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  EACS - 12th European AIDS Conference
November 11-14, 2009
Cologne, Germany
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Good 4-Year HIV Response in People Over 60, But High Cancer and Heart Disease Rates
  12th European AIDS Conference, November 11-13, 2009, Cologne, Germany
Mark Mascolini
After 4 years of follow-up, HIV-infected French people in their 60s and 70s had excellent virologic and CD4 responses to antiretroviral therapy [1]. Twenty-one of 149 cohort members (14%) died in those 4 years, half of them from cancer. And half of all study participants had new cardiovascular complications.
In developed countries people with long-term HIV infection are surviving into their 60s and 70s because of effective antiretroviral therapy and improving overall care. But much work remains in understanding the evolution of HIV infection and response to therapy in older people. People over 50 account for 24% of all HIV infections in France, as well as 18% of newly diagnosed individuals.
Clinicians at seven French hospitals created the COREVIN Ile de France Quest cohort to analyze trends in HIV care, progression, and response in people 60 years old and older. The 149 cohort members were all at least 60 in January 2004, when the cohort began enrollment. COREVIN investigators compared clinical findings at enrollment with findings in 2006 and 2008.
The initial 149-person cohort had a median age of 65.4 years (range 60.3 to 86.3) and included 115 men (77%). At enrollment, 54 people (36%) had AIDS, 4 (3%) had HBV infection, and 8 (5%) had HCV infection. Median time since HIV infection was 8.5 years (range 0.25 to 19.5), and 131 people (88%) were taking antiretrovirals for a median of 7.5 years (range 0.2 to 15.5). Initial median CD4 count stood at 372 (range 18 to 1860), and 104 people (70%) had a viral load below 200 copies.
At the 2008 follow-up point, the cohort had lost 38 members. Twenty-one (14%) had died, and 17 (11%) had been lost to follow-up. Median age of the 111 cohort members in 2008 was 71 years (range 64 to 90), and everyone was taking antiretroviral therapy. Of the 21 people who died, 11 (52%) died from cancer, 4 (19%) from acute cardiovascular disease, 3 (14%) from end-stage liver disease, 1 (5%) from neurologic disease, and the rest from unknown or unreported causes.
During follow-up, half of the cohort members had 106 new cardiovascular problems, 32% had hypercholesterolemia, 19% had bone diseases, and 15% had diabetes. Clinicians diagnosed 24 new cancers, including 6 digestive cancers (2 colon, 2 rectal, 2 anal) and 2 cases each of skin cancer, prostate cancer, bladder cancer, liver cancer, lung cancer, and leukemia. There were 36 liver disease diagnoses in 24% of the cohort, 30 neurologic disease diagnoses in 17%, and 14 liver disease diagnoses in 9%. No one suffered a new opportunistic infection during the 4 years of follow-up.
From 2004 to 2008, the proportion of people living at home without help from others declined modestly:
· 91% living at home without aid
· 9% living at home with aid
· 83% living at home without aid
· 14% living at home with aid
· 3% living in an institution
After 4 years of follow-up, 96% of the surviving cohort had a viral load below 200 copies. Between 2004 and 2008, 18 people (16% of 111) had a virologic failure. The proportion of people with a CD4 count under 200 fell from about 17% in 2004, to 8% in 2006, and to 7% in 2008. Proportions with a CD4 count above 500 rose from 33% in 2004, to 38% in 2006, and to 47% in 2008. Median CD4 count in 2008 stood at 494 (range 6 to 1054).
Of the 111 cohort members in 2008, 63 (57%) had switched antiretrovirals, 24 (22%) had intolerance to one or more antiretrovirals, and 21 (19%) simplified their regimen.
The investigators concluded that immunologic improvement can continue in 60- to 70-year-olds taking antiretrovirals. They urged colleagues to screen aging patients for cancers and to monitor them closely for metabolic, heart, and bone disease.
1. Flexor Zucman D, Berthe H, et al. Long-term evolution of a cohort of HIV-infected patients older than 60 years (COREVIH-IDF-Quest France). 12th European AIDS Conference. November 11-13, 2009. Cologne, Germany. Abstract BPD2/5.