Publication:
The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV

1

Issued Date

2019-02-01

Resource Type

Article

ISSN

17582652

DOI

10.1002/jia2.25228

Other identifier(s)

2-s2.0-85062190409

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of the International AIDS Society. Vol.22, No.2 (2019)

Suggested Citation

Mi Young Ahn, Awachana Jiamsakul, Suwimon Khusuwan, Vohith Khol, Thuy T. Pham, Romanee Chaiwarith, Anchalee Avihingsanon, Nagalingeswaran Kumarasamy, Wing Wei Wong, Sasisopin Kiertiburanakul, Sanjay Pujari, Kinh V. Nguyen, Man Po Lee, Adeeba Kamarulzaman, Fujie Zhang, Rossana Ditangco, Tuti P. Merati, Evy Yunihastuti, Oon Tek Ng, Benedict L.H. Sim, Junko Tanuma, Winai Ratanasuwan, Jeremy Ross, Jun Yong Choi The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV. Journal of the International AIDS Society. Vol.22, No.2 (2019). doi:10.1002/jia2.25228 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/51941

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Title

The influence of age-associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV

Author(s)

Mi Young Ahn
 Awachana Jiamsakul
 Suwimon Khusuwan
 Vohith Khol
 Thuy T. Pham
 Romanee Chaiwarith
 Anchalee Avihingsanon
 Nagalingeswaran Kumarasamy
 Wing Wei Wong
 Sasisopin Kiertiburanakul
 Sanjay Pujari
 Kinh V. Nguyen
 Man Po Lee
 Adeeba Kamarulzaman
 Fujie Zhang
 Rossana Ditangco
 Tuti P. Merati
 Evy Yunihastuti
 Oon Tek Ng
 Benedict L.H. Sim
 Junko Tanuma
 Winai Ratanasuwan
 Jeremy Ross
 Jun Yong Choi

Other Contributor(s)

Hospital Sungai Buloh
 Beijing Ditan Hospital Capital Medical University
 VHS Medical Centre India
 Gokila
 Bach Mai Hospital
 Universitas Udayana
 University of Indonesia, RSUPN Dr. Cipto Mangunkusumo
 Kirby Institute
 National Center for Global Health and Medicine
 The HIV Netherlands Australia Thailand Research Collaboration
 Yonsei University College of Medicine
 Faculty of Medicine, Ramathibodi Hospital, Mahidol University
 Queen Elizabeth Hospital Hong Kong
 University of Malaya Medical Centre
 Veterans General Hospital-Taipei
 Faculty of Medicine, Siriraj Hospital, Mahidol University
 Tan Tock Seng Hospital
 Seoul Medical Center
 National Hospital for Tropical Diseases
 National Center for HIV/AIDS
 amfAR - The Foundation for AIDS Research
 Research Institute for Health Sciences
 Institute of Infectious Diseases
 Chiangrai Prachanukroh Hospital

Abstract

© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Introduction: Multiple comorbidities among HIV-positive individuals may increase the potential for polypharmacy causing drug-to-drug interactions and older individuals with comorbidities, particularly those with cognitive impairment, may have difficulty in adhering to complex medications. However, the effects of age-associated comorbidities on the treatment outcomes of combination antiretroviral therapy (cART) are not well known. In this study, we investigated the effects of age-associated comorbidities on therapeutic outcomes of cART in HIV-positive adults in Asian countries. Methods: Patients enrolled in the TREAT Asia HIV Observational Database cohort and on cART for more than six months were analysed. Comorbidities included hypertension, diabetes, dyslipidaemia and impaired renal function. Treatment outcomes of patients ≥50 years of age with comorbidities were compared with those <50 years and those ≥50 years without comorbidities. We analysed 5411 patients with virological failure and 5621 with immunologic failure. Our failure outcomes were defined to be in-line with the World Health Organization 2016 guidelines. Cox regression analysis was used to analyse time to first virological and immunological failure. Results: The incidence of virologic failure was 7.72/100 person-years. Virological failure was less likely in patients with better adherence and higher CD4 count at cART initiation. Those acquiring HIV through intravenous drug use were more likely to have virological failure compared to those infected through heterosexual contact. On univariate analysis, patients aged <50 years without comorbidities were more likely to experience virological failure than those aged ≥50 years with comorbidities (hazard ratio 1.75, 95% confidence interval (CI) 1.31 to 2.33, p < 0.001). However, the multivariate model showed that age-related comorbidities were not significant factors for virological failure (hazard ratio 1.31, 95% CI 0.98 to 1.74, p = 0.07). There were 391 immunological failures, with an incidence of 2.75/100 person-years. On multivariate analysis, those aged <50 years without comorbidities (p = 0.025) and age <50 years with comorbidities (p = 0.001) were less likely to develop immunological failure compared to those aged ≥50 years with comorbidities. Conclusions: In our Asia regional cohort, age-associated comorbidities did not affect virologic outcomes of cART. Among those with comorbidities, patients <50 years old showed a better CD4 response.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/51941

Collections

Scopus 2019