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PLoS One. 2018 Sep 21;13(9):e0203895. doi: 10.1371/journal.pone.0203895. eCollection 2018.

Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients.

Allavena C1,2, Hanf M2,3, Rey D4, Duvivier C5,6,7, BaniSadr F8,9, Poizot-Martin I10,11, Jacomet C12, Pugliese P13, Delobel P14,15, Katlama C16,17, Joly V18,19, Chidiac C20, Dournon N21,22, Merrien D23, May T24, Reynes J25,26, Gagneux-Brunon A27, Chirouze C28,29, Huleux T30, Cabié A22,31,32, Raffi F1,2; Dat’AIDS study group.

Author information

1
Infectious Diseases Department, University Hospital of Nantes, Nantes, France.
2
INSERM CIC1413, University Hospital of Nantes, Nantes, France.
3
INSERM UMR 1181 B2PHI, Versailles Saint Quentin University, institut Pasteur, Villejuif, France.
4
Centre for HIV Infection Care, Strasbourg, France.
5
AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Centre, Paris, France.
6
Medical Centre of Pasteur Institut, Necker-Pasteur Infectiology Centre, Paris, France.
7
EA7327, Paris Descartes University, Sorbonne Paris Cité, Paris, France.
8
Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims Teaching Hospitals, University of Reims, Reims, France.
9
Université de Reims Champagne-Ardenne, Faculté de médecine, EA-4684 / SFR CAP-SANTE, Reims, France.
10
Immuno-Hematology Clinic, Aix-Marseille University, APHM Hôpital Sainte-Marguerite, Marseille, France.
11
Inserm U912 (SESSTIM), Marseille, France.
12
Infectious Diseases Department, University of Clermont-Ferrand, Clermont-Ferrand, France.
13
Department of Infectious Diseases, Centre Hospitalier Universitaire de l'Archet, Nice, France.
14
INSERM, UMR1043, Toulouse and Université Toulouse III Paul Sabatier, Toulouse, France.
15
Department of Infectious Diseases, Toulouse University Hospital, Toulouse, France.
16
Department of Infectious Diseases, Assistance publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris, France.
17
Inserm Unité Mixte de Recherche en Santé 1136, Université Pierre et Marie Curie Paris 06, Sorbonne Universités, Paris, France.
18
Infectious Diseases Department, Hôpital Bichat, AP-HP, Paris, France.
19
National Institute of Health and Medical Research (INSERM) IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France.
20
Infectious and Tropical Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France.
21
Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Faculté de Médecine Hyacinthe Bastaraud, Université des Antilles, Pointe à Pitre, France.
22
Inserm CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France.
23
Departement of infectious diseases, CHD Vendee, La Roche sur yon, France.
24
Department of infectious diseases, University Hospital Centre, Nancy, France.
25
Infectious Diseases Department, Montpellier University Hospital, Montpellier, France.
26
UMI233 INSERM U1175, Montpellier University Hospital, Montpellier, France.
27
Infectious Diseases Department, University of Saint-Etienne, Saint-Etienne, France.
28
Infectious Diseases Department, University hospital of Besançon, Besançon, France.
29
UMR CNRS 6249, University of Bourgogne-Franche Comté, Besançon, France.
30
Infectious Diseases Department, University hospital of Tourcoing, Tourcoing, France.
31
Infectious Diseases Department, University Hospital of Martinique, Fort-de-France, France.
32
EA4537, Université des Antilles, Fort-de-France, France.

Abstract

As HIV-infected adults on successful antiretroviral therapy (ART) are expected to have close to normal lifespans, they will increasingly develop age-related comorbidities. The objective of this cross-sectional study was to compare in the French Dat'AIDS cohort, the HIV geriatric population, aged 75 years and over, to the elderly one, aged from 50 to 74 years. As of Dec 2015, 16,436 subjects (43.8% of the French Dat'AIDS cohort) were aged from 50 to 74 (elderly group) and 572 subjects (1.5%) were aged 75 and over (geriatric group). Durations of HIV infection and of ART were slightly but significantly different, median at 19 and 18 years, and 15 and 16 years in the elderly and geriatric group, respectively. The geriatric group was more frequently at CDC stage C and had a lower nadir CD4. This group had been more exposed to first generation protease inhibitors and thymidine analogues. Despite similar virologic suppression, type of ART at the last visit significantly differed between the 2 groups: triple ART in 74% versus 68.2%, ART ≥ 4 drugs in 4.7% versus 2.7%; dual therapy in 11.6% versus 16.4% in the elderly group and the geriatric group, respectively. In the geriatric group all co-morbidities were significantly more frequent, except dyslipidemia, 4.3% of the elderly group had ≥4 co-morbidities versus18.4% in the geriatric group. Despite more co-morbidities and more advanced HIV infection the geriatric population achieve similar high rate of virologic suppression than the elderly population. A multidisciplinary approach should be developed to face the incoming challenge of aging HIV population.

PMID:
30240419
PMCID:
PMC6150468
DOI:
10.1371/journal.pone.0203895
Free PMC Article

Conflict of interest statement

CA received travel grants and honoraria from Gilead, ViiV Healthcare, MSD, Janssen. DR is member of editorial board (past) for Gilead and received meeting expenses from BMS, Gilead, MSD, ViiV, Janssen. CD has received travel grants, honoraria or study grants from Abbvie, Bristol-Myers-Squibb, Gilead Sciences, Janssen, Merck and ViiV Healthcare. JR reports grants and personal fees from Gilead, Janssen, MSD, ViiV Healthcare. TM received travel grants or honoraria from VIIV, BMS, MSD, Janssen. FR received research funding or honoraria or consulted for Abbvie, BMS, Gilead, Janssen, and MSD, MH, FBS, AGB, CJ, IPM, PP, AC, PD, CK, VJ, ChC, BH, DM, TM, AGB, CCh, TH have no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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