Andrea Calcagno1, Stefania Piconi, Emanuele Focà, Silvia Nozza, Federica Carli, Chiara Montrucchio, Annamaria M Cattelan, Giancarlo Orofino, Benedetto M Celesia, Valentina Morena, Giuseppe V De Socio, Giovanni Guaraldi. 1. *Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy; †1st Division of Infectious Diseases Unit, University of Milano, Ospedale L. Sacco, Milano, Italy; ‡Department of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy; §Department of Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy; ‖Department of Mother, Child and Adult Medicine and Surgical Science, University of Modena and Reggio Emilia, Infectious Diseases Clinic, Modena, Italy; ¶Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Padova, Padova, Italy; #Unit of Infectious Diseases, "Divisione A", OspedaleAmedeo di Savoia, ASLTO2, Torino, Italy; **Department of Clinical and Molecular Biomedicine, Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy; ††3rd Division of Infectious Diseases, University of Milano, Ospedale L. Sacco, Milano, Italy; and ‡‡Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy.
Abstract
BACKGROUND: Adults aging with HIV are at greater risk for several comorbidities. The CD4 cell count and CD4/CD8 ratio often fail to normalize in elderly patients despite prolonged antiretroviral therapy; this has been associated with concomitant diseases and poor prognosis. METHODS: A cross-sectional analysis in antiretroviral-treated HIV-positive patients aged 65 years and older. The aim of the study was to describe the predictors of normalized T-cell subsets ("nT", CD4/CD8 ratio ≥1 and CD4 ≥500 cells/μL) in a cohort of geriatric HIV-positive patients and its association with HIV-associated non-AIDS conditions (HANA). RESULTS: One thousand ninety-two patients were included: nT was observed in 340 patients (31.1%). Multivariate binary logistic analysis showed that plasma HIV RNA <50 copies/mL (P = 0.004), female sex (P = 0.002), and nadir CD4 cell count (P < 0.001) were independent predictors of nT. Age and sex-adjusted prevalence of hypertension (P = 0.037), lipid abnormalities (P = 0.040), and multimorbidity (P = 0.034) were higher in subjects with nT, whereas chronic obstructive pulmonary disease (COPD) and cancer were lower (respectively, P = 0.028 and P = 0.005). Multivariate analysis showed that HIV duration was an independent predictor of several comorbidities, whereas nT was protective for cancer and COPD. HIV duration and nT were simultaneously predictors of multimorbidity. CONCLUSIONS: Normalized T-cell subsets were observed in approximately one-third of geriatric HIV-positive subjects, and they were predicted by female sex and immunovirological features. HIV-associated non-AIDS conditions were more prevalent in patients with longer HIV duration, whereas nT represented a protective factor for cancer and COPD.
BACKGROUND: Adults aging with HIV are at greater risk for several comorbidities. The CD4 cell count and CD4/CD8 ratio often fail to normalize in elderly patients despite prolonged antiretroviral therapy; this has been associated with concomitant diseases and poor prognosis. METHODS: A cross-sectional analysis in antiretroviral-treated HIV-positive patients aged 65 years and older. The aim of the study was to describe the predictors of normalized T-cell subsets ("nT", CD4/CD8 ratio ≥1 and CD4 ≥500 cells/μL) in a cohort of geriatric HIV-positive patients and its association with HIV-associated non-AIDS conditions (HANA). RESULTS: One thousand ninety-two patients were included: nT was observed in 340 patients (31.1%). Multivariate binary logistic analysis showed that plasma HIV RNA <50 copies/mL (P = 0.004), female sex (P = 0.002), and nadir CD4 cell count (P < 0.001) were independent predictors of nT. Age and sex-adjusted prevalence of hypertension (P = 0.037), lipid abnormalities (P = 0.040), and multimorbidity (P = 0.034) were higher in subjects with nT, whereas chronic obstructive pulmonary disease (COPD) and cancer were lower (respectively, P = 0.028 and P = 0.005). Multivariate analysis showed that HIV duration was an independent predictor of several comorbidities, whereas nT was protective for cancer and COPD. HIV duration and nT were simultaneously predictors of multimorbidity. CONCLUSIONS: Normalized T-cell subsets were observed in approximately one-third of geriatric HIV-positive subjects, and they were predicted by female sex and immunovirological features. HIV-associated non-AIDS conditions were more prevalent in patients with longer HIV duration, whereas nT represented a protective factor for cancer and COPD.
Authors: Emanuele Focà; Paola Magro; Giovanni Guaraldi; Agostino Riva; Anna Maria Cattelan; Giuseppe Vittorio De Socio; Cecilia Costa; Stefania Piconi; Benedetto Maurizio Celesia; Silvia Nozza; Giancarlo Orofino; Antonella Castagna; Giovanni Di Perri; Francesco Castelli; Andrea Calcagno Journal: PLoS One Date: 2019-10-17 Impact factor: 3.240