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

Clotilde Allavena 1 Matthieu Hanf 1 David Rey 2 Claudine Duvivier 3 Firouze Banisadr 4 Isabelle Poizot-Martin 5 Christine Jacomet 6 Pascal Pugliese 7 Pierre Delobel 8 Christine Katlama 9 Veronique Joly 10 Christian Chidiac 11 Nathalie Dournon 12 Dominique Merrien 13 Thierry May 14 Jacques Reynes 15, 16 Amandine Gagneux-Brunon 17 Catherine Chirouze 18 Thomas Huleux 19 Andre Cabie 20 Francois Raffi 1
1 Hôpital Hôtel-Dieu de Nantes - CHU de Nantes - Hôpital Hôtel-Dieu de Nantes - Centre Hospitalier Universitaire de Nantes
2 CeGIDD [Strasbourg]
3 Centre d'infectiologie Necker-Pasteur [CHU Necker]
4 URCA - Université de Reims Champagne-Ardenne
5 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
6 Université de Clermont-Ferrand
7 Centre Hospitalier Universitaire de l’Archet,
8 Hôpital Universitaire de Toulouse
9 CHU Pitié-Salpêtrière [AP-HP]
10 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
11 UCBL - Université Claude Bernard Lyon 1
12 UA UFR SM - Université des Antilles - UFR des sciences médicales Hyacinthe Bastaraud
13 CHD Vendee (La Roche Sur Yon)
14 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
15 Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France
16 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses
17 Université de Saint-Etienne
18 Université de Besançon
19 Hôpital de Tourcoing
20 Université des Antilles (Pôle Martinique)
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.
Keywords : HIV infections HIV diagnosis and management Geriatric psychiatry Geriatrics Geriatric depression Elderly Antiretroviral therapy HIV
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Clotilde Allavena, Matthieu Hanf, David Rey, Claudine Duvivier, Firouze Banisadr, et al.. Antiretroviral exposure and comorbidities in an aging HIV-infected population: The challenge of geriatric patients. PLoS ONE, Public Library of Science, 2018, 13 (9), pp.e0203895. ⟨10.1371/journal.pone.0203895⟩. ⟨hal-02146850⟩

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