Médecins Sans Frontières, London, UK.
AIDS. 2012 Jul 31;26 Suppl 1:S31-7. doi: 10.1097/QAD.0b013e3283558446.
Recent studies have highlighted the increased risk of adverse outcomes among older patients on antiretroviral therapy (ART). We report on the associations between older age and adverse outcomes in HIV/AIDS antiretroviral programmes across 17 programmes in sub-Saharan Africa.
We included data from nine countries: Central African Republic, Côte d'Ivoire, Democratic Republic of Congo, Ethiopia, Nigeria, Republic of Congo, Uganda, Zambia and Zimbabwe. We describe survival probability for progression to death and loss to follow-up for patients initiating ART aged less than 50 years and at least 50 years. Multivariate Cox proportional hazards models were used to assess the association between age (15-39, 40-49, 50-59, 60-69 and 70-94 years) and adverse outcomes adjusting for confounders identified a priori.
Our analysis included 17,561 patients followed for a median of 12 months. The majority (65%) were female and 6672 (38%) were severely immunosuppressed at baseline. Median age at ART initiation was 36.0 years (interquartile range 30.1-42.8); 11.4% of patients were aged at least 50 years. Median gain in CD4 cell count at 6 and 12 months was significantly higher in patients less than 50 years old compared with those at least 50 years (134 vs. 112 cells/μl at 6 months; 170 vs. 139 cells/μl at 12 months; both P < 0.001). In multivariate analysis, there was a significant increased risk of mortality beyond 3 months after ART initiation in all age groups of at least 40 years of age compared with less than 40 years [40-49 years adjusted hazard ratios (aHRs) 1.59, P < 0.001; 50-59 years aHR 1.58, P = 0.002; 60-69 years aHR 2.63, P < 0.001; 70-94 years aHR 3.64, P = 0.004).
Older age groups represent an important proportion of the overall treatment cohort in these sub-Saharan Africa programmes, and risk of mortality increased as age increased. Future research should be directed at further understanding the reasons for higher mortality, and defining simple interventions that are feasible in highly under-resourced settings to allow for adapted follow-up and care approaches for older age groups.
最近的研究强调了在接受抗逆转录病毒治疗（ART）的老年患者中出现不良结局的风险增加。我们报告了在撒哈拉以南非洲的 17 个项目中，年龄与艾滋病毒/艾滋病抗逆转录病毒方案中的不良结局之间的关联。
我们纳入了来自 9 个国家的数据：中非共和国、科特迪瓦、刚果民主共和国、埃塞俄比亚、尼日利亚、刚果共和国、乌干达、赞比亚和津巴布韦。我们描述了年龄小于 50 岁和至少 50 岁的开始接受 ART 的患者进展为死亡和失访的生存概率。使用多变量 Cox 比例风险模型评估年龄（15-39、40-49、50-59、60-69 和 70-94 岁）与不良结局之间的关联，同时调整了预先确定的混杂因素。
我们的分析包括 17561 名中位随访时间为 12 个月的患者。大多数（65%）为女性，6672 名（38%）基线时严重免疫抑制。开始接受 ART 的中位年龄为 36.0 岁（四分位距 30.1-42.8）；至少 50 岁的患者占 11.4%。与年龄至少 50 岁的患者相比，年龄小于 50 岁的患者在 6 个月和 12 个月时 CD4 细胞计数的平均增加量显著更高（6 个月时为 134 个细胞/μl 比 112 个细胞/μl；12 个月时为 170 个细胞/μl 比 139 个细胞/μl；均 P<0.001）。在多变量分析中，与年龄小于 40 岁的患者相比，年龄至少为 40 岁的所有年龄组在 ART 开始后 3 个月以上的死亡率均显著增加[40-49 岁校正危险比（aHR）为 1.59，P<0.001；50-59 岁 aHR 为 1.58，P=0.002；60-69 岁 aHR 为 2.63，P<0.001；70-94 岁 aHR 为 3.64，P=0.004]。
在这些撒哈拉以南非洲项目中，年龄较大的年龄组代表了整个治疗队列的重要比例，并且随着年龄的增长，死亡率风险增加。未来的研究应致力于进一步了解高死亡率的原因，并确定在资源严重不足的情况下可行的简单干预措施，以实现对老年人群的适应性随访和护理方法。
