. Two older and two younger patients changed their HAART regimens due to gastrointestinal side effects and two younger patients switched antiretroviral combinations due to abnormal cholesterol levels.
Conclusions: Younger and older HIV-infected adults had similar increases in CD4+ T-cells and decreases in viral loads after initiation of HAART. The clinical course and adverse effects after HAART were relatively similar in the two age groups. Older age does not appear to be a contraindication to HAART. Our data suggest that clinicians and policy makers should continue to treat and plan care following guidelines developed for predominantly younger patients. Aggressive or different medication regimens and increased monitoring for adverse reations to HAART for older HIV-infected patients do not appear warranted.
Impact: HAART has revolutionized the care of HIV-infected patients, changing HIV infection from an acute, deadly disease to a chronic disease with extended life expectancies and long-term problems. Previous research on HAART has been primarily conducted in clinical trials with populations of young, adult men. It is unclear whether results from these trials can be generalized to the growing, older HIV/AIDS population. We found that HAART produced similar, positive effects in both older and younger HIV-infected adults. Our findings suggest that unless specific contraindications exist, older HIV-infected patients should be cared for according to current national guidelines.