icon-folder.gif   Conference Reports for NATAP  
  12th Conference on Retroviruses and Opportunistic Infections (CROI)
Feb 22-25, 2005
Boston, MA
Back greyarrowrt.gif
Effect of Aging on Epidemiologic and Clinical Features in HIV-infected Individuals with Neurological Disorders
  12th CROI abstract 960
Authors and Affiliations: D Larussa1, P Lorenzini1, A Cingolani2, S Bossolasco3, G Liuzzi1, L Quaranta1, M Bongiovanni4, S Brighi5, A Vetica6, M Figoni7, A Vivarelli8, A Ammassari2, A d'Arminio Monforte4, P Cinque3, Andrea Antinori*1, and Italian Registry Investigative Neuro AIDS (IRINA) Study Group 1L Spallanzani, IRCCS, Rome, Italy; 2Univ Cattolica S Cuore, Rome, Italy; 3Hosp San Raffaele, Milan, Italy; 4Hosp Luigi Sacco, Milan, Italy; 5Presidio Ospedaliero M Bufalini, Cesena, Italy; 6Hosp S Maria Goretti, Latina, Italy; 7Hosp DA Cotugno, Napoli, Italy; and 8ASL 3, Pistoia, Italy
Background: In the last years there has been an increase in the prevalence of HIV infection among older adults due to epidemiological changes and HAART-related prolonged survival.
Methods: A longitudinal, multicentric study collecting data of neurological cases from 45 Italian Infectious Diseases Centers. The study population was divided into 2 groups (<50 years and ≥ 50 years) according to age at neurological diagnosis. For statistics, c2 comparisons for categorical variables, Mann-Withney for continuous variables, and Cox regression for survival were employed.
Results: From 2000 to 2004, 1147 patients affected by neurological diseases, were enrolled. Of those, 141 patients (12.3%) were aged ≥ 50 years, 1006 (87.7%) were < 50 years old. The most frequent diagnosis in the younger and in the older groups, respectively, was cerebral toxoplasmosis (310 [30.8%] vs 30 [21.3%], p = 0.023] and HIV encephalopathy (51 [36.2%] vs 205 [20.4%] p < 0.001). Male gender (87.2% vs 71.5%, p < 0.001) and sexual HIV transmission (67.4% vs 38.0%, p < 0.001) were more frequent among older patients. A previous AIDS-defining event had occurred in 24% of older patients compared with 33% of the younger group (p = 0.027), and the interval between first HIV+ test and neurological diagnosis was shorter in older patients (38 55 vs 82 76 months). A previous antiretroviral treatment was present in 42% of older patients compared with 51.9% of younger (p = 0.036). Older patients had higher CD4 cell count (159 (+183) cells/L, vs 121 (+158), p = 0.008) at neurological diagnosis, while no significant differences in plasma and CSF HIV-1 RNA were found between the 2 groups. Analysing clinical characteristics, in older patients cognitive symptoms and cerebral atrophy at neuroimaging were observed more frequently (75.2% vs 55.7%, p < 0.001; 57.4% vs 30.7%, p < 0.001, respectively). Probability of improvement/resolution at 6 months was similar in both groups. During a follow-up of 848 person-years, 268 patients died, 219 (27.5%) of which was due to neurological diseases. In a multivariable Cox model risk of death was independently associated with neurological diagnosis, CD4 cell count and injection drug use as an HIV risk factor, while there was no association between age and survival.
Conclusions: Older HIV-infected neurologic patients were more often nave, with a shorter interval of disease, and with a higher probability of developing HIV encephalopathy. In our cohort, aging did not affect clinical response and survival of patients with neurological disorders.