Affiliations 

  • 1 Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  • 2 The Kirby Institute, UNSW, Sydney, NSW, Australia
  • 3 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 4 National Center for HIV/AIDS, Dermatology & STDs, Phnom Penh, Cambodia
  • 5 Bach Mai Hospital, Hanoi, Vietnam
  • 6 Research Institute for Health Sciences, Chiang Mai, Thailand
  • 7 HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 8 Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India
  • 9 Taipei Veterans General Hospital, Taipei, Taiwan
  • 10 Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 11 Institute of Infectious Diseases, Pune, India
  • 12 National Hospital for Tropical Diseases, Hanoi, Vietnam
  • 13 Queen Elizabeth Hospital, Hong Kong SAR, China
  • 14 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 15 Beijing Ditan Hospital, Capital Medical University, Beijing, China
  • 16 Research Institute for Tropical Medicine, Muntinlupa City, Philippines
  • 17 Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
  • 18 Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 19 Tan Tock Seng Hospital, Singapore City, Singapore
  • 20 Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • 21 National Center for Global Health and Medicine, Tokyo, Japan
  • 22 Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 23 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
J Int AIDS Soc, 2019 Feb;22(2):e25228.
PMID: 30803162 DOI: 10.1002/jia2.25228

Abstract

INTRODUCTION: Multiple comorbidities among HIV-positive individuals may increase the potential for polypharmacy causing drug-to-drug interactions and older individuals with comorbidities, particularly those with cognitive impairment, may have difficulty in adhering to complex medications. However, the effects of age-associated comorbidities on the treatment outcomes of combination antiretroviral therapy (cART) are not well known. In this study, we investigated the effects of age-associated comorbidities on therapeutic outcomes of cART in HIV-positive adults in Asian countries.

METHODS: Patients enrolled in the TREAT Asia HIV Observational Database cohort and on cART for more than six months were analysed. Comorbidities included hypertension, diabetes, dyslipidaemia and impaired renal function. Treatment outcomes of patients ≥50 years of age with comorbidities were compared with those <50 years and those ≥50 years without comorbidities. We analysed 5411 patients with virological failure and 5621 with immunologic failure. Our failure outcomes were defined to be in-line with the World Health Organization 2016 guidelines. Cox regression analysis was used to analyse time to first virological and immunological failure.

RESULTS: The incidence of virologic failure was 7.72/100 person-years. Virological failure was less likely in patients with better adherence and higher CD4 count at cART initiation. Those acquiring HIV through intravenous drug use were more likely to have virological failure compared to those infected through heterosexual contact. On univariate analysis, patients aged <50 years without comorbidities were more likely to experience virological failure than those aged ≥50 years with comorbidities (hazard ratio 1.75, 95% confidence interval (CI) 1.31 to 2.33, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.