icon-folder.gif   Conference Reports for NATAP  
  First International Workshop
on HIV and Aging
October 4-5, 2010
Baltimore, MD
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CD4 Counts Lower on Entry Into Care Among People 50 and Older: NA-ACCORD
  A 44,000-person analysis of the North-American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) found that people 50 years old or older began care for HIV infection at lower CD4 counts than younger people from 1997 through 2007 [1]. However, CD4 count on entering care rose steadily over those years in both the 50-and-over group and younger cohort members.
NA-ACCORD combines data from 13 US and Canadian HIV cohorts. Keri Althoff and NA-ACCORD colleagues reported earlier that median age at presentation for HIV care in the cohort climbed from 40 in 1997 to 43 in 2007, a significant increase (P < 0.01) [2]. The new analysis involved 44,491 HIV-positive people entering care over those years. The proportion of cohort members 50 and older rose from 17% in 1997 to 27% in 2007 (P < 0.01). The corresponding drop in the proportion of the cohort members under 50, from 83% to 73%, was also statistically significant (P < 0.01).
Median CD4 count at entry into care lay consistently lower in the 50-and-over group, climbing from 203 in 1997 to 226 in 2007. In 2007, the median CD4 count in the older group was still lower than the median 269 CD4 count in the younger group in 1997. By 2007, the median count in the younger group had jumped to 336.
However, NA-ACCORD cohort members 50 and older appeared to be closing the gap with younger people in CD4 count at entry into care. In an analysis adjusted for age, race, HIV transmission group, and cohort, estimated average annual increase in CD4 count at presentation rose by 7 cells (95% confidence interval 5 to 9) in the 50-and-over group and by 5 cells (95% confidence interval 4 to 6) in people under 50.
The proportion of people with an AIDS-defining condition when they entered care or in the next 3 months remained higher in the 50-and-over group throughout the study period, although proportions with AIDS dropped in both age groups. Among older people, the proportion with AIDS at entry into care or during the next 3 months fell from 18% to 9% from 1997 through 2007 (P < 0.01). In the younger group that proportion dropped from 11% to 8% over the study period (P < 0.01).
Althoff and coworkers noted that their analysis was limited by lack of data on time since HIV seroconversion. The NA-ACCORD team proposed that "renewed HIV testing efforts are needed at all ages, including older adults." The researchers observed that delayed entry into care raises the risk of comorbid conditions that complicate HIV care and the risk of onward transmission of HIV.
1. Althoff K, Gebo KA, Gange SJ, et al. CD4 count at presentation for HIV care in the United States and Canada: Are those over 50 years more likely to have a delayed presentation? First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_17.
2. Althoff KN, Gange SJ, Klein MB, et al. Late presentation for human immunodeficiency virus care in the United States and Canada. Clin Infect Dis. 2010;50:1512-1520.