Slide 1 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA. IAS–USA

David Alain Wohl, MDAssociate Professor of MedicineThe University of North Carolina

at Chapel Hill

Aging and HIV

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

Slide 2 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

A 35 yo man, non-IDU, diagnosed with HIV starting HIV therapy at CD4>200 can expect to live into his 70’s

ART-CC, The Lancet , 2008, 372:293-299

Slide 3 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

Slide 4 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

Slide 5 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

4%6%

Poly-pathology is more common in HIV+ patients and increases with age

• Co-morbidities included: hypertension, diabetes mellitus, hypothyroidism, cardiovascular disease, bone fractures.

Cases Controls100%

41 to 50 yrs 51 to 60 yrs > 60 yrs 40 yrs 41 to 50 yrs 51 to 60 yrs > 60 yrs 40 yrsn = 542 n = 1,724 n = 452 n = 136

No age-related diseases 2 co-morbidities1 co-morbidity 3 co-morbidities 4 co-morbidities

n = 1,626 n = 5,172 n= 1,356 n= 408

0%

75%

50%

25%

90%

9%

80%

17%

65%

28%

6%

40%

42%

15%

80%

16%

3%

60%

31%

8%

42%

35%

17%

21%

31%

29%

15%

1% 1% 1% 2% 1%2%

0.25%

Polypathology (Pp) prevalence among HIV+ cases and HIV-uninfected controls, by age categories.

Pp prevalence 3.9% 9.0% 20.0% 46.9% 0.5% 1.9% 6.6% 18.7%

Guaraldi G, et al. CID 2011;53:1102-1126.

Slide 6 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

COHERE Study: Baseline Virologicand Immunologic Profile by Age

Baseline HIV RNA

HIV

RN

A (lo

g 10 c

opie

s/m

L)

13-17

4.8

18-29 30-39 40-49 50-54 55-59 >60

4.8

5.0 5.0 5.0

5.1

4.9

COHERE Study Group. AIDS. 2008;22:1463-1113.

Age at Baseline (years)

CD

4 (c

ells

/mm

3 )

13-17

222

18-29 30-39 40-49 50-54 55-59 >60

256

188

178 178173

210

Age at Baseline (years)

Baseline CD4 Count

Slide 7 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

COHERE Study:Response by Baseline Age

Achieving CD4 Count>200 Cells/mm3 at 12 Months

Patie

nts

(%)

13-17

85.6%

18-29 30-39 40-49 50-54 55-59 >60

86.7%

76.3% 75.2% 73.9% 74.7%

80.5%

COHERE Study Group. AIDS. 2008;22:1463-1113.

Age at Baseline (years)

Patie

nts

(%)

13-17 18-29 30-39 40-49 50-54 55-59 >60

Age at Baseline (years)

New AIDS EventAt 12 Months

P<0.0001 for trend

4.8%5.2%

8.5%

9.6% 9.3%

7.0%

9.7%

P<0.0001 for trend

Slide 8 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

COHERE Study:Continuation of HAART by Baseline Age

COHERE Study Group. AIDS. 2008;22:1463-1113.

Patie

nts

(%)

13-17 18-29 30-39 40-49 50-54 55-59 >60

Age at Baseline (years)

Discontinuation ofAll ARTs at 12 Months

15.3% 14.8%

9.2%

6.9%7.9%

11.4%

7.3%

P<0.0001 for trend

● Similar rates of discontinuing or switching >1 antiretroviral agent during the first 12 months of HAART

● Complete treatment discontinuation was rare- Lower rates were

observed among those >40 years of age

Slide 9 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

Kaiser Permanente Northern California:Immunologic Response and Age

0 1 2 3 4 5 6 Time After HAART Initiation (years)

CD4 Cell Count

CD

4 C

ount

(cel

ls/m

m3 )

Years of Age 18 to 39 (n=2259) 40 to 49 (n=1834) >50 (n=997)

Silverberg MJ, et al. Arch Intern Med. 2007;167:684-691.

P=0.001

P=0.07

P=0.66

● CD4 gains 1 year after HAART initiation were lower in the older group (P=0.046)- 18-39 years of age

• +131.8 cells/mm3

- 40-49 years of age• +121.38 cells/mm3

- >50 years of age• +111.8 cells/mm3

● Despite blunted initial immunologic responses in the older group, CD4 counts were similar by year 3

Slide 10 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

DHHS. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.

Slide 11 of 11

From DA Wohl, MD, at New York, NY: May 03, 2012, IAS-USA.

MACS: Frailty Phenotype in HIV-Positive MSMs 50 to 70 Years of Age

• Prospective cohort of MSMs (2009-2010)– 2850 person-visits– HIV positive on HAART

(n=1451)– HIV negative (n=92)

• Ages 50 to 70 years – Frailty phenotype more

common in HIV-positive men versus HIV-negative men

• May be effect of HIV infection, HAART, or both

• Further longitudinal studies are needed Age Group (years)

Prev

alen

ce (%

)5%

Prevalence of Frailty Phenotype

<40 40-49 50-59 60-69 >70

Desquilbet L, et al. 18th CROI. Boston, 2011. Abstract 794.

HIV-positive on HAARTHIV-negative

4%

8% 8%

15%

8%

20%

10%

33%

24%