de Górgolas M, Bello E, García Vázquez E, Moya M J, García Delgado R, Fernández Guerrero M L
División de Enfermedades Infecciosas, Fundación Jiménez Díaz, Universidad Autónoma, Madrid.
An Med Interna. 1999 Jun;16(6):273-6.
HIV infection is common in young persons and its clinical picture, outcome and response to antiretroviral therapy is well known, but it is not the case in the elderly.
To evaluate the clinical characteristics and response to antiretroviral therapy of HIV elderly patients.
Retrospective study of 37 patients elder than 60 years. The control group comprised of 64 HIV positive patients with less than 60 years. None of them were drug abusers.
The mean age of patients was 65 years (range 60-79), 86% were males. The most frequent causes for HIV testing were: wasting (22%), P. carinii pneumonia (19%), tuberculosis (13%) and Kaposi sarcoma (10%), but in the control group voluntary testing was the most common reason (64%). The mean CD4 count at diagnosis was lower in the elderly group (233 cells/microL vs 323 cells/microL). During follow up, the most frequent complications for those with less than 200 CD4 cells were: oral candidiasis (44%), P. carinii pneumonia (27%), Kaposi sarcoma (22%) and esophageal candidiasis (22%), while in the young group P. carinii pneumonia (22%), Kaposi sarcoma (9%) and esophageal candidiasis (9%) were less frequent. 67% of the elderly received antiretroviral therapy. Zidovudine had to be discontinued due to anaemia in half of them. Survival at 6 and 12 months was significantly longer in treated patients compared to those who did not received antiretrovirals (100% vs 14% at 6 months, P < 0.001; and 54% vs 0% at 12 months, p = 0.03); and at 2 years it was almost similar to that of the young group (36% vs 52%, p = 0.38).
HIV infection in the elderly is generally diagnosed in an advance stage, but antiretroviral therapy prolongs survival. Zidovudine should be reserve as a second line drug because its frequent haematological toxicity.
HIV感染在年轻人中很常见，其临床表现、预后及对抗逆转录病毒治疗的反应已为人熟知，但在老年人中情况并非如此。
评估老年HIV患者的临床特征及对抗逆转录病毒治疗的反应。
对37名60岁以上患者进行回顾性研究。对照组由64名年龄小于60岁的HIV阳性患者组成。他们均非药物滥用者。
患者的平均年龄为65岁（范围60 - 79岁），86%为男性。进行HIV检测的最常见原因是：消瘦（22%）、卡氏肺孢子虫肺炎（19%）、结核病（13%）和卡波西肉瘤（10%），但在对照组中自愿检测是最常见原因（64%）。老年组诊断时的平均CD4细胞计数较低（233个/微升 vs 323个/微升）。在随访期间，CD4细胞少于200个的患者最常见的并发症是：口腔念珠菌病（44%）、卡氏肺孢子虫肺炎（27%）、卡波西肉瘤（22%）和食管念珠菌病（22%），而在年轻组中卡氏肺孢子虫肺炎（22%）、卡波西肉瘤（9%）和食管念珠菌病（9%）的发生率较低。67%的老年人接受了抗逆转录病毒治疗。其中一半患者因贫血不得不停用齐多夫定。与未接受抗逆转录病毒治疗的患者相比，接受治疗的患者在6个月和12个月时的生存率显著更长（6个月时为100% vs 14%，P < 0.001；12个月时为54% vs 0%，p = 0.03）；在2年时与年轻组几乎相似（36% vs 52%，p = 0.38）。
老年HIV感染通常在晚期被诊断出来，但抗逆转录病毒治疗可延长生存期。齐多夫定应留作二线药物，因为其常有血液学毒性。
