Asher Ilan, Guri Keren Mahlab, Elbirt Daniel, Bezalel Shira Rosenberg, Maldarelli Frank, Mor Orna, Grossman Zehava, Sthoeger Zev M
From the Unit of Clinical Immunology, Allergy, and Neve -Or AIDS center and the Department of Medicine B, Kaplan Medical Center, Rehovot, affiliated with Hebrew University-Hadassah Medical School, Jerusalem, Israel (IA, KMG, DE, SRB, ZMS); National Cancer Institute, Frederick, Maryland (FM, ZG); Central Virology Laboratory, Ministry of Health, Ramat-Gan (OM); and School of Public Health, Tel-Aviv University, Tel-Aviv, Israel (ZG).
Medicine (Baltimore). 2016 Jan;95(1):e2327. doi: 10.1097/MD.0000000000002327.
To characterize the clinical, virological, and immunological status at presentation as well as the outcome of patients diagnosed with HIV above the age of 50. A retrospective study of 418 patients newly diagnosed with HIV in 1 Israeli center, between the years 2004 and 2013. Patients with new HIV diagnosis ≥ 50 years of age defined as "older' and < 50 defined as "younger.' Patients were evaluated every 1 to 3 months (mean follow-up 53 ± 33 months). Patients with < 2 CD4/viral-load measurements or with < 1 year of follow-up were excluded. Time of HIV infection was estimated by HIV sequence ambiguity assay. Ambiguity index ≤ 0.43 indicated recent (≤ 1 year) HIV infection. Eighty nine (21%) patients were diagnosed with HIV at an older age. Those older patients presented with significant lower CD4 cell counts and higher viral-load compared with the younger patients. At the end of the study, the older patients had higher mortality rate (21% vs 3.5%; P < 0.001) and lower CD4 cell counts (381 ± 228 vs 483 ± 26 cells/μL; P < 0.001) compared with the younger patients. This difference was also observed between older and younger patients with similar CD4 cell counts and viral load at the time of HIV diagnosis and among patients with a recent (≤ 1 year) HIV infection. One-fifth of HIV patients are diagnosed at older age (≥ 50 years). Those older patients have less favorable outcome compared with the younger patients. This point to the need of educational and screening programs within older populations and for a closer follow-up of older HIV patients.
为了描述50岁以上HIV确诊患者就诊时的临床、病毒学和免疫学状况以及预后。对2004年至2013年间以色列1个中心新确诊的418例HIV患者进行回顾性研究。HIV新诊断年龄≥50岁的患者定义为“老年”患者，<50岁的患者定义为“年轻”患者。每1至3个月对患者进行评估（平均随访53±33个月）。排除CD4/病毒载量测量次数<2次或随访时间<1年的患者。通过HIV序列模糊度测定法估计HIV感染时间。模糊度指数≤0.43表明近期（≤1年）HIV感染。八十九名（21%）患者在老年时被诊断出感染HIV。与年轻患者相比，这些老年患者的CD4细胞计数显著更低，病毒载量更高。在研究结束时，与年轻患者相比，老年患者的死亡率更高（21%对3.5%；P<0.001），CD4细胞计数更低（381±228对483±26个细胞/μL；P<0.001）。在HIV诊断时CD4细胞计数和病毒载量相似的老年和年轻患者之间以及近期（≤1年）HIV感染的患者中也观察到了这种差异。五分之一的HIV患者在老年（≥50岁）时被诊断出来。与年轻患者相比，这些老年患者的预后较差。这表明需要在老年人群中开展教育和筛查项目，并对老年HIV患者进行更密切的随访。
