HIV Therapy Works for Older People, Too

Despite concerns that older people do not respond as well as younger people to HIV medications, the results of a new study published in the April Journal of the American Geriatrics Society (2002;50:605-7) suggest that the drugs provide similar benefits to people ages 50 and older as younger patients. In fact, older patients in the study were more likely to have their HIV levels under control, perhaps because they did a better job of taking the medication as prescribed, the report indicates. "Older HIV-infected patients respond just as well as younger HIV patients," said Dr. Kenneth E. Schmader, of Duke University Medical Center and lead author of the report.

As therapies for HIV have improved, more and more older people are living with the virus. Some studies have shown that older patients do not fare as well after being diagnosed with HIV, but this research was conducted before drug combination therapy became available in the mid-1990s. To see whether the benefits of these therapies extend to older patients, Schmader and his colleagues reviewed the records of 101 patients ages 50 and older and 2002 patients ages 18 to 39 who were treated from 1993 through 1999.

The researchers detected no signs that HIV therapy was any less effective in older patients. Both groups experienced similar rises in levels of CD4 T cells, and older patients were actually more likely to have extremely low blood levels of HIV. Viral load was undetectable in 47 percent of patients ages 50 and older but only in 34 percent of younger patients. That was "a little surprising," said Schmader. "I don't think that's because they have better immune systems," he said.

Though older and younger patients had similar treatment histories, older patients were less likely to have stopped taking their medications. Schmader speculated that older individuals might be more likely to adhere to the often complex cocktail regimens. He and his colleagues note that more research is needed to confirm the findings and to determine the long-term outcomes of older patients on HIV therapy. They concluded that combination therapy, "should be offered to older patients when clinically indicated, and the failure of an older patient to respond to this regimen should not be attributed to age alone."

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