Elderly HIV-positive women: A gender-based analysis from the Multicenter Italian “GEPPO” Cohort


Autoři: Emanuele Focà aff001;  Paola Magro aff001;  Giovanni Guaraldi aff002;  Agostino Riva aff003;  Anna Maria Cattelan aff004;  Giuseppe Vittorio De Socio aff005;  Cecilia Costa aff006;  Stefania Piconi aff007;  Benedetto Maurizio Celesia aff008;  Silvia Nozza aff009;  Giancarlo Orofino aff010;  Antonella Castagna aff009;  Giovanni Di Perri aff006;  Francesco Castelli aff001;  Andrea Calcagno aff0060
Působiště autorů: Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy aff001;  Infectious Diseases Clinic, Department of Mother, Child and Adult Medicine and Surgical Science, University of Modena and Reggio Emilia, Modena, Italy aff002;  Third Division of Infectious Diseases, University of Milan, Ospedale L. Sacco, Milano, Italy aff003;  Unit of Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy aff004;  Department of Infectious Diseases, Azienda Ospedaliero-Universitaria di Perugia, Perugia, Italy aff005;  Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, Turin, Italy aff006;  First Division of Infectious Diseases Unit, University of Milan, Ospedale L. Sacco, Milan, Italy aff007;  Division of Infectious Diseases, University of Catania, ARNAS Garibaldi, Catania, Italy aff008;  Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy aff009;  Unit of Infectious Diseases, Division A, Ospedale Amedeo di Savoia, Turin, Italy aff010
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222225

Souhrn

Background

HIV-positive patients are facing age-and disease-related comorbidities. Since gender differences in viro-immunological, clinical and therapeutic features have been described, aim of this analysis was to explore such differences in elderly HIV-positive females compared to males coming from the same cohort.

Design

Cross-sectional study.

Setting

Ten Infectious Diseases Center participating to a new multicenter Italian geriatric Cohort aiming at describing health transition over time in HIV-positive individuals.

Participants

HIV-positive patients aged ≥65 years old.

Measurements

We recorded clinical, viro-immunological and therapeutical data.

Results

We included 210 women (17%) out of 1237 patients. Compared to males, elderly females were less likely to present a HIV-RNA <50 copies/mL (74.3% vs. 81.8%, OR 0.64, 95%CI 0.44–0.93); they showed higher CD4+/CD8+ ratio (p = 0.016). Combined antiretroviral therapy (cART) strategies were similar between genders (p>0.05), although women were less likely to be treated with protease Inhibitors (PIs) (p = 0.05); specifically, in triple-drug regimens females received less PIs (28% vs 38% p = 0.022) and more integrase inhibitors (30% vs. 20% p = 0.012). Bone disease was more common in females (p<0.001) while males presented more frequently cardiovascular disease (CVD) (p<0.001). In females with bone disease, PIs and boosted regimens (38% vs. 53.7% p = 0.026 and 30.4 vs 44.0% p = 0.048 respectively) were prescribed less frequently. Polypharmacy was common and similar in both genders (20% vs. 22.8%, p = >0.05). A higher use of lipid-lowering drugs (20.5% vs. 14.8%, p = 0.04) was observed in females and yet they were less likely to receive anti-thrombotic agents (18.6% vs. 26.3%, p = 0.019) even when CVD was recorded (57.1% vs. 83.1%, p = 0.018). In multivariate analysis, we found that female gender was independently associated with a higher CD4+/CD8+ ratio but not with virological suppression

Conclusions

Elderly HIV-positive women display a worse virologic response despite a better immune reconstitution compared to males. The burden of comorbidities as well as the medications received (including cART) may slightly differ according to gender. Our data suggest that more efforts and focused interventions are needed in this population.

Klíčová slova:

Antiretroviral therapy – Cardiovascular diseases – Elderly – Geriatrics – HIV – HIV diagnosis and management – HIV infections – T cells


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