HIV and Ageing

This article from NAM Aidsmap focuses on the importance of early treatment to stem the damage to the immune systems of people living with HIV who are aged 50 or over. As the HIV population is becoming gradually older this could also have an impact on HIV support services in many areas of the UK. HIV Weekly, 19 June 2013.

New UK research shows why it’s important for older people living with HIV to start HIV treatment promptly.

Current UK HIV treatment guidelines recommend that people should start antiretroviral therapy when their CD4 cell count is around 350.

People over 50 are one of the groups encouraged to start treatment promptly. This is because older age is associated with declines in immune function. In addition, health problems associated with ageing are an increasingly important cause of illness and death in people living with HIV.

Researchers wanted to see the impact of late diagnosis and not starting HIV therapy on short-term outcomes, especially in older people.

The study population comprised 64,000 adults newly diagnosed with HIV in England, Wales and Northern Ireland between 2000 and 2009.

People were defined as older if they were aged 50 or over. Researchers examined mortality rates one year after diagnosis and also the factors associated with mortality.

Overall, 9% of people newly diagnosed with HIV were aged 50 or older.

Almost half of older people had a CD4 cell count below 200 when they entered care and were therefore considered to be diagnosed very late. A third of younger people were also diagnosed very late.

A CD4 cell count below 200 is associated with an increased risk of serious illness and death.

The twelve-month mortality rate among older people was 10%. This compared to a 3% mortality rate in people aged 49 or younger.

Mortality risk was especially high for older people diagnosed late who did not start HIV therapy (46 vs 15% for younger people).

Starting antiretroviral therapy was beneficial for people diagnosed late. The benefits were greatest for people aged 50 and older, with treatment associated with a 40% reduction in the absolute number of deaths, compared to a 12% absolute reduction in younger people.

The researchers conclude that their findings show the importance of prompt HIV diagnosis and early antiretroviral therapy, especially for older people.

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