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

PLoS One. 2019 Oct 17;14(10):e0222225. doi: 10.1371/journal.pone.0222225. eCollection 2019.

Abstract

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-HIV Agents / administration & dosage
  • Bone Diseases / complications
  • Bone Diseases / epidemiology*
  • Bone Diseases / pathology
  • Bone Diseases / virology
  • CD4-Positive T-Lymphocytes / drug effects*
  • CD4-Positive T-Lymphocytes / virology
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / pathology
  • Cardiovascular Diseases / virology
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / virology
  • HIV Seropositivity / blood
  • HIV Seropositivity / virology
  • HIV-1 / drug effects*
  • HIV-1 / pathogenicity
  • Humans
  • Male
  • RNA, Viral / genetics
  • Sex Characteristics
  • Viral Load / drug effects

Substances

  • Anti-HIV Agents
  • RNA, Viral

Grants and funding

All the authors received non-specific funding for this work. EF has received travel grants, consultancy fees and speaker’s honoraria from Gilead Science, ViiV Healthcare, Janssen-Cilag and Merck Sharp & Dohme. GVDS has received travel grants and speaker’s honoraria from Gilead Science, ViiV Healthcare, Janssen-Cilag and Merck Sharp & Dohme. SN received travel grants, consultancy fees and speaker’s honoraria from Gilead Science, ViiV Healthcare, Janssen-Cilag and Merck Sharp & Dohme. AC received travel grants, consultancy fees and speaker’s honoraria from Gilead Science, ViiV Healthcare, Janssen-Cilag and Merck Sharp & Dohme. The other Authors have no conflicts to disclose. This work has been possible thanks to the unconditional grant by Viiv Healthcare Italy within the “Ageing and Frailty Working Group”. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.