The Body Covers: The 45th Annual Meeting of the Infectious Diseases Society of America
Older Age and NNRTI Regimens Associated With Faster Virologic Response in a Multisite Cohort of HIV-Infected Patients
An Interview With Adena Greenbaum, M.P.H.
October 6, 2007
Welcome. This is Bonnie Goldman, Editorial Director of The Body PRO. I'm in San Diego at IDSA 2007, one of the year's HIV conferences. Right now, I'm in the poster session where researchers are standing in front of their posters. There's nothing like hearing the results of research directly from those who actually conducted the research. In this interview, the researchers will introduce themselves and then summarize their study. After their summary, I'll ask a few questions.
Hi. My name is Adena Greenbaum. I'm a fourth year medical student at Johns Hopkins [School of Medicine]. We were looking at the effect of age and HAART [highly active antiretroviral therapy] regimen in HIV-infected older adults. This is important because the percentage of people with HIV who are elderly is going to be increasing. It is increasing now; it's going to be increasing even more in the coming years. So we looked at time to virologic suppression in these older adults versus younger adults.1
Our older adults are those who are 50 and older, versus younger adults who are less than 40 years of age. Just looking at this population at baseline, this is about 900 patients. It's a multisite study. We had four different sites in this, which were both community-based and academic centers. We had 965 younger patients, and 270 patients who, at baseline, had similar CD4 counts and similar viral loads. The older patients were more likely to have IDU [intravenous drug use] and heterosexual sex as risk factors, as opposed to younger patients who were more likely to have MSM [men who have sex with men] as a risk factor.
The first thing we looked at was time to virologic suppression. So, looking overall at older patients versus younger patients, older patients suppressed faster than younger patients. Older patients suppressed in about four months, whereas younger patients suppressed in about five months.
Did you look at whether or not they had similar adherence rates?
That's really interesting. We don't have adherence in this data set. So, adherence is unknown here.
When we looked at the data stratified by age, if you look at people over 50, the time to suppression was very similar between those on non-nukes [NNRTIs] and PIs [protease inhibitors]. However, looking at people less than 40, our younger group, people on non-nukes suppressed faster. People on PIs took about six months. That was the median time to suppression for them.
Looking at our regression factors associated with increased time to suppression, the adjusted hazard ratios show that both older age and being on a non-nuke regimen are associated with faster virologic suppression.
The implications for this: First, it shows that older patients are suppressing [the virus]. So it's important to get them on therapy, and it's important to keep them on therapy, because they are suppressing.
The next steps are to look at some more clinical endpoints. So, CD4: Does their CD4 boost as well as younger patients'? What are the opportunistic infections they are getting? How many of those are they getting? What's their mortality like? What's the cause of mortality? Is it HIV related, or is it related to other things that are seen in the general older population? What are the toxicities associated with these drugs? Are they different in the older population versus the younger population?
So that, you didn't look at.
Those are the next steps. CD4 is ongoing now.
I see. And the viral load? It looks like, from your poster, it was very similar.
Yes. Baseline viral loads were very similar between the two groups. There was no significant difference in median baseline viral load. When you look at the number of patients who had less than 10,000, 10,000 to 100,000, greater than 100,000 -- at baseline -- it was somewhere between the two groups.
Can you explain what the HIV Research Network is?
Sure. It's a group of several sites across the country, both adult and pediatric sites. There are several sites in each of the geographic regions. There are also academic sites and community sites. It was originally started to gather data on health care utilization: How people with HIV are using different aspects of both inpatient and outpatient services, and emergency rooms. They recently have expanded to include information on clinical outcomes, as well, such as this.
How many sites participated?
This includes data on four sites. There are a total of 21 sites in the network. But since they are just starting to gather more of the clinical information, this includes the four sites.
Thank you very much.
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