Two Conflicting Reports in Older Patients
1st Report in Clinical Infectious Diseases (June 1, 2002, Volume 34, number
Clinical Experience with Human Immunodeficiency VirusInfected Older
Patients in the Era of Effective Antiretroviral Therapy
Richard M. Grimes, 1 Max E. Otiniano, 5 Maria C. Rodriguez-Barradas, 3, 4 and
Departments of 1Management and Policy Sciences and 2Biometry, School of
Public Health, University of TexasHouston Health Science Center, 3Department
of Medicine, Baylor College of Medicine, and 4HIV Clinic, Houston Veteran's
Administration Medical Center, Houston, and 5Department of Internal Medicine,
University of Texas Medical Branch, Galveston, Texas; Received 5 July 2001;
revised 5 February 2002; electronically published 8 May 2002.
New therapies for human immunodeficiency virus (HIV) infected patients suggest
the need to examine whether these therapies are as effective in older
patients as in younger patients. Fifty-two patients aged 50 years were
compared with 52 patients aged <50 years for changes in CD4+ counts, viral
loads, opportunistic disease, hospitalizations, drug side effects, and death.
No differences were found, except for higher rates of candidiasis in younger
patients. Antiretroviral therapy seems to be equally effective in older and
younger patients. In this study both older and younger patients started
therapy at about the same time: Cd4s and HIV RNA were about the same.
These authors concluded that these results may indicate that successful
treatment with ART is sufficiently effective and that it overcomes the
natural disadvantages associated with advancing age. These findings can be
supported by the fact that the older patients in this study had increases in
CD4+ T lymphocyte counts that were comparable to those observed in the
younger patients, even though a previous study had suggested that older
HIV-infected patients were unable to replenish these cells as rapidly as were
younger individuals . These results provide evidence that there should be
no difference in the management of older and younger HIV-infected patients.
The standard approach to therapy (i.e., ART) seems to produce the same
outcomes without causing any additional side effects. Clinicians should also
expect to see the immune function and HIV loads of older patients show
improvements similar to those seen in younger patients. Therefore, because
treatment outcomes seem to be the same for both groups, clinicians should
judge the effectiveness of therapy for older HIV-infected patients in the
same manner that they judge the effectiveness of therapy for younger
HOWEVER, 2nd Report-
Do Older Folks (>50) Progress More Quickly
In this study reported at Retrovirus 2002 researchers found older folks >50
years who were untreated had less chance for survival than younger folks not
treated. But if treated both groups had same survival.