Geriatric human immune deficiency virus (HIV) Infection in Nigeria: A caseseries report (original) (raw)
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Journal of HIV and AIDS, 2019
Background: Although the National HIV Infection Control Program has adopted the "Test and Treat" option, virological, immunological and clinical parameters are still important for the decision of the appropriate treatment and proper care. Objective: The objective of this work was to evaluate the immunological and virological profile of HIV-infected patients over 50 years of age starting antiretroviral treatment in Kinshasa. Methods: Twenty-seven subjects over the age of 50 years diagnosed with HIV Type 1 by serology in 3 treatment centers in Kinshasa during the period from 08 November 2013 to 14 February 2014 participated voluntarily in this work. After signing informed consent, blood samples were collected in 5 ml tubes with EDTA. The CD4 count and Viral Load (VL) were performed in each patient at the inclusion (D0) in the Laboratory of Molecular Biology of the Faculty of Medicine of the University of Kinshasa. The clinical and paraclinical parameters were recorded on the patient files previously designed for the work. Results: Of the 27 patients, 14 (51.85%) were women. The median age of the population was 58 years in the range of 50 to 70 years. Four patients (14.8%) were in clinical stage 2 while 20 (74.1%) in stage 3 and 3 (11.1%) in stage 4 according to the classification recommendations of the World Health Organization. The median CD4 count is 227.78 cells/ml; the minimum and maximum values were 90 and 350 cells/ml respectively. The median value of the VL of the patients included was 5.49 log 10 copies of RNA/ml; the minimum and maximum values were respectively 4.25 and 7.15 log 10 copies of RNA/ml. Conclusion: The immunological and virological profile of HIV positive patients aged over 50 year in Kinshasa is not significantly different from the profiles of the general heterogeneous populations.
Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria
Open Forum Infectious Diseases, 2017
Background Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and old...
Clinical Infectious Diseases, 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 у50 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.
Journal of the International Association of Providers of AIDS Care, 2017
In sub-Saharan Africa, few studies exist on elderly HIV-positive populations. Therefore, we aimed to examine the profiles of elderly people living with HIV (PLHIV) in Burkina Faso and their response to antiretroviral therapy (ART). We reviewed the monitoring and treatment of PLHIV over the age of 50 years and then compared with the monitoring and treatment of PLHIV under 50 years. A total of 3367 patients were included. The median age of elderly people was 54.5 years and of young people was 34.9 years ( P = .03). In both the groups, screening was performed following clinical suspicion (64.9% in elderly versus 56% in young people; P < .001). Cardiovascular risk factors were generally more significant in the elderly people. The risk of death while on ART was 2.3 times higher in elderly people ( P < .001). HIV infection in older people occurs in those who already have some cardiovascular risk factors. Particular attention should be given to multidisciplinary care for the elderly ...
HIV infection in older patients in the HAART era
Journal of Antimicrobial Chemotherapy, 2005
An increasing number of patients over 50 years of age are now living with HIV, owing to highly active antiretroviral therapy (HAART) that prolongs survival on the one hand and to late diagnosis of patients living with occult HIV infection on the other hand. Most studies have shown that compared with younger patients, patients over 50 generally have a slower immunological response to HAART and experience more rapid clinical progression, despite a better virological response. Low thymic output probably plays a role in the poorer CD4 cell response in patients initiating HAART over 50 years. Management of HIV infection in older patients is particularly complex, mainly because they are more likely to have co-morbidities necessitating specific medications that may interact with antiretroviral drugs. More controlled studies of HAART efficacy and tolerability in such patients are needed to establish specific management guidelines. Information campaigns targeting older patients and their doctors are also needed to ensure timely diagnosis of HIV infection and antiretroviral treatment initiation.
Background. Limited information exists on adults ≥50 years receiving HIV care in sub-Saharan Africa despite their increasing number. We aimed at studying immunologic and clinical responses to ART in this population. Methods. Data of patients who initiated HAART between 30th of June 2004 and 1st of May 2008 at Sekou Toure Care and Treatment Clinic were retrospectively analyzed. Date of ART initiation was used as a baseline and 48 months as a follow-up date. Immune recovery was defined as a CD4 count of ≥350 cells/mm 3 at 48 months and late presentation as presentation with WHO stage 3 or 4 at clinic enrollment. Proportions of patients reaching this endpoint were compared between the two groups. Results. A total of 728 patients were included in our study; of these 73 (10.0%) were aged 50 years and above. Late presentation was more common in elderly patients than young patients (65.7% versus 56.1%, í µí± = 0.12). Proportion of patients with CD4 count ≥350 (immune recovery) was higher in younger patients than in elderly patients, although this was not statistically significant (54.5% versus 44.9%, í µí± = 0.2). Median absolute increase in CD4 at 48 months was higher in younger patients than in elderly patients (+241.5 cells/mm 3 versus +146 cells/mm 3 , í µí± = 0.007). Conclusion. Elderly HIV patients have higher rates of late presentation, with lower immune recovery. Strategies to increase HIV testing in this group are required for early diagnosis and treatment to improve outcomes.
Current infectious disease reports, 2009
The prevalence of HIV in patients over the age of 50 years is increasing. Although older patients may achieve equal or better virologic suppression at equal rates compared with younger patients, the immunologic benefit of highly active antiretroviral therapy (HAART) in older patients may be reduced compared with younger patients. Comorbidities are more common in older patients than younger patients and can impact management of HIV in these patients. Providers must be cognizant of drug-drug interactions and side effects of HAART regimens when selecting an antiretroviral regimen in older HIV patients. As the HIV-infected population ages, there is a growing need to better determine the ideal HAART regimen and timing of HAART initiation in older patients.
AIDS Research and Treatment, 2012
records and causes of deaths of hospitalised medical HIV-infected patients were retrieved and analysed according to antiretroviral (ART) status. Results. Of the 207 HIV/AIDS patients reviewed, majority were newly diagnosed (73.4%), and most were hospitalised and died from various AIDS-defining illnesses, mainly disseminated tuberculosis and sepsis. Immune-inflammatoryreconstitution-syndrome, ART-toxicity and ART-failure, contributed to morbidity and mortality in patients receiving ART. Sixty six (31.9%) patients died, with higher mortality in males and in those with lower CD4-cell count, lower PCV, and shorter hospital stay. However, hospital stay ≤3 days and severe anaemia (PCV < 24%) were independent predictors of mortality. Conclusion. In the current HAART era, late presentation and tuberculosis continue to fuel the HIV/AIDS pandemic in Africa, with emerging challenges due to ART-related complications.