When it comes to HIV treatment, starting right after a diagnosis is the new normal. Starting ART early has a host of documented personal and public health benefits, including stopping transmission of the virus. Most people of every age will start a medication regimen not long after finding out that they are HIV positive.
The landmark Strategic Timing of Antiretroviral Treatment (START) study previously made clear the importance of starting HIV treatment early. However, the median age for the cohort was 36 years old, with the middle 50% of patients between 29 and 44 years old. Researchers from the U.S. Centers for AIDS Research Network of Integrated Clinical Systems (CNIS) have now shown that for people 45 to 65 years old, delaying antiretroviral treatment (ART) may have especially "deleterious effects."
As reported by Aidsmap, a new study published in Clinical Infectious Diseases shows that HIV-positive people over 45 who delayed HIV treatment had a higher mortality rate than those who started right away. Older patients whose CD4 counts were lower at time of treatment initiation (350 or 200 cells/mm3) showed higher mortality rates compared to those who started with a higher count (over 500 cells/mm3). There was also a higher mortality rate for persons over 45 who delayed treatment compared to younger people who delayed treatment. The 10-year mortality rate for all study subjects aged 18-65 who delayed HIV treatment was about 13%, while persons aged 45-65 who waited had a 28% mortality rate.
Aging with HIV is already known to have many complications and risks. Recent studies have shown that HIV-positive men experience geriatric conditions much earlier than the general population, and prolonged inflammation due to the body's response to HIV is still being studied.
Now, according to CNIS researchers, for those persons over 45 who are wondering whether to start HIV treatment, the writing is on the wall. "The striking increase in 10-year mortality under delayed ART initiation for adults over 45 years stresses the heightened importance of early ART initiation in this group," said the investigators.
They added, "[I]f patients over 45 years are to capitalize on the potential benefits of early ART, it is time to redouble national efforts to ensure that early treatment is truly viable. Testing, linkage ART initiation and retention are key."
Currently, U.S. HIV treatment guidelines recommend immediate treatment; however, according the U.S. HIV care continuum, only about 37% of people diagnosed with HIV are prescribed antiretrovirals.
As with many populations, those over 45 years of age face specific challenges in each of the steps of the HIV care continuum as mentioned by the investigators above. For instance, food insecurity among older Americans is a roadblock to getting into care and good medication adherence. Some nonprofits, like God's Love We Deliver, attempt to ameliorate food insecurity problems in their own backyards, though hunger is still rampant nationally. Recently, Gay Men's Health Crisis (GMHC) even revived its famous "buddy program" to help long-term survivors who are in need of assistance with everyday tasks, including grocery shopping and cooking.
To read the abstract for the CNIS study, head over to Clinical Infectious Diseases.
Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com. You can follow him on Twitter at @mathewrodriguez, like his Facebook page or visit him on his personal website.