{"id":11075,"date":"2003-05-01T14:50:57","date_gmt":"2003-05-01T14:50:57","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=11075"},"modified":"2014-05-28T13:05:42","modified_gmt":"2014-05-28T13:05:42","slug":"immune-reconstitution-in-older-hiv-positive-individuals","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/11075","title":{"rendered":"Immune reconstitution in older HIV-positive individuals"},"content":{"rendered":"

David Margolis, for NATAP.org<\/strong><\/p>\n

Kalayjian and colleagues from the ACTG presented clinically important findings from ACTG protocol 5015 at the Retrovirus Conference.<\/strong> [1] Older age has been known to be a predictor of accelerated HIV-disease progression, regardless of whether or not a patient is treated with HAART. However this could be due to various epidemiological factors in older individuals with HIV infection.<\/strong><\/p>\n

ACTG 5015 directly compared the virological and immunological responses to a single, standardised antiretroviral regimen in two age-defined cohorts treated at multiple clinics across the US. Antiretroviral therapy-naive subjects either older than 45 years or younger than 30 years with HIV-RNA >2000 copies\/ml and CD4 <600 cells\/mL were treated with lopinavir\/ritonavir, d4T and FTC. Forty-five older (median age 50; range 45-79 yrs) and 45 younger (median 26; 18-30 yrs) subjects with similar demographic characteristics were enrolled.<\/p>\n

At baseline viral loads were similar, while the older group had lower CD4 counts (155 vs 287; p=0.029), naive CD4 numbers (37 vs 105; p <0.001), and naive CD8 numbers (125 vs 185; p=0.030). After 48 weeks of therapy, HIV-RNA was suppressed to <50 copies\/ml with equal frequency in the two groups (73% of older subjects vs. 67% of younger). Although there were a few more episodes of grade three or four toxicity, the onset of lipodystrophy or diabetes, or death in the older group, there were too few observations to reach statistical significance.<\/p>\n

Changes in absolute CD4 counts, CD4%, CD8 counts and CD8% were not different in the two groups. However, the older group gained fewer naive CD4 cells (47 vs. 85; p=0.028) and the rise in naive CD8% was lower (9 vs. 13; p=0.019). The increase in naive CD8 cells was also lower, but did not achieve statistical significance. Data on thymic size also suggested that thymic mass increased to a lesser extent in older subjects.<\/p>\n

These findings may weigh in the mind of the clinician when a decision to withhold or begin therapy in an older HIV-positive\u00a0patient is being made. More toxicities and deaths were observed in the older cohort, although a larger or longer study would be needed to make this a significant finding. Although many of these events are likely drug-induced, the choice of withholding therapy in late stage disease is also unattractive. Therefore in HIV-positive\u00a0individuals >45 years old, both increased disease progression, poorer immune reconstitution, and possibly poorer tolerance for therapy in late disease could encourage the earlier initiation of HAART.<\/p>\n

Reference:<\/p>\n

    \n
  1. Kalayjian et al. Older age is associated with reduced na\u00efve T-cell responses to antiretroviral therapy: 48-week results of ACTG protocol 5015 (abstr. 346) at the Retrovirus Conference (Feb 10-14, 2003)
    \nhttp:\/\/www.retroconference.org\/2003\/Abstract\/Abstract.aspx?AbstractID=449<\/a><\/li>\n<\/ol>\n

    Source: NATAP.org<\/p>\n

    http:\/\/www.natap.org\/2003\/Retro\/day54.htm<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

    David Margolis, for NATAP.org Kalayjian and colleagues from the ACTG presented clinically important findings from ACTG protocol 5015 at the Retrovirus Conference. [1] Older age has been known to be a predictor of accelerated HIV-disease progression, regardless of whether or …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,41],"tags":[],"class_list":["post-11075","post","type-post","status-publish","format-standard","hentry","category-antiretrovirals","category-treatment-strategies"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/11075","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=11075"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/11075\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=11075"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=11075"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=11075"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}