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Poor immunological response and high mortality in HIV-infected patients older than 50 years receiving antiretroviral treatment in West Africa: the IeDEA WestAfrica collaboration
Presented by Didier Koumavi Ekouevi (Cote D'Ivoire).
A. Lokossoue1,2, S.-P. Eholie1, M. Maiga3, E. Messou4, D.M. Zannou5, A. Minga6, E. Bissagnene1, P.S. Sow7, F. Dabis2, D.K. Ekouevi2,8, IeDEA West Africa Collaboration
1Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Cote D'Ivoire, 2ISPED, HIV Africa team, Bordeaux, France, 3Service d'Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Bamako, Mali, 4ACONDA - CePReF, Abidjan, Cote D'Ivoire, 5Service de Médecine Interne, CHU Hubert Maga, Cotonou, Benin, 6Centre National de Transfusion Sanguine (CNTS), Abidjan, Cote D'Ivoire, 7SMIT, CHU de Fann, Dakar, Senegal, 8Programme PAC-CI, IeDEA-West Africa, Abidjan, Cote D'Ivoire
Background: Older patients may have a poorer immunological response to antiretroviral treatment (ART). We studied the 6-month immunological response and 12-month mortality according to age at ART initiation in the International epidemiological database to evaluate AIDS (IeDEA) in West Africa.
Methods: Collaboration of 12 prospective cohorts of HIV-infected adults from five countries: Benin, Côte d'Ivoire, Gambia, Mali, and. Senegal. Inclusion criteria were: age >=16 years, and starting ART. Baseline was the date of ART initiation. The outcomes were immunological failure (increase of CD4 count < 50 cells/µL six months after ART initiation) and death. The main variable of interest was age ≥50 years. Logistic regression and Cox model were adjusted for gender, baseline CD4 count, clinical stage hemoglobin level, body mass index and year of ART initiation.
Results: Between 1997 and 2008, 16,854 HIV-infected adult patients were enrolled in the participating sites. The median age at ART initiation was 37 years (IQR: 31-44), the median CD4 count 133 cells/µL (IQR: 50-227) and 62% were female. Overall, 1,861 patients were ≥50 years (11%); this proportion remained stable over time. Old patients were less female (42%) and had a comparable median CD4 count at ART initiation than the younger ones. Six months after ART initiation 2,042 of the 7,833 patients with a CD4 count available had immunological failure (26.1%). In multivariable analysis, age was not associated with immunological failure (p=0.09): adjusted odds ratio (aOR) =1.25 (1.02-1.53) for [45-50 years[, and 1.18 (0.96-1.45) for ≥50 years (reference group age < 30 years). At 12-month, 691 of patients were reported to have died (3.9%); 2121 (13.9%) were lost-to-follow-up. An association between age ≥50 years and death (Hazard Ratio =1.32, (1.01-1.73) was observed.
Conclusion: The management of patients ≥50 years needs special attention in Africa. The documentation of co-morbidities is necessary to understand the prognosis differences by age group.
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