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The authors undertook the prospective observational study to determine whether there is a "significant difference in survival between elderly (>50 years) and nonelderly adult patients receiving combination antiretroviral therapy [ART] in Uganda between 2004 and 2010."Patients enrolled in the AIDS Support Organization Uganda HIV/AIDS national program were evaluated for time to all-cause mortality. The investigators applied a Weilbull multivariable regression.
Of the 22,087 patients in the analyses, 89.0 percent (19,657) were ages 18-49 and 11.0 percent (2,430) were age 50 or older. "These populations differed in terms of the distributions of sex, baseline CD4 cell count and death. The age group 40-44 displayed the lowest crude mortality rate (31.4 deaths per 1,000 person-years; 95 percent confidence interval 28.1, 34.7) and the age group 60-64 displayed the highest crude mortality rate (58.9 deaths per 1,000 person-years, 95 percent CI 42.2, 75.5)," the results showed. Nonelderly patients had better survival than elderly patients (P<0.001), per Kaplan-Meier survival estimates. Adjusted Weilbull analysis indicated that elderly age status was significantly associated (adjusted hazard ratio 1.23, 95 percent CI 1.08-1.42) with mortality, after controlling for sex, baseline CD4 cell count and year of ART initiation.
"As antiretroviral treatment cohorts mature, the proportion of patients who are elderly will inevitably increase. Elderly patients may require focused clinical care that extends beyond HIV treatment," the study authors concluded.
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