CD4 cell reconstitution is significantly slower in older patients

An analysis of 2,614 antiretroviral naïve people under 50 years of age, and 401 over that age, who started on HAART in France between 1997 and 2001, reveals that patients over 50 exhibit an immune response after HAART, but that their CD4 cell reconstitution was significantly slower than in younger patients. The researchers conclude that this may explain why older patients have a higher risk of clinical progression.

Using information from the French Hospital Database on HIV, patients were divided into two groups: over and under 50. Among patients with baseline HIV viral load below 100,000 copies/ml, in the first six months the CD4 count increase was +17.3 cells/month in the younger group, versus +14.1 cells/month in the older group and thereafter was +11.1 cells/month in the younger group, versus +9.8 cells/month in the older group. Among patients with baseline viral load over 100,000 copies/ml, it was respectively, +42.9 versus +36.9 cells/month in the first six months versus +17.9 cells/month +15.6 cells/month thereafter. All these differences were highly statistically significant (all = p<0.0001).

Within a median period of time of 31.5 months, 263 patients had a new AIDS-defining disease and 44 patients died. After adjustments for baseline characteristics, the hazard ratio of clinical progression was significantly higher in the older group as compared with the younger group: HR=1.52, IC95=1.1–2.00.

Grabar S, Kousignian I, Sobel A et al. Immunological and clinical responses to HAART over 50 years of age, results from the French Hospital Database on HIV. 2nd IAS Conference on HIV Pathogenesis and Treatment, 13-16 July 2003, Paris.Abstract 85.