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CD4s Rise More Slowly in HIV Patients 50 or Older
Starting Antiretrovirals (ICAAC June 2017)
  ASM 2017/ICAAC, June 1-5, 2017, New Orleans
Mark Mascolini
Significantly fewer people 50 or older gained 50 to 150 CD4 cells in the first 14 months of antiretroviral therapy (ART), according to a 158-person analysis at the State University of New York (SUNY) Downstate Medical Center in Brooklyn [1]. Similar proportions of older and younger people reached an undetectable viral load within 24 weeks of starting ART.
In a single-center retrospective study, SUNY Downstate researchers aimed to determine immunologic and virologic responses in antiretroviral-naive adults starting their first regimen between January 2005 and April 2015. They excluded people who did not have baseline and follow-up CD4 and viral load measures within 12 months of starting ART, and they excluded people who stopped or changed their regimen within 12 months of starting.
The SUNY Downstate team defined immunologic response as a CD4-cell gain of 50 to 150 during the first 14 months of ART; they defined virologic response as an undetectable viral load within 24 weeks of starting ART. The researchers compared responses in people 50 years old or older versus younger cohort members.
The study included 158 people, 78 in the older group and 80 in the younger group. After 14 months of ART, 67 of 78 in the 50-or-older group and 74 of 80 in the younger group attained an immunologic response, a significant difference (85.9% versus 92.5%, P = 0.0207). Proportions who had a virologic response within 24 weeks did not differ significantly between the older group (50 of 78, 64.1%) and the younger group (52 of 80, 65%).
Among people 50 or older, pretreatment CD4 count was not significantly associated with immunologic response: 29 of 34 under 200 CD4s before ART and 38 of 44 over 200 CD4s had an immunologic response (85.3% and 86.4%). Nor did pretreatment CD4 count predict virologic response: 22 of 34 under 200 CD4s before ART and 28 of 44 over 200 CD4s had a virologic response (64.7% and 63.6%). Immunologic and virologic responses did not differ significantly by type of antiretroviral regimen in people 50 or older. Finally, the older group did not take significantly longer than the younger group to reach an undetectable viral load (P = 0.459).
The study did not assess clinical outcomes, so the potential impact of a slower CD4 response in people 50 or older remains unknown in this cohort. Some research in large groups links lower CD4 counts to higher rates of non-AIDS cancers [2,3] and to greater non-AIDS mortality [4].
1. Ocheretyaner ER, Yusuff J, Park TE. Immunologic and virologic responses to antiretroviral therapy in treatment-naive, HIV-infected elderly patients. ASM 2017/ICAAC, June 1-5, 2017, New Orleans. Session 419.
2. Shiels MS, Althoff KN, Pfeiffer RM, et al. HIV infection, immunosuppression, and age at diagnosis of non-AIDS-defining cancers. Clin Infect Dis. 2017;64:468-475.
3. Hema MN, Ferry T, Dupon M, et al. Low CD4/CD8 ratio is associated with non AIDS-defining cancers in patients on antiretroviral therapy: ANRS CO8 (Aproco/Copilote) prospective cohort study. PLoS One. 2016;11:e0161594.
4. Palella FJ Jr, Armon C, Chmiel JS, et al. CD4 cell count at initiation of ART, long-term likelihood of achieving CD4 >/=750 cells/mm3 and mortality risk. J Antimicrob Chemother. 2016;71:2654-2662.

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